A comparison of very old patients admitted to intensive care unit after acute versus elective surgery or intervention

• Published in: Journal of critical care Vol. 52; pp. 141 - 148
• Main Authors: Jung, Christian, Wernly, Bernhard, Muessig, Johanna M., Kelm, Malte, Boumendil, Ariane, Morandi, Alessandro, Andersen, Finn H., Artigas, Antonio, Bertolini, Guido, Cecconi, Maurizio, Christensen, Steffen, Faraldi, Loredana, Fjølner, Jesper, Lichtenauer, Michael, Bruno, Raphael Romano, Marsh, Brian, Moreno, Rui, Oeyen, Sandra, Öhman, Christina Agvald, Pinto, Bernardo Bollen, Soliman, Ivo W., Szczeklik, Wojciech, Valentin, Andreas, Watson, Ximena, Zafeiridis, Tilemachos, De Lange, Dylan W., Guidet, Bertrand, Flaatten, Hans
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2019; Elsevier Limited
• Subjects: Age; Clinical outcomes; Critical care; Critically ill; Elective; Elective surgery; Frailty; Intensive care; Intubation; Medicin och hälsovetenskap; Mortality; Old; Older; Older people; Oldest old people; Outcome; Physiology; Renal replacement therapy; Surgery; Survival analysis; United Kingdom > UK; Frailty; Critically ill; Elective; Outcome; Old; Older
• ISSN: 0883-9441; 1557-8615; 1557-8615
• DOI: 10.1016/j.jcrc.2019.04.020

We aimed to evaluate differences in outcome between patients admitted to intensive care unit (ICU) after elective versus acute surgery in a multinational cohort of very old patients (≥80 years; VIP). Predictors of mortality, with special emphasis on frailty, were assessed.
In total, 5063 VIPs were included in this analysis, 922 were admitted after elective surgery or intervention, 4141 acutely, with 402 after acute surgery. Differences were calculated using Mann-Whitney-U test and Wilcoxon test. Univariate and multivariable logistic regression were used to assess associations with mortality.
Compared patients admitted after acute surgery, patients admitted after elective surgery suffered less often from frailty as defined as CFS (28% vs 46%; p < 0.001), evidenced lower SOFA scores (4 ± 5 vs 7 ± 7; p < 0.001). Presence of frailty (CFS >4) was associated with significantly increased mortality both in elective surgery patients (7% vs 12%; p = 0.01), in acute surgery (7% vs 12%; p = 0.02).
VIPs admitted to ICU after elective surgery evidenced favorable outcome over patients after acute surgery even after correction for relevant confounders. Frailty might be used to guide clinicians in risk stratification in both patients admitted after elective and acute surgery.
Trial registration: NCT03134807. Registered 1st May 2017.
•We evaluated differences in outcome between VIPs admitted to ICU after elective versus acute intervention•VIPs after elective intervention evidenced favorable outcome after correction for relevant confounders•Frailty might be used to guide clinicians in risk stratification in both patients admitted after elective and acute surgery.