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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 5/2016

01-05-2016 | Original Article

Severe Sepsis in Elderly Patients Undergoing Gastrointestinal Surgery—a Prospective Multicenter Follow-up Study of Finnish Intensive Care Units

Authors: Mika Ukkonen, Sari Karlsson, Johanna Laukkarinen, Tuomo Rantanen, Hannu Paajanen, Finnsepsis Study Group

Published in: Journal of Gastrointestinal Surgery | Issue 5/2016

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Abstract

Background

We aimed to evaluate the outcome of elderly patients with severe sepsis after alimentary tract surgery.

Methods

A prospective study was conducted in 24 intensive care units (ICU) in Finland. Four thousand five hundred consecutive patients were admitted to ICUs and 470 patients fulfilled the criteria for severe sepsis. All patients who had undergone gastrointestinal surgery were included. The outcomes of elderly (≥65 years) and younger patients were compared. The key factor under analysis was death from any cause during the hospitalization or within 1 year after the surgery.

Results

A total of 73 elderly patients (and 81 younger patients) were found to have severe alimentary tract surgery-related sepsis. The mean age of the elderly patients was 76.4 years, and 56.2 % were female. The most common indication for surgery was acute cholecystitis (21.9 %), followed by acute diverticulitis (13.7 %), and gastroduodenal ulcer (13.7 %). The anatomic site of the infection was intra-abdominal in 86.3 % of cases, the second most common being pulmonary (13.7 %). In-hospital mortality was 47.9 % and 1-year mortality 64.4 %. Of the discharged patients, 31.6 % died within 1 year. Patients who died were older and more frequently had concomitant conditions. The ICU scoring systems (APACHE, SAPS, and SOFA) and elevated lactate levels were predictive of increased mortality.

Conclusion

Severe sepsis among the elderly is a rare but often-fatal infectious event. In addition to high in-hospital mortality, it is also associated with significant 1-year mortality.
Literature
1.
2.
United Nations Department of Economic and Social Affairs, Population Division. Population Ageing 1950–2050. 2002.
3.
Turrentine FE, Wang H, Simpson VB et al. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg 2006;203(6):865–77.CrossRefPubMed
4.
Hamel MB, Henderson WG, Khuri SF et al. Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc 2005;53(3):424–9.CrossRefPubMed
5.
Marik PE. Management of the critically ill geriatric patient. Crit Care Med 2006;34(9 Suppl):S176-82.CrossRefPubMed
6.
van Diepen S, Bakal JA, McAlister FA et al. Mortality and readmission of patients with heart failure, atrial fibrillation, or coronary artery disease undergoing noncardiac surgery: an analysis of 38 047 patients. Circulation 2011;124(3):289–96.CrossRefPubMed
7.
Cooper GS, Shlaes DM, Salata RA. Intraabdominal infection: differences in presentation and outcome between younger patients and the elderly. Clin Infect Dis 1994;19(1):146–8.CrossRefPubMed
8.
Azuhata T, Kinoshita K, Kawano D et al. Time from admission to initiation of surgery for source control is a critical determinant of survival in patients with gastrointestinal perforation with associated septic shock. Crit Care 2014;18(3):R87.CrossRefPubMedPubMedCentral
9.
Weber DG, Bendinelli C, Balogh ZJ. Damage control surgery for abdominal emergencies. Br J Surg 2014;101(1):e109-18.CrossRefPubMed
10.
Karlsson S, Varpula M, Ruokonen E et al. Incidence, treatment, and outcome of severe sepsis in ICU-treated adults in Finland: the Finnsepsis study. Intensive Care Med 2007;33(3):435–43.CrossRefPubMed
11.
Bone RC, Balk RA, Cerra FB et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992;101(6):1644–55.CrossRefPubMed
12.
Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 1993;270(24):2957–63.CrossRefPubMed
13.
Knaus WA, Draper EA, Wagner DP et al. APACHE II: a severity of disease classification system. Crit Care Med 1985;13(10):818–29.CrossRefPubMed
14.
15.
Martin GS, Mannino DM, Eaton S et al. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003;348(16):1546–54.CrossRefPubMed
16.
Rivers E, Nguyen B, Havstad S et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345(19):1368–77.CrossRefPubMed
17.
Nasa P, Juneja D, Singh O et al. Severe sepsis and its impact on outcome in elderly and very elderly patients admitted in intensive care unit. J Intensive Care Med 2012;27(3):179–83.CrossRefPubMed
18.
Angus DC, Linde-Zwirble WT, Lidicker J et al. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001;29(7):1303–10.CrossRefPubMed
19.
Wang HE, Szychowski JM, Griffin R et al. Long-term mortality after community-acquired sepsis: a longitudinal population-based cohort study. BMJ Open 2014;4(1):e004283, 2013-004283.CrossRefPubMedPubMedCentral
20.
Laitelainen E, Helakorpi S, Nissinen A, Uutela A. Health Behaviour and Health among Finnish Elderly, Spring 2007, with trends 1993–2007. Publications of the National Public Health Institute 2008;B14.
21.
Leskinen MR, Laatikainen TK, Tuomilehto JO et al. Trends in health status and the use of services among the 80-84-year-old Finnish war veterans during 1992 and 2004. Scand J Public Health 2010;38(4):434–41.CrossRefPubMed
22.
23.
Vaughan-Sarrazin MS, Bayman L, Cullen JJ. Costs of postoperative sepsis: the business case for quality improvement to reduce postoperative sepsis in veterans affairs hospitals. Arch Surg 2011;146(8):944–51.CrossRefPubMed
24.
Riall TS, Zhang D, Townsend CM, Jr et al. Failure to perform cholecystectomy for acute cholecystitis in elderly patients is associated with increased morbidity, mortality, and cost. J Am Coll Surg 2010;210(5):668,77, 677–9.CrossRefPubMedPubMedCentral
25.
26.
Liu V, Escobar GJ, Greene JD et al. Hospital deaths in patients with sepsis from 2 independent cohorts. JAMA 2014;312(1):90–2.CrossRefPubMed
27.
Hakala T, Vironen J, Karlsson S et al. Fatal surgical or procedure-related complications: a Finnish registry-based study. World J Surg 2014;38(4):759–64.CrossRefPubMed
28.
Walkey AJ, Wiener RS, Ghobrial JM et al. Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis. JAMA 2011;306(20):2248–54.CrossRefPubMedPubMedCentral
29.
Iwashyna TJ, Ely EW, Smith DM et al. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA 2010;304(16):1787–94.CrossRefPubMedPubMedCentral
30.
Uchino S, Kellum JA, Bellomo R et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 2005;294(7):813–8.CrossRefPubMed
31.
Karlsson S, Ruokonen E, Varpula T et al. Long-term outcome and quality-adjusted life years after severe sepsis. Crit Care Med 2009;37(4):1268–74.CrossRefPubMed
32.
33.
Weil MH, Afifi AA. Experimental and clinical studies on lactate and pyruvate as indicators of the severity of acute circulatory failure (shock). Circulation 1970;41(6):989–1001.CrossRefPubMed
34.
Vosylius S, Sipylaite J, Ivaskevicius J. Determinants of outcome in elderly patients admitted to the intensive care unit. Age Ageing 2005;34(2):157–62.CrossRefPubMed
35.
Dellinger RP, Levy MM, Rhodes A et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2013;39(2):165–228.CrossRefPubMed
36.
Solomkin JS, Mazuski JE, Bradley JS et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis 2010;50(2):133–64.CrossRefPubMed
37.
Bratzler DW, Dellinger EP, Olsen KM et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013;70(3):195–283.CrossRefPubMed
38.
Varpula M, Karlsson S, Parviainen I et al. Community-acquired septic shock: early management and outcome in a nationwide study in Finland. Acta Anaesthesiol Scand 2007;51(10):1320–6.CrossRefPubMed
39.
Girard TD, Opal SM, Ely EW. Insights into severe sepsis in older patients: from epidemiology to evidence-based management. Clin Infect Dis 2005;40(5):719–27.CrossRefPubMed
40.
Girard TD, Ely EW. Bacteremia and sepsis in older adults. Clin Geriatr Med 2007;23(3):633–47, viii.CrossRefPubMed
Metadata
Title
Severe Sepsis in Elderly Patients Undergoing Gastrointestinal Surgery—a Prospective Multicenter Follow-up Study of Finnish Intensive Care Units
Authors
Mika Ukkonen
Sari Karlsson
Johanna Laukkarinen
Tuomo Rantanen
Hannu Paajanen
Finnsepsis Study Group
Publication date
01-05-2016
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 5/2016
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-016-3076-4

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