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Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 3/2017

01-03-2017 | Reports of Original Investigations

Outcomes of elderly critically ill medical and surgical patients: a multicentre cohort study

Authors: Ian M. Ball, MD, MSc, Sean M. Bagshaw, MD, MSc, Karen E. A. Burns, MD, MSc, Deborah J. Cook, MD, MSc, Andrew G. Day, MSc, Peter M. Dodek, MD, MHSc, Demetrios J. Kutsogiannis, MD, MHS, Sangeeta Mehta, MD, FRCPC, John G. Muscedere, MD, Alexis F. Turgeon, MD, MSc, Henry T. Stelfox, MD, PhD, George A. Wells, PhD, Ian G. Stiell, MD, MSc

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 3/2017

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Abstract

Purpose

Very elderly (over 80 yr of age) critically ill patients admitted to medical-surgical intensive care units (ICUs) have a high incidence of mortality, prolonged hospital length of stay, and dependent living conditions should they survive. The primary purpose of this study is to describe the outcomes and differences in outcomes between very elderly medical patients and their surgical counterparts admitted to Canadian ICUs, thereby informing decision-making for clinicians and substitute decision-makers.

Methods

This was a prospective multicentre cohort study of very elderly medical and surgical patients admitted to 22 Canadian academic and non-academic ICUs. Outcome measures included ICU length of stay and mortality, hospital length of stay and mortality, and disposition following hospital discharge.

Results

There were 1,671 patients evaluated in this study. Patient demographics included a mean age of 84.5 yr, baseline Acute Physiology and Chronic Health Evaluation (APACHE) II score of 22.4, baseline Sequential Organ Failure Assessment (SOFA) score of 5.3, overall ICU mortality of 21.8%, and overall hospital mortality of 35.0%. Medical patient median ICU length of stay was 4.1 days, hospital length of stay was 16.2 days, ICU mortality was 26.5%, and hospital mortality was 41.5%. Surgical patient median ICU length of stay was 3.8 days, hospital length of stay was 20.1 days, ICU mortality was 18.7%, and hospital mortality was 31.6%. Only 45.0% of medical patients and 41.6% of surgical emergency patients were able to return home to live.

Conclusions

In this large sample of critically ill medical and surgical patients, the admission SOFA score and hospital lengths of stay were not different between the two groups, but medical patients had longer ICU lengths of stay and higher ICU and hospital mortality than surgical patients.
Literature
1.
Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat. World Population Prospects: The 2010 Revision. 2015.
2.
US Census Bureau. Profile of general demographic characteristics. 2010.
3.
Anonymous. World Population ageing: 1950-2050. Department of Economic and Social Affairs PD; 2001.
4.
Bagshaw SM, Webb SA, Delaney A, et al. Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis. Crit Care 2009; 13: R45.CrossRefPubMedPubMedCentral
5.
Canadian Demographics at a Glance. 2004. Statistics Canada.
6.
Council on Scientific Affairs. American Medical Association. Good care of the dying patient. JAMA 1996; 275: 474-8.CrossRef
7.
Baker R, Wu AW, Teno JM, et al. Family satisfaction with end-of-life care in seriously ill hospitalized adults. J Am Geriatr Soc 2000; 48(5 Suppl): S61-9.CrossRefPubMed
8.
Angus DC, Kelley MA, Schmitz RJ, White A, Popovich J Jr. Caring for the critically ill patient. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population? JAMA 20006; 284: 2762-70.
9.
Marik PE. Management of the critically ill geriatric patient. Crit Care Med 2006; 34(9 Suppl): S176-82.CrossRefPubMed
10.
Heyland DK, Dodek P, Rocker G, et al. What matters most in end-of-life care: perceptions of seriously ill patients and their family members. CMAJ 2006; 174: 627-33.CrossRefPubMedPubMedCentral
11.
Garrouste-Org, Timsit JF, Montuclard L, et al. Decision-making process, outcome, and 1-year quality of life of octogenarians referred for intensive care unit admission. Intensive Care Med 2006; 32: 1045-51.
12.
Suresh R, Kupfer YY, Tessler S. The greying of the intensive care unit: Demographic changes 1988–1998. Crit Care Med 1999; 27: A27.CrossRef
13.
Niskanen M, Kari A, Halonen P. Five-year survival after intensive care–comparison of 12,180 patients with the general population. Finnish ICU Study Group. Crit Care Med 1996; 24: 1962-7.CrossRefPubMed
14.
Somogyi-Zalud E, Zhong Z, Hamel MB, Lynn J. The use of life-sustaining treatments in hospitalized persons aged 80 and older. J Am Geriatr Soc 2002; 50: 930-4.CrossRefPubMed
15.
Williams TA, Dobb GJ, Finn JC, et al. Determinants of long-term survival after intensive care. Crit Care Med 2008; 36: 1523-30.CrossRefPubMed
16.
Nathanson BH, Higgins TL, Brennan MJ, Kramer AA, Stark M, Teres D. Do elderly patients fare well in the ICU? Chest 2011; 139: 825-31.CrossRefPubMed
17.
Heyland D, Cook D, Bagshaw SM, et al. The very elderly admitted to ICU: a quality finish? Crit Care Med 2015; 43: 1352-60.CrossRefPubMed
18.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13: 818-29.CrossRefPubMed
19.
Moreno R, Vincent JL, Matos R, et al. The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study. Working Group on Sepsis related Problems of the ESICM. Intensive Care Med 1999; 25: 686-96.CrossRefPubMed
20.
Groll DL, To T, Bombardier C, Wright JG. The development of a comorbidity index with physical function as the outcome. J Clin Epidemiol 2005; 58: 595-602.CrossRefPubMed
21.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373-83.CrossRefPubMed
22.
Boumendil A. Prognosis of patients aged 80 years and over admitted in medical intensive care unit. Intensive Care Med 2004; 30: 647-54.CrossRefPubMed
23.
de Rooij SE, Govers A, Korevaar JC, Abu-Hanna A, Levi M, de JE. Short-term and long-term mortality in very elderly patients admitted to an intensive care unit. Intensive Care Med 2006; 32: 1039-44.
24.
Minne L, Ludikhuize J, de JE, de RS, Abu-Hanna A. Prognostic models for predicting mortality in elderly ICU patients: a systematic review. Intensive Care Med 2011; 37: 1258-68.
25.
Rob A.Ruff. Change the warfare metaphors when it comes to illness. KevinMD.com April 12, 2013.
26.
Alexander KP, Anstrom KJ, Muhlbaier LH, et al. Outcomes of cardiac surgery in patients > or = 80 years: results from the National Cardiovascular Network. J Am Coll Cardiol 2000; 35: 731-8.CrossRefPubMed
27.
Hamel MB, Davis RB, Teno JM, et al. Older age, aggressiveness of care, and survival for seriously ill, hospitalized adults. SUPPORT Investigators. Study to Understand prognoses and preferences for outcomes and risks of treatments. Ann Intern Med 1999; 131: 721-8.CrossRefPubMed
28.
Hartl WH, Wolf H, Schneider CP, Kuchenhoff H, Jauch KW. Acute and long-term survival in chronically critically ill surgical patients: a retrospective observational study. Crit Care 2007; 11: R55.CrossRefPubMedPubMedCentral
29.
Somme D, Maillet JM, Gisselbrecht M, Novara A, Ract C, Fagon JY. Critically ill old and the oldest-old patients in intensive care: short- and long-term outcomes. Intensive Care Med 2003; 29: 2137-43.CrossRefPubMed
30.
Rady MY, Johnson DJ. Hospital discharge to care facility: a patient-centered outcome for the evaluation of intensive care for octogenarians. Chest 2004; 126: 1583-91.CrossRefPubMed
31.
Wright JC, Plenderleith L, Ridley SA. Long-term survival following intensive care: subgroup analysis and comparison with the general population. Anaesthesia 2003; 58: 637-42.CrossRefPubMed
32.
Chalfin DB, Carlon GC. Age and utilization of intensive care unit resources of critically ill cancer patients. Crit Care Med 1990; 18: 694-8.CrossRefPubMed
33.
Fedullo AJ, Swinburne AJ. Relationship pf patient age to cost and survival in a medical ICU. Crit Care Med 1983; 11: 155-9.CrossRefPubMed
34.
Garrouste-Org, Boumendil A, Pateron D, et al. Selection of intensive care unit admission criteria for patients aged 80 years and over and compliance of emergency and intensive care unit physicians with the selected criteria: An observational, multicenter, prospective study. Crit Care Med 2009; 37: :2919-28.
35.
Wu AW, Rubin HR, Rosen MJ. Are elderly people less responsive to intensive care? J Am Geriatr Soc 1990; 38: 621-7.CrossRefPubMed
Metadata
Title
Outcomes of elderly critically ill medical and surgical patients: a multicentre cohort study
Authors
Ian M. Ball, MD, MSc
Sean M. Bagshaw, MD, MSc
Karen E. A. Burns, MD, MSc
Deborah J. Cook, MD, MSc
Andrew G. Day, MSc
Peter M. Dodek, MD, MHSc
Demetrios J. Kutsogiannis, MD, MHS
Sangeeta Mehta, MD, FRCPC
John G. Muscedere, MD
Alexis F. Turgeon, MD, MSc
Henry T. Stelfox, MD, PhD
George A. Wells, PhD
Ian G. Stiell, MD, MSc
Publication date
01-03-2017
Publisher
Springer US
Published in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 3/2017
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-016-0798-4

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