Intensive Care Medicine

, Volume 43, Issue 10, pp 1476–1484 | Cite as

Trends in short-term and 1-year mortality in very elderly intensive care patients in the Netherlands: a retrospective study from 2008 to 2014

  • Attila KarakusEmail author
  • Lenneke E. M. Haas
  • Sylvia Brinkman
  • Dylan W. de Lange
  • Nicolette F. de Keizer



To describe the trends in short-term and long-term mortality in very elderly intensive care unit (ICU) patients between 2008 and 2014.


A retrospective cohort study was conducted using data from the National Intensive Care Evaluation Foundation from 31 Dutch ICUs. Generalized linear mixed-effects models were used to determine the change in adjusted short-term mortality (ICU/hospital deaths) and long-term mortality (3, 6, and 12 months after ICU admission) over the period 2008–2014 in very elderly patients and in patients less than 80 years old admitted to the ICU.


A total of 216,196 patients admitted to 31 ICUs in the period from 2008 to 2014 were included in the study, including 28,284 (13.1%) very elderly patients (80 years or older). Follow-up data for determination of 3-, 6-, and 12-month mortality were available for, respectively, 210,005 (97.1%), 202,551 (93.7%), and 176,847 (81.8%) ICU admissions. The crude ICU and in-hospital mortality decreased, respectively, from 17.6% to 13.0% and from 30.7% to 21.0%. The annual risk-adjusted ICU and in-hospital mortality of very elderly patients (adjusted for APACHE III score, comorbidities, and admission type) decreased significantly during the study period [adjusted odds ratio 0.97 (0.95–0.99) and 0.92 (0.91–0.93), respectively]. Additionally, the annual risk-adjusted 3-, 6-, and 12-month mortality decreased significantly from 2008 to 2014 [adjusted odds ratio 0.96 (0.95–0.97), 0.96 (0.94–0.97), and 0.97 (0.95–0.98), respectively]. A similar significant annual decrease in risk-adjusted short-term and long-term mortality was observed in patients aged less than 80 years.


Both short-term and long-term risk-adjusted mortality decreased significantly during the study period in both very elderly ICU patients and patients aged less than 80 years in the Netherlands. This study clearly shows that in our setting very elderly patients benefit almost as much as their younger counterparts from improvement in quality of care over time.


Elderly Very elderly Octogenarians Intensive care Mortality Short-term and long-term outcome 



Acute Physiology and Chronic Health Evaluation


Intensive care unit


Interquartile range


Length of stay


National Intensive Care Evaluation



We thank all Dutch ICUs participating in the NICE registry for their willingness to continuously collect data for quality improvement and providing these data for research.

Author contributions

AK designed the study, contributed to the interpretation of the data, and was the primary author of the manuscript. LEMH contributed to the design of the study and participated in the interpretation and critical revision of the manuscript. SB performed the statistical analysis and contributed to the interpretation of the data and the writing of the manuscript. DWdL contributed to the writing of the manuscript. NRdK contributed to the design of the study, the acquisition and interpretation of the data, the writing of the manuscript, and supervised the study. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Supplementary material

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  1. 1.
    Andrews RM, Russo CA, Pancholi M (2007) Trends in hospital risk-adjusted mortality for select diagnoses and procedures: 1994–2004. Healthcare Cost and Utilization Project (HCUP) Statistical Brief#38. Agency for Healthcare Research and QualityGoogle Scholar
  2. 2.
    Hines A, Stranges E, Andrews R (2010) Trends in hospital risk-adjusted mortality for select diagnoses by patient subgroups: 2000–2007. Healthcare Cost and Utilization Project (HCUP) Statistical Brief#98. Agency for Healthcare Research and QualityGoogle Scholar
  3. 3.
    Korabathina R, Weintraub AR, Price LL, Kapur NK, Kimmelstiel CD, Iafrati MD, Ali Tahir SM (2013) Twenty-year analysis of trends in the incidence and in-hospital mortality for lower-extremity arterial thromboembolism. Circulation 128(2):115–121CrossRefPubMedGoogle Scholar
  4. 4.
    Insam C, Paccaud F, Marques-Vidal P, BMC Public Health (2013) Trends in hospital discharges, management and in-hospital mortality from acute myocardial infarction in Switzerland between 1998 and 2008. BMC Public Health 13:270. doi: 10.1186/1471-2458-13-270 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Slobbe LC, Arah OA, de Bruin A, Westert GP (2008) Mortality in Dutch hospitals: trends in time, place and cause of death after admission for myocardial infarction and stroke. An observational study. BMC Health Serv Res 8:52CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Kirksey M, Chiu YL, Ma Y, Della Valle AG, Poultsides L, Gerner P, Memtsoudis SG (2012) Trends in in-hospital major morbidity and mortality after total joint arthroplasty: United States 1998–2008. Anesth Analg 115(2):321–327CrossRefPubMedGoogle Scholar
  7. 7.
    Ruhnke GW, Perraillon MC, Cutler DM (2013) Mortality reduction among pneumonia patients still substantial despite the impact of coding changes. Am J Med 126(3):266–269CrossRefPubMedGoogle Scholar
  8. 8.
    Finks JF, Osborne NH, Birkmeyer JD (2011) Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med 364:2128–2837CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Zimmerman JE, Kramer AA, Knaus WA (2013) Changes in hospital mortality for United States intensive care unit admissions from 1988 to 2012. Crit Care 17(2):R81CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Moran JL, Bristow P, Solomon PJ, George C, Hart GK (2008) Mortality and length-of-stay outcomes, 1993–2003, in the binational Australian and New Zealand intensive care adult patient database. Australian and New Zealand Intensive Care Society Database Management Committee (ADMC). Crit Care Med 36(1):46–61CrossRefPubMedGoogle Scholar
  11. 11.
    Hutchings A, Durand MA, Grieve R, Harrison D, Rowan K, Green J, Carins J, Black N (2009) Evaluation of modernization of adult critical care services in England: time series and cost effectiveness analysis. BMJ 339:b4353CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Lerolle N, Trinquart L, Bornstain C et al (2010) Increased intensity of treatment and decreased mortality in elderly patients in an intensive care unit over a decade. Crit Care Med 38(1):59–64. doi: 10.1097/CCM.0b013e3181b088ec CrossRefPubMedGoogle Scholar
  13. 13.
    Bagshaw SM, Webb SA, Delaney A, George C, Pilcher D, Hart GK, Bellomo R (2009) Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis. Crit Care 13(2):R45. doi: 10.1186/cc7768 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Dutch National Intensive Care Evaluation (NICE) Foundation (2012). Accessed 24 July 2012
  15. 15.
    van de Klundert N, Holman R, Dongelmans DA, de Keizer NF (2015) Data resource profile: the Dutch National Intensive Care Evaluation (NICE) registry of admissions to adult intensive care units. Int J Epidemiol 44(6):1850–1850h. doi: 10.1093/ije/dyv291 CrossRefPubMedGoogle Scholar
  16. 16.
    Vektis (2012). Accessed 24 July 2012
  17. 17.
    Roos LL, Wajda A (1991) Record linkage strategies. Part I: estimating information and evaluating approaches. Methods Inf Med 30(2):117–123PubMedGoogle Scholar
  18. 18.
    Knaus WA, Wagner DP, Draper EA et al (1991) The APACHE III prognostic system: risk prediction of hospital mortality for critically ill hospitalized adults. Chest 100(6):1619–1636CrossRefPubMedGoogle Scholar
  19. 19.
    Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR (1996) A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 49(12):1373–1379. doi: 10.1016/S0895-4356(96)00236-3 CrossRefPubMedGoogle Scholar
  20. 20.
    Moineddin R, Matheson FI, Glazier RH (2007) A simulation study of sample size for multilevel logistic regression models. BMC Med Res Methodol 7:34. doi: 10.1186/1471-2288-7-34 CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    R Core Team (2015) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna. Accessed June 2015
  22. 22.
    Bates D, Mächler M, Bolker B, Walker S (2015) Fitting linear mixed-effects models using lme4. J Stat Softw 67(1):1–48CrossRefGoogle Scholar
  23. 23.
    Haas LE, Karakus A, Holman R, Cihangir S, Reidinga AC, de Keizer NF (2015) Trends in hospital and intensive care admissions in the Netherlands attributable to the very elderly in an ageing population. Crit Care 30(19):353. doi: 10.1186/s13054-015-1061-z CrossRefGoogle Scholar
  24. 24.
    Castillo-Lorente E, Rivera-Fernandez R, Vazquez-Mata G (1997) Limitation of therapeutic activity in elderly critically ill patients. Project for the epidemiological analysis of critical care patients. Crit Care Med 25(10):1643–1648CrossRefPubMedGoogle Scholar
  25. 25.
    Boumendil A, Aegerter P, Guidet B, CUB-Rea Network (2005) Treatment intensity and outcome of patients aged 80 and older in intensive care units: a multicenter matched-cohort study. J Am Geriatr Soc 53(1):88–93CrossRefPubMedGoogle Scholar
  26. 26.
    Sprung CL, Artigas A, Kesecioglu J et al (2012) The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II: intensive care benefit for the elderly. Crit Care Med 40(1):132–138. doi: 10.1097/CCM.0b013e318232d6b0 CrossRefPubMedGoogle Scholar
  27. 27.
    Wehler M, Strauss R, Mueller A, Reulbach U, Martus P, Hahn EG (2000) Therapeutic activity in elderly medical intensive care patients. Crit Care 4(Suppl 1):P226CrossRefPubMedCentralGoogle Scholar
  28. 28.
    Roch A, Wiramus S, Pauly V, Forel JM, Guervilly C, Gainnier M, Papazian L (2011) Long-term outcome in medical patients aged 80 or over following admission to an intensive care unit. Crit Care 15(1):R36. doi: 10.1186/cc9984 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    de Rooij SE, Govers A, Korevaar JC, Abu-Hanna A, Levi M, de Jonge E (2006) Short-term and long-term mortality in very elderly patients admitted to an intensive care unit. Intensive Care Med 32(7):1039–1044. doi: 10.1007/s00134-006-0171-0 CrossRefPubMedGoogle Scholar
  30. 30.
    Docherty AB, Anderson NH, Walsh TS, Lone NI (2016) Equity of access to critical care among elderly patients in Scotland: a National Cohort Study. Crit Care Med 44(1):3–13. doi: 10.1097/CCM.0000000000001377 CrossRefPubMedGoogle Scholar
  31. 31.
    Somme D, Maillet JM, Gisselbrecht M, Novara A, Ract C, Fagon JY (2003) Critically ill old and the oldest-old patients in intensive care: short- and long-term outcomes. Intensive Care Med 29(12):2137–2143. doi: 10.1007/s00134-003-1929-2 CrossRefPubMedGoogle Scholar
  32. 32.
    Heyland D, Cook D, Bagshaw SM, Garland A, Stelfox HT, Mehta S, Dodek P, Kutsogiannis J, Burns K, Muscedere J, Turgeon AF, Fowler R, Jiang X, Day AG (2015) The very elderly admitted to ICU: a quality finish? Crit Care Med 43(7):1352–1360. doi: 10.1097/CCM.0000000000001024 CrossRefPubMedGoogle Scholar
  33. 33.
    Nielsson MS, Christiansen CF, Johansen MB, Rasmussen BS, Tønnesen E, Nørgaard M (2014) Mortality in elderly ICU patients: a cohort study. Acta Anaesthesiol Scand 58(1):19–26. doi: 10.1111/aas.12211 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany and ESICM 2017

Authors and Affiliations

  • Attila Karakus
    • 1
    Email author
  • Lenneke E. M. Haas
    • 1
  • Sylvia Brinkman
    • 2
  • Dylan W. de Lange
    • 2
  • Nicolette F. de Keizer
    • 2
  1. 1.Department of Intensive Care MedicineDiakonessenhuis UtrechtUtrechtThe Netherlands
  2. 2.NICE Foundation, Academic Medical Centre AmsterdamAmsterdamThe Netherlands

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