Trends in short-term and 1-year mortality in very elderly intensive care patients in the Netherlands: a retrospective study from 2008 to 2014
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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.
KeywordsElderly Very elderly Octogenarians Intensive care Mortality Short-term and long-term outcome
Acute Physiology and Chronic Health Evaluation
Intensive care unit
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.
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.
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