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

  • Ian M. Ball
  • Sean M. Bagshaw
  • Karen E. A. Burns
  • Deborah J. Cook
  • Andrew G. Day
  • Peter M. Dodek
  • Demetrios J. Kutsogiannis
  • Sangeeta Mehta
  • John G. Muscedere
  • Alexis F. Turgeon
  • Henry T. Stelfox
  • George A. Wells
  • Ian G. Stiell
Reports of Original Investigations

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.

Pronostics des patients âgés et gravement malades en médecine et en chirurgie: une étude de cohorte multicentrique

Résumé

Objectif

Chez les patients gravement malades et très âgés (plus de 80 ans) admis dans les unités de soins intensifs (USI) médico-chirurgicales, l’incidence de mortalité, de séjour hospitalier prolongé, et de conditions de vie à charge d’autrui en cas de survie est élevée. L’objectif principal de cette étude est de décrire les pronostics et les différences de pronostics entre les patients médicaux très âgés et leurs pendants chirurgicaux admis dans les USI canadiennes, et d’ainsi éclairer la prise de décision des cliniciens et autres décideurs.

Méthode

Nous avons réalisé une étude de cohorte multicentrique et prospective portant sur des patients médicaux et chirurgicaux très âgés admis dans 22 USI canadiennes situés dans des centres universitaires et non universitaires. Les critères d’évaluation comprenaient la durée de séjour et la mortalité à l’USI, la durée de séjour et la mortalité à l’hôpital, et l’état après le congé de l’hôpital.

Résultats

Au total, 1671 patients ont été évalués dans cette étude. Voici les données démographiques des patients : âge moyen de 84,5 ans, score APACHE II (Acute Physiology and Chronic Health Evaluation) à l’arrivée de 22,4, score SOFA (Sequential Organ Failure Assessment) à l’arrivée de 5,3, mortalité globale à l’USI de 21,8%, et mortalité globale à l’hôpital de 35,0%. Pour les patients en médecine, la durée de séjour médiane à l’USI était de 4,1 jours, la durée de séjour à l’hôpital de 16,2 jours, la mortalité à l’USI de 26,5% et la mortalité hospitalière de 41,5%. Pour les patients en chirurgie, la durée de séjour médiane à l’USI était de 3,8 jours, la durée de séjour à l’hôpital de 20,1 jours, la mortalité à l’USI de 18,7% et la mortalité hospitalière de 31,6%. Seuls 45,0% des patients en médecine et 41,6% des patients d’urgence chirurgicale ont été capables de rentrer chez eux pour y vivre après avoir reçu leur congé.

Conclusion

Dans ce vaste échantillon de patients médicaux et chirurgicaux gravement malades, le score SOFA à l’admission et les durées de séjour hospitalier étaient comparables entre les deux groupes, mais les patients médicaux sont restés plus longtemps à l’USI et ont souffert d’une mortalité plus élevée tant à l’USI qu’à l’hôpital par rapport aux patients chirurgicaux.

Notes

Acknowledgements

The authors gratefully acknowledge the Canadian Institute of Health Research and Queen’s University for their support for this project. We also sincerely thank the Canadian Critical Care Trials Group and Dr. Daren Heyland for their support and contributions.

Conflicts of interest

None declared.

Editorial responsibility

This submission was handled by Dr. Steven Backman, Associate Editor, Canadian Journal of Anesthesia.

Author contributions

Ian Ball and Ian G. Stiell conceived the idea for the manuscript and analyzed the data. Ian Ball is the primary author of the manuscript. Sean M. Bagshaw, Karen E.A. Burns, Deborah J. Cook, Andrew G. Day, Peter M. Dodek, Demetrios J. Kutsogiannis, Sangeeta Mehta, John G. Muscedere, Alexis F. Turgeon, and Henry T. Stelfox contributed to the study design. Sean M. Bagshaw, Karen E.A. Burns, Deborah J. Cook, Peter M. Dodek, and Demetrios J. Kutsogiannis participated in running the study. Sean M. Bagshaw, Karen E.A. Burns, Deborah J. Cook, Andrew G. Day, Peter M. Dodek, Demetrios J. Kutsogiannis, Sangeeta Mehta, John G. Muscedere, Alexis F. Turgeon, Henry T. Stelfox, George A. Wells, and Ian G. Stiell co-authored this manuscript. Andrew G. Day and George A. Wells provided statistical expertise. Sangeeta Mehta, John G. Muscedere, Alexis F. Turgeon, and Henry T. Stelfox provided study oversight.

Funding

Financial support for this study was provided by a Canadian Institute of Health Research Grant (Funding Reference Number: 93610) awarded to Dr. Daren Heyland, Principal Investigator of the Realistic 80 Study. The work was also supported by a Queen’s University Research Initiation Grant awarded to Dr. Ian Ball.

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Copyright information

© Canadian Anesthesiologists' Society 2016

Authors and Affiliations

  • Ian M. Ball
    • 1
  • Sean M. Bagshaw
    • 2
  • Karen E. A. Burns
    • 3
  • Deborah J. Cook
    • 4
  • Andrew G. Day
    • 5
  • Peter M. Dodek
    • 6
  • Demetrios J. Kutsogiannis
    • 7
  • Sangeeta Mehta
    • 8
  • John G. Muscedere
    • 5
  • Alexis F. Turgeon
    • 9
    • 10
  • Henry T. Stelfox
    • 11
  • George A. Wells
    • 12
  • Ian G. Stiell
    • 13
  1. 1.Division of Critical Care Medicine and Department of Epidemiology and BiostatisticsWestern UniversityLondonCanada
  2. 2.University of AlbertaEdmontonCanada
  3. 3.University of TorontoTorontoCanada
  4. 4.St Joseph’s HealthCare HamiltonMcMaster UniversityHamiltonCanada
  5. 5.Kingston General HospitalQueen’s UniversityKingstonCanada
  6. 6.University of British ColumbiaVancouverCanada
  7. 7.Royal Alexandra HospitalUniversity of AlbertaEdmontonCanada
  8. 8.Mount Sinai HospitalUniversity of TorontoTorontoCanada
  9. 9.Department of Anesthesiology and Critical Care Medicine, Division of Critical Care MedicineUniversité LavalQuébec CityCanada
  10. 10.CHU de Québec - Université Laval Research Centre, Population Health and Optimal Health Practices Unit (Trauma - Emergency - Critical Care Medicine), CHU de Québec - Université Laval (Hôpital de L’Enfant-Jésus)Université LavalQuébec CityCanada
  11. 11.University of CalgaryCalgaryCanada
  12. 12.University of Ottawa Heart InstituteOttawaCanada
  13. 13.University of OttawaOttawaCanada

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