A comparison of very old patients admitted to intensive care unit after acute versus elective surgery or intervention

Christian Jung, Bernhard Wernly, Johanna M. Muessig, Malte Kelm, Ariane Boumendil, Alessandro Morandi, Finn H. Andersen, Antonio Artigas, Guido Bertolini, Maurizio Cecconi, Steffen Christensen, Loredana Faraldi, Jesper Fjølner, Michael Lichtenauer, Raphael Romano Bruno, Brian Marsh, Rui Moreno, Sandra Oeyen, Christina Agvald Öhman, Bernadro Bollen Pinto & 8 others Ivo W. Soliman, Wojciech Szczeklik, Andreas Valentin, Ximena Watson, Tilemachos Zafeiridis, Dylan W. De Lange, Bertrand Guidet, Hans Flaatten

Research output: Contribution to journalArticle

Abstract

Background: We aimed to evaluate differences in outcome between patients admitted to intensive care unit (ICU) after elective versus acute surgery in a multinational cohort of very old patients (≥80 years; VIP). Predictors of mortality, with special emphasis on frailty, were assessed. Methods: In total, 5063 VIPs were included in this analysis, 922 were admitted after elective surgery or intervention, 4141 acutely, with 402 after acute surgery. Differences were calculated using Mann-Whitney-U test and Wilcoxon test. Univariate and multivariable logistic regression were used to assess associations with mortality. Results: Compared patients admitted after acute surgery, patients admitted after elective surgery suffered less often from frailty as defined as CFS (28% vs 46%; p < 0.001), evidenced lower SOFA scores (4 ± 5 vs 7 ± 7; p < 0.001). Presence of frailty (CFS >4) was associated with significantly increased mortality both in elective surgery patients (7% vs 12%; p = 0.01), in acute surgery (7% vs 12%; p = 0.02). Conclusions: VIPs admitted to ICU after elective surgery evidenced favorable outcome over patients after acute surgery even after correction for relevant confounders. Frailty might be used to guide clinicians in risk stratification in both patients admitted after elective and acute surgery. Trial registration: NCT03134807. Registered 1st May 2017.

Original languageEnglish
Pages (from-to)141-148
Number of pages8
JournalJournal of critical care
Volume52
DOIs
Publication statusPublished - 1 Aug 2019

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Intensive Care Units
Mortality
Nonparametric Statistics
Logistic Models

Keywords

  • Critically ill
  • Elective
  • Frailty
  • Old
  • Older
  • Outcome

Cite this

Jung, Christian ; Wernly, Bernhard ; Muessig, Johanna M. ; Kelm, Malte ; Boumendil, Ariane ; Morandi, Alessandro ; Andersen, Finn H. ; Artigas, Antonio ; Bertolini, Guido ; Cecconi, Maurizio ; Christensen, Steffen ; Faraldi, Loredana ; Fjølner, Jesper ; Lichtenauer, Michael ; Bruno, Raphael Romano ; Marsh, Brian ; Moreno, Rui ; Oeyen, Sandra ; Öhman, Christina Agvald ; Pinto, Bernadro Bollen ; Soliman, Ivo W. ; Szczeklik, Wojciech ; Valentin, Andreas ; Watson, Ximena ; Zafeiridis, Tilemachos ; De Lange, Dylan W. ; Guidet, Bertrand ; Flaatten, Hans. / A comparison of very old patients admitted to intensive care unit after acute versus elective surgery or intervention. In: Journal of critical care. 2019 ; Vol. 52. pp. 141-148.
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abstract = "Background: We aimed to evaluate differences in outcome between patients admitted to intensive care unit (ICU) after elective versus acute surgery in a multinational cohort of very old patients (≥80 years; VIP). Predictors of mortality, with special emphasis on frailty, were assessed. Methods: In total, 5063 VIPs were included in this analysis, 922 were admitted after elective surgery or intervention, 4141 acutely, with 402 after acute surgery. Differences were calculated using Mann-Whitney-U test and Wilcoxon test. Univariate and multivariable logistic regression were used to assess associations with mortality. Results: Compared patients admitted after acute surgery, patients admitted after elective surgery suffered less often from frailty as defined as CFS (28{\%} vs 46{\%}; p < 0.001), evidenced lower SOFA scores (4 ± 5 vs 7 ± 7; p < 0.001). Presence of frailty (CFS >4) was associated with significantly increased mortality both in elective surgery patients (7{\%} vs 12{\%}; p = 0.01), in acute surgery (7{\%} vs 12{\%}; p = 0.02). Conclusions: VIPs admitted to ICU after elective surgery evidenced favorable outcome over patients after acute surgery even after correction for relevant confounders. Frailty might be used to guide clinicians in risk stratification in both patients admitted after elective and acute surgery. Trial registration: NCT03134807. Registered 1st May 2017.",
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author = "Christian Jung and Bernhard Wernly and Muessig, {Johanna M.} and Malte Kelm and Ariane Boumendil and Alessandro Morandi and Andersen, {Finn H.} and Antonio Artigas and Guido Bertolini and Maurizio Cecconi and Steffen Christensen and Loredana Faraldi and Jesper Fj{\o}lner and Michael Lichtenauer and Bruno, {Raphael Romano} and Brian Marsh and Rui Moreno and Sandra Oeyen and {\"O}hman, {Christina Agvald} and Pinto, {Bernadro Bollen} and Soliman, {Ivo W.} and Wojciech Szczeklik and Andreas Valentin and Ximena Watson and Tilemachos Zafeiridis and {De Lange}, {Dylan W.} and Bertrand Guidet and Hans Flaatten",
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Jung, C, Wernly, B, Muessig, JM, Kelm, M, Boumendil, A, Morandi, A, Andersen, FH, Artigas, A, Bertolini, G, Cecconi, M, Christensen, S, Faraldi, L, Fjølner, J, Lichtenauer, M, Bruno, RR, Marsh, B, Moreno, R, Oeyen, S, Öhman, CA, Pinto, BB, Soliman, IW, Szczeklik, W, Valentin, A, Watson, X, Zafeiridis, T, De Lange, DW, Guidet, B & Flaatten, H 2019, 'A comparison of very old patients admitted to intensive care unit after acute versus elective surgery or intervention' Journal of critical care, vol. 52, pp. 141-148. https://doi.org/10.1016/j.jcrc.2019.04.020

A comparison of very old patients admitted to intensive care unit after acute versus elective surgery or intervention. / Jung, Christian; Wernly, Bernhard; Muessig, Johanna M.; Kelm, Malte; Boumendil, Ariane; Morandi, Alessandro; Andersen, Finn H.; Artigas, Antonio; Bertolini, Guido; Cecconi, Maurizio; Christensen, Steffen; Faraldi, Loredana; Fjølner, Jesper; Lichtenauer, Michael; Bruno, Raphael Romano; Marsh, Brian; Moreno, Rui; Oeyen, Sandra; Öhman, Christina Agvald; Pinto, Bernadro Bollen; Soliman, Ivo W.; Szczeklik, Wojciech; Valentin, Andreas; Watson, Ximena; Zafeiridis, Tilemachos; De Lange, Dylan W.; Guidet, Bertrand; Flaatten, Hans.

In: Journal of critical care, Vol. 52, 01.08.2019, p. 141-148.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A comparison of very old patients admitted to intensive care unit after acute versus elective surgery or intervention

AU - Jung, Christian

AU - Wernly, Bernhard

AU - Muessig, Johanna M.

AU - Kelm, Malte

AU - Boumendil, Ariane

AU - Morandi, Alessandro

AU - Andersen, Finn H.

AU - Artigas, Antonio

AU - Bertolini, Guido

AU - Cecconi, Maurizio

AU - Christensen, Steffen

AU - Faraldi, Loredana

AU - Fjølner, Jesper

AU - Lichtenauer, Michael

AU - Bruno, Raphael Romano

AU - Marsh, Brian

AU - Moreno, Rui

AU - Oeyen, Sandra

AU - Öhman, Christina Agvald

AU - Pinto, Bernadro Bollen

AU - Soliman, Ivo W.

AU - Szczeklik, Wojciech

AU - Valentin, Andreas

AU - Watson, Ximena

AU - Zafeiridis, Tilemachos

AU - De Lange, Dylan W.

AU - Guidet, Bertrand

AU - Flaatten, Hans

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Background: We aimed to evaluate differences in outcome between patients admitted to intensive care unit (ICU) after elective versus acute surgery in a multinational cohort of very old patients (≥80 years; VIP). Predictors of mortality, with special emphasis on frailty, were assessed. Methods: In total, 5063 VIPs were included in this analysis, 922 were admitted after elective surgery or intervention, 4141 acutely, with 402 after acute surgery. Differences were calculated using Mann-Whitney-U test and Wilcoxon test. Univariate and multivariable logistic regression were used to assess associations with mortality. Results: Compared patients admitted after acute surgery, patients admitted after elective surgery suffered less often from frailty as defined as CFS (28% vs 46%; p < 0.001), evidenced lower SOFA scores (4 ± 5 vs 7 ± 7; p < 0.001). Presence of frailty (CFS >4) was associated with significantly increased mortality both in elective surgery patients (7% vs 12%; p = 0.01), in acute surgery (7% vs 12%; p = 0.02). Conclusions: VIPs admitted to ICU after elective surgery evidenced favorable outcome over patients after acute surgery even after correction for relevant confounders. Frailty might be used to guide clinicians in risk stratification in both patients admitted after elective and acute surgery. Trial registration: NCT03134807. Registered 1st May 2017.

AB - Background: We aimed to evaluate differences in outcome between patients admitted to intensive care unit (ICU) after elective versus acute surgery in a multinational cohort of very old patients (≥80 years; VIP). Predictors of mortality, with special emphasis on frailty, were assessed. Methods: In total, 5063 VIPs were included in this analysis, 922 were admitted after elective surgery or intervention, 4141 acutely, with 402 after acute surgery. Differences were calculated using Mann-Whitney-U test and Wilcoxon test. Univariate and multivariable logistic regression were used to assess associations with mortality. Results: Compared patients admitted after acute surgery, patients admitted after elective surgery suffered less often from frailty as defined as CFS (28% vs 46%; p < 0.001), evidenced lower SOFA scores (4 ± 5 vs 7 ± 7; p < 0.001). Presence of frailty (CFS >4) was associated with significantly increased mortality both in elective surgery patients (7% vs 12%; p = 0.01), in acute surgery (7% vs 12%; p = 0.02). Conclusions: VIPs admitted to ICU after elective surgery evidenced favorable outcome over patients after acute surgery even after correction for relevant confounders. Frailty might be used to guide clinicians in risk stratification in both patients admitted after elective and acute surgery. Trial registration: NCT03134807. Registered 1st May 2017.

KW - Critically ill

KW - Elective

KW - Frailty

KW - Old

KW - Older

KW - Outcome

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U2 - 10.1016/j.jcrc.2019.04.020

DO - 10.1016/j.jcrc.2019.04.020

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JO - Journal of critical care

JF - Journal of critical care

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