Home Return After Surgery in Patients Aged over 85 Years is Associated with Preoperative Albumin Levels, the Type of Surgery, and APACHE II Score

Abstract

Background: Owing to an aging society, both the number of operations for patients aged >85 years and the average age of patients admitted to the intensive care unit (ICU) are rapidly increasing. However, mortality is not an appropriate outcome measurement in patients aged >85 years; a more important outcome is home return (HR), because quality of life is valuable to these patients. We identified predictors for HR of patients aged >85 years admitted to the ICU after surgery.

Methods: Retrospective analysis of medical records was conducted at a university hospital. Patients aged > 85 years, admitted to the ICU after surgery from March 2006 to June 2015 (n = 187), were divided into a HR group (patients who returned home after discharge) and non-HR group (deceased or transferred to nursing facilities). Perioperative data and outcome were assessed and compared. Multivariate logistic regression analysis was conducted to identify independent predictors.

Results: The average age of patients was 88 years. HR occurred in 61% of patients, and mortality was 9%. The HR group had higher preoperative albumin level than did the non-HR group. More patients in the non-HR group experienced hip surgery than in the HR group (51 vs. 12%, P < 0.001). APACHE II score was higher (P < 0.001) in the non-HR group. In multivariate analysis, preoperative albumin, hip surgery, and APACHE II score were independent predictors of HR.

Conclusion: Predictors of HR of surgical critically ill elderly patients included preoperative albumin level, hip surgery, and APACHE II score on ICU admission.