Intensive care admission and hospital mortality in the elderly after non-cardiac surgery

Abstract

Objective: To assess whether patient age is independently associated to Intensive Care Unit (ICU) admission after non-cardiac surgery.

Design: An observational cohort study of the Spanish subset of the European Surgical Outcome Study (EuSOS) was carried out.

Setting: Hospitals of the public National Health Care System and private hospitals in Spain.

Intervention: None.

Patients and methods: All patients over 16 years of age undergoing inpatient non-cardiac surgery in the participating hospitals during a 7-day period in the month of April 2011 were consecutively included.

Main variables of interest: ICU admission rate, factors associated with ICU admission and hospital mortality were assessed using logistic regression analysis and fractional polynomial regression.

Results: Out of 5412 patients, 677 (12.5%) were admitted to the ICU after surgery. The adjusted odds ratio (95% confidence interval [CI]) for ICU admission was 1.1 (0.8-1.4) for patients aged 65-74 years, 0.7 (0.5-1) for patients aged 75-85 years, and 0.4 (0.2-0.8) for patients over 85 years, respectively. Age, ASA score, grade of surgery (minor, intermediate, major), urgent surgery, surgical specialty, laparoscopic surgery and metastatic disease were independent factors for ICU admission. Global risk-adjusted mortality was 1.4 (95% CI 0.9-2.2). The ASA score, urgent surgery, surgical specialty and diabetes were predictors of hospital mortality.

Conclusions: Elderly patients (over 80 years) appear less likely to be admitted to ICU after non-cardiac surgery in Spanish hospitals. There was no significant association between age and postoperative mortality in this cohort.

Keywords: Cirugía no cardiaca; Edad avanzada; Elderly; Intensive care unit; Mortalidad postoperatoria; Non-cardiac surgery; Postoperative mortality; Unidad de cuidados intensivos.