Outcome of the elderly critically ill after intensive care in an era of cost containment

BACKGROUND: Economical constraints have, in many countries, led to a reduction in provision of health care services, including care of the critically ill, after decades of expansion. We hypothesized that elderly critically ill patients may be particularly vulnerable to these changes. The purpose of the present study was to examine survival of patients > or = 75 years between 1993 and 1999 when overall staff and ICU/HDU-beds were stepwise reduced, but the nurse/bed ratio increased. METHODS: Patient demographics, reason for admission, APACHE II and TISS scores were retrieved from a prospectively collected clinical database, and 180-day mortality was secured from a national database. Multivariate logistic regression was used to determine the role of year of admission on outcome. RESULTS: The annual number of elderly admissions (mean 656, range 611-702) and their APACHE II-derived probability of death (mean 0.25, range 0.24-0.26) did not alter significantly during the period. For patients admitted after anesthesia and surgery, length of stay was significantly shorter (P < 0.001) and TISS points per admission were fewer (P < 0.05) at the end of the period, whereas 180-day survival remained unchanged (mean 27.5%, range 25.3-29.3%). Year of admission had no explanatory power with an odds ratio of 1.0 (95% CI 0.9-1.1) per year. CONCLUSION: Reduction of intensive care services led to shorter stay and lower TISS allocation for elderly critically ill without any significant increase in 180-day mortality.