Why the study?
Critical care admission is a pivotal juncture for older surgical patients, but their in-hospital and postdischarge outcomes after intensive care unit admission needed to be identified.
What are the predictors of 1-year mortality in older postsurgical patients admitted to the ICU?
What are the predictors of 1-year mortality in older postsurgical patients admitted to the ICU?
APACHE III score, age ≥85, and surgery subtype (major/emergency) are strong predictors of 1-year mortality in older postsurgical ICU patients, aiding in preoperative risk stratification.
May inform cautious preoperative counseling in the oldest surgical patients; leaves open whether these predictors should guide ICU or operative decisions.
OBJECTIVES: Critical care admission is a pivotal juncture for older patients undergoing surgery. We aimed to identify the in-hospital and postdischarge outcomes of older postsurgical patients (≥65 years) admitted to the intensive care unit (ICU). METHODS: We collected clinical, morbidity and survival data on all patients aged ≥65 years postsurgically admitted to a tertiary metropolitan ICU between 2014 and 2019. RESULTS: Within this older cohort (n = 370), the oldest patients (≥85 years) had the highest 1-year mortality (RR: 4.00; P < 0.001). Major surgery (RR: 5.67; P < 0.001), emergency surgery (RR: 2.89; P < 0.001) and APACHE III score ≥50 (RR: 2.63; P < 0.001) were associated with reduced 1-year survival. CONCLUSIONS: APACHE III score and surgery subtype are strong predictors of post-ICU mortality and may be useful to preoperatively stratify whether surgery and subsequent ICU admission are in patients' best interests. These data may also inform prospective discussions regarding end-of-life care and advanced care planning.
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Zhang et al. (2021) studied this question.
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