Why the study?
The study aimed to describe the 30-day mortality rate and identify risk factors associated with mortality in patients aged 80 years and older undergoing surgical and nonsurgical procedures under anaesthesia in Europe.
What is the 30-day all-cause mortality rate and what are the associated independent risk factors in patients aged 80 years and older undergoing surgical and nonsurgical procedures under anaesthesia in Europe?
Cohort (n=9,497)
Yes
What is the 30-day all-cause mortality rate and what are the associated independent risk factors in patients aged 80 years and older undergoing surgical and nonsurgical procedures under anaesthesia in Europe?
Answers are grounded in this paper and cite their sources.
In octogenarians and nonagenarians undergoing surgical or nonsurgical procedures under anaesthesia across Europe, 30-day mortality was lower than historically reported at 4.2%, with frailty, multimorbidity, limited mobility, and procedural urgency serving as strong independent predictors of death.
OBJECTIVES: The aim of this study was to describe the 30-day mortality rate of patients aged 80 years and older undergoing surgical and nonsurgical procedures under anaesthesia in Europe and to identify risk factors associated with mortality. DESIGN: A prospective cohort study. SETTING: European multicentre study, performed from October 2017 to December 2018. Centres committed to a 30-day recruitment period within the study period. PATIENTS: Nine thousand four hundred and ninety-seven consecutively recruited patients aged 80 years and older undergoing any kind of surgical or nonsurgical procedures under anaesthesia. MAIN OUTCOME MEASURES: The primary outcome was all-cause mortality within 30 days after procedure described by Kaplan-Meier curves with 95% CI. Risk factors for 30-day mortality were analysed using a Cox regression model with 14 fixed effects and a random centre effect. RESULTS: Data for 9497 patients (median age, 83.0 years; 52.8% women) from 177 academic and nonacademic hospitals in 20 countries were analysed. Patients presented with multimorbidity (77%), frailty (14%) and at least partial functional dependence (38%). The estimated 30-day mortality rate was 4.2% (95% CI 3.8 to 4.7). Among others, independent risk factors for 30-day mortality were multimorbidity, hazard ratio 1.87 (95% CI 1.26 to 2.78), frailty, hazard ratio 2.63 (95% CI 2.10 to 3.30), and limited mobility, hazard ratio 2.19 (95% CI 1.24 to 3.86). The majority of deaths (76%) occurred in hospital. Mortality risk for unplanned ICU admission was higher, hazard ratio 3.57 (95% CI 2.38 to 5.26) than for planned ICU admission, hazard ratio 1.92 (95% CI 1.47 to 2.50). Compared with other studies, the in-hospital complication rates of 17.4 and 3.9% after discharge were low. Admission to a unit with geriatric care within 30 days after the intervention was associated with a better survival within the first 10 days. CONCLUSIONS: The estimated 30-day mortality rate of 4.2% was lower than expected in this vulnerable population. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03152734, https://clinicaltrials.gov.
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A 2021 study conducted a cohort in Patients aged 80 years and older undergoing surgical and nonsurgical procedures under anaesthesia (n=9,497). Surgical or nonsurgical procedures under anaesthesia (and associated risk factors such as frailty) was evaluated on All-cause mortality within 30 days after procedure (HR 2.63 (for frailty), 95% CI 2.10 to 3.30, p=<0.001).
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