The very elderly surgical population in a critically ill scenario: clinical characteristics and outcomes

Silva, Diana de Jesus Neves; Casimiro, Luís Guilherme Galego; Oliveira, Mónica Isabel Sequeira de; Ferreira, Luciana Brás da Cunha; Abelha, Fernando José Pereira Alves

doi:10.1016/j.bjane.2020.02.002

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Scientific Articles • Rev. Bras. Anestesiol. 70 (1) • Jan-Feb 2020 • https://doi.org/10.1016/j.bjane.2020.02.002 copy

The very elderly surgical population in a critically ill scenario: clinical characteristics and outcomes

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

The elderly population is an especially heterogeneous group of patients with a rising number of surgical interventions being performed in the very elderly patient. The aim of this study was to evaluate the correlation between different age strata and functional status with the surgical outcome of the elderly patient.

Methods:

Retrospective cohort study conducted in a Surgical Intensive Care Unit (SICU), between 2006 and 2013. A total of 2331 surgical patients’ ≥ 65 years old were included. Patients were grouped according to age: Older Elderly Group (OEG: 65‒85 years old); Very Elderly Group (VEG > 85 years old). Demographic and perioperative data were recorded. Revised Cardiac Risk Index, APACHE II and SAPS II scores were calculated and postoperative complications were documented. Variables were compared on univariate analysis.

Results:

The incidence of the VEG was 5.4%. This group had a higher proportion of non-elective surgery (22.4% vs. 11.2%, p < 0.001), higher APACHE II (12.0 vs. 10.0, p < 0.001) and SAPS II (26.6 vs. 22.2, p < 0.001) scores, higher incidence of organ failure (24.6% vs. 17.6%, p = 0.048) and a higher mortality rate during SICU (14.0% vs. 5.2%, p = 0.026) and hospital stay (9.3% vs. 5.0%, p = 0.012).

Conclusion:

We found that very elderly patients represented a significant proportion of patients admitted to the SICU. They had higher severity scores with a higher prevalence of organ failure and were more likely to undergo non-elective surgery. They had worse outcomes in regarding mortality during SICU and hospital stay.

KEYWORDS
Elderly; Surgery; Critical care; Postoperative complications; Mortality

Variables	OEG	VEG	p-value
	(65-85 years old)	(> 85 years old)
	n = 2205	n = 126
Gender, n (%)			<0.001^a a Chi-square test.
Male	1400 (63.5)	52 (41.3)
Female	805 (36.5)	74 (58.7)
Type of admission, n (%)			<0.001^a a Chi-square test.
Elective surgery	1942 (88.8)	97 (77.6)
Non-elective surgery	245 (11.2)	28 (22.4)
High risk surgery, n (%)	1245 (56.5)	59 (46.8)	0.034^a a Chi-square test.
History of ischemic heart disease, n (%)	421 (19.1)	21 (16.7)	0.499^a a Chi-square test.
History of congestive heart disease, n (%)	462 (21.0)	45 (35.7)	<0.001^a a Chi-square test.
History of cerebrovascular disease, n (%)	412 (18.7)	20 (15.9)	0.430^a a Chi-square test.
Preoperative insulin therapy, n (%)	139 (6.3)	7 (5.6)	0.736^a a Chi-square test.
Chronic renal failure, n (%)	169 (7.7)	14 (11.1)	0.162^a a Chi-square test.
RCRI, n (%)			0.830^a a Chi-square test.
≤ 2	1964 (89.1)	113 (89.7)
> 2	241 (10.9)	13 (10.3)
Glasgow coma scale, n (%)			0.968^a a Chi-square test.
≤ 7	34 (1.5)	2 (1.6)
> 7	2171 (98.5)	124 (98.4)
Mechanical ventilation, n (%)	651 (29.5)	32 (25.4)	0.322^a a Chi-square test.
Body temperature (ºC), median (IQR)	35.7 (34.5-36.0)	35.6 (34.6-36.0)	0.812^b b Mann-Whitney U test.
Heart rate (beats per min), median (IQR)	85 (70-96)	78 (65-93)	0.589^b b Mann-Whitney U test.
Systolic pressure (mmHg), median (IQR)	122 (102-145)	121 (99-140)	0.082^b b Mann-Whitney U test.
Mean arterial pressure (mmHg), median (IQR)	85 (70-96)	78 (65-93)	0.015^b b Mann-Whitney U test.
Respiratory rate, median (IQR)	14 (12-16)	14 (12-16)	0.621^b b Mann-Whitney U test.
Haematocrit (%), median (IQR)	33.0 (29.5-36.0)	32.3 (30.0-35.6)	0.281^b b Mann-Whitney U test.
Serum urea (mg.dL^-1), median (IQR)	32 (22-46)	36 (25-50)	0.046^b b Mann-Whitney U test.
Serum creatinine (mg.L^-1), median (IQR)	9.0 (7.0-12.0)	10.0 (7.0-13.0)	0.288^b b Mann-Whitney U test.
Total bilirubin (mg.L^-1), median (IQR)	5.0 (1.0-7.0)	4.0 (1.0-7.0)	0.118^b b Mann-Whitney U test.
Leucocyte count, median (IQR)	10.4 (7.6-13.4)	10.6 (7.7-13.0)	0.894^b b Mann-Whitney U test.
Serum sodium (mEq.L^-1), median (IQR)	140 (137-142)	139 (137-142)	0.293^b b Mann-Whitney U test.
Serum potassium (mEq.L^-1), median (IQR)	3.8 (3.4-4.1)	3.8 (3.3-4.0)	0.330^b b Mann-Whitney U test.
FiO₂ (%), median (IQR)	0.40 (035-0.40)	0.40 (0.33-0.40)	0.148^b b Mann-Whitney U test.
pH, median (IQR)	7.4 (7.3-7.4)	7.4 (7.3-7.4)	0.648^b b Mann-Whitney U test.
PaO₂ (mmHg), median (IQR)	100.0 (99.0-109.0)	100.0 (100.0-105.0)	0.695^b b Mann-Whitney U test.
PaCO₂ (mmHg), median (IQR)	40.0 (35.0-45.0)	41.0 (35.7-45.0)	0.096^b b Mann-Whitney U test.
Serum bicarbonate (mmoL.L^-1), median (IQR)	22 (21-24)	22 (21-24)	0.080^b b Mann-Whitney U test.

Variables	OEG	VEG	p-values
	(65-85 years old)	(> 85 years old)
	n = 2205	n = 126
APACHE II, median (IQR)	10.0 (8.8-13.0)	12.0 (9.0-15.3)	<0.001^b b Mann-Whitney test.
SAPS II, median (IQR)	22.2 (17.8-28.9)	26.6 (20.0-33.9)	<0.001^b b Mann-Whitney test.
Length of stay in SICU, hours, median (IQR)	20.0 (16.0-41.0)	20.0 (16.0-43.0)	0.898^b b Mann-Whitney test.
Organ insufficiency,^c c Organ insufficiency as defined by APACHE II. n (%)	389 (17.6)	31 (24.6)	0.048^a a Chi-square test.
MACE, n (%)	74 (3.4)	1 (0.8)	0.079^a a Chi-square test.
ARF, n (%)	167 (7.6)	14 (11.1)	0.149^a a Chi-square test.
Mortality in SICU, n (%)	120 (5.2)	6 (14.0)	0.026^a a Chi-square test.
Mortality in hospital, n (%)	105 (5.0)	21 (9.3)	0.012^a a Chi-square test.

Sociedade Brasileira de Anestesiologia R. Professor Alfredo Gomes, 36, 22251-080 Botafogo RJ Brasil, Tel: +55 21 2537-8100, Fax: +55 21 2537-8188 - Campinas - SP - Brazil
E-mail: bjan@sbahq.org

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[1] * Corresponding author. E-mail:fernando.abelha@gmail.com (F.J. Abelha).