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Original article
Intensive care admission and hospital mortality in the elderly after non-cardiac surgery
Ingreso en cuidados intensivos y mortalidad hospitalaria en pacientes de edad avanzada tras cirugía no cardiaca
M. de Nadala,, , S. Pérez-Hoyosb, J.C. Montejo-Gonzálezc, R. Pearsed, C. Aldecoae, on behalf of the European Surgical Outcomes Study (EuSOS) in Spain 1
a Department of Anaesthesiology and Intensive Care, Hospital Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
b Statistics and Bioinformatics Unit, Vall d’Hebron Research Institute, Barcelona, Spain
c Department of Intensive Care, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
d Department of Intensive Care Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
e Department of Anaesthesia and Surgical Critical Care, Hospital Universitario Río Hortega, Valladolid, Spain
Received 22 November 2017, Accepted 20 January 2018
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.

Resumen
Objetivo

Evaluar si la edad del paciente se asociaba independientemente con el ingreso en la unidad de cuidados intensivos (UCI) tras cirugía no cardiaca.

Diseño

Estudio observacional de cohortes del subgrupo español del European Surgical Outcome Study (EuSOS).

Ámbito

Hospitales públicos y privados en España.

Intervención

Ninguna.

Pacientes y métodos

Pacientes consecutivos mayores de 16 años sometidos a cirugía no cardiaca con ingreso durante un periodo de 7 días del mes de abril de 2011.

Variables de interés principal

Tasa de ingreso en la UCI, factores asociados con ingreso en la UCI y mortalidad hospitalaria, analizadas mediante regresión logística y regresión fraccional polinómica.

Resultados

De 5.412 pacientes, 677 (12,5%) fueron ingresados en la UCI tras la cirugía. La odds ratio ajustada (intervalo de confianza [IC] del 95%) de ingreso en la UCI fue de 1,1 (0,8-1,4) para 65-74 años, 0,7 (0,5-1) para 75-85 años y de 0,4 (0,2-0,8) para más de 85 años, respectivamente. La edad, el grado ASA, el grado de la cirugía (menor, intermedia, mayor), la cirugía urgente, la especialidad quirúrgica, la cirugía laparoscópica y la enfermedad metastásica fueron factores independientes de ingreso en la UCI. El riesgo global ajustado de mortalidad fue de 1,4 (IC 95%: 0,9-2,2). El grado ASA, cirugía urgente, especialidad quirúrgica y diabetes fueron predictores de mortalidad hospitalaria.

Conclusiones

En los hospitales españoles, los pacientes ancianos (más de 80 años) son menos propensos a ser ingresados en la UCI tras cirugía no cardiaca. En esta cohorte, la edad y la mortalidad hospitalaria no se asociaron significativamente.

Keywords
Elderly, Intensive care unit, Postoperative mortality, Non-cardiac surgery
Palabras clave
Edad avanzada, Unidad de cuidados intensivos, Mortalidad postoperatoria, Cirugía no cardiaca

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