A comparison of very old patients admitted to intensive care unit after acute versus elective surgery or intervention

Christian Jung; Bernhard Wernly; Johanna M Muessig; Malte Kelm; Ariane Boumendil; Alessandro Morandi; Finn H Andersen; Antonio Artigas; Guido Bertolini; Maurizio Cecconi; Steffen Christensen; Loredana Faraldi; Jesper Fjølner; Michael Lichtenauer; Raphael Romano Bruno; Brian Marsh; Rui Moreno; Sandra Oeyen; Christina Agvald Öhman; Bernardo Bollen Pinto; Ivo W Soliman; Wojciech Szczeklik; Andreas Valentin; Ximena Watson; Tilemachos Zafeiridis; Dylan W De Lange; Bertrand Guidet; Hans Flaatten; VIP1 study group; Bodil Steen Rasmussen

doi:10.1016/j.jcrc.2019.04.020

A comparison of very old patients admitted to intensive care unit after acute versus elective surgery or intervention

Christian Jung, Bernhard Wernly, Johanna M Muessig, Malte Kelm, Ariane Boumendil, Alessandro Morandi, Finn H Andersen, Antonio Artigas, Guido Bertolini, Maurizio Cecconi, Steffen Christensen, Loredana Faraldi, Jesper Fjølner, Michael Lichtenauer, Raphael Romano Bruno, Brian Marsh, Rui Moreno, Sandra Oeyen, Christina Agvald Öhman, Bernardo Bollen PintoIvo W Soliman, Wojciech Szczeklik, Andreas Valentin, Ximena Watson, Tilemachos Zafeiridis, Dylan W De Lange, Bertrand Guidet, Hans Flaatten, VIP1 study group, Bodil Steen Rasmussen (Member of study group)

Research output: Contribution to journal › Journal article › Research › peer-review

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Abstract

BACKGROUND: We aimed to evaluate differences in outcome between patients admitted to intensive care unit (ICU) after elective versus acute surgery in a multinational cohort of very old patients (≥80 years; VIP). Predictors of mortality, with special emphasis on frailty, were assessed.

METHODS: In total, 5063 VIPs were included in this analysis, 922 were admitted after elective surgery or intervention, 4141 acutely, with 402 after acute surgery. Differences were calculated using Mann-Whitney-U test and Wilcoxon test. Univariate and multivariable logistic regression were used to assess associations with mortality.

RESULTS: Compared patients admitted after acute surgery, patients admitted after elective surgery suffered less often from frailty as defined as CFS (28% vs 46%; p < 0.001), evidenced lower SOFA scores (4 ± 5 vs 7 ± 7; p < 0.001). Presence of frailty (CFS >4) was associated with significantly increased mortality both in elective surgery patients (7% vs 12%; p = 0.01), in acute surgery (7% vs 12%; p = 0.02).

CONCLUSIONS: VIPs admitted to ICU after elective surgery evidenced favorable outcome over patients after acute surgery even after correction for relevant confounders. Frailty might be used to guide clinicians in risk stratification in both patients admitted after elective and acute surgery.

TRIAL REGISTRATION: NCT03134807. Registered 1st May 2017.

Original language	English
Journal	Journal of Critical Care
Volume	52
Pages (from-to)	141-148
Number of pages	8
ISSN	0883-9441
DOIs	https://doi.org/10.1016/j.jcrc.2019.04.020
Publication status	Published - Aug 2019

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Jung, C., Wernly, B., Muessig, J. M., Kelm, M., Boumendil, A., Morandi, A., Andersen, F. H., Artigas, A., Bertolini, G., Cecconi, M., Christensen, S., Faraldi, L., Fjølner, J., Lichtenauer, M., Bruno, R. R., Marsh, B., Moreno, R., Oeyen, S., Öhman, C. A., ... Rasmussen, B. S. (2019). A comparison of very old patients admitted to intensive care unit after acute versus elective surgery or intervention. Journal of Critical Care, 52, 141-148. https://doi.org/10.1016/j.jcrc.2019.04.020

@article{b593192011ff411583853e08f7dd0642,

title = "A comparison of very old patients admitted to intensive care unit after acute versus elective surgery or intervention",

abstract = "BACKGROUND: We aimed to evaluate differences in outcome between patients admitted to intensive care unit (ICU) after elective versus acute surgery in a multinational cohort of very old patients (≥80 years; VIP). Predictors of mortality, with special emphasis on frailty, were assessed.METHODS: In total, 5063 VIPs were included in this analysis, 922 were admitted after elective surgery or intervention, 4141 acutely, with 402 after acute surgery. Differences were calculated using Mann-Whitney-U test and Wilcoxon test. Univariate and multivariable logistic regression were used to assess associations with mortality.RESULTS: Compared patients admitted after acute surgery, patients admitted after elective surgery suffered less often from frailty as defined as CFS (28% vs 46%; p < 0.001), evidenced lower SOFA scores (4 ± 5 vs 7 ± 7; p < 0.001). Presence of frailty (CFS >4) was associated with significantly increased mortality both in elective surgery patients (7% vs 12%; p = 0.01), in acute surgery (7% vs 12%; p = 0.02).CONCLUSIONS: VIPs admitted to ICU after elective surgery evidenced favorable outcome over patients after acute surgery even after correction for relevant confounders. Frailty might be used to guide clinicians in risk stratification in both patients admitted after elective and acute surgery.TRIAL REGISTRATION: NCT03134807. Registered 1st May 2017.",

author = "Christian Jung and Bernhard Wernly and Muessig, {Johanna M} and Malte Kelm and Ariane Boumendil and Alessandro Morandi and Andersen, {Finn H} and Antonio Artigas and Guido Bertolini and Maurizio Cecconi and Steffen Christensen and Loredana Faraldi and Jesper Fj{\o}lner and Michael Lichtenauer and Bruno, {Raphael Romano} and Brian Marsh and Rui Moreno and Sandra Oeyen and {\"O}hman, {Christina Agvald} and Pinto, {Bernardo Bollen} and Soliman, {Ivo W} and Wojciech Szczeklik and Andreas Valentin and Ximena Watson and Tilemachos Zafeiridis and {De Lange}, {Dylan W} and Bertrand Guidet and Hans Flaatten and {VIP1 study group} and Rasmussen, {Bodil Steen}",

year = "2019",

month = aug,

doi = "10.1016/j.jcrc.2019.04.020",

language = "English",

volume = "52",

pages = "141--148",

journal = "Journal of Critical Care",

issn = "0883-9441",

publisher = "W.B.Saunders Co.",

}

Jung, C, Wernly, B, Muessig, JM, Kelm, M, Boumendil, A, Morandi, A, Andersen, FH, Artigas, A, Bertolini, G, Cecconi, M, Christensen, S, Faraldi, L, Fjølner, J, Lichtenauer, M, Bruno, RR, Marsh, B, Moreno, R, Oeyen, S, Öhman, CA, Pinto, BB, Soliman, IW, Szczeklik, W, Valentin, A, Watson, X, Zafeiridis, T, De Lange, DW, Guidet, B, Flaatten, H, VIP1 study group & Rasmussen, BS 2019, 'A comparison of very old patients admitted to intensive care unit after acute versus elective surgery or intervention', Journal of Critical Care, vol. 52, pp. 141-148. https://doi.org/10.1016/j.jcrc.2019.04.020

TY - JOUR

T1 - A comparison of very old patients admitted to intensive care unit after acute versus elective surgery or intervention

AU - Jung, Christian

AU - Wernly, Bernhard

AU - Muessig, Johanna M

AU - Kelm, Malte

AU - Boumendil, Ariane

AU - Morandi, Alessandro

AU - Andersen, Finn H

AU - Artigas, Antonio

AU - Bertolini, Guido

AU - Cecconi, Maurizio

AU - Christensen, Steffen

AU - Faraldi, Loredana

AU - Fjølner, Jesper

AU - Lichtenauer, Michael

AU - Bruno, Raphael Romano

AU - Marsh, Brian

AU - Moreno, Rui

AU - Oeyen, Sandra

AU - Öhman, Christina Agvald

AU - Pinto, Bernardo Bollen

AU - Soliman, Ivo W

AU - Szczeklik, Wojciech

AU - Valentin, Andreas

AU - Watson, Ximena

AU - Zafeiridis, Tilemachos

AU - De Lange, Dylan W

AU - Guidet, Bertrand

AU - Flaatten, Hans

AU - VIP1 study group

A2 - Rasmussen, Bodil Steen

PY - 2019/8

Y1 - 2019/8

N2 - BACKGROUND: We aimed to evaluate differences in outcome between patients admitted to intensive care unit (ICU) after elective versus acute surgery in a multinational cohort of very old patients (≥80 years; VIP). Predictors of mortality, with special emphasis on frailty, were assessed.METHODS: In total, 5063 VIPs were included in this analysis, 922 were admitted after elective surgery or intervention, 4141 acutely, with 402 after acute surgery. Differences were calculated using Mann-Whitney-U test and Wilcoxon test. Univariate and multivariable logistic regression were used to assess associations with mortality.RESULTS: Compared patients admitted after acute surgery, patients admitted after elective surgery suffered less often from frailty as defined as CFS (28% vs 46%; p < 0.001), evidenced lower SOFA scores (4 ± 5 vs 7 ± 7; p < 0.001). Presence of frailty (CFS >4) was associated with significantly increased mortality both in elective surgery patients (7% vs 12%; p = 0.01), in acute surgery (7% vs 12%; p = 0.02).CONCLUSIONS: VIPs admitted to ICU after elective surgery evidenced favorable outcome over patients after acute surgery even after correction for relevant confounders. Frailty might be used to guide clinicians in risk stratification in both patients admitted after elective and acute surgery.TRIAL REGISTRATION: NCT03134807. Registered 1st May 2017.

AB - BACKGROUND: We aimed to evaluate differences in outcome between patients admitted to intensive care unit (ICU) after elective versus acute surgery in a multinational cohort of very old patients (≥80 years; VIP). Predictors of mortality, with special emphasis on frailty, were assessed.METHODS: In total, 5063 VIPs were included in this analysis, 922 were admitted after elective surgery or intervention, 4141 acutely, with 402 after acute surgery. Differences were calculated using Mann-Whitney-U test and Wilcoxon test. Univariate and multivariable logistic regression were used to assess associations with mortality.RESULTS: Compared patients admitted after acute surgery, patients admitted after elective surgery suffered less often from frailty as defined as CFS (28% vs 46%; p < 0.001), evidenced lower SOFA scores (4 ± 5 vs 7 ± 7; p < 0.001). Presence of frailty (CFS >4) was associated with significantly increased mortality both in elective surgery patients (7% vs 12%; p = 0.01), in acute surgery (7% vs 12%; p = 0.02).CONCLUSIONS: VIPs admitted to ICU after elective surgery evidenced favorable outcome over patients after acute surgery even after correction for relevant confounders. Frailty might be used to guide clinicians in risk stratification in both patients admitted after elective and acute surgery.TRIAL REGISTRATION: NCT03134807. Registered 1st May 2017.

U2 - 10.1016/j.jcrc.2019.04.020

DO - 10.1016/j.jcrc.2019.04.020

M3 - Journal article

C2 - 31055187

SN - 0883-9441

VL - 52

SP - 141

EP - 148

JO - Journal of Critical Care

JF - Journal of Critical Care

ER -

A comparison of very old patients admitted to intensive care unit after acute versus elective surgery or intervention

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