Short-and long-term health implications of surgical intensive care in the elderly

DOI: 10.4236/health.2010.212209   PDF   HTML     4,535 Downloads   8,194 Views   Citations


Background: Treatment of elderly patients on intensive care units is an increasing challenge all over the world. Objectives: To evaluate short- term survival and long-term quality of life im-plications of intensive care for the elderly. Methods: Retrospective analysis of 314 patients 75 years of age or more requiring over 48 hours of intensive care. Results: In multivariate analy-sis, significant risk factors for mortality were chronic renal impairment (OR for survival .30, p < 0.001) and chronic obstructive pulmonary disease (OR 0.48, p = 0.003), pneumonia (OR for non-surviving 3.01, p < 0.001), or thrombosis (OR 1.89, p = 0.003); sepsis was not (OR 1.96, p = 0.055). Therapeutic measures associated with mortality were ventilator therapy > 24 h (OR 4.5), hemodialysis (OR 6.8), and vasopressor therapy (OR 2.5, p < 0.001 for each). A health survey questionnaire in an up to 60-month follow-up of 28 patients revealed considerably lower physi-cal subscores of our patients compared to the general elderly population. Conclusions: Elderly patients benefit from intensive care in terms of survival. Complications are frequent, as are severe consequences for long-term quality of life. Short-term mortality in elderly intensive care patients correlates most closely to pre- existing disease, not age.

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Utzolino, S. , Ober, P. , Kaffarnik, M. , Fischer, A. , Hopt, U. and Baier, P. (2010) Short-and long-term health implications of surgical intensive care in the elderly. Health, 2, 1405-1412. doi: 10.4236/health.2010.212209.

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The authors declare no conflicts of interest.


[1] Statistisches bundesamt (federal bureau of statistics ger-many) [online]. Available at:
[2] Etzioni D.A., Liu J.H., Maggard M.A. and Ko C.Y., “The aging population and its impact on the surgery work-force,” Ann Surg, Vol. 238, No. 2, 2003, pp. 170-177.
[3] Knaus W.A., Draper E.A., Wagner D.P. and Zimmerman J.E., “Apache ii: A severity of disease classification sys-tem,” Crit Care Med, Vol. 13, No. 10, 1985, pp. 818-829.
[4] Knaus W.A., Zimmerman J.E., Wagner D.P., Draper E.A. and Lawrence D.E., “Apache-acute physiology and chronic health evaluation: A physiologically based clas-sification system,” Crit Care Med, Vol. 9, No. 8, 1981, pp. 591-597.
[5] German Institute of Medical Documentation and Infor-mation. Available Online At: Http://
[6] Cullen D.J., Civetta J.M., Briggs B. A. and Ferrara L.C., “Therapeutic intervention scoring system: A method for quantitative comparison of patient care,” Crit Care Med, Vol. 2, No. 2, 1974, pp. 57-60.
[7] Miranda D.R., De Rijk A. and Schaufeli W., “Simplified therapeutic intervention scoring system: The tiss-28 items-results from a multicenter study,” Crit Care Med, Vol. 24, No. 1, 1996, pp. 64-73.
[8] Ware J. E., Jr. and Sherbourne C. D., “The mos 36-item short-form health survey (sf-36). I. Conceptual framework and item selection,” Med Care, Vol. 30, No. 6, 1992, pp. 473-483.
[9] Mchorney C.A., Ware J. E., Jr., Rogers W., Raczek A. E. and Lu J. F., “The validity and relative precision of mos short-and long-form health status scales and dartmouth coop charts. Results from the medical outcomes study,” Med Care, Vol. 30, No. 5 Suppl, 1992, pp. MS253-265.
[10] Garratt A.M., Ruta D.A., Abdalla M.I., Buckingham J.K. and Russell I.T., “The sf36 health survey questionnaire: An outcome measure suitable for routine use within the nhs?,” Bmj, Vol. 306, No. 6890, 1993, pp. 1440-1444.
[11] Bullinger M K.I.Sf 36-fragebogen zum gesundheitszus-tand – handlungsanweisungen. 1994.
[12] Singh N., Rogers P., Atwood C.W., Wagener M.M. and Yu V. L., “Short-course empiric antibiotic therapy for pa-tients with pulmonary infiltrates in the intensive care unit. A proposed solution for indiscriminate antibiotic pre-scription,” Am J Respir Crit Care Med, Vol. 162, No. 2 Pt 1, 2000, pp. 505-511.
[13] Campion E.W., Mulley A.G., Goldstein R.L., Barnett G.O. and Thibault G. E., “Medical intensive care for the elderly. A study of current use, costs, and outcomes,” Jama, Vol. 246, No. 18, 1981, pp. 2052-2056.
[14] Dragsted L. and Qvist J., “Outcome from intensive care. Iii. A 5-year study of 1308 patients: Activity levels,” Eur J Anaesthesiol, Vol. 6, No. 5, 1989, pp. 385-396.
[15] Bo M., Massaia M., Raspo S., Bosco F., Cena P., Mola-schi M. and Fabris F., “Predictive factors of in-hospital mortality in older patients admitted to a medical intensive care unit,” J Am Geriatr Soc, Vol. 51, No. 4, 2003, pp. 529-533.
[16] Pocard M., Frileux P., Vaillant J.C., Ollivier J.M., Gentil B. and Parc R., “[intensive care after digestive surgery: The outcome in elderly patients],” Ann Chir, Vol. 126, No. 2, 2001, pp. 127-132.
[17] Kleinpell R. M. and Ferrans C. E., “Factors influencing intensive care unit survival for critically ill elderly pa-tients,” Heart Lung, Vol. 27, No. 5, 1998, pp. 337-343.
[18] Udekwu P., Gurkin B., Oller D., Lapio L. and Bourbina J., “Quality of life and functional level in elderly patients surviving surgical intensive care,” J Am Coll Surg, Vol. 193, No. 3, 2001, pp. 245-249.
[19] Roche V.M., Kramer A., Hester E. and Welsh C.H., “Long-term functional outcome after intensive care,” J Am Geriatr Soc, Vol. 47, No. 1, 1999, pp. 18-24.
[20] Wilson M. T., Crawford K. L. and Shabot M. M., “Inten-sive care unit outcomes of surgical centenarians: The “Oldest old” Of the new millennium, Am Surg, Vol. 66, No. 9, 2000, pp. 870-873.
[21] Pellicane J. V., Byrne K. and Demaria E. J., “Preventable complications and death from multiple organ failure among geriatric trauma victims,” J Trauma, Vol. 33, No. 3, 1992, pp. 440-444.
[22] Perdue P. W., Watts D. D., Kaufmann C. R. and Trask A. L., “Differences in mortality between elderly and younger adult trauma patients: Geriatric status increases risk of delayed death,” J Trauma, Vol. 45, No. 4, 1998, pp. 805-810.
[23] Torres O. H., Francia E., Longobardi V., Gich I., Benito S. and Ruiz D., “Short- and long-term outcomes of older patients in intermediate care units,” Intensive Care Med, Vol. 32, No. 7, 2006, pp. 1052-1059.
[24] Mcgory M. L., Kao K. K., Shekelle P. G., Rubenstein L. Z., Leonardi M. J., Parikh J. A., Fink A. and Ko C. Y., “Developing quality indicators for elderly surgical pa-tients,” Ann Surg, Vol. 250, No. 2, 2009, pp. 338-347.
[25] Holt G., Smith R., Duncan K., Hutchison J. D. and Gre-gori A., “Outcome after surgery for the treatment of hip fracture in the extremely elderly,” J Bone Joint Surg Am, Vol. 90, No. 9, 2008, pp. 1899-1905.
[26] Pisani M. A., Redlich C. A., Mcnicoll L., Ely E. W., Friedkin R. J. and Inouye S. K., “Short-term outcomes in older intensive care unit patients with dementia,” Crit Care Med, Vol. 33, No. 6, 2005, pp. 1371-1376.
[27] Hamrick I., Weiss G., Lippert H. and Meyer F., “[geriatric problems in the perioperative management of surgical interventions],” Zentralbl Chir, Vol. 130, No. 1, 2005, pp. 41-47.
[28] Scalea T. M., Simon H. M., Duncan A. O., Atweh N. A., Sclafani S. J., Phillips T. F. and Shaftan G. W., “Geriatric blunt multiple trauma: Improved survival with early in-vasive monitoring,” J Trauma, Vol. 30, No. 2, 1990, pp. 129-134; discussion 134-126.
[29] Orwelius L., Nordlund A., Edell-Gustafsson U., Simons-son E., Nordlund P., Kristenson M., Bendtsen P. and Sjoberg F., “Role of preexisting disease in patients’ per-ceptions of health-related quality of life after intensive care,” Crit Care Med, Vol. 33, No. 7, 2005, pp. 1557- 1564.
[30] Montuclard L., Garrouste-Orgeas M., Timsit J. F., Misset B., De Jonghe B. and Carlet J., “Outcome, functional autonomy, and quality of life of elderly patients with a long-term intensive care unit stay,” Crit Care Med, Vol. 28, No. 10, 2000, pp. 3389-3395.
[31] Shurland S., Zhan M., Bradham D. D. and Roghmann M. C., “Comparison of mortality risk associated with bacte-remia due to methicillin-resistant and methicil-lin-susceptible staphylococcus aureus,” Infect Control Hosp Epidemiol, Vol. 28, No. 3, 2007, pp. 273-279.
[32] De Rooij S. E., Govers A. C., Korevaar J. C., Giesbers A. W., Levi M. and De Jonge E., “Cognitive, functional, and quality-of-life outcomes of patients aged 80 and older who survived at least 1 year after planned or unplanned surgery or medical intensive care treatment,” J Am Geriatr Soc, Vol. 56, No. 5, 2008, pp. 816-822.
[33] Kaarlola A., Tallgren M. and Pettila V., “Long-term sur-vival, quality of life, and quality-adjusted life-years among critically ill elderly patients,” Crit Care Med, Vol. 34, No. 8, 2006, pp. 2120-2126.
[34] Merlani P., Chenaud C., Mariotti N. and Ricou B., “Long-term outcome of elderly patients requiring intensive care admission for abdominal pathologies: Survival and quality of life,” Acta Anaesthesiol Scand, Vol. 51, No. 5, 2007, pp. 530-537.
[35] Rockwood K., Noseworthy T. W., Gibney R. T., Konopad E., Shustack A., Stollery D., Johnston R. and Grace M., “One-year outcome of elderly and young patients admitted to intensive care units,” Crit Care Med, Vol. 21, No. 5, 1993, pp. 687-691.
[36] Jandziol A. K. and Ridley S. A., “Validation of outcome prediction in elderly patients,” Anaesthesia, Vol. 55, No. 2, 2000, pp. 107-112.
[37] Rellos K., Falagas M. E., Vardakas K. Z., Sermaides G. and Michalopoulos A., “Outcome of critically ill oldest-old patients (aged 90 and older) admitted to the intensive care unit,” J Am Geriatr Soc, Vol. 54, No. 1, 2006, pp. 110-114.
[38] Akposso K., Hertig A., Couprie R., Flahaut A., Alberti C., Karras G. A., Haymann J. P., Costa De Beauregard M. A., Lahlou A., Rondeau E. and Sraer J. D., “Acute renal fail-ure in patients over 80 years old: 25-years' experience,” Intensive Care Med, Vol. 26, No. 4, 2000, pp. 400-406.
[39] Heijmeriks J. A., Pourrier S., Dassen P., Prenger K. and Wellens H. J., “Comparison of quality of life after coro-nary and/or valvular cardiac surgery in patients > or =75 years of age with younger patients,” Am J Cardiol, Vol. 83, No. 7, 1999, pp. 1129-1132, A1129.
[40] Mittermair R. P. and Muller L. C., “Quality of life after cardiac surgery in the elderly,” J Cardiovasc Surg (Torino), Vol. 43, No. 1, 2002, pp. 43-47.
[41] Szalados J. E., “Age and functional status as determinants of intensive care unit outcome: Sound basis for health policy or tip of the outcomes iceberg,” Crit Care Med, Vol. 32, No. 1, 2004, pp. 291-293.
[42] Garrouste-Orgeas M. and Carlet J., “Predicting whether the icu can help older patients: Score needed,” Crit Care, Vol. 9, No. 4, 2005, pp. 331-332.
[43] De Rooij S. E., Abu-Hanna A., Levi M. and De Jonge E., “Factors that predict outcome of intensive care treatment in very elderly patients: A review,” Crit Care, Vol. 9, No. 4, 2005, pp. R307-314.
[44] Ranhoff A. H., Rozzini R., Sabatini T., Cassinadri A., Boffelli S., Ferri M., Travaglini N., Ricci A., Morandi A. and Trabucchi M., “Subintensive care unit for the elderly: A new model of care for critically ill frail elderly medical patients,” Intern Emerg Med, Vol. 1, No. 3, 2006, pp. 197-203.
[45] Baldwin F. J., Hinge D., Dorsett J. and Boyd O. F., “Quality of life and persisting symptoms in intensive care unit survivors: Implications for care after discharge,” BMC Res Notes, Vol. 2, No., 2009, pp. 160.

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