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BJA Advance Access originally published online on October 24, 2007
British Journal of Anaesthesia 2007 99(6):824-829; doi:10.1093/bja/aem307
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Determinants of outcome in critically ill octogenarians after surgery: an observational study

P. N. R. Ford1,*, I. Thomas2, T. M. Cook3, E. Whitley4 and C. J. Peden3

1 Department of Anaesthesia, Royal Devon and Exeter Hospital, Barrack Road, Exeter EX2 5DW, UK
2 Department of Anaesthesia, Frenchay Hospital, Frenchay Park Road, Bristol BS16 1LE, UK
3 Department of Anaesthesia, Royal United Hospital, Combe Park, Bath BA1 3NG, UK
4 Bristol NHS Research and Development Support Unit, The Coach House, Southmead Hospital, Westbury on Trym, Bristol BS 10 5NB, UK

* Corresponding author. E-mail: fordpeter{at}doctors.org.net

Background: The population in the UK is growing older and the number of elderly patients cared for on intensive care units (ICU) is increasing. This study was designed to identify risk factors for mortality in critically ill patients of >80 yr of age after surgery.

Methods: We identified 275 patients, aged 80 yr or greater, admitted to the ICU after surgery. After exclusions, 255 were selected for further analysis. Multivariate analysis was then performed to determine the covariates associated with hospital mortality.

Results: The overall ICU and hospital mortality was 20.4% and 33.3%, respectively. Patients who received i.v. vasoactive drugs on days 1 and 2 had hospital mortality of 54.4% and 60.5%, respectively. Multivariate analysis showed that requirement for i.v. vasoactive drugs within the first 24 h on ICU [odds ratio (OR) 4.29; 95% CI, 2.35–7.84, P<0.001] and requirement for i.v. vasoactive drugs for a further 24 h (OR 3.63; 95% CI, 1.58–8.37, P<0.01) were associated with hospital mortality. The requirement for i.v. vasoactive drugs was also strongly associated with hospital mortality in all the subgroups studied (elective surgery, emergency surgery, and emergency laparotomy).

Conclusions: For patients aged 80 yr and more, admitted to ICU after surgery, the requirement for i.v. vasoactive drugs in the first and second 24 h was the strongest predictor of hospital mortality.

Keywords: age factors; complications, death; intensive care; surgery, postoperative period


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E-letters:

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Are Treatment limitations the unwritten conclusion?
Jack Parry-Jones
British Journal of Anaesthesia, 10 Jan 2008 [Full text]
Predicting mortality in critically ill octogenarian surgical patients
William H Konarzewski, et al.
British Journal of Anaesthesia, 10 Jan 2008 [Full text]

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