Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.02.0a02
Brazilian Journal of Anesthesiology
Scientific Article

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

A população cirúrgica muito idosa em cuidados intensivos: características clínicas e desfechos

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

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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

Resumo

Introdução
A população idosa envolve um grupo muito heterogêneo de doentes, com um crescente número de doentes muito idosos a serem propostos para cirurgia. O objetivo do presente estudo foi avaliar a relação entre diferentes grupos etários e estados funcionais com os resultados cirúrgicos do doente idoso.

Métodos
Estudo retrospectivo de coorte realizado em uma Unidade de Cuidados Intensivos Cirúrgica (UCIC) que incluiu um total de 2331 doentes cirúrgicos com idade ≥ 65 anos, entre 2006 e 2013. Os doentes foram agrupados de acordo com a idade: doentes idosos ( 65‒85 anos); doentes muito idosos (DMI > 85 anos). Dados demográficos e perioperatórios foram registrados. Índice de Risco Cardíaco Revisto,scores de APACHE e SAPS II foram calculados e complicações pós-operatórias, documentadas. As variáveis foram comparadas em análise univariada.

Resultados
A incidência de DMI foi de 5,4%. Este grupo foi mais frequentemente submetido à cirurgia não eletiva (22,4%vs. 11,2%; p < 0,001, apresentou scores maiores de APACHE II (12,0 vs. 10,0; p < 0,001 e SAPS II 26,6 vs. 22,2; p < 0,001, maior incidência de insuficiência do órgão 24,6% vs. 17,6%; p = 0,048 e uma mortalidade superior na UCIC 14,0% vs. 5,2%; p = 0,026 e no hospital 9,3% vs. 5,0%; p = 0,012.

Discussão
Os piores resultados nos DMI podem refletir uma maior vulnerabilidade a complicações pós-operatórias, possivelmente relacionadas com múltiplas comorbilidades e uma reserva fisiológica diminuídas.

Conclusão
Os doentes muito idosos representaram uma porção importante dos doentes admitidos na UCIC, tinhamscores de gravidade mais elevados e maior prevalência de falência orgânica e foram mais frequentemente submetidos a cirurgias não eletivas. Tinham piores resultados relativamente à mortalidade durante a permanência na UCIC e no hospital.

Palavras-chave

Idosos, Cirurgia, Cuidados críticos, Complicações pós-operatórias, Mortalidade

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