Rady Mohamed Y, Johnson Daniel J
Mayo Clinic Hospital, 5777 East Mayo Blvd, Phoenix, AZ 85054, USA.
Chest. 2004 Nov;126(5):1583-91. doi: 10.1378/chest.126.5.1583.
Hospital survival and length of stay are commonly used for the evaluation of intensive care outcome for the young and octogenarian patients (>/= 80 years old).
Hospital discharge to a care facility should be considered for more accurate evaluation of intensive care outcome, especially for octogenarian patients.
An observational descriptive study.
A total of 6,154 consecutive hospital admissions requiring intensive care over 4 years.
Demographics, preadmission comorbidities, severity of illness, acute hospital diagnosis categories, charges and destination after discharge, and postdischarge survival for up to 42 months.
Octogenarians represented 15% of intensive care admissions (900 admissions). The interventions performed in the ICU, the severity of illness measured by sequential organ failure assessment (SOFA), and hospital length of stay were similar for octogenarian and younger patients. Octogenarians had higher hospital mortality (10% vs 6%, p < 0.01) and discharge to care facility (35% vs 18%, p < 0.01) than younger patients. The average hospital charge per octogenarian hospital survivor discharged to home was $128,000, compared to $100,000 for a younger hospital survivor. At follow-up, octogenarian hospital survivors who were discharged to a care facility had higher mortality than hospital survivors discharged to home (31% vs 17%, p < 0.01). On multiple logistic regression, older age, female gender, preadmission comorbidities, type of admission, SOFA score >/= 4, mechanical ventilation >/= 96 h, requirement for tracheotomy, and hospital diagnosis categories were independent factors for discharge of hospital survivors to a care facility.
Hospital survival and length of stay did not accurately measure intensive care outcome for octogenarians. Care dependency among octogenarians who survived intensive care was prevalent and decreased their long-term survival. Care dependency and functional disability among hospital survivors should be considered for more accurate evaluation of intensive care outcome in that age group.
医院生存率和住院时间常用于评估年轻患者和老年患者（≥80岁）的重症监护结果。
应考虑将出院后转至护理机构纳入考量，以便更准确地评估重症监护结果，尤其是对于老年患者。
一项观察性描述性研究。
4年间共6154例连续入院并需要重症监护的患者。
人口统计学资料、入院前合并症、疾病严重程度、急性医院诊断类别、费用及出院目的地，以及出院后长达42个月的生存率。
老年患者占重症监护入院患者的15%（900例）。老年患者和年轻患者在重症监护病房接受的干预措施、通过序贯器官衰竭评估（SOFA）测量的疾病严重程度以及住院时间相似。老年患者的医院死亡率（10%对6%，p<0.01）和转至护理机构的比例（35%对18%，p<0.01）均高于年轻患者。每位出院回家的老年医院幸存者的平均住院费用为12.8万美元，而年轻医院幸存者为10万美元。在随访中，出院后转至护理机构的老年医院幸存者的死亡率高于出院回家的医院幸存者（31%对17%，p<0.01）。多因素logistic回归分析显示，年龄较大、女性、入院前合并症、入院类型、SOFA评分≥4、机械通气≥96小时、气管切开需求以及医院诊断类别是医院幸存者出院后转至护理机构的独立因素。
医院生存率和住院时间并不能准确衡量老年患者的重症监护结果。重症监护存活的老年患者中护理依赖普遍存在，且降低了他们的长期生存率。为更准确地评估该年龄组的重症监护结果，应考虑医院幸存者中的护理依赖和功能残疾情况。
