Ball Ian M, Bagshaw Sean M, Burns Karen E A, Cook Deborah J, Day Andrew G, Dodek Peter M, Kutsogiannis Demetrios J, Mehta Sangeeta, Muscedere John G, Turgeon Alexis F, Stelfox Henry T, Wells George A, Stiell Ian G
Division of Critical Care Medicine and Department of Epidemiology and Biostatistics, Western University, Critical Care Trauma Centre, Rm D2-521, London Health Sciences Centre, 800 Commissioner's Road, London, ON, N6A 5W9, Canada.
University of Alberta, Edmonton, AB, Canada.
Can J Anaesth. 2017 Mar;64(3):260-269. doi: 10.1007/s12630-016-0798-4. Epub 2016 Dec 27.
Very elderly (over 80 yr of age) critically ill patients admitted to medical-surgical intensive care units (ICUs) have a high incidence of mortality, prolonged hospital length of stay, and dependent living conditions should they survive. The primary purpose of this study is to describe the outcomes and differences in outcomes between very elderly medical patients and their surgical counterparts admitted to Canadian ICUs, thereby informing decision-making for clinicians and substitute decision-makers.
This was a prospective multicentre cohort study of very elderly medical and surgical patients admitted to 22 Canadian academic and non-academic ICUs. Outcome measures included ICU length of stay and mortality, hospital length of stay and mortality, and disposition following hospital discharge.
There were 1,671 patients evaluated in this study. Patient demographics included a mean age of 84.5 yr, baseline Acute Physiology and Chronic Health Evaluation (APACHE) II score of 22.4, baseline Sequential Organ Failure Assessment (SOFA) score of 5.3, overall ICU mortality of 21.8%, and overall hospital mortality of 35.0%. Medical patient median ICU length of stay was 4.1 days, hospital length of stay was 16.2 days, ICU mortality was 26.5%, and hospital mortality was 41.5%. Surgical patient median ICU length of stay was 3.8 days, hospital length of stay was 20.1 days, ICU mortality was 18.7%, and hospital mortality was 31.6%. Only 45.0% of medical patients and 41.6% of surgical emergency patients were able to return home to live.
In this large sample of critically ill medical and surgical patients, the admission SOFA score and hospital lengths of stay were not different between the two groups, but medical patients had longer ICU lengths of stay and higher ICU and hospital mortality than surgical patients.
入住内科-外科重症监护病房（ICU）的高龄（80岁以上）重症患者死亡率高、住院时间延长，若存活则生活依赖他人。本研究的主要目的是描述入住加拿大ICU的高龄内科患者及其外科患者的结局以及结局差异，从而为临床医生和替代决策者的决策提供依据。
这是一项对入住22家加拿大学术性和非学术性ICU的高龄内科和外科患者进行的前瞻性多中心队列研究。结局指标包括ICU住院时间和死亡率、住院时间和死亡率以及出院后的处置情况。
本研究共评估了1671例患者。患者人口统计学特征包括平均年龄84.5岁、基线急性生理与慢性健康状况评估（APACHE）II评分为22.4、基线序贯器官衰竭评估（SOFA）评分为5.3、ICU总体死亡率为21.8%、住院总体死亡率为35.0%。内科患者ICU中位住院时间为4.1天，住院时间为16.2天，ICU死亡率为26.5%，住院死亡率为41.5%。外科患者ICU中位住院时间为3.8天，住院时间为20.1天，ICU死亡率为18.7%，住院死亡率为31.6%。只有45.0%的内科患者和41.6%的外科急诊患者能够回家生活。
在这个大量的重症内科和外科患者样本中，两组患者入院时的SOFA评分和住院时间无差异，但内科患者的ICU住院时间更长，ICU和住院死亡率高于外科患者。
