Christian Jung1, Bernhard Wernly2, Johanna M Muessig3, Malte Kelm4, Ariane Boumendil5, Alessandro Morandi6, Finn H Andersen7, Antonio Artigas8, Guido Bertolini9, Maurizio Cecconi10, Steffen Christensen11, Loredana Faraldi12, Jesper Fjølner13, Michael Lichtenauer14, Raphael Romano Bruno15, Brian Marsh16, Rui Moreno17, Sandra Oeyen18, Christina Agvald Öhman19, Bernardo Bollen Pinto20, Ivo W Soliman21, Wojciech Szczeklik22, Andreas Valentin23, Ximena Watson24, Tilemachos Zafeiridis25, Dylan W De Lange26, Bertrand Guidet27, Hans Flaatten28. 1. Dep. of Cardiology, Pulmonology and Angiology, University Hospital, Düsseldorf, Germany. Electronic address: Christian.Jung@med.uni-duesseldorf.de. 2. Department of Cardiology, Paracelsus Medical University, Salzburg, Austria. Electronic address: bernhard@wernly.at. 3. Dep. of Cardiology, Pulmonology and Angiology, University Hospital, Düsseldorf, Germany. Electronic address: johanna.muessig@med.uni-duesseldorf.de. 4. Dep. of Cardiology, Pulmonology and Angiology, University Hospital, Düsseldorf, Germany. Electronic address: malte.kelm@med.uni-duesseldorf.de. 5. Assistance Publique-Hôpital de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris F-75012, France. 6. Department of Rehabilitation Hospital Ancelle di Cremona, Italy, Geriatric Research Group, Brescia, Italy. 7. Dep. Of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway. NTNU, Dep of Circulation and Medical Imaging, Trondheim, Norway. Electronic address: finn.andersen@ntnu.no. 8. Department of Intensive Care Medecine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain; Department of Intensive Care Medecine, University Hospitals Sagrado Corazón and General de Catalunya. Quirón Salud. Barcelona-Sant Cugat, Spain. Electronic address: aartigas@tauli.cat. 9. Laboratorio di Epidemiologia Clinica, Centro di Coordinamento GiViTI Dipartimento di Salute Pubblica, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri" Villa Camozzi, 24020 Ranica, Bergamo, Italy. Electronic address: guido.bertolini@marionegri.it. 10. Department of Anaesthesia IRCCS Instituto Clínico Humanitas, Humanitas University, Milan, Italy. Electronic address: Maurizio.cecconi@huamitas.it. 11. Department of Anaesthesia and Intensive Care Medicine, Aarhus University Hospital, Denmark. Electronic address: steffen.christensen@auh.rm.dk. 12. Grande Ospedale Metropolitano Niguarda, Milano, Italy. Electronic address: loredana.faraldi@ospedaleniguarda.it. 13. Department of Anaesthesia and Intensive Care Medicine, Aarhus University Hospital, Denmark. Electronic address: jespfjoe@rm.dk. 14. Department of Cardiology, Paracelsus Medical University, Salzburg, Austria. Electronic address: m.lichtenauer@salk.at. 15. Dep. of Cardiology, Pulmonology and Angiology, University Hospital, Düsseldorf, Germany. Electronic address: raphael.bruno@med.uni-duesseldorf.de. 16. Mater Misericordiae University Hospital, Dublin, Ireland. Electronic address: bmarsh@mater.ie. 17. Unidade de Cuidados Intensivos Neurocríticos. Hospital de São José, Centro Hospitalar de Lisboa Central, Faculdade de Ciência Médicas de Lisboa, Nova Médical School, Lisbon, Portugal. Electronic address: r.moreno@mail.telepac.pt. 18. Department of Intensive Care 1K12IC Ghent University Hospital, Ghent, Belgium. Electronic address: Sandra.Oeyen@UGent.be. 19. Karolinska University Hospital, Sweden. Electronic address: christina.agvald-ohman@sll.se. 20. Geneva University Hospitals, Geneva, Switzerland. 21. Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, the Netherlands. Electronic address: i.w.soliman@umcutrecht.nl. 22. Intensive Care and Perioperative Medicine Division, Jagiellonian University Medical College, Kraków, Poland. Electronic address: wojciech.szczeklik@uj.edu.pl. 23. Kardinal Schwarzenberg Hospital, Schwarzach, Austria. Electronic address: Andreas.Valentin@ks-klinikum.at. 24. St George's University Hospital, London, UK. Electronic address: ugm2xw@doctors.org.uk. 25. Intensive Care Unit General Hospital of Larissa Tsakalof Larissa, Greece. 26. Department of Intensive Care Medicine, University Medical Center, University Utrecht, the Netherlands. Electronic address: d.w.delange@umcutrecht.nl. 27. Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, Paris, F-75012, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France; INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France. Electronic address: bertrand.guidet@aphp.fr. 28. Department of Clinical Medecine,University of Bergen, Department of Anaestesia and Intensive Care, Haukeland University Hospital, Bergen, Norway. Electronic address: hans.flaatten@uib.no.
Abstract
BACKGROUND: We aimed to evaluate differences in outcome between patients admitted to intensive care unit (ICU) after elective versus acute surgery in a multinational cohort of very old patients (≥80 years; VIP). Predictors of mortality, with special emphasis on frailty, were assessed. METHODS: In total, 5063 VIPs were included in this analysis, 922 were admitted after elective surgery or intervention, 4141 acutely, with 402 after acute surgery. Differences were calculated using Mann-Whitney-U test and Wilcoxon test. Univariate and multivariable logistic regression were used to assess associations with mortality. RESULTS: Compared patients admitted after acute surgery, patients admitted after elective surgery suffered less often from frailty as defined as CFS (28% vs 46%; p < 0.001), evidenced lower SOFA scores (4 ± 5 vs 7 ± 7; p < 0.001). Presence of frailty (CFS >4) was associated with significantly increased mortality both in elective surgery patients (7% vs 12%; p = 0.01), in acute surgery (7% vs 12%; p = 0.02). CONCLUSIONS: VIPs admitted to ICU after elective surgery evidenced favorable outcome over patients after acute surgery even after correction for relevant confounders. Frailty might be used to guide clinicians in risk stratification in both patients admitted after elective and acute surgery. TRIAL REGISTRATION: NCT03134807. Registered 1st May 2017.
BACKGROUND: We aimed to evaluate differences in outcome between patients admitted to intensive care unit (ICU) after elective versus acute surgery in a multinational cohort of very old patients (≥80 years; VIP). Predictors of mortality, with special emphasis on frailty, were assessed. METHODS: In total, 5063 VIPs were included in this analysis, 922 were admitted after elective surgery or intervention, 4141 acutely, with 402 after acute surgery. Differences were calculated using Mann-Whitney-U test and Wilcoxon test. Univariate and multivariable logistic regression were used to assess associations with mortality. RESULTS: Compared patients admitted after acute surgery, patients admitted after elective surgery suffered less often from frailty as defined as CFS (28% vs 46%; p < 0.001), evidenced lower SOFA scores (4 ± 5 vs 7 ± 7; p < 0.001). Presence of frailty (CFS >4) was associated with significantly increased mortality both in elective surgery patients (7% vs 12%; p = 0.01), in acute surgery (7% vs 12%; p = 0.02). CONCLUSIONS: VIPs admitted to ICU after elective surgery evidenced favorable outcome over patients after acute surgery even after correction for relevant confounders. Frailty might be used to guide clinicians in risk stratification in both patients admitted after elective and acute surgery. TRIAL REGISTRATION: NCT03134807. Registered 1st May 2017.
Authors: Mercedes Ibarz; Ariane Boumendil; Lenneke E M Haas; Marian Irazabal; Hans Flaatten; Dylan W de Lange; Alessandro Morandi; Finn H Andersen; Guido Bertolini; Maurizio Cecconi; Steffen Christensen; Loredana Faraldi; Jesper Fjølner; Christian Jung; Brian Marsh; Rui Moreno; Sandra Oeyen; Christina Agwald Öhman; Bernardo Bollen Pinto; Ivo W Soliman; Wojciech Szczeklik; Andreas Valentin; Ximena Watson; Tilemachos Zaferidis; Bertrand Guidet; Antonio Artigas Journal: Ann Intensive Care Date: 2020-05-13 Impact factor: 6.925
Authors: Raphael Romano Bruno; Bernhard Wernly; Behrooz Mamandipoor; Richard Rezar; Stephan Binnebössel; Philipp Heinrich Baldia; Georg Wolff; Malte Kelm; Bertrand Guidet; Dylan W De Lange; Daniel Dankl; Andreas Koköfer; Thomas Danninger; Wojciech Szczeklik; Sviri Sigal; Peter Vernon van Heerden; Michael Beil; Jesper Fjølner; Susannah Leaver; Hans Flaatten; Venet Osmani; Christian Jung Journal: Front Med (Lausanne) Date: 2021-07-09
Authors: Bertrand Guidet; Dylan W de Lange; Ariane Boumendil; Susannah Leaver; Ximena Watson; Carol Boulanger; Wojciech Szczeklik; Antonio Artigas; Alessandro Morandi; Finn Andersen; Tilemachos Zafeiridis; Christian Jung; Rui Moreno; Sten Walther; Sandra Oeyen; Joerg C Schefold; Maurizio Cecconi; Brian Marsh; Michael Joannidis; Yuriy Nalapko; Muhammed Elhadi; Jesper Fjølner; Hans Flaatten Journal: Intensive Care Med Date: 2019-11-29 Impact factor: 17.440
Authors: Bernhard Wernly; Raphael Romano Bruno; Malte Kelm; Ariane Boumendil; Alessandro Morandi; Finn H Andersen; Antonio Artigas; Stefano Finazzi; Maurizio Cecconi; Steffen Christensen; Loredana Faraldi; Michael Lichtenauer; Johanna M Muessig; Brian Marsh; Rui Moreno; Sandra Oeyen; Christina Agvald Öhman; Bernado Bollen Pinto; Ivo W Soliman; Wojciech Szczeklik; David Niederseer; Andreas Valentin; Ximena Watson; Susannah Leaver; Carole Boulanger; Sten Walther; Joerg C Schefold; Michael Joannidis; Yuriy Nalapko; Muhammed Elhadi; Jesper Fjølner; Tilemachos Zafeiridis; Dylan W De Lange; Bertrand Guidet; Hans Flaatten; Christian Jung Journal: Sci Rep Date: 2020-10-29 Impact factor: 4.379