Risk Factors for Hospital and Long-Term Mortality of Critically Ill Elderly Patients Admitted to an Intensive Care Unit

Background. Data on long-term outcomes of elderly (≥65 years) patients in ICU are sparse.Materials and Methods. Adult patients (n=1563, 45.4% elderly) admitted over 28 months were analyzed by competing risks regression model to determine independent factors related to in-hospital and long-term mortality.Results. 414 (26.5%) and 337 (21.6%) patients died in-hospital and during the 52 months following discharge, respectively; the elderly group had higher mortality during both periods. After discharge, elderly patients had 2.3 times higher mortality compared to the general population of the same age-group. In-hospital mortality was independently associated with mechanical ventilation (subdistribution hazard ratio (SHR) 2.74), vasopressors (SHR 2.56), neurological disease (SHR 1.77), and Mortality Prediction Model II score (SHR 1.01) regardless of age and with malignancy (SHR, hematological 3.65, nonhematological 3.4) and prior renal replacement therapy (RRT, SHR 2.21) only in the elderly. Long-term mortality was associated with low hemoglobin concentration (SHR 0.94), airway disease (SHR 2.23), and malignancy (SHR hematological 1.11, nonhematological 2.31) regardless of age and with comorbidities especially among the nonelderly.Conclusions. Following discharge, elderly ICU patients have higher mortality compared to the nonelderly and general population. In the elderly group, prior RRT and malignancy contribute additionally to in-hospital mortality risk. In the long-term, comorbidities (age-related), anemia, airway disease, and malignancy were significantly associated with mortality.

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Surgery for meningioma in the elderly and long-term survival: comparison with an age- and sex-matched general population and with younger patients

Journal of Neurosurgery ◽

10.3171/2016.2.jns152611 ◽

2017 ◽

Vol 126 (4) ◽

pp. 1201-1211 ◽

Cited By ~ 21

Author(s):

Benjamin Brokinkel ◽

Markus Holling ◽

Dorothee Cäcilia Spille ◽

Katharina Heß ◽

Cristina Sauerland ◽

...

Keyword(s):

General Population ◽

Elderly Patients ◽

Older Patients ◽

The Elderly ◽

Spinal Tumors ◽

Subtotal Resection ◽

High Grade ◽

Younger Patients ◽

Age And Sex

OBJECTIVE The purpose of this study was to compare long-term prognosis after meningioma surgery in elderly and younger patients as well as to compare survival of elderly patients with surgically treated meningioma to survival rates for the general population. METHODS Five hundred meningioma patients (median follow-up 90 months) who underwent surgery between 1994 and 2009 were subdivided into “elderly” (age ≥ 65 years, n = 162) and “younger” (age < 65 years, n = 338) groups for uni- and multivariate analyses. Mortality was compared with rates for the age- and sex-matched general population. RESULTS The median age at diagnosis was 71 in the elderly group and 51 years in the younger group. Sex, intracranial tumor location, grade of resection, radiotherapy, and histopathological subtypes were similar in the 2 groups. High-grade (WHO Grades II and III) and spinal tumors were more common in older patients than in younger patients (15% vs 8%, p = 0.017, and 12% vs 4%, p = 0.001, respectively). The progression-free interval (PFI) was similar in the 2 groups, whereas mortality at 3 months after surgery was higher and median overall survival (OS) was shorter in older patients (7%, 191 months) than in younger patients (1%, median not reached; HR 4.9, 95% CI 2.75–8.74; p < 0.001). Otherwise, the median OS in elderly patients did not differ from the anticipated general life expectancy (HR 1.03, 95% CI 0.70–1.50; p = 0.886). Within the older patient group, PFI was lower in patients with high-grade meningiomas (HR 24.74, 95% CI 4.23–144.66; p < 0.001) and after subtotal resection (HR 10.57, 95% CI 2.23–50.05; p = 0.003). Although extent of resection was independent of perioperative mortality, the median OS was longer after gross-total resection than after subtotal resection (HR 2.7, 95% CI 1.09–6.69; p = 0.032). CONCLUSIONS Elderly patients with surgically treated meningioma do not suffer from impaired survival compared with the age-matched general population, and their PFI is similar to that of younger meningioma patients. These data help mitigate fears concerning surgical treatment of elderly patients in an aging society.

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Safety and Long-Term Effect Assessment of Neoadjuvant Chemoradiotherapy for Elderly Patients With Locally Advanced Rectal Cancer: A CHN Single-Center Retrospective Study

Technology in Cancer Research & Treatment ◽

10.1177/1533033820970339 ◽

2020 ◽

Vol 19 ◽

pp. 153303382097033

Author(s):

Hengchang Liu ◽

Chunxiang Li ◽

Zhixun Zhao ◽

Xu Guan ◽

Ming Yang ◽

...

Keyword(s):

Elderly Patients ◽

Locally Advanced ◽

Neoadjuvant Chemoradiotherapy ◽

Advanced Rectal Cancer ◽

The Elderly ◽

Locally Advanced Rectal Cancer ◽

Term Effect ◽

Elderly Group ◽

Long Term Effect

Introduction: Neoadjuvant chemoradiotherapy (nCRT) followed by operation has become the standard treatment for locally advanced rectal cancer (LARC). However, considering the possible toxicity and complications of radiochemotherapy, nCRT is seldom used for the elderly. The purpose of this study was to assess the safety and long-term effect of nCRT combined with TME in elderly patients with LARC. Method: Four-hundred-fourteen LARC patients were divided into 2 groups: 108 patients were in the elderly group (≥ 65 years old) and 306 patients were in the non-elderly group (<65 years old). The side effects, toxicity, complications, disease-free survival (DFS), and overall survival (OS) of all of the patients were assessed. Results: The data comprised 103 patients in the elderly group and 292 patients in the non-elderly group who completed nCRT sessions following operation. The treatment-completion rates of the elderly and non-elderly groups were 95.37% and 95.42%, respectively. Twenty-two patients developed radiotherapy complications (grade III) in the elderly group and 37 such cases developed in the non-elderly group. Diarrhea, skinulcer, and perianal pain were ranked as the top 3 most common complications. The incidence of infection, anastomotic leakage, and intestinal obstruction was 0.97% in the elderly group. The 5-year DFS and 5-year OS rate were 70.7% and 80.8% in the elderly group, 67.3% and 81.6% in the non-elderly group respectively. Conclusions: nCRT are safe and effective for elderly patients, and it does not increase the risk of postoperative complications for the elderly. Hence, nCRT should not be withheld based on age alone.

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Safety and feasibility of minimally invasive esophagectomy for elderly esophageal cancer patients

Diseases of the Esophagus ◽

10.1093/dote/doaa083 ◽

2020 ◽

Author(s):

Y Sugita ◽

T Nakamura ◽

R Sawada ◽

G Takiguchi ◽

N Urakawa ◽

...

Keyword(s):

Minimally Invasive ◽

Elderly Patients ◽

Minimally Invasive Esophagectomy ◽

The Elderly ◽

Elderly Group ◽

Hospital Death ◽

Cancer Specific Survival ◽

Invasive Esophagectomy ◽

Short And Long Term

Summary The number of elderly patients with esophageal cancer has increased in recent years. The use of thoracoscopic esophagectomy has also increased, and its minimal invasiveness is believed to contribute to postoperative outcomes. However, the short- and long-term outcomes in elderly patients remain unclear. This study aimed to elucidate the safety and feasibility of minimally invasive esophagectomy in elderly patients. This retrospective study included 207 patients who underwent radical thoracoscopic esophagectomy for thoracic esophageal squamous cell carcinoma at Kobe University Hospital between 2005 and 2014. Patients were divided into non-elderly (<75 years) and elderly (≥75 years) groups. A propensity score matching analysis was performed for sex and clinical T and N stage, with a total of 29 matched pairs. General preoperative data, surgical procedures, intraoperative data, postoperative complications, in-hospital death, cancer-specific survival, and overall survival were compared between groups. The elderly group was characterized by lower preoperative serum albumin levels and higher American Society of Anesthesiologists grade. Intraoperative data and postoperative complications did not differ between the groups. The in-hospital death rate was 4% in the elderly group, which did not significantly differ from the non-elderly group. Cancer-specific survival was similar between the two groups. Although overall survival tended to be poor in the elderly group, it was not significantly worse than that of the non-elderly group. In conclusion, the short- and long-term outcomes of minimally invasive esophagectomy in elderly versus non-elderly patients were acceptable. Minimally invasive esophagectomy is a safe and feasible modality for elderly patients with appropriate indications.

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Age-related differences in the impact of coagulopathy in patients with isolated traumatic brain injury: an observational cohort study

10.21203/rs.2.19876/v1 ◽

2020 ◽

Author(s):

Wataru Takayama ◽

Akira Endo ◽

Hazuki Koguchi ◽

Kiyoshi Murata ◽

Yasuhiro Otomo

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Hospital Mortality ◽

The Elderly ◽

International Normalized Ratio ◽

Elderly Group ◽

Age Related ◽

Correlation Degree ◽

Observational Cohort ◽

The Impact

Abstract Background Although age and trauma-induced coagulopathy (TIC) are well-known predictors of poor outcome after traumatic brain injury (TBI), the interaction effect of these two predictors remains unclear.Objectives We assessed age-related differences in the impact of TIC on the outcome following isolated TBI.Methods We conducted a retrospective observational study in two tertiary emergency critical care medical centers in Japan from 2013 to 2018. A total of 1036 patients with isolated TBI [head abbreviated injury scale (AIS) ≥3, and other AIS <3] were selected, and divided into the non-elderly (n = 501, 16-64 years) and elderly group (n = 535, age ≥65 years). We further evaluated the impact of coagulopathy (international normalized ratio ≥1.2, and/or platelet count <120 × 10 9 /L, and/or fibrinogen ≤150 mg/dL) on TBI outcomes [Glasgow Outcome Scale-Extended (GOS-E) scores, in-hospital mortality, and ventilation-free days (VFD)] in both groups using univariate and multivariate models. Further, we conducted an age-based assessment of the impact of coagulopathy on GOS-E using a generalized additive model.Results The multivariate model showed a significant association of age and coagulopathy with lower GOS-E scores, in-hospital mortality, and shorter VFD in the non-elderly group; however, significant impact of coagulopathy was not observed for all the outcomes in the elderly group. There was a decrease in the correlation degree between coagulopathy and GOS-E scores decreased with age over 65 years old.Conclusions There was a low impact of coagulopathy on functional and survival outcomes in geriatric patients with isolated TBI.

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PS01.229: SHORT- AND LONG-TERM OUTCOMES OF MINIMALLY INVASIVE TRANSTHORACIC ESOPHAGECTOMY FOR ELDERLY PATIENTS WITH ESOPHAGEAL CANCER

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.229 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 115-115

Author(s):

Yusuke Muneoka ◽

Yasuyuki Kawachi ◽

Shigeto Makino ◽

Yu Sato ◽

Chie Kitami ◽

...

Keyword(s):

Esophageal Cancer ◽

Minimally Invasive ◽

Elderly Patients ◽

Survival Rates ◽

The Elderly ◽

Elderly Group ◽

Transthoracic Esophagectomy ◽

Long Term Outcomes ◽

Short And Long Term

Abstract Background Recently, the number of elderly patients with esophageal cancer is increasing as the aging of population in Japan. Because of the benefit to reduce postoperative pulmonary complications, minimally invasive transthoracic esophagectomy (MIE) is being increasingly implemented in surgical treatment for esophageal cancer. However, short- and long-term outcomes of MIE in elderly patients have not been fully investigated. Methods We retrospectively reviewed the records of 86 patients with thoracic esophageal cancer who underwent MIE between January 2010 and December 2014 at Nagaoka Chuo General Hospital. We classified the patients into two groups according to their age: the elderly group (≥ 75 years old, n = 19) and the non-elderly group (< 75 years old, n = 67). We compared the short- and long-term outcomes between the two groups. Results There were no significant differences between the two groups in gender, comorbidity, the extent of lymphadenectomy, TNM status, or Stage (0/I/II/III/IVa/IVb: elderly group 1/1/9/8/0/0 vs. non-elderly group 5/12/26/21/2/1). Conversion rate to open esophagectomy is 10.5% in the elderly group and 6.0% in the non-elderly group (P = 0.610). The proportion of patients who received preoperative chemotherapy was significantly lower in the elderly group (21.1% vs. 67.2%, P < 0.01). With regard to surgical outcomes, there were no significant differences in operative time (301 vs. 343 min), the amount of blood loss (126 vs. 110 ml), or the median length of hospital stay (14 vs. 14 days) between the two groups. Overall morbidity was not significantly different between the two groups (47.4% vs. 49.3%, P = 0.885). The incidence of postoperative complications that were ≥ grade II according to the Clavien-Dindo classification was higher in the elderly group, but the difference was not statistically significant (42.1% vs. 25.4%, P = 0.156). The 5-year overall survival rates were 56.8% and 62.9% (P = 0.449), and the 5-year disease specific survival rates were 67.4% and 69.3% in the elderly and non-elderly groups (P = 0.564), respectively. Conclusion MIE in elderly patients with esophageal cancer can be safely performed and the long-term outcome was acceptable. However, there is a possibility of selection bias in this retrospective single-institutional study. Further multi-institutional prospective study is necessary to establish the evidence for clinical benefit of MIE for this disease. Disclosure All authors have declared no conflicts of interest.

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Clinical Outcome and Predictive Factors in the Response to Splenectomy in Elderly Patients with Primary Immune Thrombocytopenia: A Multicenter Retrospective Study

Acta Haematologica ◽

10.1159/000442703 ◽

2016 ◽

Vol 135 (3) ◽

pp. 162-171 ◽

Cited By ~ 17

Author(s):

Young Hoon Park ◽

Hyeon Gyu Yi ◽

Chul Soo Kim ◽

Junshik Hong ◽

Jinny Park ◽

...

Keyword(s):

Elderly Patients ◽

Predictive Factors ◽

Immune Thrombocytopenia ◽

The Elderly ◽

Elderly Group ◽

Relapse Free Survival ◽

Free Survival ◽

Primary Immune Thrombocytopenia ◽

Term Response

Background: Because many physicians seem reluctant to recommend splenectomy for elderly patients with immune thrombocytopenia (ITP), we investigated the safety and efficacy of splenectomy and the predictive factors for response in these patients. Methods: 184 patients with primary ITP were retrospectively analyzed based on age at splenectomy: an elderly group (≥60 years, n = 52) and a younger group (<60 years, n = 132). Results: There was no difference in the response rate of elderly versus younger patients (80.7 vs. 80.3%, p = 0.466). Relapse (45.2 vs. 22.6%, p = 0.006), complications, and median postoperative stay (9.5 vs. 7 days, p = 0.019) were significantly higher in the elderly group. The 5-year relapse-free survival of responders was 51.8% in the elderly group and 76.3% in the younger group (p = 0.002). Response to any treatment before splenectomy (HR 2.9, 95% CI: 1.24-6.80, p = 0.014) and platelet count on postoperative day 14 ≥200 × 109/l (HR 31.43, 95% CI: 4.15-238.28, p = 0.001) were independent factors for a favorable response. Conclusions: Age ≥60 years did not influence the response to splenectomy but was associated with increased relapse and postoperative complications. Splenectomy could provide a durable long-term response for elderly ITP patients.

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Renal Dysfunction is a Risk Factor of Death after Gastric Endoscopic Submucosal Dissection in Elderly Patients Aged ≥80 Years

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2019/7145182 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9

Author(s):

Kenichiro Okimoto ◽

Makoto Arai ◽

Hideaki Ishigami ◽

Takashi Taida ◽

Keiko Saito ◽

...

Keyword(s):

Risk Factor ◽

Elderly Patients ◽

Endoscopic Submucosal Dissection ◽

The Elderly ◽

Good Prognosis ◽

Elderly Group ◽

Long Term Outcomes ◽

Submucosal Dissection ◽

Severe Chronic Kidney Disease

Introduction. Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) is well accepted. However, its adaptation for elderly patients is unclear. This study aimed to investigate the prognosis and long-term outcomes of ESD for EGC in elderly patients aged ≥80 years by comparing their findings to the findings of patients aged <80 years. Materials and Methods. The study included 533 patients (632 lesions). The patients were divided into an elderly group (age, ≥80 years; 108 patients; 128 lesions; mean age, 83.4 ± 2.7 years) and a nonelderly group (age, <80 years; 425 patients; 504 lesions; mean age, 69.6 ± 7.9 years). We compared patient and lesion characteristics, overall survival (OS), and disease-specific survival (DSS) between the 2 groups retrospectively. Multivariate analysis was performed to clarify the risk factors of death after ESD. Results. The rate of curative resection and adverse events was not significantly different between the groups. The mean survival time periods with regard to OS/DSS in the elderly and nonelderly groups were 75.8 ± 5.9 and 122.8 ± 2.6 months (P<0.05)/120.0 ± 3.0 and 136.4 ± 0.6 months (not significant), respectively. In the elderly group, eGFR <30 ml/min/1.73 m2 was an independent risk factor of death (hazard ratio = 5.32; 95% confidence interval = 1.39–20.5; P=0.015). Conclusion. ESD for EGC can be performed safely and can achieve high curability with good prognosis in elderly patients aged ≥80 years. After ESD, close attention should be paid to elderly patients with severe chronic kidney disease.

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PS01.181: ESOPHAGECTOMY FOR ESOPHAGEAL CARCINOMA TO ELDERLY PATIENTS OVER 75 YEARS OLD

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.181 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 100-101

Author(s):

Naoto Ujiie ◽

Yusuke Taniyama ◽

Tadashi Sakurai ◽

Takahiro Heishi ◽

Chiaki Sato ◽

...

Keyword(s):

Surgical Treatment ◽

Survival Rate ◽

Elderly Patients ◽

Esophageal Carcinoma ◽

Operation Time ◽

The Elderly ◽

Elderly Group ◽

Control Group ◽

And Control

Abstract Background Recently, operation cases of elderly patients are increasing in esophageal carcinoma. Because elderly patients often have pre-existing disease and may easily cause postoperative complications, it is necessary to consider whether surgical treatment is appropriate for those elderly patients. The aim of this study is to investigate the safety of esophagectomy for elderly patients with esophageal carcinoma. Methods All 483 patients who underwent esophagectomy for esophageal carcinoma between April 2007 and March 2015 were included in this study. Patients were divided into two groups: elderly group (over 75 years old: n = 72) and control group (under 75 years old: n = 411). The short and long-term outcomes were retrospectively examined to those groups. Results In the elderly group, their median age was 77 [75–85] and all of their performance status was 0 or 1, except 4 patients. 66 cases of the elderly group had some comorbidity, which was significantly higher than that of the control group (93.0 vs. 80.2%, P = 0.007). Pre-surgical treatment was performed to 38.9% of the elderly group, whereas 58.9% in the control group (P = 0.002). No significant differences were demonstrated in clinical stage, occupation site, histological type and pathological stage between these groups. The operation time was relatively shorter in the elderly group compare to the control group (549 vs. 585min, P = 0.018). The number of dissected lymph node was also smaller in elderly group (31 vs. 35, P = 0.048). The postoperative complications such as pneumonia, recurrent laryngeal nerve paralysis did not show any difference between these groups. The 5-year overall survival rate (OS) and the 5-year disease specific survival rate (DSS) also did not show statistical differences between the elderly and control group (OS: 53.0 vs. 57.0%, P = 0.765; DSS: 64.6 vs. 62.7%, P = 0.605). Conclusion Between elderly and control group, there was no difference in postoperative complication and long-term survival. This study confirmed the safety of esophagectomy for elderly patients with esophageal carcinoma by reducing treatment stress such as neoadjuvant therapy, extended operation time and extensive lymphadenectomy. Disclosure All authors have declared no conflicts of interest.

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Validation of APACHE II, APACHE III and SAPS II scores in short- and long-term mortality prediction in a mixed intensive care unit in Poland: a cohort study

10.21203/rs.3.rs-24209/v2 ◽

2020 ◽

Author(s):

Szymon Czajka ◽

Katarzyna Ziębińska ◽

Konstanty Marczenko ◽

Barbara Posmyk ◽

Anna Szczepańska ◽

...

Keyword(s):

Intensive Care Unit ◽

Hospital Mortality ◽

Mortality Prediction ◽

Apache Ii ◽

Post Discharge ◽

Saps Ii ◽

Apache Iii ◽

Short And Long Term ◽

Long Term Mortality

Abstract Background. There are several scores used for in-hospital mortality prediction in critical illness. Their application in a local scenario requires validation to ensure appropriate diagnostic accuracy. Moreover, their use in assessing post-discharge mortality in intensive care unit (ICU) survivors has not been extensively studied. We aimed to validate APACHE II, APACHE III and SAPS II scores in short- and long-term mortality prediction in a mixed adult ICU in Poland. APACHE II, APACHE III and SAPS II scores, with corresponding predicted mortality ratios, were calculated for 303 consecutive patients admitted to a 10-bed ICU in 2016. Short-term (in-hospital) and long-term (12-month post-discharge) mortality was assessed.Results. Median APACHE II, APACHE III and SAPS II scores were 19 (IQR 12-24), 67 (36.5-88) and 44 (27-56) points, with corresponding in-hospital mortality ratios of 25.8% (IQR 12.1-46.0), 18.5% (IQR 3.8-41.8) and 34.8% (IQR 7.9-59.8). Observed in-hospital mortality was 35.6%. Moreover, 12-month post-discharge mortality reached 17.4%. All the scores predicted in-hospital mortality (p<0.05): APACHE II (AUC=0.78; 95%CI 0.73-0.83), APACHE III (AUC=0.79; 95%CI 0.74-0.84) and SAPS II (AUC=0.79; 95%CI 0.74-0.84); as well as mortality after hospital discharge (p<0.05): APACHE II (AUC=0.71; 95%CI 0.64-0.78), APACHE III (AUC=0.72; 95%CI 0.65-0.78) and SAPS II (AUC=0.69; 95%CI 0.62-0.76), with no statistically significant difference between the scores (p>0.05). The calibration of the scores was good.Conclusions. All the scores are acceptable predictors of in-hospital mortality. In the case of post-discharge mortality, their diagnostic accuracy is lower and of borderline clinical relevance. Further studies are needed to create scores estimating the long-term prognosis of subjects successfully discharged from the ICU.

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Killip-Kimball Classification Validation, Outcomes and Demographics in an Octogenarian Cohort with Acute Coronary Syndrome in a Developing Country: A Third-Level Multicenter 11-Year Experience

10.1101/2020.09.14.20194480 ◽

2020 ◽

Author(s):

Diego Ramonfaur ◽

David E Hinojosa-Gonzalez ◽

Jose G Paredes-Vazquez

Keyword(s):

Acute Coronary Syndrome ◽

Hospital Mortality ◽

Kidney Injury ◽

The Elderly ◽

Killip Class ◽

Coronary Syndrome ◽

Short And Long Term ◽

Catheterization Procedure ◽

Long Term Mortality

Introduction: The Killip-Kimball Classification (KC) is used to group patients with acute coronary syndrome (ACS) based on their clinical profile. It has proven to be useful while predicting both short- and long-term mortality. Contemporary data in the elderly population is limited. We sought to analyze trends in outcomes of patients 80 years or older admitted for ACS, by Killip Class. In addition, we assess the validity of the KC in this population. Methodology: A retrospective analysis of patients who underwent a catheterization procedure for ACS was performed. ACS was defined as per AHA guidelines, and included STEMI, non-STEMI and Unstable Angina. We determined factors influencing the KC in which patients present to the emergency room. Likewise, we compared in-hospital mortality, length of stay, and other outcomes dividing the patients by KC. Results: A total of 133 patients were analyzed. Included were: 86, 9, 23 and 15 patients in KC-I through IV respectively with a mean age of 83. The main comorbidities were hypertension (73%), and diabetes (43%). In-hospital mortality was 12%, which was different between KC groups (p< 0.01). In addition, we found higher KC groups to be associated with acute kidney injury during the hospitalization (p< 0.01). Conclusion: Despite a strong reduction in mortality for elderly patients with ACS in recent decades, patients presenting with ACS and higher Killip class have a high mortality rate, as described in younger cohorts. The Killip-Kimball classification remains a reliable prognostic tool, with applicability in octogenarian patients.

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