Prediction of ICU admission after orthopedic surgery in elderly patients

Objectives: Prediction of ICU admission after surgery are important for rational decision-making for different patients in clinical practice. Little information is available about the risk factors of postoperative ICU admission in elderly patients undergoing orthopedic surgery. This study aimed to identify risk factors and develop a predictive model for postoperative ICU admission in elderly patients undergoing orthopedic surgery. Methods: A total of 2826 cases of elderly patients receiving orthopedic surgery from October 2010 to September 2016 were retrospectively collected and analyzed. Logistic regression was used to evaluate the impacts of covariates. Support vector machine (SVM) was employed to develop a predictive model based on all pre-operative covariates and the demographic information. Results: There were 256 patients transferred to ICU after surgery. ASA III or IV and emergency surgery were found to be independent risk factors while neuraxial anesthesia and joint surgery were protective factors. In addition, a SVM-based predictive model was developed, which had a sensitivity of 90.99%, a specificity of 99.10% and an area under ROC curve of 0.9678. Conclusions: Our study revealed that emergency surgery, anesthesia method, surgery type and ASA grade were risk factors to predict postoperative ICU admission in elderly orthopedic patients. doi: https://doi.org/10.12669/pjms.37.4.3371 How to cite this:Tang Y, Li H, Guo Z. Prediction of ICU admission after orthopedic surgery in elderly patients. Pak J Med Sci. 2021;37(4):1179-1184. doi: https://doi.org/10.12669/pjms.37.4.3371 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Download Full-text

Risk factors associated with outcomes of hip fracture surgery in elderly patients

Korean Journal of Anesthesiology ◽

10.4097/kjae.2015.68.6.561 ◽

2015 ◽

Vol 68 (6) ◽

pp. 561 ◽

Cited By ~ 11

Author(s):

Byung Hoon Kim ◽

Sangseok Lee ◽

Byunghoon Yoo ◽

Woo Yong Lee ◽

Yunhee Lim ◽

...

Keyword(s):

Risk Factors ◽

Hip Fracture ◽

Elderly Patients ◽

Factors Associated ◽

Hip Fracture Surgery ◽

Fracture Surgery ◽

Surgery In Elderly

Download Full-text

Effect of injection speed on hypotension associated with spinal anesthesia for orthopedic surgery in elderly patients

European Journal of Anaesthesiology ◽

10.1097/00003643-201206001-00401 ◽

2012 ◽

Vol 29 ◽

pp. 123

Author(s):

L. Mirea ◽

R. Ungureanu ◽

R. Burtea ◽

D. Pavelescu ◽

I. Grintescu

Keyword(s):

Elderly Patients ◽

Spinal Anesthesia ◽

Orthopedic Surgery ◽

Injection Speed ◽

Surgery In Elderly

Download Full-text

Methicillin-resistant Staphylococcus aureus in the ICU: risk factors and a predictive model to detect it at ICU admission

Critical Care ◽

10.1186/cc14181 ◽

2015 ◽

Vol 19 (Suppl 1) ◽

pp. P101

Author(s):

F Callejo-Torre ◽

JM Eiros ◽

S Ossa-Echeverri ◽

P Olaechea ◽

M Palomar ◽

...

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Predictive Model ◽

Methicillin Resistant Staphylococcus Aureus ◽

Methicillin Resistant ◽

Icu Admission

Download Full-text

Predicting the risk of sarcopenia in elderly patients with patellar fracture: Development and assessment of a new predictive nomogram

10.1101/702548 ◽

2019 ◽

Author(s):

Chen Yisheng ◽

Tao Jie

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Elderly Patients ◽

Prediction Model ◽

Predictive Model ◽

Body Mass ◽

Curve Analysis ◽

Decision Curve Analysis ◽

Low Body Mass Index ◽

Patellar Fractures

AbstractPurposeThis study was aimed at developing a risk prediction model for postoperative dysplasia in elderly patients with patellar fractures in China.Patients and methodsWe conducted a community survey of patients aged ≥55 years who underwent surgery for patellar fractures between January 2013 and October 2018, through telephone interviews, community visits, and outpatient follow-up. We established a predictive model for assessing the risk of sarcopenia after patellar fractures. We developed the prediction model by combining multivariate logistic regression analysis with the least absolute shrinkage model and selection operator regression (Lasso analysis). The predictive quality and clinical utility of the predictive model were determined using C-index, calibration plots, and decision curve analysis. We conducted internal sampling methods for qualitative assessment.ResultWe recruited 61 participants (males: 20, mean age: 68.1 years). Various risk factors were assessed, and low body mass index and diabetes mellitus were identified as the most important risk factors (P<0.05). The model showed a good prediction rate (C-index: 0.909; 95% confidence interval: 0.81–1.00) and good correction effect. The C-index remained high (0.828) even after internal sample verification. Decision curve analysis showed that the risk of sarcopenia was 8.3–80.0%, suggesting good clinical practicability.ConclusionOur prediction model shows promise as a cost-effective tool for predicting the risk of postoperative sarcopenia in elderly patients based on the following: advanced age, low body mass index, diabetes, longer postoperative hospital stay, no higher education, no postoperative rehabilitation, removal of internal fixation, and less outdoor exercise.

Download Full-text

Emergency surgery and male gender are risk factors of postoperative delirium after general or gastrointestinal surgery in elderly patients: A multicenter cohort study

International Surgery ◽

10.9738/intsurg-d-16-00112.1 ◽

2020 ◽

Author(s):

Kazuyoshi Yamamoto ◽

Noriko Shimakawa ◽

Takao Mizumoto ◽

Kazuhisa Shiroyama ◽

Tsutomu Shichino ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Elderly Patients ◽

Emergency Surgery ◽

Postoperative Delirium ◽

Elective Surgery ◽

Gastrointestinal Surgery ◽

Male Gender ◽

Hospital Organization ◽

Multicenter Cohort Study

Objective: The aim of this study was to investigate the incidence and risk factors of postoperative delirium (PD) in elderly patients after general or gastrointestinal surgery. Summary of Background Data: Societies worldwide are rapidly aging and the number of surgeries in elderly patients has been increasing. PD, which adversely influences postoperative course, has thus become more common. Methods: The Surgery and Anesthesia Network Group of the National Hospital Organization in Japan conducted this retrospective cohort study of patients aged over 70 years who underwent general or gastrointestinal surgery. Results: A total of 219 patients from 9 participating institutes underwent surgery between July 2013 and August 2014. We excluded 2 patients who died within 2 weeks after surgery. Of the remaining 217 cases, 31 (14.3%) developed PD. These patients were older (80 vs. 76 years, P = 0.013), more likely to be male (74.2 vs. 54.8%, P = 0.039), and had higher American Society of Anesthesia Physical Status scores than those without PD. Emergency surgery was more common than elective surgery in the PD group (41.9 vs. 10.2%, P < 0.0001). Multivariate analysis showed that male gender (odds ratio, 3.31; 95% confidence interval, 1.32-9.39; P = 0.0098) and emergency surgery (7.47; 2.79-20.83; P < 0.0001) were independent risk factors of PD. Conclusions: The incidence of PD was high in male patients and those undergoing emergency surgery. Effective interventions in these groups will be necessary to improve treatment outcomes in elderly patients. (UMIN R000022185)

Download Full-text

Development and Validation of a Risk Prediction Model of Linezolid-induced Thrombocytopenia in Elderly Patients

10.21203/rs.3.rs-582799/v1 ◽

2021 ◽

Author(s):

Yan Qin ◽

Zhe Chen ◽

Shuai Gao ◽

Ming Kun Pan ◽

Yu Xiao Li ◽

...

Keyword(s):

Risk Factors ◽

Elderly Patients ◽

Predictive Model ◽

Bacterial Infections ◽

Demographic Data ◽

Multivariate Logistic Regression Analysis ◽

Platelet Counts ◽

Linezolid Therapy ◽

Validation Set ◽

Development And Validation

Abstract Background Linezolid is an oxazolidinone antimicrobial agent developed for treating multi-drug-resistant gram-positive bacterial infections. Objective This study aimed at investigating risk factors of linezolid (LI)-induced thrombocytopenia (LI-TP) and establishing a risk predictive model for LI-TP.Setting ZhongShan Hospital, FuDan University, China. Method A retrospective study was performed in patients aged ≥ 65 years receiving linezolid therapy from January 2015 to April 2021. Clinical characteristics and demographic data were collected and compared between patients with LI-TP and those without.Main outcome measures Incidence and risk factors of LI-TP in elderly patients.Results A total of 343 inpatients were included as the train set from January 2015 to August 2020. Among them, 67 (19.5%) developed LI-TP. Multivariate logistic regression analysis revealed that baseline platelet counts < 150×109·L-1 (OR=3.576; P< 0.001), age ≥ 75 years (OR=2.258; P=0.009), eGFR< 60 mL·(min·1.73m2)-1 (OR=2.553; P=0.002), duration of linezolid therapy ≥ 10 d (OR=3.218; P<0.001), ICU admittance (OR=2.682; P=0.004), and concomitant with piperacillin-tazobactam (PTZ) (OR=3.863; P=0.006) were independent risk factors for LI-TP. The risk predictive model was established and exhibited a moderate discriminative power, with an AUC of 0.795 [95%CI 0.740-0.851] and 0.849 [95%CI 0.760-0.939] in train set (n=343) and validation set (n=90), respectively.Conclusion The risk factors of LI-TP in elderly patients were duration of linezolid therapy, age, eGFR, ICU admittance, baseline platelet counts, and concomitant with PTZ. A risk predictive model based on these risk factors may be useful to identify patients with high risk of LI-TP.

Download Full-text

Analysis of Risk Factors Associated with Hospital Readmission Within 360 Days After Degenerative Lumbar Spine Surgery in Elderly Patients

World Neurosurgery ◽

10.1016/j.wneu.2019.01.293 ◽

2019 ◽

Vol 126 ◽

pp. e196-e207 ◽

Cited By ~ 2

Author(s):

Jong Joo Lee ◽

Seong Bae An ◽

Tae Woo Kim ◽

Dong Ah Shin ◽

Seong Yi ◽

...

Keyword(s):

Risk Factors ◽

Lumbar Spine ◽

Elderly Patients ◽

Spine Surgery ◽

Hospital Readmission ◽

Lumbar Spine Surgery ◽

Factors Associated ◽

Degenerative Lumbar Spine ◽

Surgery In Elderly

Download Full-text

The Charlson Comorbidity Index (CCI) as a Mortality Predictor after Surgery in Elderly Patients

The American Surgeon ◽

10.1177/000313481608200113 ◽

2016 ◽

Vol 82 (1) ◽

pp. 22-27 ◽

Cited By ~ 13

Author(s):

Anat Laor ◽

Sari Tal ◽

Vladimir Guller ◽

Andrew P. Zbar ◽

Eli Mavor

Keyword(s):

Elderly Patients ◽

Emergency Surgery ◽

Charlson Comorbidity Index ◽

Oldest Old ◽

Chronological Age ◽

Age Group ◽

Emergency Operations ◽

Comorbidity Index ◽

The Impact ◽

Surgery In Elderly

The increasing range of surgery in elderly patients reflects the changing demography where in the next 10 years one quarter of the population will be 65 years of age or older. There is presently no consensus concerning the optimal predictive markers for postoperative morbidity and mortality after surgery in older patients with an appreciation that physical frailty is more important than chronological age. In this retrospective analysis, we have compared the impact of age and the calculated preoperative Charlson Comorbidity Index (CCI) on early (30-day) and late (one-year) mortality in a group of patients >75 years of age dividing them into an “older old” cohort (75–84 years of age, Group A) and an “oldest old” group (≥85 years of age, Group B). Increased age was associated with a higher death rate after emergency surgery, with late deaths after elective surgery exceeding those after emergency operations. A higher mean CCI was noted in both age groups in early nonsurvivors after both elective and emergency surgery with a more significant effect of the preoperative CCI than chronological age for the prediction of late postoperative death for both groups after elective and emergency operations. Although the CCI was not designed to predict perioperative mortality in surgical cohorts, it correlates with a greater risk than age for perioperative death in the elderly.

Download Full-text