Inhospital outcome of elderly patients in an intensive care unit in a Sub-Saharan hospital.

BACKGROUND: In Burkina Faso, demographics are changing and we are seeing a growing prevalence of older patients in intensive care units. Elderly people have increased health care needs but there is a lack of geriatric specialists. This study aimed to analyze in-hospital outcome of patients aged over 65 years, admitted to the Intensive Care Unit (ICU) at Yalgado Hospital. METHODS: We carried out a 5-year retrospective study in the ICU of Yalgado Ouédraogo Hospital. Elderly patients with completed records were included. Baseline characteristics, clinical and outcome were analyzed. RESULTS: Two thousand one hundred sixteen patients were admitted to ICU, 237 (11.2%) of whom were included. There were 70 females and 167 males. The median age was 71.7 ± 6.1 years. The overall mortality rate in ICU was 73%, of whom 90% died within 7 days after admission. In multivariate analysis, shock (Odds Ratio: OR = 2.2, p = 0.002), severe brain trauma (OR; 9.6, p = 0.002), coma (OR 5.8 p < 0.003), surgical condition (OR = 4.2, p = 0.003), ASAPS Score ≥ 8 (OR = 4.3, p = 0.001), complication occurring (OR = 5.2, p = 0.001) and stroke (OR = 3.7, p = 0.001) were independent factors. CONCLUSION: Elderly patients were frequent in ICU and their mortality rate was high. Stroke, severe brain trauma, surgery, complications occurring during hospitalization were independent risk factors of death.

[Assessment of pertinence and cost of preoperative examinations prescriptions by surgeons for programmed surgery]. / Evaluation de la pertinence et du cout de la prescription des examens preoperatoires par les chirurgiens pour une chirurgie programmee.

OBJECTIVE: To assess the pertinence and the cost of preoperative examinations prescriptions by surgeons at CHU-YO for programmed surgery. PATIENTS AND METHODS: This was a prospective and observational study of 145 patients received in preanesthetic consultations between February 4 and April 4, 2016 in the department of anesthesiology, intensive care unit and emergency of CHU-YO. It consisted of an evaluation of 1106 preoperative examinations prescribed by the surgeons of this hospital compared to the formalized recommendations of French experts. RESULTS: Out of a total of 1,106 prescribed preoperative examinations, 1069 (96.6%) have been achieved. The six most commonly prescribed tests were hemogram (95.9%), blood grouping (90.3%), prothrombin (PT) (91.7%), active cephalin time (ACT) (86.9%), blood sugar (92.4%) and creatininemia (89%). Ninety-two results (8.6%) examinations were abnormal. Prescriptions for preoperative examinations were relevant in 30.2% of cases. The average cost of performing preoperative examinations per patient was 19832±14023 FCFA. CONCLUSION: Prescriptions for preoperative examinations by surgeons are mostly non-rational, the application of a repository is essential to improve this practice.

OBJECTIF: évaluer la pertinence et le coût de la prescription des examens préopératoires par les chirurgiens au centre hospitalier universitaire Yalgado Ouédraogo (CHU-YO) en chirurgie réglée. PATIENTS ET MÉTHODES: Il s'est agi d'une étude prospective observationnelle portant sur 145 patients reçus en consultation préanesthésique entre le 4 février et le 4 avril 2016 dans le service d'anesthésie-réanimation et d'urgences du CHU-YO. Elle a consisté en une évaluation de 1106 examens préopératoires prescrits par les chirurgiens de cet hôpital, par comparaison aux recommandations formalisées d'experts français. RÉSULTATS: Sur un total de 1106 examens préopératoires prescrits, 1069 (96,6%) ont été réalisés. Les six examens les plus fréquemment prescrits étaient l'hémogramme (95,9%), le groupage sanguin (90,3%), la détermination du taux de prothrombine (TP) (91,7%), le temps de céphaline activée (TCA) (86,9%), la glycémie (92,4%) et la créatininémie (89%). Quatre-vingt-douze résultats (8,6%) d'examens étaient anormaux. Les prescriptions d'examens préopératoires étaient pertinentes dans 30,2% des cas. Le coût moyen de réalisation des examens préopératoires par patient était de 19832 ± 14023 FCFA. CONCLUSION: Les prescriptions d'examens préopératoires par les chirurgiens sont majoritairement non rationnelles, l'application d'un référentiel y relatif est indispensable pour améliorer cette pratique.