RESUMO
BACKGROUND: The elderly population is an especially heterogeneous group of patients with a rising number of surgical interventions being performed in the very elderly patient. The aim of this study was to evaluate the correlation between different age strata and functional status with the surgical outcome of the elderly patient. METHODS: Retrospective cohort study conducted in a Surgical Intensive Care Unit (SICU), between 2006 and 2013. A total of 2331 surgical patients ≥ 65 years old were included. Patients were grouped according to age: Older Elderly Group (OEG: 65-85 years old); Very Elderly Group (VEG > 85 years old). Demographic and perioperative data were recorded. Revised Cardiac Risk Index, APACHE II and SAPS II scores were calculated and postoperative complications were documented. Variables were compared on univariate analysis. RESULTS: The incidence of the VEG was 5.4%. This group had a higher proportion of non-elective surgery (22.4% vs. 11.2%, p < 0.001), higher APACHE II (12.0 vs. 10.0, p < 0.001) and SAPS II (26.6 vs. 22.2, p < 0.001) scores, higher incidence of organ failure (24.6% vs. 17.6%, p = 0.048) and a higher mortality rate during SICU (14.0% vs. 5.2%, p = 0.026) and hospital stay (9.3% vs. 5.0%, p = 0.012). CONCLUSION: We found that very elderly patients represented a significant proportion of patients admitted to the SICU. They had higher severity scores with a higher prevalence of organ failure and were more likely to undergo non-elective surgery. They had worse outcomes in regarding mortality during SICU and hospital stay.
Assuntos
Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Correlação de Dados , Estado Terminal , Feminino , Estado Funcional , Humanos , Unidades de Terapia Intensiva , Masculino , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Abstract Background: The elderly population is an especially heterogeneous group of patients with a rising number of surgical interventions being performed in the very elderly patient. The aim of this study was to evaluate the correlation between different age strata and functional status with the surgical outcome of the elderly patient. Methods: Retrospective cohort study conducted in a Surgical Intensive Care Unit (SICU), between 2006 and 2013. A total of 2331 surgical patients' ≥ 65 years old were included. Patients were grouped according to age: Older Elderly Group (OEG: 65‒85 years old); Very Elderly Group (VEG > 85 years old). Demographic and perioperative data were recorded. Revised Cardiac Risk Index, APACHE II and SAPS II scores were calculated and postoperative complications were documented. Variables were compared on univariate analysis. Results: The incidence of the VEG was 5.4%. This group had a higher proportion of non-elective surgery (22.4% vs. 11.2%, p < 0.001), higher APACHE II (12.0 vs. 10.0, p < 0.001) and SAPS II (26.6 vs. 22.2, p < 0.001) scores, higher incidence of organ failure (24.6% vs. 17.6%, p = 0.048) and a higher mortality rate during SICU (14.0% vs. 5.2%, p = 0.026) and hospital stay (9.3% vs. 5.0%, p = 0.012). Conclusion: We found that very elderly patients represented a significant proportion of patients admitted to the SICU. They had higher severity scores with a higher prevalence of organ failure and were more likely to undergo non-elective surgery. They had worse outcomes in regarding mortality during SICU and hospital stay.
Resumo Introdução: A população idosa envolve um grupo muito heterogêneo de doentes, com um crescente número de doentes muito idosos a serem propostos para cirurgia. O objetivo do presente estudo foi avaliar a relação entre diferentes grupos etários e estados funcionais com os resultados cirúrgicos do doente idoso. Métodos: Estudo retrospectivo de coorte realizado em uma Unidade de Cuidados Intensivos Cirúrgica (UCIC) que incluiu um total de 2331 doentes cirúrgicos com idade ≥ 65 anos, entre 2006 e 2013. Os doentes foram agrupados de acordo com a idade: doentes idosos (65-85 anos); doentes muito idosos (DMI > 85 anos). Dados demográficos e perioperatórios foram registrados. Índice de Risco Cardíaco Revisto, scores de APACHE e SAPS II foram calculados e complicações pós-operatórias, documentadas. As variáveis foram comparadas em análise univariada. Resultados: A incidência de DMI foi de 5,4%. Este grupo foi mais frequentemente submetido à cirurgia não eletiva (22,4%vs.11,2%; p< 0,001), apresentou scores maiores de APACHE II (12,0vs.10,0; p< 0,001) e SAPS II (26,6 vs. 22,2; p< 0,001), maior incidência de insuficiência do órgão (24,6%vs.17,6%; p= 0,048) e uma mortalidade superior na UCIC (14,0%vs.5,2%; p= 0,026) e no hospital (9,3% vs.5,0%; p= 0,012). Discussão: Os piores resultados nos DMI podem refletir uma maior vulnerabilidade a complicações pós-operatórias, possivelmente relacionadas com múltiplas comorbilidades e uma reserva fisiológica diminuídas. Conclusão: Os doentes muito idosos representaram uma porção importante dos doentes admitidos na UCIC, tinham scores de gravidade mais elevados e maior prevalência de falência orgânica e foram mais frequentemente submetidos a cirurgias não eletivas. Tinham piores resultados relativamente à mortalidade durante a permanência na UCIC e no hospital.
