The significance of demographic factors (age, sex, preoperative physiological status) and type of surgery on patients’ outcome in ICU

The incidence of postoperative death has changed little in recent years. Most deaths occur in older patients with coexisting medical diseases who undergo major surgery.

The objective of our research was to investigate the significance of demographic factors (age, gender, preoperational physiological status) and type of surgery on the outcome of treatment. This study included 288 patients older than 18 years of age that were treated in the intensive care unit (ICU) for at least 24 hours after a surgical procedure (both elective and emergency) between 1st January 2010 and 31st March 2011. The average age of patients included in the survey was 68 (range 19-88). APACHE II score was between 2.9 and 83.1 points, with an average value of 12.90 points. In this study, male gender (n=186) was much more common than female gender (n=102). Age of patients who died in the ICU was higher than the age of those who were discharged but it was not a statistically significant predictor of patient death. APACHE II score is associated with increased age of patients, neurosurgical operations and incidence of nosocomial infections. Patients’ age and female gender had a strong negative correlation with nosocomial infection. Actual mortality rate for patients was 21%. Ratio between actual and predicted mortality was 1.4. 

demographics, ICU, APACHE, type of surgery, nosocomi-al infections

1. Miller MR, Elixhauser A, Zhan C, Meyer GS. Patient Safety Indicators: using administrative data to identify potential patient safety concerns. Health Serv Res 2001;36:110–32.

2. Pearse RM, Harrison DA, James P, Watson D, Hinds C, Rhodes A, et al. Identification and characterization of the hight-risk surgical popu-lation in the United Kingdom. Crit Care 2006;10:1-6.

3. Mayo Clinic. Risk-Adjusted Mortality Rate. [Online]. 2012 [cited 2013 Jan 12]. Available from: URL:http://www.mayoclinic.org/quality/adjusted-mortality.html.

4. Reinikainen M, Niskanen M, Uusaro A, Rokonen E. Impact of gender on treatment and outcome of ICU Patients. Acta Anaesthesiol Scand 2005;49:984-90.

5. Boumendil A, Maury E, Reinhard I, Luguel L, Offenstadt G, Guidet B. Prognosis of patients aged 80 years and over admitted in medical intensive care unit. Intensive Care Med 2004;30:647-54.

6. Clarke A, Murdoch H, Thomas MJ, Cook TM, Peden CJ. Mortality and postoperative care after emergency laparotomy. Eur J Anaesthesiol 2011;28:16-9.

7. Weissman C, Klein N. The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care 2008;23:308-16.

8. Santini M. Ishod lije􀀃enja bolesnika starije životne dobi oboljelih od teških infekcija u jedinici intenzivne medicine [dissertation]. Zagreb: University of Zagreb Medical school. 2011. Croatian.

9. Angus DC, Kelley MA, Schmitz RJ, White A, Popovich J Jr. Caring for the critically ill patient. Current and projected workforce requirements for care of the critically ill patients with pulmonary disease: can we meet the requirements of an aging population? JAMA 2000;284:2762-70.

10. Esteban A, Anzueto A, Frutos F, Alia I, Brochard L, Stewart TE, et al. Characteristics and outcome in adult patients receiving mechanical ventilation a 28-day international study. JAMA 2002;287:345-55.

11. Somme D, Maillet JM, Gisselbrecht M, Novara A, Ract C, Fagon JY. Critically ill old and the oldest-old patients in intensive care: short – and long –term outcomes. Intensive Care Med 2003;29:2137-43.

12. Wunsch H, Guerra C, Barnate AE, Angus DC, Li G, Linde-Zwirble WT. Three – year outcomes for Medicare beneficiaries who survive intensive care. JAMA 2010;303:849-56.

13. Sligl WI, Majumdar SR. How important is age in defining the prognosis of the patients with community-acquired pneumonia? Curr Opin Infect Dis 2011;24:142-7.

14. Craven DE, Kunches LM, Lichtenberger DA, Kollisch NR, Barry MA, Heeren TC, et al. Nosocomial infection and fatality in medical and surgical intensive care unit patients. Arch Intern Med 1988;148:1161-8.

15. Gross PA, Levine JF, LoPresti A, Urdaneta M. Infections in the elderly. In: Wenzel RP, editor. Prevention and control of nosocomial infec-tions. 3rd ed. Baltimore: Williams & Wilkins; 1997 p. 1059-97.

16. Smith PW. Nosocomial infections in the elderly. Infect Dis Clin North Am 1989;3:763-77.

17. Prowle JR, Echeverri JE, Ligabo EV, Sherry N, Taori GC, Crozier TM, et al. Acquired bloodstream infection in the intensive care unit: inci-dence and attributable mortality. Crit Care 2011;15:R100.

18. Blot S, Cunkurtaran M, Petrovi􀀂 M, Vandijck D, Lizy C, Decruyenaere J, et al. Epidemiology and outcome of nosocomial bloodstream infection in elderly critically ill patients: a comparison between middle-aged, old, and very old patients. Crit Care Med 2009;37:1634-41.

19. Nachtigall T, Tafelski S, Rothbart A, Kaufner L, Schmidt M, Tamarkin A, et al. Gender related outcome difference is related to course of sepsis on mixed ICUs – a prospective, observational clinical study. Crit Care 2011; 15:R151.

20. Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE. APACHE - acute physiology and chronic health evaluation: a physio-logically based classification system. Crit Care Med 1981;9:591-7.

21. Mihaljevi􀀂 LJ, Bedeni􀀂 B, Mihaljevi􀀂 S, Majerovi􀀂 M, Petrovi􀀂 P, Vasilj I. Microbiological surveillance of the surgical intensive care unit in Zagreb – a pivot for guideline – based therapy of severe sepsis. Coll Antropol 2007;31:1093-7.