Association between age and use of intensive care among surgical Medicare beneficiaries

Abstract

Purpose To determine the role age plays in use of intensive care for patients who have major surgery. Materials and Methods Retrospective cohort study examining the association between age and admission to an intensive care unit (ICU) for all Medicare beneficiaries aged 65 or older who had a hospitalization for one of five surgical procedures: esophagectomy, cystectomy, pancreaticoduodenectomy (PD), elective open abdominal aortic aneurysm repair (open AAA), and elective endovascular AAA repair (endo AAA) from 2004–08. The primary outcome was admission to an ICU. Secondary outcomes were complications and hospital mortality. We used multi-level mixed-effects logistic regression to adjust for other patient and hospital-level factors associated with each outcome. Results The percentage of hospitalized patients admitted to ICU ranged from 41.3% for endo AAA to 81.5% for open AAA. In-hospital mortality also varied, from 1.1% for endo AAA to 6.8% for esophagectomy. After adjusting for other factors, age was associated with admission to ICU for cystectomy (Adjusted Odds Ratio (AOR) 1.56 (95% CI 1.36–1.78) for age 80–84+; 2.25 (1.85–2.75) age 85+ compared with age 65–69), PD (AOR 1.26 (1.06–1.50) age 80–84; 1.49 (1.11–1.99) age 85+) and esophagectomy (AOR 1.26 (1.02–1.55) age 80–84; 1.28 (0.91–1.80) age 85+). Age was not associated with use of intensive care for open or endo AAA. Older age was associated with increases in complication rates and in-hospital mortality for all five surgical procedures. Conclusions The association between age and use of intensive care was procedure-specific. Complication rates and in-hospital mortality increased with age for all five surgical procedures.

Use of Intensive Care Services for Medicare Beneficiaries Undergoing Major Surgical Procedures

“…This dataset contains data on all Medicare hospitalizations from 2004 through 2008, linked with data from the American Hospital Association annual survey from 2007. 13…”

“…We included all patients 65 years or older undergoing five select surgical procedures during a hospitalization, and excluded Medicare beneficiaries under age 65 since they represent a highly selected group of individuals with specific diagnoses, as previously described. 13 The procedures were: elective endovascular repair of abdominal aortic aneurysm (endovascular AAA), cystectomy, pancreaticoduodenectomy (PD), esophagectomy, and elective open repair of an abdominal aortic aneurysm (open AAA). We chose these surgical procedures from a larger list of possible procedures after initial inspection of the data because they are 1) commonly performed in patients over the age of 65, 2) well circumscribed and usually not associated with another surgery, and 3) associated with a range of different hospital mortality rates (see Supplemental Digital Content Table 1, listing individual ICD-9-CM and procedure codes used).…”

Mortality and Outcomes in Very Elderly Patients 90 Years of Age or Older Admitted to the ICU

“…[1][2][3] Older people require more medical services than younger people because of the higher rates of functional impairment and chronic morbidity. [1][2][3][4] Consequently, the number of very elderly patients admitted to the ICU with acute illnesses is increasing. [1][2][3] A study in Australia and New Zealand found an annual increase of 5.6% in the number of ICU patients over 85 y.…”

Documenting pessary offer prior to hysterectomy for management of pelvic organ prolapse

“…Prior studies have shown that younger women are more likely to opt for surgical management of prolapse; however, our study suggests that these factors influence physicians' counseling as well [8,24]. Older women and those with Medicare may have more comorbidities that make them poorer surgical candidates [25][26][27]; therefore, physicians may be more apt to offer them conservative management. However, in our study cohort, all women ultimately had surgery for prolapse and the proportion of women with ASA Class ≥3 was the same among women with and without a pessary offer.…”