Advertisement

Evaluating the effect of age on postoperative and clinical outcomes in patients admitted to the intensive care unit after gastrointestinal cancer surgery

Published:August 05, 2022DOI:https://doi.org/10.1016/j.surg.2022.04.037

      Abstract

      Background

      This study aimed to compare postoperative and clinical outcomes according to age and analyze the effect of age on mortality in patients admitted to the intensive care unit immediately after gastrointestinal cancer surgery.

      Methods

      A total of 477 patients admitted to the intensive care unit after gastrointestinal cancer surgery between March 2018, and February 2020, were classified into 3 groups according to age: young (<65 years), older (65–79 years), and oldest (≥80 years) groups. We compared their disease severity scores as well as postoperative and clinical outcomes including mortality.

      Results

      The young group comprised 167 (35.0%) patients, the older group 222 (46.5%) patients, and the oldest group 88 (18.4%) patients. There was a significant difference in the American Society of Anesthesiologists score, but not in the Acute Physiology and Chronic Health Evaluation II score, among the groups. The younger the age, the higher was the rate of vasopressor use; however, there were no significant differences in other postoperative and clinical outcomes, such as mechanical ventilation, length of hospital stay, length of intensive care unit stay, form of discharge, intensive care unit re-admission rate, in-hospital mortality, and in-30 days mortality. No significant differences in in-hospital survival, in-30 days survival, and overall survival were observed among the 3 groups.

      Conclusion

      The comorbidities of patients increase with age; however, there was no significant difference in postoperative and clinical outcomes related to age. Thereby, the older population can successfully undergo major operations if adequate perioperative management is provided.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Guidet B.
        • Vallet H.
        • Boddaert J.
        • de Lange D.W.
        • Morandi A.
        • Leblanc G.
        • et al.
        Caring for the critically ill patients over 80: a narrative review.
        Ann Intensive Care. 2018; 8: 114
        • Bagshaw S.M.
        • Webb S.A.
        • Delaney A.
        • et al.
        Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis.
        Crit Care. 2009; 13: R45
        • Monson K.
        • Litvak D.A.
        • Bold R.J.
        Surgery in the aged population: surgical oncology.
        Archi Surg. 2003; 138: 1061-1067
        • Menaker J.
        • Scalea T.M.
        Geriatric care in the surgical intensive care unit.
        Crit Care Med. 2010; 38: S452-S459
        • Feng M.A.
        • McMillan D.T.
        • Crowell K.
        • Muss H.
        • Nielsen M.E.
        • Smith A.B.
        Geriatric assessment in surgical oncology: a systematic review.
        J Surg Res. 2015; 193: 265-272
        • Ramesh H.S.J.
        • Pope D.
        • Gennari R.
        • Audisio R.A.
        Optimising surgical management of elderly cancer patients.
        World J Surg Oncol. 2005; 3: 17
        • Kim J.
        • Lee J.
        • Choi S.
        • Lee J.
        • et al.
        Trends in the use of intensive care by very elderly patients and their clinical course in a single tertiary hospital in Korea.
        Korean Journal of Critical Care Medicine. 2016; 31: 25-33
        • Atramont A.
        • Lindecker-Cournil V.
        • Rudant J.
        • et al.
        Association of age with short-term and long-term mortality among patients discharged from intensive care units in France.
        JAMA Netw Open. 2019; 2e193215
        • Brandberg C.
        • Blomqvist H.
        • Jirwe M.
        What is the importance of age on treatment of the elderly in the intensive care unit?.
        Acta Anaesthesiol Scand. 2013; 57: 698-703
        • Fuchs L.
        • Chronaki C.E.
        • Park S.
        • et al.
        ICU admission characteristics and mortality rates among elderly and very elderly patients.
        Intensive Care Med. 2012; 38: 1654-1661
        • Soares M.
        • Carvalho M.S.
        • Salluh J.I.
        • et al.
        Effect of age on survival of critically ill patients with cancer.
        Crit Care Med. 2006; 34: 715-721
        • Yeo H.L.
        • O'Mahoney P.R.
        • Lachs M.
        • et al.
        Surgical oncology outcomes in the aging US population.
        J Surg Res. 2016; 205: 11-18
        • Kassahun W.T.
        • Staab H.
        • Gockel I.
        • Mehdorn M.
        Factors associated with morbidity and in-hospital mortality after surgery beyond the age of 90: comparison with outcome results of younger patients matched for treatment.
        Am J Surg. 2018; 216: 1063-1069
        • van Gestel Y.R.
        • Lemmens V.E.
        • de Hingh I.H.
        • et al.
        Influence of comorbidity and age on 1-, 2-, and 3-month postoperative mortality rates in gastrointestinal cancer patients.
        Ann Surg Onc. 2013; 20: 371-380
        • Papis D.
        • Vagliasindi A.
        • Maida P.
        Hepatobiliary and pancreatic surgery in the elderly: current status.
        Ann Hepatobiliary Pancreat Surg. 2020; 24: 1-5
        • Andersen F.
        • Kvåle R.
        Do elderly intensive care unit patients receive less intensive care treatment and have higher mortality?.
        Acta Anaesthesiol Scand. 2012; 56: 1298-1305
        • Boumendil A.
        • Aegerter P.
        • Guidet B.
        • CUB-Rea Network
        Treatment intensity and outcome of patients aged 80 and older in intensive care units: a multicenter matched-cohort study.
        J Am Geriatr Soc. 2005; 53: 88-93
        • Oh D.K.
        • Na W.
        • Park Y.R.
        • et al.
        Medical resource utilization patterns and mortality rates according to age among critically ill patients admitted to a medical intensive care unit.
        Medicine (Baltimore). 2019; 98e15835
        • World Health Organization (WHO)
        Men, ageing and health: achieving health across the life span.
        • Lee H.
        • Shim H.
        • Jang J.Y.
        • Jung A.R.
        • Kim S.H.
        • Pharm B.
        • et al.
        Development of a new nutrition screening tool for use in an acute care hospital.
        J Korean Soc Parenter Enter Nutr. 2013; 5: 82-88
        • Oken M.M.
        • Creech R.H.
        • Tormey D.C.
        • et al.
        Toxicity and response criteria of the Eastern Cooperative Oncology Group.
        Am J Clin Oncol. 1982; 5: 649-656
        • Knaus W.A.
        • Draper E.A.
        • Wagner D.P.
        • Zimmerman J.E.
        APACHE II: a severity of disease classification system.
        Crit Care Med. 1985; 13: 818-829
        • Ayeni O.
        • Dickson L.
        • Ignacy T.A.
        • Thoma A.
        A systematic review of power and sample size reporting in randomized controlled trials within plastic surgery.
        Plast Reconstr Surg. 2012; 130: 78e-86e
        • Breau R.H.
        • Carnat T.A.
        • Gaboury I.
        Inadequate statistical power of negative clinical trials in urological literature.
        J Urol. 2006; 176: 263-266
        • Ryou H.W.
        • Lee M.J.
        • Kim J.K.
        • Choe M.S.P.
        Inadequate post-hoc statistical power analysis in journal of the Korean Society of Emergency Medicine.
        J Korean Soc Emerg Med. 2013; 24: 338-345
      1. Korea Central Cancer Registry, National Cancer Center. Annual report of cancer statistics in Korea in 2018. Ministry of Health and Welfare.
        • Soares M.
        • Caruso P.
        • Silva E.
        • et al.
        Characteristics and outcomes of patients with cancer requiring admission to intensive care units: a prospective multicenter study.
        Crit Care Med. 2010; 38: 9-15
        • Bos M.M.
        • Verburg I.W.
        • Dumaij I.
        • et al.
        Intensive care admission of cancer patients: a comparative analysis.
        Cancer Med. 2015; 4: 966-976
        • O'Connell J.B.
        • Maggard M.A.
        • Livingston E.H.
        • Cifford K.Y.
        Colorectal cancer in the young.
        Am J Surg. 2004; 187: 343-348
        • Patel S.G.
        • Ahnen D.J.
        Colorectal cancer in the young.
        Current Gastroenterology Reports. 2018; 20: 1-12
        • Mothes H.
        • Bauschke A.
        • Schuele S.
        • Eigendorff E.
        • Altendorf-Hofmann A.
        • Settmacher U.
        Surgery for colorectal cancer in elderly patients: how can we improve outcome?.
        J Cancer Res Clin Oncol. 2017; 143: 1879-1889
        • Audisio R.
        • Bozzetti F.
        • Gennari R.
        • et al.
        The surgical management of elderly cancer patients: recommendations of the SIOG surgical task force.
        Eur J Cancer. 2004; 40: 926-938
        • Pericleous M.
        • Khan S.A.
        Epidemiology of HPB malignancy in the elderly.
        Eur J Surg Oncol. 2021; 47: 503-513
        • Glimelius B.
        Pancreatic and hepatobiliary cancers: adjuvant therapy and management of inoperable disease.
        Ann Oncol. 2000; 11: 153-160
        • Nguyen Y.L.
        • Angus D.C.
        • Boumendil A.
        • Guidet B.
        The challenge of admitting the very elderly to intensive care.
        Ann Intensive Care. 2011; 1: 29
        • Tricoli J.V.
        • Bleyer A.
        Adolescent and young adult cancer biology.
        Cancer J. 2018; 24: 267-274
        • Khan A.
        • Ituarte P.H.
        • Raoof M.
        • et al.
        Disparate and alarming impact of gastrointestinal cancers in young adult patients.
        Ann Surg Oncol. 2021; 28: 785-796
        • Chang L.
        • Horng C.F.
        • Huang Y.C.T.
        • Hsieh Y.Y.
        Prognostic accuracy of Acute Physiology and Chronic Health Evaluation II scores in critically ill cancer patients.
        Am J Crit Care. 2006; 15: 47-53
        • Shpata V.
        • Prendushi X.
        • Kreka M.
        • Kola I.
        • Kurti F.
        • Ohri I.
        Malnutrition at the time of surgery affects negatively the clinical outcome of critically ill patients with gastrointestinal cancer.
        Med Arch. 2014; 68: 263-267
        • Lerolle N.
        • Trinquart L.
        • Bornstain C.
        • et al.
        Increased intensity of treatment and decreased mortality in elderly patients in an intensive care unit over a decade.
        Crit Care Med. 2010; 38: 59-64
        • Vacante M.
        • Cristaldi E.
        • Basile F.
        • Borzì A.M.
        • Biondi A.
        Surgical approach and geriatric evaluation for elderly patients with colorectal cancer.
        Updates Surg. 2019; 71: 411-417