Analysis of risk factors and clinical characteristics affecting the prognosis of elderly patients in the surgical intensive care unit after non-cardiac surgery
10.3969/j.issn.1008-9691.2024.06.009
- VernacularTitle:影响非心脏手术SICU老年患者预后的危险因素及临床特征分析
- Author:
Min XU
1
;
Qiang LI
1
;
Yao CHEN
1
;
Jinglan ZHANG
1
Author Information
1. 首都医科大学附属北京安贞医院综合外科监护室,北京 100029
- Publication Type:Journal Article
- Keywords:
Surgical intensive care unit;
Sepsis;
Mortality
- From:
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2024;31(6):690-694
- CountryChina
- Language:Chinese
-
Abstract:
Objective By analyzing the trends in the overall age of patients in the surgical intensive care unit(SICU)over the past decade,to explore the risk factors influencing perioperative mortality in patients undergoing non-cardiac surgery in the SICU.Methods A retrospective analysis was conducted on the clinical data of 12 535 patients admitted to Beijing Anzhen Hospital,Capital Medical University,from 1 January,2013 to 31 December,2022,including gender,age,underlying diseases,mechanical ventilation after admission to SICU,continuous renal replacement therapy(CRRT),sepsis occurrence,detention time,and mortality.The patients were divided into<60 years old(young and middle-aged group),60-80 years old(aged group)and≥80 years old(elderly group)according to age,and the differences of the above clinical data in the 3 groups at different ages were compared.The main clinical outcome was death during admission to SICU.Univariate and multivariate Logistic regression were used to analyze the risk factors affecting the prognosis of elderly patients.Results Over the past 10 years,the average age of patients in the SICU of our hospital has increased by 4.29 years,with a notable acceleration in this trend observed in 2020-2022.As age increased,the proportion of patients receiving CRRT,the incidence of sepsis,and the mortality rate all gradually increased,while the length of stay was significantly prolonged,the differences among the young and middle-aged group,the aged group,and the elderly group were statistically significant[CRRT rates:0.84%(44/5 213),1.42%(92/6 477),3.55%(30/845);sepsis incidence rates were 0.84%(44/5 213),1.13%(73/6 477),and 4.14%(35/845);observation time(days):1.00(1.00,1.00),1.00(1.00,1.00),1.00(1.00,3.00);mortality rates:0.63%(33/5 213),0.97%(63/6 477),and 3.08%(26/845),all P<0.05].The proportions of male patients,as well as those with coronary artery disease,diabetes,and ventilator use,were highest in the aged group.Significant differences were observed across the three groups for male proportion[48.1%(2 507/5 213),60.9%(3 942/6 477),54.6%(461/845)],coronary artery disease[12.6%(656/5 213),39.4%(2 549/6 477),37.5%(317/845)],hypertension[27.2%(1 416/5 213),51.6%(3 343/6 477),55.9%(472/845)],diabetes[10.7%(557/5 213),22.1%(1 433/6 477),19.4%(164/845)],and ventilator use[73.0%(3 808/5 213),87.5%(5 667/6 477),74.1%(626/845)],all with statistically significant differences(all P<0.05).The proportion of hypertension in the elderly survival group was significantly higher than that in the death group[56.5%(463/819)vs.34.6%(9/26),P<0.05],the proportion of mechanical ventilation and CRRT,as well as the incidence of sepsis were significantly lower than those in the death group[mechanical ventilation:73.5%(602/819)vs.92.3%(24/26),CRRT:2.8%(23/819)vs.26.9%(7/26),incidence of sepsis:2.9%(24/819)vs.42.3%(11/26),all P<0.05],the observation time was significantly shorter than that in the death group[days:1.00(1.00,3.00)vs.5.00(2.00,22.00),P<0.05].In the elderly group,death was taken as the dependent variable,Logistic regression analysis was conducted on 5 factors,hypertension,mechanical ventilation,CRRT,sepsis and observation time.The results showed that the independent risk factors affecting the prognosis of elderly patients were observation time and the occurrence of sepsis[odds ratio(OR)and 95%confidence interval(95%CI)were 9.329(3.018-28.838)and 1.051(1.000-1.104),Pvalues was 0.048 and<0.001].Conclusions The average age of patients in our SICU has increased,primarily due to the rising number of patients aged 60-80 years.Although the number of elderly patients(≥80 years)has remained stable,the mortality rate significantly exceeds that of other age groups,sepsis and observation time are independent risk factors for mortality in the elderly patients.
