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Mirzaiee M, Soleimani M, Banoueizadeh S, Mahdood B, Bastami M, Merajikhah A. Ability to predict surgical outcomes by surgical Apgar score: a systematic review. BMC Surg 2023; 23:282. [PMID: 37723504 PMCID: PMC10506220 DOI: 10.1186/s12893-023-02171-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 08/25/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND The Surgical Apgar score (SAS) is a straightforward and unbiased measure to assess the probability of experiencing complications after surgery. It is calculated upon completion of the surgical procedure and provides valuable predictive information. The SAS evaluates three specific factors during surgery: the estimated amount of blood loss (EBL), the lowest recorded mean arterial pressure (MAP), and the lowest heart rate (LHR) observed. Considering these factors, the SAS offers insights into the probability of encountering postoperative complications. METHODS Three authors independently searched the Medline, PubMed, Web of Science, Scopus, and Embase databases until June 2022. This search was conducted without any language or timeframe restrictions, and it aimed to cover relevant literature on the subject. The inclusion criteria were the correlation between SAS and any modified/adjusted SAS (m SAS, (Modified SAS). eSAS, M eSAS, and SASA), and complications before, during, and after surgeries. Nevertheless, the study excluded letters to the editor, reviews, and case reports. Additionally, the researchers employed Begg and Egger's regression model to evaluate publication bias. RESULTS In this systematic study, a total of 78 studies \were examined. The findings exposed that SAS was effective in anticipating short-term complications and served as factor for a long-term prognostic following multiple surgeries. While the SAS has been validated across various surgical subspecialties, based on the available evidence, the algorithm's modifications may be necessary to enhance its predictive accuracy within each specific subspecialty. CONCLUSIONS The SAS enables surgeons and anesthesiologists to recognize patients at a higher risk for certain complications or adverse events. By either modifying the SAS (Modified SAS) or combining it with ASA criteria, healthcare professionals can enhance their ability to identify patients who require continuous observation and follow-up as they go through the postoperative period. This approach would improve the accuracy of identifying individuals at risk and ensure appropriate measures to provide necessary care and support.
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Affiliation(s)
- Mina Mirzaiee
- Department of Operating Room, School of Paramedical Science, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahdieh Soleimani
- Bachelor of Surgical Technology, Imam Reza Hospital of Tabriz, East Azerbaijan, Iran
| | - Sara Banoueizadeh
- Department of Operating Room, School of Paramedical Science, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Operating Room, Faculty Member of Paramedical School, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Bahareh Mahdood
- Department of Operating Room, Faculty Member of Paramedical School, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Maryam Bastami
- Instructor of Operating Room, Department of Operating Room, School of Allied Sciences, Ilam University of Medical Sciences, Ilam, Iran
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Sá E Silva R, Gonçalves AR, Duarte S, Machado H. Would surgical Apgar score be useful to predict postoperative complications after proximal femoral fracture surgery? - A retrospective cohort study. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:198-208. [PMID: 36842691 DOI: 10.1016/j.redare.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 02/19/2022] [Indexed: 02/28/2023]
Abstract
BACKGROUND The surgical Apgar score (SAS) is a perioperative risk evaluation score, which considers intraoperative minimum heart rate, minimum mean arterial pressure and estimated blood loss. Although validated in multiple surgical fields, SAS remains quite controversial in the orthopedic one. The main purpose of this study was to investigate if SAS relates with the occurrence of complications during the first 30-days after proximal femoral fracture surgery. METHODS Retrospective study including all consecutive patients submitted to proximal femoral fracture surgery between January and July 2019. Patients with no information about SAS were excluded. Patients were divided in two groups, based on the occurrence of complications during the first 30 post-operative days and their SAS calculated. Receiver operating characteristic (ROC) curves were used to assess SAS power as a predictive model of complications. RESULTS Forty-two percent (n = 76) of the 181 patients included in the study developed complications during the first 30 postoperative days. Eight patients (4,4%) died during that period. The patient's mean age was 79 years and 30,9% (n = 56) were men. Heart failure, pacemaker use, chronic kidney disease, chronic obstructive pulmonary disease and dementia were significantly associated with post-operative morbidity. There was no significant correlation between SAS and the occurrence of complications during the first 30 postoperative days. The AUC of SAS as a predictive model for postoperative complications after proximal femoral fracture surgery was 0,522, being insufficient to be considered an accepted model of prediction. CONCLUSION Based on this study, we conclude that SAS is not predictive of the development of complications in the first 30 post-operative days in patients submitted to proximal femoral fracture surgery. However, other clinical factors have been identified as associated with postoperative morbidity. In the future, prospective-based studies with higher samples may better clarify the role of SAS in this context.
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Affiliation(s)
- R Sá E Silva
- Centro Hospitalar Universitário do Porto, Porto, Portugal.
| | - A R Gonçalves
- Anesthesiology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - S Duarte
- Centro Hospitalar Universitário do Porto, Porto, Portugal; Anesthesiology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - H Machado
- Centro Hospitalar Universitário do Porto, Porto, Portugal; Anesthesiology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
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Pittman E, Dixon E, Duttchen K. The Surgical Apgar Score: A Systematic Review of Its Discriminatory Performance. ANNALS OF SURGERY OPEN 2022; 3:e227. [PMID: 37600284 PMCID: PMC10406005 DOI: 10.1097/as9.0000000000000227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/10/2022] [Indexed: 02/05/2023] Open
Abstract
To review the current literature evaluating the performance of the Surgical Apgar Score (SAS). Background The SAS is a simple metric calculated at the end of surgery that provides clinicians with information about a patient's postoperative risk of morbidity and mortality. The SAS differs from other prognostic models in that it is calculated from intraoperative rather than preoperative parameters. The SAS was originally derived and validated in a general and vascular surgery population. Since its inception, it has been evaluated in many other surgical disciplines, large heterogeneous surgical populations, and various countries. Methods A database and gray literature search was performed on March 3, 2020. Identified articles were reviewed for applicability and study quality with prespecified inclusion criteria, exclusion criteria, and quality requirements. Thirty-six observational studies are included for review. Data were systematically extracted and tabulated independently and in duplicate by two investigators with differences resolved by consensus. Results All 36 included studies reported metrics of discrimination. When using the SAS to correctly identify postoperative morbidity, the area under the receiver operating characteristic curve or concordance-statistic ranged from 0.59 in a general orthopedic surgery population to 0.872 in an orthopedic spine surgery population. When using the SAS to identify mortality, the area under the receiver operating characteristic curve or concordance-statistic ranged from 0.63 in a combined surgical population to 0.92 in a general and vascular surgery population. Conclusions The SAS provides a moderate and consistent degree of discrimination for postoperative morbidity and mortality across multiple surgical disciplines.
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Affiliation(s)
- Elliot Pittman
- From the Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, AB, Canada
| | - Elijah Dixon
- Department of General Surgery, Foothills Medical Centre, Professor of Surgery, Oncology, and Community Health Sciences, University of Calgary, Calgary AB, Canada
| | - Kaylene Duttchen
- Department of Anesthesiology, Foothills Medical Centre, Clinical Assistant Professor, University of Calgary, Calgary AB, Canada
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Peterle VCU, Novaes MRCG, Junior PEB, Júnior JCG, Magalhães Cavalcante RT, da Silva Junior JB, Portela RC, de Paula AP. Osteoporotic hip fracture-Comorbidities and factors associated with in-hospital mortality in the elderly: A nine-year cohort study in Brazil. PLoS One 2022; 17:e0272006. [PMID: 35960782 PMCID: PMC9374234 DOI: 10.1371/journal.pone.0272006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/11/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The aim of the study was to identify factors associated with the causes of in-hospital morbidity and mortality in an elderly Brazilian population due to osteoporotic hip fractures. METHOD Retrospective cohort study involving a population over 60 years of age admitted to hospital due to osteoporotic hip fractures and followed up from hospitalization to outcome (discharge or mortality) from 2010 to 2018, in a public hospital in Brasília, the capital of Brazil. Multivariate analysis was performed using the Poisson regression model with a robust variance, observing the hierarchical model proposed and the receiver operating characteristic (ROC) curve to obtain the cutoff point for mortality incidence in relation the total length of hospital stay. Significance level was set as p < 0.05. The analyses were conducted using the SAS 9.4 software. RESULT The mean hospital mortality rate among the 402 patients involved was 18.4%, and the associations made with the outcome mortality were per relevance: respiratory infection, age over 90 years, high preoperative cardiovascular risk, chronic obstructive pulmonary disease (COPD) as comorbidity, serum hemoglobin level ≤ 10 and other infections. Mortality also showed association with longer total length of hospital stay, as well as with prolonged postoperative period. CONCLUSION Hip fractures in the elderly due to osteoporosis indicate a relationship between the sicker profile of the aging elderly population and the prevalence of chronic diseases strongly associated with in-hospital infections, contributing to increased mortality. There were fewer early interventions, and mortality was also associated with prolonged postoperative period. The aim of this study was not to compare independent variables with each other, but suggests the relationship between the presence of comorbidities, which predisposes to the development of infections, directly linked to mortality.
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Affiliation(s)
| | | | | | - João Carlos Geber Júnior
- Department of Internal Medicine, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Ray Costa Portela
- Escola Superior de Ciências da Saúde (Escs/Fepecs), Brasília, DF, Brazil
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Ana Patricia de Paula
- Escola Superior de Ciências da Saúde (Escs/Fepecs), Brasília, DF, Brazil
- Universidade de Brasilia, Brasília, DF, Brazil
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Farag E, Makarova N, Argalious M, Cywinski JB, Benzel E, Kalfas I, Sessler DI. Vasopressor Infusion During Prone Spine Surgery and Acute Renal Injury: A Retrospective Cohort Analysis. Anesth Analg 2019; 129:896-904. [PMID: 31425235 DOI: 10.1213/ane.0000000000003982] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hypotension is associated with acute kidney injury, but vasopressors used to treat hypotension may also compromise renal function. We therefore tested the hypothesis that vasopressor infusion during complex spine surgery is not associated with impaired renal function. METHODS In this retrospective cohort analysis, we considered adults who had complex spine surgery between January 2005 and September 2014 at the Cleveland Clinic Main Campus. Our primary outcome was postoperative estimated glomerular filtration rate. Secondarily, we evaluated renal function using Acute Kidney Injury Network criteria. We obtained data for 1814 surgeries, including 689 patients (38%) who were given intraoperative vasopressors infusion for ≥30 minutes and 1125 patients (62%) who were not. Five hundred forty patients with and 540 patients without vasopressor infusions were well matched across 32 potential confounding variables. RESULTS In matched patients, vasopressor infusions lasted an average of 173 ± 100 minutes (SD) and were given a median dose (1st quintile, 3rd quintile) of 3.4-mg (1.5, 6.7 mg) phenylephrine equivalents. Mean arterial pressure and the amounts of hypotension were similar in each matched group. The postoperative difference in mean estimated glomerular filtration rate in patients with and without vasopressor infusions was only 0.8 mL/min/1.73 m (95% CI, -0.6 to 2.2 mL/min/1.73 m) (P = .28). Intraoperative vasopressor infusion was also not associated with increased odds of augmented acute kidney injury stage. CONCLUSIONS Clinicians should not avoid typical perioperative doses of vasopressors for fear of promoting kidney injury. Tolerating hypotension to avoid vasopressor use would probably be a poor strategy.
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Affiliation(s)
- Ehab Farag
- From the Departments of General Anesthesiology
- Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Natalya Makarova
- Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Jacek B Cywinski
- From the Departments of General Anesthesiology
- Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Edward Benzel
- Department of Neurosurgery, Center for Spine Health, Neurosurgical Institute, Cleveland Clinic, Cleveland, Ohio
| | - Iain Kalfas
- Department of Neurosurgery, Center for Spine Health, Neurosurgical Institute, Cleveland Clinic, Cleveland, Ohio
| | - Daniel I Sessler
- Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
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Kenig J, Mastalerz K, Mitus J, Kapelanczyk A. The Surgical Apgar score combined with Comprehensive Geriatric Assessment improves short- but not long-term outcome prediction in older patients undergoing abdominal cancer surgery. J Geriatr Oncol 2018; 9:642-648. [DOI: 10.1016/j.jgo.2018.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/08/2018] [Accepted: 05/17/2018] [Indexed: 12/27/2022]
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Park SH, Lee JY, Nam EJ, Kim S, Kim SW, Kim YT. Prediction of perioperative complications after robotic-assisted radical hysterectomy for cervical cancer using the modified surgical Apgar score. BMC Cancer 2018; 18:908. [PMID: 30241512 PMCID: PMC6151059 DOI: 10.1186/s12885-018-4809-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 09/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although there has been marked development in surgical techniques, there is no easy and fast method of predicting complications in minimally invasive surgeries. We evaluated whether the modified surgical Apgar score (MSAS) could predict perioperative complications in patients undergoing robotic-assisted radical hysterectomy. METHODS All patients with cervical cancer undergoing robotic-assisted radical hysterectomy at our institution between January 2011 and May 2017 were included. Their clinical characteristics were retrieved from their medical records. The surgical Apgar score (SAS) was calculated from the estimated blood loss, lowest mean arterial pressure, and lowest heart rate during surgery. We modified the SAS considering the lesser blood loss typical of robotic surgeries. Perioperative complications were defined using a previous study and the Clavien-Dindo classification and subdivided into intraoperative and postoperative complications. We analyzed the association of perioperative complications with low MSAS. RESULTS A total of 138 patients were divided into 2 groups: with (n = 53) and without (n = 85) complications. According to the Clavien-Dindo classification, 49 perioperative complications were classified under Grade I (73.1%); 13, under Grade II (19.4%); and 5, under Grade III (7.5%); 0, under both Grade IV and Grade V. Perioperative complications were significantly associated with surgical time (p = 0.026). The MSAS had a correlation with perioperative complications (p = 0.047). The low MSAS (MSAS, ≤6; n = 52) group had significantly more complications [40 (76.9%), p = 0.01]. Intraoperative complications were more correlated with a low MSAS than were postoperative complications [1 (1.2%) vs. 21 (40.4%); p < 0.001, 13 (15.1%) vs. 25 (48.1%); p = 0.29, respectively]. We also analyzed the risk-stratified MSAS in 3 subgroups: low (MSAS, 7-10), moderate (MSAS 5-6), and high risks (MSAS, 0-4). The prevalence of intraoperative complications significantly increased as the MSAS decreased p = 0.01). CONCLUSIONS This study was consistent the concept that the intuitive and simple MSAS might be more useful in predicting intraoperative complications than in predicting postoperative complications in minimally invasive surgeries, such as robotic-assisted radical hysterectomy for cervical cancer.
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Affiliation(s)
- Seon Hee Park
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Jung-Yun Lee
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Eun Ji Nam
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Sunghoon Kim
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Sang Wun Kim
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Young Tae Kim
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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Kenig J, Mastalerz K, Lukasiewicz K, Mitus-Kenig M, Skorus U. The Surgical Apgar Score predicts outcomes of emergency abdominal surgeries both in fit and frail older patients. Arch Gerontol Geriatr 2018; 76:54-59. [DOI: 10.1016/j.archger.2018.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 01/31/2018] [Accepted: 02/02/2018] [Indexed: 12/14/2022]
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Nair A, Bharuka A, Rayani BK. The Reliability of Surgical Apgar Score in Predicting Immediate and Late Postoperative Morbidity and Mortality: A Narrative Review. Rambam Maimonides Med J 2018; 9:RMMJ.10316. [PMID: 29035696 PMCID: PMC5796735 DOI: 10.5041/rmmj.10316] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Surgical Apgar Score is a simple, 10-point scoring system in which a low score reliably identifies those patients at risk for adverse perioperative outcomes. Surgical techniques and anesthesia management should be directed in such a way that the Surgical Apgar Score remains higher to avoid postoperative morbidity and mortality.
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Affiliation(s)
- Abhijit Nair
- To whom correspondence should be addressed. E-mail:
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Nijmeijer WS, Folbert EC, Hegeman JH. Author's reply to 'Letter to the Editor: Use of Almelo Hip Fracture Score to predict early mortality following hip fracture surgery'. Injury 2017; 48:1717. [PMID: 28502380 DOI: 10.1016/j.injury.2017.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 04/09/2017] [Indexed: 02/02/2023]
Affiliation(s)
- W S Nijmeijer
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo/Hengelo, Zilvermeeuw 1, 7609 PP Almelo, The Netherlands.
| | - E C Folbert
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo/Hengelo, Zilvermeeuw 1, 7609 PP Almelo, The Netherlands.
| | - J H Hegeman
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo/Hengelo, Zilvermeeuw 1, 7609 PP Almelo, The Netherlands.
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Use of the surgical Apgar score to enhance Veterans Affairs Surgical Quality Improvement Program surgical risk assessment in veterans undergoing major intra-abdominal surgery. Am J Surg 2017; 213:696-705. [DOI: 10.1016/j.amjsurg.2016.05.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 05/21/2016] [Accepted: 05/31/2016] [Indexed: 02/06/2023]
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Abstract
The incidence of symptomatic spinal metastasis has increased due to treatment improvements and longer patient survival. More patients with spinal tumors are choosing operative treatment with an associated increased rate of perioperative complications. Operative metastatic disease treatment complication rates have also increased with overall rates ranging from 5.3% to 76.20%. The common surgical-related complications are iatrogenic dural injury and wound complications. The most common postoperative medical complications are delirium, pneumonia, and deep vein thrombosis. Risk factors for perioperative complications after spinal metastatic surgery include older age, multilevel of spinal metastases, preoperative irradiation, low preoperative Karnofsky Performance Score (10-40) and multiple comorbidities. Charlson Comorbidity Index and New England Spinal Metastasis Score were significant predictor of 30-day complications. The reoperation rate is 10.7%, and the reoperation is most commonly performed in the same admission. In addition, the 30-day mortality rate in this patient population is ∼7% (0.9%-13%) and is influenced by the type of cancer, disease burden, and patient comorbidities. We reviewed the prevalence and risk factors of common perioperative complications that occur with surgical treatment of metastatic spine disease, in an effort to guide the spine surgeon in anticipating and potentially avoiding these complications.
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Strøyer S, Mantoni T, Svendsen LB. Evaluation of the surgical apgar score in patients undergoing Ivor-Lewis esophagectomy. J Surg Oncol 2017; 115:186-191. [DOI: 10.1002/jso.24483] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 09/28/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Simon Strøyer
- The Abdominal Centre; Rigshospitalet; Copenhagen Denmark
| | - Teit Mantoni
- Department of Anaesthesiology, The Abdominal Centre; Rigshospitalet; Copenhagen Denmark
| | - Lars Bo Svendsen
- Department of Surgical Gastroenterology, The Abdominal Centre; Rigshospitalet; Copenhagen Denmark
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One-Year Outcome of Geriatric Hip-Fracture Patients following Prolonged ICU Treatment. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8431213. [PMID: 26881228 PMCID: PMC4737470 DOI: 10.1155/2016/8431213] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/05/2015] [Accepted: 12/13/2015] [Indexed: 02/02/2023]
Abstract
Purpose. Incidence of geriatric fractures is increasing. Knowledge of outcome data for hip-fracture patients undergoing intensive-care unit (ICU) treatment, including invasive ventilatory management (IVM) and hemodiafiltration (CVVHDF), is sparse. Methods. Single-center prospective observational study including 402 geriatric hip-fracture patients. Age, gender, the American Society of Anesthesiologists (ASA) classification, and the Barthel index (BI) were documented. Underlying reasons for prolonged ICU stay were registered, as well as assessed procedures like IVM and CVVHDF. Outcome parameters were in-hospital, 6-month, and 1-year mortality and need for nursing care. Results. 15% were treated > 3 days and 68% < 3 days in ICU. Both cohorts had similar ASA, BI, and age. In-hospital, 6-month, and 12-month mortality of ICU > 3d cohort were significantly increased (p = 0.001). Most frequent indications were cardiocirculatory pathology followed by respiratory failure, renal impairment, and infection. 18% of patients needed CVVHDF and 41% IVM. In these cohorts, 6-month mortality ranged > 80% and 12-month mortality > 90%. 100% needed nursing care after 6 and 12 months. Conclusions. ICU treatment > 3 days showed considerable difference in mortality and nursing care needed after 6 and 12 months. Particularly, patients requiring CVVHDF or IVM had disastrous long-term results. Our study may add one further element in complex decision making serving this vulnerable patient cohort.
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