Background and Goal of Study: Post-operative intensive care admission may improve outcomes, especially in high-risk patients. Very elderly patients (over 80 or 85 years) represent a high-risk population due to their frailty and associated morbidity. The findings of studies exploring the benefits of post-operative intensive care admission for elderly patients are inconsistent. The aim of this study was to determine the impact of age as an independent factor of ICU admission after non-cardiac surgery in Spain using data from the European Surgical Outcome Study (EuSOS).
Materials and Methods: EuSOS study methodology is described in detail in the original article. A descriptive analysis of the Spanish subset of the EuSOS, including demographic and surgical characteristics, was carried out. Age differences of ICU admission and mortality, adjusted by other demographic and surgical variables, were tested by means of a chi squared and Kruskal-Wallis test. A logistic model was fitted to relate age with ICU admission, outcomes and mortality. A multivariate model was built adding the demographic and surgical variables.
Results and Discussion: A total of 677 patients (12.5%) were admitted to an intensive care unit (ICU) after surgery, 339 (50.1%) were less than 65 years, 181 (26,7%) were 65-74 years, 140 (20,7%) were 75-85 years and 17 (2,5%) were over 85 years. Adjusted odds ratio [95% confidence interval (CI)] for ICU admission was 1.1 (0.8-1.4) for patients aged 65-74 years, 0.7 (0.5-1) for patients aged 75-85 years and 0.4 (0.2-0.8) for patients over 85 years, respectively. Age was an independent factor for ICU admission. The global risk-adjusted mortality (by age, ASA, cirrhosis, metastatic disease, surgical specialty, grade and urgency of surgery) was 1.4 (CI 0.9-2.2). No
association between age and hospital mortality was found. Adjusted odds ratio (CI) for hospital mortality was 1.1 (0.7-1.7) for patients aged 65-74 years, 1.3 (0.9-2.1) for patients aged 75-85 years and 1.0 (0.5-2.4) for patients over 85 years, respectively. Factors predictive of hospital mortality were ASA score, urgency of surgery, surgical speciality and diabetes.
Conclusion(s): Patients aged over 80 years appear less likely to be admitted to ICU after non cardiac surgery in Spanish hospitals. There was no significant association between age and postoperative mortality in this cohort.

Intensive care admission and hospital mortality in the elderly after non-cardiac surgery in Spain: secondary analysis of EuSOS study