Activities of daily living associated with postoperative intensive care unit survival in elderly patients following elective major abdominal surgery

Abstract

Elderly patients who undergo major abdominal surgery are being in increasing numbers. Intensive care unit (ICU) survival is critical for surgical decision-making process. Activities of daily living (ADL) are associated with clinical outcomes in the elderly. We aimed to investigate the relationship between ADL and postoperative ICU survival in elderly patients following elective major abdominal surgery. We conducted a retrospective cohort study involving patients aged ≥65 years admitted to the surgical intensive care unit (SICU) following elective major abdominal surgery. Data from all patients were extracted from the electronic medical records. The Barthel Index (BI) was used to assess the level of dependency in ADL at the time of hospital admission. ICU survivors group had higher Barthel Index (BI) scores than non-survivors group ( P < .001). With the increase of BI score, postoperative ICU survival rate gradually increased. The ICU survivals in patients with BI 0–20, BI 21–40, BI 41–60, BI 61–80 and BI 81–100 were 55.7%, 67.6%, 72.4%, 83.3% and 84.2%, respectively. In logistic regression, The Barthel Index (BI) was significantly correlated with the postoperative ICU survival in elderly patients following elective major abdominal surgery (OR = 1.33, 95% CI: 1.20–1.47, P = .02). The area under the receiver operating characteristic (ROC) curve of Barthel Index in predicting postoperative ICU survival was 0.704 (95% CI, 0.638–0.771). Kaplan–Meier survival curve in BI≥30 patients and BI < 30 patients showed significantly different. Activity of daily living upon admission was associated with postoperative intensive care unit survival in elderly patients following elective major abdominal surgery. The Barthel Index(BI) ≥30 was associated with increased postoperative ICU survival. For the elderly with better functional status, they could be given more surgery opportunities. For those elderly patients BI < 30, these results provide useful information for clinicians, patients and their families to make palliative care decisions.

Relationship between Degree of Dependency and Hospitalization Time of Surgical Patients

“…Likewise, during surgical interventions, unexpected situations may arise that delay their resolution and encourage modifying the surgical procedure initially established, which, added to the physical, psychological, and demographic characteristics of the users, determine the post-surgery process. Aspects that have a considerable impact on rehabilitation time and patient survival, (6,(22)(23)(24) more so when the nursing resource is scarce or when the care needs exceed their working hours. (4) Situations that must be addressed by those responsible of the health sector for better management of the nursing resource and of their clinical practice, which will contribute to increased patient satisfaction.…”

“…For this reason, the risk-benefit assessment of the surgery and the health staff’s foreseeing incidences, gains relevance upon its planning to achieve the independence of patients in the shortest time and under the best conditions. 6 …”

“…For this reason, the riskbenefit assessment of the surgery and the health staff's foreseeing incidences, gains relevance upon its planning to achieve the independence of patients in the shortest time and under the best conditions. (6) Patients with comorbidities or sensitive conditions known prior to the surgery have prolonged hospitalization time and greater demand for nursing care, according to their degree of dependency. On average, one third of patients undergoing elective abdominal surgery fail to restore normal mobility after four weeks of the surgical intervention, due in large part to extensive surgeries, open surgeries, post-surgery complications, and reduced mobility levels during the postoperative.…”

Health-related quality of life among critically ill patients after discharge from the ICU—A systematic review protocol

“…Poor HRQOL among ICU survivors is a significant concern linked to higher mortality, financial burden, and family caregiver burden [11][12][13]. Indeed, survivors with better HRQOL generally have less anxiety, depression, and Post-traumatic stress disorder (PTSD) [14][15][16]. Over the past several decades, poor HRQOL among ICU survivors has received increasing attention from researchers, leading to a growth in HRQOL research.…”

Is a guideline required to predict the intensive care unit need of patients over 65 years of age during the preoperative period? A comparison of the American Society of Anesthesiologists, lung ultrasound score, Charlson age-added comorbidity index, surgical outcome risk tool indexes

“…[ 1 ] The physiological changes accompanying aging cause an increase in pre-operative risks and the development of post-operative complications in geriatric patients. [ 2 ] Perioperative adverse events may be prevented by identifying patients at risk with pre-operative consultations in geriatric patients; patients are tried to be returned to baseline and have better functional status after the surgical procedure. [ 1 ] The aging does not increase the surgical risk solely; however, advanced age is associated with an increased prevalence of chronic diseases and organ functions deteriorate.…”