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Vol. 99. Issue 1.
Pages 41-48 (January 2021)
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Vol. 99. Issue 1.
Pages 41-48 (January 2021)
Original article
DOI: 10.1016/j.cireng.2020.12.011
Influence of frailty in the outcome of surgical patients over 70 years old with admission criteria in ICU
Influencia de la fragilidad en el pronóstico de pacientes quirúrgicos mayores de 70 años con criterios de ingreso en UCI
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Pablo Ruiz de Gopegui Miguelenaa,
Corresponding author
pablo_ruiz87@hotmail.com

Corresponding author.
, María Teresa Martínez Lamazaresa, Javier Miguelena Hyckab, Luis Manuel Claraco Vegaa, Marta Gurpegui Puentea
a Hospital Universitario Miguel Servet, Zaragoza, Spain
b Hospital Universitario Ramón y Cajal, Madrid, Spain
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Tables (5)
Table 1. Result variables.
Table 2. Follow-up and adjusted variables.
Table 3. Anatomical classification of the urgent procedures.
Table 4. Surgical complications during hospitalization.
Table 5. Prognostic variables at hospital discharge.
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Abstract
Introduction

Frailty degree can influence more than age or severity in the outcome of patients older than 70 years undergoing surgery of the digestive system that require immediate postoperative control in the ICU.

Methods

A prospective and observational study of patients over 70 years of age who were admitted to the surgical ICU of a third level hospital immediately after an elective or emergent surgical intervention on the digestive system from June 1, 2018 until June 1, 2019. The variables age, frailty Clinical Frailty Scale (CFS), and modified Frailty Index (mFI), severity (APACHE II), type of surgery, surgical pathology were recorded upon admission. A bivariate analysis was performed to assess the influence of frailty and severity on hospital morbidity and mortality and baseline situation of the patient (in terms of dependence) at 6 months.

Results

A total of 90 patients were recruited, 54.4% of whom were reoperated; 74.4% were initially discharged from the ICU, with 28.4% of readmission and directly associated to frailty (CFS and mFI: P<0.01). The overall mortality at 6 months was 44.5% being CFS (OR=64.3; P<0.05, 95% CI: 12.3–333.9) and APACHE II (OR=1.17; P<0.05; 95% CI: 1.04–1.32) the covariates that best related.

Conclusions

The estimation of frailty by CSF and mFI is directly associated to the surgical morbidity and readmission of elderly and severe patients admitted to the ICU. In addition, CFS and mFI has been efficient as a predictive of mortality at 6 months.

Keywords:
Frailty
APACHE II
General surgery
Critical care
Resumen
Introducción

El grado de fragilidad puede influir más que la edad o la gravedad en el pronóstico de pacientes mayores de 70 años intervenidos de cirugía del aparato digestivo que precisan control postoperatorio inmediato en UCI.

Métodos

Estudio prospectivo y observacional de pacientes mayores de 70 años que ingresaron en UCI quirúrgica de un hospital de tercer nivel inmediatamente después de una intervención quirúrgica electiva o urgente sobre el aparato digestivo desde el 1 de junio de 2018 hasta el 1 de junio de 2019. Se registraron al ingreso las variables edad, fragilidad (Clinical Frailty Scale, CFS, y Modified Frailty Index, mFI), gravedad (APACHE II), tipo de cirugía y entidad quirúrgica. Se realizó un análisis bivariante para evaluar la influencia de la fragilidad y gravedad en la morbimortalidad hospitalaria y situación basal del paciente (en cuanto a dependencia) a 6 meses.

Resultados

Fueron seleccionados 90 pacientes, de los que el 54,4% fueron reintervenidos; el 74,4% fueron dados de alta inicialmente en UCI, con un reingreso del 28,4% y con relación directa con la fragilidad (CFS y mFI: p<0,01). La mortalidad global a los 6 meses fue 44,5%, con CFS (OR=64,3; p<0,05; IC 95%: 12,3–333,9) y APACHE II (OR=1,17; p<0,05; IC 95%: 1,04–1,32) fueron las covariables que mejor se relacionaron.

Conclusiones

La estimación de la fragilidad mediante CSF y mFI tiene relación directa con la morbilidad quirúrgica y el reingreso de pacientes graves de edad avanzada ingresados en UCI. Además, CFS y mFI han resultado eficientes como predictores de mortalidad a los 6 meses.

Palabras clave:
Fragilidad
APACHE II
Cirugía general
Cuidados críticos

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