PURPOSE: Literature suggests that the elderly account for approximately 17-48% of all ICU admissions. Invasive mechanical ventilation (IMV) is a common therapy administered in the ICU to support the failing respiratory system. National outcomes of elderly patients (particularly those aged 80 and above) undergoing IMV in terms of mortality and discharge dispositions have not been studied previously.
METHODS: Using the Nationwide Inpatient Sample from 2008, patients aged 80 or above, discharged with an ICD-9 procedure code for IMV (96.7) were identified. Outcome variables included all cause in-hospital-mortality, length of stay (LOS) and discharge disposition and were compared to age <80 years. Chi-square and Wilcoxan sign rank test were used to compare categorical and continuous variables between the two groups, respectively. Multivariate logistic regression analysis was performed to adjust for demographical and hospital characteristics, primary payer and Charlson's co-morbidity index. A subgroup analysis was performed in those requiring prolonged IMV (>96 hours).
RESULTS: Patients aged ≥80 accounted for 18.7% of the 940,538 estimated hospital admissions requiring IMV. The unadjusted all cause in hospital mortality in patients aged ≥80 was 45.7% and 28.4% in patients with age <80 (p<0.001). The adjusted odds ratio was 1.9 (95% confidence interval 1.89-1.98). Patients with aged ≥80 had lower discharge rate to home (10.2% vs. 34.3%, p<0.001) and higher discharge rate to skilled nursing facility (41.4% vs. 17.8%, p<0.001) and hospice care (13.1% vs. 4.0%, p<0.001). Those requiring prolonged IMV, the mortality were significantly higher in ages≥80 (47.3% vs. 42.9%) and discharge to home was dismal (3.8% vs. 13.2%, p< 0.001) The LOS in patients who survived was not different in two groups.
CONCLUSIONS: Patients aged 80 and above undergoing IMV have significantly higher mortality. Outcomes are worse in those who requiring prolonged IMV with only 3.8% of the survivors being discharged home.
CLINICAL IMPLICATIONS: Goals of care and quality of life need to be discussed in octogenarians and nonagenarians undergoing mechanical ventilation.
DISCLOSURE: The following authors have nothing to disclose: Gagan Kumar, Amit Taneja, Jayshil Patel, Nilay Kumar, Ankit Sakhuja, Rahul Nanchal
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