by Ran Abuhasira, Matthew Anstey, Victor Novack, Somnath
Bose, Daniel Talmor and Lior Fuchs
Annals of
Intensive Care volume 12,
Article number: 20 (2022) Published: 04
March 2022
Background
Intensive care unit (ICU) admissions among older adults are
expected to increase, while the benefit remains uncertain. The availability of
ICU beds varies between hospitals and between countries and is an important
factor in the decision to admit older adults in the ICU. We aimed to assess if
a non-restrictive approach to ICU older adults admission is associated with a
corresponding change in survival.
Methods
Retrospective cohort study that included patients ≥ 80 years
who were admitted to each of the three participating hospitals in Australia,
Israel, and the United States (USA), between the years 2006–2015, each with
distinct ICU capacities and admission criteria. The primary outcomes were
in-hospital mortality and all-cause mortality at 6, 12, 18, and 24 months
following index hospitalization.
Results
The cohort included 62,866 patients with a mean age of 85.9 ± 4.6 years
and 58.8% were women. The ICU admission rates were 22.5%, 2.6% and 2.3% in USA,
Australia, and Israel, respectively. We constructed a model for ICU admissions
based on the USA cohort (highest availability of ICU beds) and then calculated
the expected probabilities for the Israeli and Australian cohorts. For the
patients in the highest quintile of the admission model, actual ICU admission
rates were 67.6% in USA, 22.1% in Australia and 6.0% in Israel. Of these,
in-hospital death rates were 52.3% in Israel, 29.8% in Australia, and 22.1% in
USA. Two years after hospital discharge, the survival rates in the USA and
Australia were 53%, while in Israel 48%.
Conclusion
ICU admission of adults ≥ 80 years is associated with
increased in-hospital survival compared to ward admission, but survival rates 2
years later are similar.
