title: Association between age and use of intensive care among surgical Medicare beneficiaries.
abstract: OBJECTIVE
  The purpose of this study is to determine the role age plays in use of intensive care for patients who have major surgery.
  
  
  METHODS
  Retrospective cohort study examining the association between age and admission to an intensive care unit (ICU) for all Medicare beneficiaries 65 years or older who had a hospitalization for 1 of 5 surgical procedures: esophagectomy, cystectomy, pancreaticoduodenectomy, elective open abdominal aortic aneurysm repair (open AAA), and elective endovascular abdominal aortic aneurysm repair (endo AAA) from 2004 to 2008. The primary outcome was admission to an ICU. Secondary outcomes were complications and hospital mortality. We used multilevel mixed-effects logistic regression to adjust for other patient and hospital-level factors associated with each outcome.
  
  
  RESULTS
  The percentage of hospitalized patients admitted to ICU ranged from 41.3% for endo AAA to 81.5% for open AAA. In-hospital mortality also varied, from 1.1% for endo AAA to 6.8% for esophagectomy. After adjusting for other factors, age was associated with admission to ICU for cystectomy (adjusted odds ratio [AOR], 1.56 [95% confidence interval, 1.36-1.78] for age 80-84+ years; 2.25 [1.85-2.75] for age 85+ years compared with age 65-69 years), pancreaticoduodenectomy (AOR, 1.26 [1.06-1.50] for age 80-84 years; 1.49 [1.11-1.99] for age 85+ years), and esophagectomy (AOR, 1.26 [1.02-1.55] for age 80-84 years; 1.28 [0.91-1.80] age 85+ years). Age was not associated with use of intensive care for open AAA or endo AAA. Older age was associated with increases in complication rates and in-hospital mortality for all 5 surgical procedures.
  
  
  CONCLUSIONS
  The association between age and use of intensive care was procedure specific. Complication rates and in-hospital mortality increased with age for all 5 surgical procedures.
authors.affiliation: Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. Electronic address: hw2125@columbia.edu.
authors.forename: Hannah
authors.initials: H
authors.lastname: Wunsch
authors.forename: Hayley B
authors.initials: HB
authors.lastname: Gershengorn
authors.forename: Carmen
authors.initials: C
authors.lastname: Guerra
authors.forename: John
authors.initials: J
authors.lastname: Rowe
authors.forename: Guohua
authors.initials: G
authors.lastname: Li
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D006278:Medicare; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative; D014481:United States
keywords: Aged; Hospital mortality; Intensive care unit; Surgical procedures; Triage; operative