Determinants of 30-day mortality in elderly patients admitted to a cardiovascular surgery intensive care unit.

Bedih Balkan, Zahide Özlem Ulubay, Elif Güneysu, Ahmet Said Dündar, Engin Ihsan Turan
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Abstract

Background: This study aims to identify the factors influencing 30-day morbidity and mortality in patients aged 65 and older undergoing cardiovascular surgery.

Methods: Data from 360 patients who underwent cardiac surgery between January 2012 and August 2021 in the Cardiovascular Surgery Intensive Care Unit (CVS ICU) were analyzed. Patients were categorized into two groups: "mortality+" (33 patients) and "mortality-" (327 patients). Factors influencing mortality, including preoperative, intraoperative, and postoperative risk factors, complications, and outcomes, were assessed.

Results: Significant differences were observed between the two groups in factors affecting mortality, including extubation time, ICU stay duration, blood transfusion, surgical reexploration, aortic clamp duration, glomerular filtration rate (GFR), blood urea nitrogen (BUN), creatinine, hemoglobin A1c (HbA1c) levels, and the lowest systolic blood pressure during the first 24 hours in the ICU (p<0.05). The "mortality+" group had longer extubation times and ICU stays, required more blood transfusions, and had higher BUN-creatinine ratios, but lower systolic blood pressures, GFR, and HbA1c levels. Mortality was also higher in patients needing noradrenaline infusions and those who underwent reoperation for bleeding (p<0.05).

Conclusion: By optimizing preoperative renal function, minimizing extubation time, shortening ICU stays, and carefully managing blood transfusions, surgical reexplorations, aortic clamp duration, and HbA1c levels, we believe that the mortality rate can be reduced in elderly patients. Key strategies include shortening aortic clamp times, reducing perioperative blood transfusions, and ensuring effective bleeding control.

心血管外科重症监护室收治的老年患者 30 天死亡率的决定因素。
背景:本研究旨在确定影响接受心血管手术的 65 岁以上患者 30 天发病率和死亡率的因素:本研究旨在确定影响接受心血管手术的 65 岁及以上患者 30 天发病率和死亡率的因素:分析了 2012 年 1 月至 2021 年 8 月期间在心血管外科重症监护室(CVS ICU)接受心脏手术的 360 名患者的数据。患者被分为两组:"死亡率+"组(33 例)和 "死亡率-"组(327 例)。评估了影响死亡率的因素,包括术前、术中和术后风险因素、并发症和结果:结果:两组患者在影响死亡率的因素方面存在显著差异,包括拔管时间、重症监护室住院时间、输血、手术再次切除、主动脉夹持时间、肾小球滤过率(GFR)、血尿素氮(BUN)、肌酐、血红蛋白 A1c(HbA1c)水平以及重症监护室最初 24 小时内的最低收缩压(p):我们认为,通过优化术前肾功能、尽量缩短拔管时间、缩短重症监护室停留时间,以及谨慎管理输血、手术再探查、主动脉夹钳持续时间和 HbA1c 水平,可以降低老年患者的死亡率。主要策略包括缩短主动脉夹钳时间、减少围手术期输血和确保有效控制出血。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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