Abstract
Objectives:Prediction of ICU admission after surgery are important for rational decision-making for different patients in clinical practice. Little information is available about the risk factors of postoperative ICU admission in elderly patients undergoing orthopedic surgery. This study aimed to identify risk factors and develop a predictive model for postoperative ICU admission in elderly patients undergoing orthopedic surgery.Methods:A total of 2826 cases of elderly patients receiving orthopedic surgery from October 2010 to September 2016 were retrospectively collected and analyzed. Logistic regression was used to evaluate the impacts of covariates. Support vector machine (SVM) was employed to develop a predictive model based on all pre-operative covariates and the demographic information.Results:There were 256 patients transferred to ICU after surgery. ASA III or IV and emergency surgery were found to be independent risk factors while neuraxial anesthesia and joint surgery were protective factors. In addition, a SVM-based predictive model was developed, which had a sensitivity of 90.99%, a specificity of 99.10% and an area under ROC curve of 0.9678.Conclusions:Our study revealed that emergency surgery, anesthesia method, surgery type and ASA grade were risk factors to predict postoperative ICU admission in elderly orthopedic patients.
Highlights
Surgery is a common treatment method for fractures.[1]
The included patients were divided into two groups for further analysis according to postoperative Intensive Care Unit (ICU) admission status
Gender, hypertension, surgery type, anesthesia method, mechanical ventilation, and emergency surgery were significantly associated with postoperative ICU admission
Summary
Surgery is a common treatment method for fractures.[1]. elderly patients are frequently associated with many preoperative comorbidities[2] or may have reduced organ functions, resulting in high complications rates,[3,4] high postoperative mortalities and impaired quality of life.[5,6] Admission to Intensive Care Unit (ICU) for those elderly patients, will lead to high medical costs[7] and heavy medical burdens[8], and poor prognosis.It is important to balance the benefit and harm of the surgery and to choose the timing of the surgery. Surgery is a common treatment method for fractures.[1] elderly patients are frequently associated with many preoperative comorbidities[2] or may have reduced organ functions, resulting in high complications rates,[3,4] high postoperative mortalities and impaired quality of life.[5,6] Admission to Intensive Care Unit (ICU) for those elderly patients, will lead to high medical costs[7] and heavy medical burdens[8], and poor prognosis. Some studies have shown[9] that 90-day overall mortality after hip surgery in elderly patients may be related to the posterior surgical approach, anesthesia technique, and the use of anticoagulant.
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