Mortality In Elderly Patients Research Articles

Machine learning for predicting in-hospital mortality in elderly patients with heart failure combined with hypertension: a multicenter retrospective study.

Heart failure combined with hypertension is a major contributor for elderly patients (≥ 65 years) to in-hospital mortality. However, there are very few models to predict in-hospital mortality in such elderly patients. We aimed to develop and test an individualized machine learning model to assess risk factors and predict in-hospital mortality in in these patients. From January 2012 to December 2021, this study collected data on elderly patients with heart failure and hypertension from the Chongqing Medical University Medical Data Platform. Least absolute shrinkage and the selection operator was used for recognizing key clinical variables. The optimal predictive model was chosen among eight machine learning algorithms on the basis of area under curve. SHapley Additive exPlanations and Local Interpretable Model-agnostic Explanations was employed to interpret the outcome of the predictive model. This study ultimately comprised 4647 elderly individuals with hypertension and heart failure. The Random Forest model was chosen with the highest area under curve for 0.850 (95% CI 0.789-0.897), high accuracy for 0.738, recall 0.837, specificity 0.734 and brier score 0.178. According to SHapley Additive exPlanations results, the most related factors for in-hospital mortality in elderly patients with heart failure and hypertension were urea, length of stay, neutrophils, albumin and high-density lipoprotein cholesterol. This study developed eight machine learning models to predict in-hospital mortality in elderly patients with hypertension as well as heart failure. Compared to other algorithms, the Random Forest model performed significantly better. Our study successfully predicted in-hospital mortality and identified the factors most associated with in-hospital mortality.

EGS SO35 - Emergency laparotomies in the elderly: A patient perspective

Abstract Background Emergency laparotomy is known to convey worse morbidity and mortality for elderly patients. Despite a growing elderly population, there is a limited understanding of the patient experience in emergency laparotomy. This study aims to assess patient satisfaction following emergency laparotomy. Method Patients were identified from the National Emergency Laparotomy Audit (NELA) database, who were aged 80 and above, and underwent surgery between: January 2020 and August 2023 at Torbay Hospital. Of the patients who survived to discharge, a telephone-based interview was undertaken in January 2024. Exclusion criteria included: confusion, severe illness and relook laparotomy. Data was collected on functional status and satisfaction with the procedure. Patients were also asked what they wished they known prior to the operation. Post-operative outcomes were assessed in a separate study. Results 132 cases were undertaken in this period. 72 cases met inclusion criteria. We achieved a 54% response rate. 59% of respondents were living independently post operatively and had no functional decline. 92% of respondents were happy to have had the operation and if given the opportunity again would still have had the procedure. Patients were overall very happy with the information offered prior to the procedure, 8% felt they had no alternative option. One patient was not satisfied with the follow up received. Conclusion Although emergency laparotomy in the elderly is high risk, our data demonstrate excellent patient satisfaction. This study provides a better understanding of what is important to patients; this should be considered in the consent process and communication.

Systemic immune-inflammation index and 2-year all-cause mortality in elderly patients with hip fracture

PurposeTo assess the association between systemic immune-inflammation index (SII) and 2-year all-cause mortality in elderly patients with hip fractures. MethodsWe performed a cohort study of hip fracture patients aged 65 years or older who received hip fracture surgery at a tertiary hospital from January 2005 to March 2022. The SII was calculated as: SII = (neutrophil count * platelet count) / lymphocyte count, based on the latest blood test before discharge. Patients were categorized into 3 groups according to SII tertiles: low SII group (≤770.92 × 109/L), medium SII group (770.92 × 109/L -1293.03 × 109/L), and high SII group (>1293.03 × 109/L). The primary outcome was 2-year all-cause mortality. We evaluated the association between SII and 2-year all-cause mortality using the multivariate Cox regression model. ResultsAmong 2,766 patients, 296 patients died during the 2-year follow-up period. The incidence of 2-year all-cause mortality per 1,000 persons was 90.0 (95% CI, 73.2-110.2) in the low SII group, 86.8 (95% CI, 70.3-106.7) in the medium SII group, and 144.3 (95% CI, 123.1-168.5) in the high SII group. Compared with patients in the low SII group, the hazard ratio for 2-year all-cause mortality was 0.97 (95% Cl 0.69-1.37) in the medium SII group and 1.47 (95% Cl 1.07-2.01) in the high SII group (P for trend, 0.001). ConclusionSII is significantly associated with 2-year all-cause mortality in elderly patients with hip fracture. SII may be used to identify patients at high risk of mortality after hip fracture surgery.

Effects of physical activity on blood pressure and mortality among aged hypertensive patients: A cross-sectional study.

Previous research on physical activity (PA) has mostly concentrated on a single or small number of activities, with scant coverage of the effects of PA on hypertension (HTN) and all-cause mortality. Most studies examining HTN in the elderly have been too small or shown contradictory findings. We conducted a cross-sectional study using 10 cycles of the National Health and Nutrition Examination Survey data from 1999 to 2018. Our sample consisted of respondents aged 65 years or older with HTN, who underwent thorough in-person home interviews. We used a questionnaire to assess their PA levels and divided them into 2 groups: physically active and inactive. We then used logistic analysis to determine the association between PA and death in HTN patients. The gender distribution was nearly equal among the 11,258 participants, with a mean age of 74.36 ± 5.88 years. Nearly 80% of the survey respondents identified as non-Hispanic White. Patients in the physically active group were less likely to suffer from co-morbidities than those in the inactive group. A negative correlation was found between physically active and systolic blood pressure (P < .0001) and a positive correlation between physically active and diastolic blood pressure (P = .0007). There was a much higher risk of death from any cause and heart disease in the inactive group in the uncorrected COX model (HR 2.96, CI 2.65-3.32, P < .0001; HR 3.48, CI 2.64-4.58, P < .0001). The risk of death from any cause and HTN mortality was still significantly higher in the physically inactive group, even after controlling for age, sex, and race or taking all covariates into account. These results have the potential to significantly impact healthcare practices, particularly in the field of geriatric care, by emphasizing the importance of PA in reducing the risk of HTN and mortality in aged patients. The present study underscores the significant benefits of PA in patients aged 65 years and older with HTN. Notably, it was found to reduce systolic blood pressure and have a positive impact on the decrease of all-cause and hypertensive mortality. These findings highlight the crucial role of PA in the health and longevity of aged patients with HTN.

Impact of preoperative nutritional status on morbidity and mortality in elderly patients undergoing subdural hematoma evacuation: the role of the Geriatric Nutritional Risk Index.

Nutritional status has been shown to impact patient outcomes across several neurosurgical procedures. However, few prior studies have assessed associations between preoperative nutritional status and outcomes in elderly patients undergoing subdural hematoma evacuations. The aim of this study was to identify associations between preoperative nutritional status and short-term outcomes in patients aged 65 years and older undergoing subdural hematoma evacuation. A retrospective cohort study was performed using the American College of Surgeons National Surgical Quality Improvement Program database. Geriatric patients (≥ 65 years of age) were categorized into three groups based on the Geriatric Nutritional Risk Index (GNRI): normal, malnourished, and severely malnourished. Patient demographic characteristics, comorbidities, and adverse events (AEs) were assessed. Multivariate logistic regression analyses were used to identify independent predictors of 30-day postoperative AEs, extended length of hospital stay (LOS), 30-day mortality, and nonroutine discharge. Of 2026 study patients, 908 (44.8%) had normal GNRI status, 564 (27.8%) had malnourished GNRI status, and 554 (27.3%) had severely malnourished GNRI status. The proportions of patients who experienced minor AEs (normal 12.7% vs malnourished 13.3% vs severely malnourished 19.0%, p = 0.003) and severe AEs (normal 25.3% vs malnourished 20.7% vs severely malnourished 35.7%, p ≤ 0.001) were greatest in the severely malnourished cohort. Mean LOS significantly increased along with increasing malnourishment (normal 9.1 ± 6.9 days vs malnourished 9.7 ± 7.0 days vs severely malnourished 11.3 ± 7.6 days, p ≤ 0.001), whereas the proportions of patients with 30-day mortality (normal 15.5% vs malnourished 15.6% vs severely malnourished 24.0%, p ≤ 0.001) and nonroutine discharge (normal 59.4% vs malnourished 66.1% vs severely malnourished 69.9%, p ≤ 0.001) similarly increased with increasing malnourishment. On multivariate analyses, severe malnourished status was significantly associated with increased odds of developing any AE (adjusted OR [aOR] 1.72, CI 1.33-2.23, p ≤ 0.001) and extended LOS (aOR 1.47, CI 1.11-1.95, p = 0.007), whereas malnourished status but not severely malnourished status was associated with increased odds of nonroutine discharge (aOR 1.46, CI 1.12-1.92, p = 0.006). Neither malnourished (p = 0.474) nor severely malnourished status (p = 0.367) was associated with increased odds of 30-day mortality. The authors' findings suggest that preoperative nutritional status may have implications for short-term outcomes after subdural hematoma evacuation in patients aged 65 years and older. Further studies are necessary to better optimize nutritional status perioperatively in this patient population.

Predicting mortality of elderly patients undergoing open heart surgery with delirium using sequential organ failure assessment (SOFA), multi-organ dysfunction (MODS), and logistic organ dysfunction system (LODS) scores

PurposeThis study aims to assess the predictive accuracy of SOFA, MODS, and LODS scores in determining the mortality of elderly undergoing open heart surgery with delirium. MethodsA prospective study involved 111 elderly patients who met the inclusion criteria. Data were collected using scoring systems: SOFA, MODS, and LODS. ResultsUpon final follow-up, 86.5 % of the patients had recovered, 13.5 % had died. Sensitivity, specificity, negative, and positive predictive values for predicting mortality in elderly patients were calculated for the SOFA score as 99 %, 73 %, 98 %, and 76 %, respectively. For the MODS score, these values were 95 %, 60 %, 95 %, and 67 %; for the LODS score, they were 92 %, 73 %, 92 %, and 75 %, respectively. The overall accuracy of the three scores—SOFA, MODS, and LODS—was 84 %, 76 %, and 82 %, respectively. ConclusionThe results indicated that the SOFA score exhibited the highest sensitivity and specificity in predicting mortality among elderly individuals

Survival benefit of guideline-directed medical therapy in elderly patients with heart failure with reduced ejection fraction: a systematic review and meta-analysis

Abstract Background Heart failure is a major cause of mortality in the elderly and heart failure-related mortality in elderly patients has increased since 2012. The evidence of guideline-directed medical therapy (GDMT), the four pillars of treatment of heart failure with reduced ejection fraction (HFrEF), remains insufficient in this population. Aim The objective of this study was to assess the survival benefit of the four pillars of GDMT in elderly patients aged ≥ 65-years-old with HFrEF. Methods MEDLINE, EMBASE and the Cochrane Library were searched from inception to 21 July 2023. The inclusion criteria were studies comparing survival between patients ≥ 65-years-old with left ventricular systolic dysfunction receiving and not receiving GDMT. Pooled prevalence, hazard ratio (HR) and risk ratio (RR) were calculated with 95% confidence interval (CI). Heterogeneity was explored through subgroup analyses based on the number of GDMT, age cut-off, sample size, ejection fraction cut-off, study type and study publication date. Results Thirty studies with 86,941 patients from 1994 to 2019 were included. The GDMT group received three drug classes in three studies, two drug classes in four studies, and at least one class in the remaining studies. There were no reported studies on elderly patients receiving four classes of GDMT. Over 5% of the elderly HFrEF patients were frail (Pooled prevelance 7%, 95%CI 2.0–14.0, I2 98%). Frail elderly patients were less likely to receive GDMT (RR 0.63, 95%CI 0.45–0.89, I2 50%, p = 0.009). There was a survival benefit of GDMT in elderly patients with HFrEF (HR 0.70, 95%CI 0.65-0.76, I2 75%, p &amp;lt; 0.001). Elderly patients receiving BB were more likely to develop bradycardia (RR 3.96, 95%CI 2.71-5.80, p &amp;lt; 0.001, I2 0%). There was no difference in the incidence of hypotension, acute renal impairment, and hypoglycemia between the GDMT and control group. The funnel plot appeared asymmetrical which suggests possible publication bias. Conclusion The use of GDMT in elderly HFrEF patients was associated with a survival benefit. Frailty may interfere with the implementation of GDMT. High quality studies are needed to guide the safety and efficacy of GDMT, and the development of guidelines on HFrEF management the in elderly according to frailty status.Forrest plot of overall survival

Impact of atrial high-rate episodes on new onset of atrial fibrillation and all-cause mortality in elderly patients over 90 years old with dual-chamber pacemaker implantation

Objective: To investigate the impacts of atrial high-rate episodes (AHRE) on the risks of new onset of atrial fibrillation and all-cause mortality in elderly patients over 90 years old after cardiac dual-chamber pacemaker implantation. Methods: This study was a retrospective study. Patients aged 90 years and above who were implanted with cardiac dual-chamber pacemakers and followed up in the People's Liberation Army General Hospital from January 2017 to June 2022 were enrolled and divided into AHRE≥6 h group and AHRE<6 h group according to the onset time of AHRE. The primary endpoint was new onset of atrial fibrillation, and the secondary endpoints were all-cause mortality and cardiovascular mortality. Kaplan-Meier survival curve was poltted, and log-rank test was used to compare the differences in the incidence of new onset of atrial fibrillation, all-cause death and cardiovascular death between AHRE≥6 h and AHRE<6 h groups. Multivariate Cox survival analysis was used to investigate the factors affecting new onset of atrial fibrillation, all-cause death and cardiovascular death in elderly patients aged 90 years and above with dual-chamber pacemaker implantation. Results: A total of 169 patients were enrolled, aged (93.95±3.28) years, including 18 females (11%). The median follow-up time was 28.9 months. There were 87 and 82 patients in AHRE≥6 h group and AHRE<6 h group, respectively. Kaplan-Meier survival curve analysis showed that the incidence of new onset of atrial fibrillation (log-rank P<0.001), all-cause death (log-rank P=0.004) and cardiovascular death (log-rank P=0.026) in AHRE≥6 h group was significantly higher than that in AHRE<6 h group.After adjusting for traditional risk factors, multivariate Cox survival analysis showed that AHRE≥6 h was an independent risk factor for new onset of atrial fibrillation (HR=4.046, 95%CI 2.402-6.814, P<0.001) and all-cause mortality (HR=1.668, 95%CI 1.119-2.487, P=0.012) in elderly patients over 90 years old with cardiac dual-chamber pacemaker implantation. However, AHRE≥6 h had no effect on cardiovascular mortality (P>0.05). Anemia (HR=3.098, 95%CI 1.342-7.153, P=0.008) and heart failure with reduced ejection fraction (HR=3.028, 95%CI 1.181-7.763, P=0.021) were both independently associated with cardiovascular mortality. Conclusions: AHRE is common in cardiac dual-chamber pacemakers recipients aged 90 years and above, and AHRE≥6 h can be used as a predictor of new onset of atrial fibrillation or all-cause mortality in these patients.

The Geriatric Nutrition Risk Index Is Not a Prognostic Predictor for Postoperative Morbidity in Extremely Elderly Patients Undergoing Surgery for Proximal Femur Fractures.

Background/Objectives: The geriatric nutrition risk index (GnRI) has been regarded as a useful predictor of morbidity and mortality in elderly patients. This study aimed to determine the use of the GnRI as a prognostic predictor in extremely elderly patients undergoing proximal femur fracture surgery and the usefulness of evaluation tools related to a patient's underlying disease and functional capacity in predicting the prognosis of extremely elderly patients. Methods: We analyzed 548 patients who had undergone surgery for proximal femur fracture caused by trauma, with an age of ≥80 years, without other accompanying trauma. Results: Body mass index (BMI) (OR, 1.077; 95% CI, 1.010-1.149; p = 0.023), serum albumin levels (0.389; 0.223-0.678; p = 0.001), and Charlson comorbidity index (CCI) (1.170; 1.014-1.349; p = 0.031) were determined to be predictors of morbidity in a multivariable regression analysis. The area under the curve (AUC) in the receiver operating characteristic curve of BMI was 0.565 (95% CI, 0.493-0.637; p = 0.065), and the optimal cut-off value could not be determined. The AUC of serum albumin was 0.647 (0.576-0.717; p < 0.001), and the optimal cut-off value was 3.65 g/dL (sensitivity, 72.2%; specificity, 52.7%). The AUC of the CCI was 0.648 (0.580-0.715; p < 0.001), and the optimal cut-off value was 6.5 (sensitivity, 63.3%; specificity, 61.4%). Conclusions: The GnRI was not a predictive factor for patient prognosis after proximal femur fractures in extreme elderly patients. Rather, serum albumin level and CCI, which reflect the patient's underlying comorbid conditions, were more useful in predicting in-hospital morbidity after proximal femur surgery in extremely elderly patients.

The effect of nutritional status at diagnosis on mortality in elderly patients with moderate COVID-19

The effect of nutritional status at diagnosis on mortality in elderly patients with moderate COVID-19

Evaluation of the Geriatric Trauma Outcome Score (GTOS) as a Prognostic Tool in Intensive Care Unit Trauma Patients.

Existing prognostic scoring systems for intensive care unit (ICU) trauma patients require extensive data collection. The Geriatric Trauma Outcome Score (GTOS), which is based on age, injury severity, and transfusion need, has been validated for predicting mortality in elderly patients with trauma; however, its utility in the general ICU trauma population remains unexplored. This retrospective study included 2952 adult ICU trauma patients admitted between 2016 and 2021. The GTOS was calculated as follows: age + (Injury Severity Score × 2.5) + 22 (if transfused within 24 h). The area under the receiver operating characteristic curve (AUROC) was used to assess GTOS's ability to predict mortality. The optimal GTOS cutoff was determined using Youden's index. Mortality rates were compared between the high and low GTOS groups, including a propensity score-matched analysis adjusted for baseline characteristics. This study included 2952 ICU trauma patients, with an overall mortality rate of 11.0% (n = 325). GTOS demonstrated good predictive accuracy for mortality (AUROC 0.80). The optimal cutoff was 121.8 (sensitivity, 0.791; specificity, 0.685). Despite adjustments, patients with GTOS ≥ 121.8 had significantly higher mortality (17.4% vs. 6.2%, p < 0.001) and longer hospital stays (20.3 vs. 15.3 days, p < 0.001) compared to GTOS < 121.8. GTOS showed a reasonable ability to predict mortality in ICU trauma patients across all ages, although not as accurately as more complex ICU-specific models. With its simplicity, the GTOS may serve as a rapid screening tool for risk stratification in acute ICU trauma settings when combined with other data.

Comparison of the quality of logistic regression models and a classification tree in predicting hospital mortality in elderly patients with non-ST-elevation myocardial infarction

Aim. Using the CHAID (Chi Squared Automatic Interaction Detection) method to develop a classification tree for predicting hospital mortality in patients with non-ST-elevation myocardial infarction (non-STEMI) aged 75 years and older and compare the quality of the constructed model with the logistic regression model.Material and methods. A retrospective analysis of the case histories of 119 sequentially enrolled patients aged ≥75 years who were hospitalized in a cardiology department due to non-STEMI in 2020-2021 was carried out. The construction of a predictive model of probability of dying was carried out using the logistic regression method. To assess the impact of various predictors affecting the probability of dying during the of hospitalization period in patients with non-STEMI, a classification tree was developed using the CHAID method. To compare the quality of logistic regression models and the classification tree, the areas under the ROC curve and confidence intervals were estimated.Results. Based on the construction of a binary logistic regression, it was found that the factors increasing hospital mortality were cardiogenic shock (CS): odds ratio (OR) 47.55; 4.00-589.16; p=0.002; new-onset atrial fibrillation: OR 6.45; 1.39-30.42; p=0.018; and the number of points on the GRACE scale: for each increase by 1 point: OR 1.03; 1,00-1,05; p=0.046. Similar data were obtained when analyzing the classification tree: in patients with CS, the predicted mortality was 91.7%. The probability of an unfavorable outcome based on the constructed classification tree was higher than the average in the analyzed sample in persons without CS, 2-3 degree atrioventricular blocks, and pulmonary edema, but with right bundle branch block on the electrocardiogram (25.0%) and in persons without CS and atrioventricular blockages of 2-3 degrees, but with pulmonary edema and a Q wave on the electrocardiogram (50.0%). Both methods of predicting hospital mortality are applicable. There were no statistically significant differences in the quality of both constructed models; the difference in the areas under the ROC curves was 0.043±0.268 with a 95% confidence interval of -0.055-0.141, p=0.387.Conclusion. Both developed methods can be used to determine the probability of dying in a hospital. Currently, the recruitment of patients into a prospective study of a similar design has begun and is continuing, during which validation of the constructed forecasting models is planned.

Relationships between human serum albumin levels and septic shock, in-hospital, and out-of-hospital mortality in elderly patients with pneumonia in different BMI ranges

ObjectiveThis retrospective cohort identified the association of human serum albumin (HSA) with adverse outcomes (septic shock, in-hospital and out-of-hospital mortality) in elderly hospitalized patients who have community-acquired pneumonia (CAP) and specific body mass index (BMI).Materials and methodsThis research included hospitalized CAP individuals (≥ 60 years) and was conducted at a teaching hospital in western China. All the patients were categorized into three populations based on two BMI cutoff values (18.5 kg/m2 and 24 kg/m2). The data was acquired from medical records, local government mortality databases, and telephone interviews. Binomial logistic regression analysis was used to explore the associations between low HSA and septic shock and in-hospital mortality, and Cox regression analysis was used to explore the association between low HSA and out-of-hospital mortality.ResultsA total of 627 patients were included in the analysis of in-hospital death and septic shock, and 431 patients were included in the analysis of out-of-hospital death. The study showed that 120 elderly patients with CAP (19.14%) died in the hospital, while 141 patients (32.71%) died out of the hospital, and 93 patients (14.83%) developed septic shock. No differences in in-hospital and out-of-hospital mortality were observed for BMI values < 18.5 kg/m2 or BMI ≥ 24 kg/m2, regardless of whether HSA was ≥ 40 g/l or < 40 g/l. When 18.5 kg/m2 ≤ BMI < 24 kg/m2, patients with HSA < 40 g/l had both higher in-hospital and out-of-hospital mortality compared with those with HSA ≥ 40 g/l (in-hospital death: 26.13% vs. 11.46%, p < 0.001; out-of-hospital death: 46.15% vs. 19.17%, p < 0.001). No significant differences were observed in the incidence of septic shock between patients with HSA < 40 g/l and those with HSA ≥ 40 g/l either in the overall population or when the BMI values were divided according to the cutoff values of 18.5 kg/m2 and 24 kg/m2. After further logistic regression analysis and adjustment for potential confounders, the results showed that when 18.5 kg/m2 ≤ BMI < 24 kg/m2, elderly CAP patients with HSA < 40 g/l had a higher risk of in-hospital and out-of-hospital mortality compared with those with HSA ≥ 40 g/l (in-hospital death: HR = 1.964, 95%CI = 1.08–3.573; out-of-hospital death: HR = 2.841, 95%CI = 1.745–4.627).ConclusionsHSA levels can predict the risk of in-hospital and out-of-hospital mortality in elderly patients with CAP and normal BMI values. However, HSA cannot predict the risk of septic shock in elderly patients hospitalized with CAP, irrespective of their BMI classification.

Serum Albumin-to-Creatinine Ratio Predicts One-Year Mortality in Elderly Patients with Non-ST-Elevation Acute Coronary Syndrome After Percutaneous Coronary Intervention: A Prospective Cohort Analysis.

BACKGROUND Recently, the albumin-to-creatinine ratio (ACR) has been suggested as a valuable biomarker for adverse events in acute myocardial infarction. However, the prognostic value of ACR in very elderly patients (≥80 years) with non-ST-elevation acute coronary syndrome (NSTE-ACS) after percutaneous coronary intervention (PCI) remains unclear. MATERIAL AND METHODS A total of 354 very elderly patients with NSTE-ACS who underwent PCI were included in this study and followed up for 1 year. Patients were divided into 3 groups according to ACR tertiles. Logistic regression analysis proportional hazard model was used to determine the prognostic value of ACR. RESULTS Sixty-two patients (17.5%) with 114 major adverse cardiovascular and cerebrovascular events (MACCEs) were recorded during 1-year follow-up. Patients with lower ACR tended to be older and had a lower serum albumin level and higher uric acid and creatinine levels (P<0.05). Moreover, patients with lower ACR levels had elevated all-cause mortality and MACCEs. Kaplan-Meier analysis suggested that patients with a lower ACR had a significantly lower survival rate free of all-cause mortality and MACCEs. Multivariable logistic regression analysis demonstrated that ACR was an independent predictor of all-cause mortality in these patients. ROC analysis showed that when ACR was ≤42.8, sensitivity and specificity were 75.2% and 80.2%, respectively, and the area under the ROC curve was 0.802 (95% CI: 0.745-0.859; P<0.001). CONCLUSIONS A lower ACR was associated with a higher incidence of all-cause mortality in very elderly patients with NSTE-ACS after PCI. The ACR is a promising indicator for risk stratification and prognostic assessment in these individuals.

Retrospective Outcome Analysis of Geriatric Traumatic Brain Injury Treated at a Tertiary Care Center in India

Abstract Background Trauma is a major cause of morbidity and mortality in elderly patients and its management is challenging. Outcome assessment in these patients is difficult because of preexisting chronic medical conditions as it may be impossible to isolate the effect of traumatic brain injury. This study aimed to examine the clinical outcomes and epidemiological and clinicoradiological characteristics of geriatric traumatic brain injury patients at a tertiary care center. Methods The clinical records of patients aged ≥60 years with head injuries treated at King George's Medical University between 2016 and 2020 were included in the study. Patients were followed up in the outpatient department or through telephone consultation. The follow-up period was updated using the Glasgow outcome score (GOS) of patients for current neurological status and relevant radiological investigations. Results The mean age of subjects was 66.16 ± 6.55 years. Road traffic accidents were the most frequent cause of brain injuries (448 [68.5%]). In total, 41% of the study patients had severe head injuries (Glasgow coma scale, GCS &lt; 9) at admission. The in-hospital mortality was 25.2%. In total, 60.7% of discharged patients showed favorable outcomes (GOS: 4 or 5). GCS at admission, best motor response, and associated comorbidity (diabetes mellitus) significantly predicted the outcome at 6 months. The majority of the patients (82.6 %) were 60 to 70 years of age. Conclusion Road traffic accidents are the most frequent cause of brain injuries in geriatrics. Most of them were managed medically, and majority were discharged (74.8%). Out of those discharged, 39.3% had unfavorable outcomes.

ASA-score is associated with 90-day mortality after complicated mild traumatic brain injury – a retrospective cohort study

PurposeThis study explores the association of the American Society of Anesthesiologists (ASA) score with 90-day mortality in complicated mild traumatic brain injury (mTBI) patients, and in trauma patients without a TBI.MethodsThis retrospective study was conducted using a cohort of trauma patients treated at a level III trauma center in Stockholm, Sweden from January to December 2019. The primary endpoint was 90-day mortality. The population was identified using the Swedish Trauma registry. The Trauma and Injury Severity Score (TRISS) was used to estimate the likelihood of survival. Trauma patients without TBI (NTBI) were used for comparison. Data analysis was conducted using R software, and statistical analysis included univariate and multivariate logistic regression.ResultsA total of 244 TBI patients and 579 NTBI patients were included, with a 90-day mortality of 8.2% (n = 20) and 5.4% (n = 21), respectively. Deceased patients in both cohorts were generally older, with greater comorbidities and higher injury severity. Complicated mTBI constituted 97.5% of the TBI group. Age and an ASA score of 3 or higher were independently associated with increased mortality risk in the TBI group, with odds ratios of 1.04 (95% 1.00–1.09) and 3.44 (95% CI 1.10–13.41), respectively. Among NTBI patients, only age remained a significant mortality predictor. TRISS demonstrated limited predictive utility across both cohorts, yet a significant discrepancy was observed between the outcome groups within the NTBI cohort.ConclusionThis retrospective cohort study highlights a significant association between ASA score and 90-day mortality in elderly patients with complicated mTBI, something that could not be observed in comparative NTBI cohort. These findings suggest the benefit of incorporating ASA score into prognostic models to enhance the accuracy of outcome prediction models in these populations, though further research is warranted.

Anatomical Evaluation of Proximal Femur Fractures in Trauma Patients Aged 65 or Older Admitted to the Emergency Department

Purpose: This retrospective study aimed to assess the association between classification systems for proximal femur fractures and mid-term mortality in elderly patients, focusing on their clinical and anatomical aspects. Materials and methods: Radiological images of patients aged 65 years and older who underwent surgical procedures for proximal femur fractures were reviewed. Various classification systems were applied, including Anatomical, Pipkin, Garden, Evans-Jensen, Seinsheimer, and AO/OTA classifications. Electronic hospital records provided patient data, and statistical analyses were performed. Results: The study included 298 patients, and the mean age was 81.7±7.3 years, and 63,1% were female. Median length of stay in hospital 7(1-63) days, 19.1% requiring intensive care, and a 13.8% mortality rate within 3 months. Patients were distributed based on anatomical classification, and the distribution of intracapsular and extracapsular fractures according to clinical classifications was detailed. The findings suggest that proximal femur fracture classification systems do not significantly influence mortality rates (p=0.787). Conclusion: Anatomical classification systems may be favored for their simplicity and potential to establish a common language among healthcare professionals. This study provides valuable insights into proximal femur fractures in elderly patients, informing clinical practice.

WP5.9 - Emergency laparotomies in the elderly: a patient perspective

Abstract Aims Emergency laparotomy is known to convey worse morbidity and mortality for elderly patients. Despite a growing elderly population, there is a limited understanding of the patient experience in emergency laparotomy. This study aims to assess patient satisfaction following emergency laparotomy. Methods Patients were identified from the National Emergency Laparotomy Audit (NELA) database, who were aged 80 and above, and underwent surgery between: January 2020 and August 2023 at Torbay Hospital. Of the patients who survived to discharge, a telephone-based interview was undertaken in January 2024. Exclusion criteria included: confusion, severe illness and relook laparotomy. Data were collected on functional status and satisfaction with the procedure. Patients were also asked what they wished they known prior to the operation. Post-operative outcomes were assessed in a separate study. Results 132 cases were undertaken in this period. 72 cases met inclusion criteria. We achieved a 61% response rate. 59% of respondents were living independently post operatively and 61% had no functional decline. 93% of respondents were happy to have had the operation and if given the opportunity again would still have had the procedure. Patients were overall very happy with the information offered prior to the procedure, 7% felt they had no alternative option. One patient was not satisfied with the follow up received. Conclusions Although emergency laparotomy in the elderly is high risk, our data demonstrate excellent patient satisfaction. This study provides a better understanding of what is important to patients; this should be considered in the consent process and communication.

Invasive and conservative management of elderly patients presenting with acute coronary syndrome: A meta-analysis of randomized controlled trials and adjusted observational studies

BackgroundElderly patients are often under-represented in studies about coronary revascularization in acute coronary syndromes (ACS) and undertreated in clinical practice. We sought to evaluate differences in outcomes between an initial invasive or conservative strategy in this subset of patients, MethodsThe analysis was performed following PRISMA guidelines. Randomized controlled trials (RCTs) and adjusted observational studies comparing an invasive and conservative strategy in old patients with ACS were systematically identified. Random or fixed effect model was used accordingly to heterogeneity testing results. Short-term mortality was the primary outcome. 30-day and longer-term re-infarction, MACE and all-cause mortality were secondary endpoints. Sensitivity analysis including RCTs only were performed for the primary endpoint and 1 year mortality and another analysis, stratifying NSTEMI and STEMI studies, was performed for short-term mortality. ResultsInvasive management was associated with lower short and long-term mortality (30 days OR 0.64, 95 % CI 0.54–0.76, p < 0.001; 1 year HR 0.60, 95 % CI 0.52–0.78, p < 0.001; Long-term HR 0.62, 95 % CI 0.55–0.71, p < 0.001) compared to a conservative strategy. In the short-term follow-up, the benefit was preserved when differentiating for NSTEMI or STEMI studies but not when considering only RCTs. Major bleedings were more frequent in the invasive group (30 days OR 1.61, 95 % CI 1.39–1.87, p < 0.001). The mean difference in length of stay was not significantly different between the two strategies (mean difference in days 0.14, 95 % CI -0.79 to 1.06, p = 0.77). ConclusionAn initial invasive strategy might lead to reduced short and long-term mortality in elderly patients presenting with acute coronary syndrome but it is associated with increased bleeding events rate. No difference in hospital stay length was observed. Results were mainly driven by non-randomized studies.

Association of triglyceride-glucose-body mass index with all-cause and cardiovascular mortality among individuals with chronic kidney disease

There is still a paucity of research on the relationship between triglyceride-glucose-body mass index (TyG-BMI) and long-term all-cause and cardiovascular disease (CVD) mortality in patients with chronic kidney disease (CKD). The objective of this study was to explore the relationship between the TyG-BMI index and mortality rate and to determine valuable predictive factors for the survival status of this population. Data were obtained from the National Health and Nutrition Examination Survey (NHANES 2001–2018) and the National Death Index (NDI). We used multivariate Cox regression and restricted cubic spline (RCS) to analyze the link between the TyG-BMI index and all-cause and CVD mortality. Subgroup analysis was conducted according to age, gender, race, education and poverty. In addition, receiver operating characteristic (ROC) curves were utilized to assess the differentiation of the TyG-BMI index in predicting mortality. A total of 3089 individuals were enrolled. Over a median follow-up period of 81 months, 1097 individuals passed away. The RCS analysis revealed a U-shaped link between the TyG-BMI index and all-cause and CVD mortality. The ROC curve indicated that the TyG-BMI index has a stronger diagnostic effect than the TyG index. Subgroup analysis results demonstrated that the TyG-BMI index was more significantly correlated with all-cause and CVD mortality rates in elderly patients. In the American population, a U-shaped association was discovered between the baseline TyG-BMI index and all-cause and cardiovascular mortality rates in CKD patients. The thresholds for all-cause and CVD mortality were found to be 299.31 and 294.85, respectively.