A prospective observational study of factors affecting the mortality of elderly patients admitted to the surgical intensive care unit

In India, geriatric medicine is still an evolving field, and the elderly population is expected to increase to 319 million by 2050. However, addressing the healthcare needs of this growing number of vulnerable and heterogeneous populations is a big challenge. Most of the studies on the elderly population are from Western countries; however, data on the outcomes of elderly patients in Indian intensive care units (ICU) is limited. Most of this data is from mixed medical and surgical intensive care units and does not cover the issues related to a perioperative setting. Elderly patients undergoing surgery have additional stressors along with the multiple co-morbidities that accompany old age, that may affect that outcome. Concerns like frailty, comorbidities, poly-pharmacy come up even before admission into the unit. Physiological changes, including immunosenescence -a term used to describe age-related immune dysregulation and alterations in respiratory capacity (loss of lung elasticity, reduced muscle strength, altered sensitivity of respiratory centres to hypoxia and/or hypercapnia) contribute to increased risk of susceptibility to pathogens, viral reactivation, respiratory failure, and finally death. Frail patients have reduced resilience, making their recovery more difficult and prolonging their hospital length of stay. Pre-existing cognitive impairment represents a decisive risk factor for delirium within the ICU, associated with increased mortality and further cognitive decline. Advances in surgical technique and intensive care have significantly reduced the mortality rates of critically ill surgical patients. However, the burden of critically ill surgical patients is increasing as more elderly patients are seeking surgical treatment. Lack of data hinders informed decision making by the clinical team and the family. A better understanding of risk factors associated with mortality of surgical ICU patients is of great importance for treatment evaluation, patient triage and resource allocation. Hence we planned a study to investigate predictors of in-ICU mortality in elderly patients admitted to the surgical ICU, ,to assess the system wise disease spectrum of elderly patients admitted to surgical ICU, to determine mortality in elderly patients admitted to the surgical ICU: during ICU stay, in-hospital and at 28 days.