@article{7f60c3f4e7904f9192af178318ab672e,
title = "Peri-interventional outcome study in the elderly in Europe A 30-day prospective cohort study",
abstract = "OBJECTIVES The aim of this study was to describe the 30-day mortality rate of patients aged 80 years and older undergoing surgical and nonsurgical procedures under anaesthesia in Europe and to identify risk factors associated with mortality.DESIGN A prospective cohort study.SETTING European multicentre study, performed from October 2017 to December 2018. Centres committed to a 30-day recruitment period within the study period.PATIENTS Nine thousand four hundred and ninety-seven consecutively recruited patients aged 80 years and older undergoing any kind of surgical or nonsurgical procedures under anaesthesia.MAIN OUTCOME MEASURES The primary outcome was all-cause mortality within 30 days after procedure described by Kaplan-Meier curves with 95% CI. Risk factors for 30-day mortality were analysed using a Cox regression model with 14 fixed effects and a random centre effect.RESULTS Data for 9497 patients (median age, 83.0 years; 52.8% women) from 177 academic and nonacademic hospitals in 20 countries were analysed. Patients presented with multimorbidity (77%), frailty (14%) and at least partial functional dependence (38%). The estimated 30-day mortality rate was 4.2% (95% CI 3.8 to 4.7). Among others, independent risk factors for 30-day mortality were multimorbidity, hazard ratio 1.87 (95% CI 1.26 to 2.78), frailty, hazard ratio 2.63 (95% CI 2.10 to 3.30), and limited mobility, hazard ratio 2.19 (95% CI 1.24 to 3.86). The majority of deaths (76%) occurred in hospital. Mortality risk for unplanned ICU admission was higher, hazard ratio 3.57 (95% CI 2.38 to 5.26) than for planned ICU admission, hazard ratio 1.92 (95% CI 1.47 to 2.50). Compared with other studies, the in-hospital complication rates of 17.4 and 3.9% after discharge were low. Admission to a unit with geriatric care within 30 days after the intervention was associated with a better survival within the first 10 days.CONCLUSIONS The estimated 30-day mortality rate of 4.2% was lower than expected in this vulnerable population.",
keywords = "Preoperative assessment, Surgical outcomes, Mortality, Surgery, Frailty, Derivation, Patient, Older",
author = "Mark Coburn and {POSE-Study group} and Wolfgang Buhre and {Smit - Fun}, Valerie",
note = "Funding Information: Financial support and sponsorship: this study was supported by the European Society of Anaesthesiology and Intensive Care (ESAIC) as an ESAIC Research Group. This comprised the advertising of the POSE study and POSE meetings on the annual Euroanaesthesia congress, the indirect use of the ESAIC members contact lists and the financial support for holding three steering committee meetings at the ESAIC Secretariat in Brussels. Funding Information: Assistance with the study: we gratefully acknowledge Prof. Soo Borson (Professor Emerita, University of Washington, Seattle, Washington, USA), the developer of the Mini-Cog screening tool, for her great support with the use of the Mini-Cog tool in our POSE study. Further, we thank Mr. Monroe Coburn for his valuable English language support and Mr. Marian Ohligs for his excellent support with the OpenClinica database. Only Mr. Ohligs listed in this section received compensation for his work. Financial support and sponsorship: this study was supported by the European Society of Anaesthesiology and Intensive Care (ESAIC) as an ESAIC Research Group. This comprised the advertising of the POSE study and POSE meetings on the annual Euroanaesthesia congress, the indirect use of the ESAIC members contact lists and the financial support for holding three steering committee meetings at the ESAIC Secretariat in Brussels. The funder had no role in the study design or in the collection, analysis, interpretation of data, writing of the report or decision to submit the article for publication. POSE-Study group. All contributing co-authors and collaborators are listed in the Supplementary Digital Content 1, http://links.lww.com/EJA/A655. Conflicts of interest: all authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare the following: AK, RR and MC report grants from ESAIC, during the conduct of the study. RDH reports personal fees from Bayer and Regeneron, outside the submitted work. SR reports personal fees from Edwards Lifesciences, Nordic Pharma, Orion Pharma and Vifor Pharma; nonfinancial support from Air Liquide; and grants from FWO, outside the submitted work. WB report grants from STARS, WearIt4Health/Interreg, Fresenius/B. Braun and other financial support from ESA Research Committee, outside the submitted work. MM reports nonfinancial support from Pfizer Serbia and personal fees from Astellas Pharma, outside the submitted work; and World Federation of Societies of Anaesthesiologists (WFSA), Council member and Chair of the Education Committee. SM report grants from the French Government and Health ministry, during the conduct of the study. MC reports personal fees from Baxter Healthcare and Orion Pharma, and grants and personal fees from Air Liquide Sante International, outside the submitted work. TS declares to be a board member of the Perioperative Medicine Clinical Trials Network, UK. OD reports personal fees from Medtronic, outside the submitted work. MLG reports personal fees from Fisher and Paykel, and other financial support for an airway management workshop from Medtronic, outside the submitted work. All other authors declare no competing interests. Funding Information: Pfizer Serbia and personal fees from Astellas Pharma, outside the submitted work; and World Federation of Societies of Anaesthesiologists (WFSA), Council member and Chair of the Education Committee. SM report grants from the French Government and Health ministry, during the conduct of the study. MC reports personal fees from Baxter Healthcare and Orion Pharma, and grants and personal fees from Air Liquide Sant{\'e} International, outside the submitted work. TS declares to be a board member of the Perioperative Medicine Clinical Trials Network, UK. OD reports personal fees from Medtronic, outside the submitted work. MLG reports personal fees from Fisher and Paykel, and other financial support for an airway management workshop from Med-tronic, outside the submitted work. All other authors declare no competing interests. Funding Information: Conflicts of interest: all authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare the following: AK, RR and MC report grants from ESAIC, during the conduct of the study. RDH reports personal fees from Bayer and Regeneron, outside the submitted work. SR reports personal fees from Edwards Lifesciences, Nordic Pharma, Orion Pharma and Vifor Pharma; nonfinancial support from Air Liquide; and grants from FWO, outside the submitted work. WB report grants from STARS, WearIt4Health/Interreg, Fresenius/B. Braun and other financial support from ESA Research Committee, outside the submitted work. MM reports nonfinancial support from Publisher Copyright: Copyright {\textcopyright} 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society of Anaesthesiology and Intensive Care.",
year = "2022",
month = mar,
doi = "10.1097/EJA.0000000000001639",
language = "English",
volume = "39",
pages = "198--209",
journal = "European Journal of Anaesthesiology",
issn = "0265-0215",
publisher = "LIPPINCOTT WILLIAMS & WILKINS",
number = "3",
}