Callum Taylor
2023-05-02
“Many clinicians fear that post-operative ICU care may result in outcomes inconsistent with older adults’ wishes,
including admission to a nursing home or ongoing support to perform activities of daily living”
“among older adults there is limited information,
regarding patient-reported experience after a post-op ICU admission.
This lack of understanding of the patient’s perception of their outcomes,
result in communication pitfalls and lead to plans inconsistent with their values”
“To address this knowledge gap”
“John Hopkins Adjusted Clinical Groups (ACG) System”
ICD-10 Diagnoses -> “Adjusted Diagnostic Groups”
“A patient with both:
Obstructive Chronic Bronchitis (ICD-9-CM code 491.2) and
Congestive Heart Failure (ICD-9-CM code 428.0)
will fall into only one ADG,
Chronic Medical: Unstable (ADG-11),”
| Allergies | Asthma | Likely To Recur: Progressive |
|---|---|---|
| Chronic Medical - Stable | Dermatologic | Chronic Specialty: Orthopaedic |
| Injuries - Minor | Malignancy | Psychosocial |
| Signs/Symptoms: Uncertain | Discretionary | Time Limited |
Unplanned ICU: 19%
Remainder: 12%
Unplanned ICU: 30%
Remainder: 33%
“…most patients do not experience a high overall symptom burden during the year after surgery.
These findings support the role of aggressive therapy among older adults after major surgery.”
“Many clinicians fear that post-operative ICU care may result
in outcomes inconsistent with older adults’ wishes,
including admission to a nursing home or ongoing support to perform activities of daily living”
| Outcome | Unplanned ICU | No Unplanned ICU |
|---|---|---|
| Home Independent | 52% | 59% |
| Inpatient Rehab | 11.6% | 2.3% |
| Home - Homecare | 35.7% | 38.1% |
| Impaired Independence | 48% | 41% |
| Age | Sex | Income |
|---|---|---|
| Geographic Location | Comorbidity | Frailty |
| Cancer Site | Stage | Year |
modified log-poisson model with an autoregressive correlation structure
Generalised Linear mixed models with a spatial correlation
structure,
and an unstructured covariance matrix
Autoregressive correlation structure
Spatial Correlation structure