Frail patients admitted to ICU and the utilization of healthcare resources: a systematic review and meta-analysis reporting on secondary outcomes.
CCCF ePoster library. Waters B. Oct 2, 2017; 198186; 39
Dr. Braden Waters
Dr. Braden Waters
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Abstract
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Frail patients admitted to ICU and the utilization of healthcare resources: a systematic review and meta-analysis reporting on secondary outcomes.

Waters, Braden. Division of Critical Care Medicine, McMaster University, Hamilton, ON, Canada.

Varambally, Aditya. School of Medicine, Midwestern University, Glendale, AZ, USA.

Bagshaw, Sean.  Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.

Boyd, John Gordon. Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.

Maslove, David. Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.

Sibley, Stephanie. Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.

Rockwood, Kenneth. Department of Medicine, Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada.

Muscedere, John. Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.


Introduction
Frailty is a clinical state characterized by reduced mobility, weakness, decreased muscle mass, poor nutritional status, and diminished cognitive function rendering frail patients more vulnerable to extrinsic stress, such as infection or trauma. Critically ill frail patients may therefore need increased and prolonged healthcare resources compared to their non-frail counterparts. As the average age of populations increase, the prevalence of frailty increases, which furthers our need to understand the healthcare resources required to treat this at-risk population (1).
 
Objectives
We conducted a systematic review and meta-analysis comparing outcomes in frail and non-frail patients admitted to ICUs (2). Herein we report health service utilization outcomes.
 
Methods
We searched Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, Pubmed, and Clinicaltrials.gov. All study types except for narrative reviews, case reports and editorials were included. Studies must have reported outcomes of frail patients > 18 years of age who were admitted to ICU. Two reviewers independently applied eligibility criteria, assessed quality, and extracted data. Patient-centred outcomes included ICU mortality and health-related quality of life (HRQL). Outcomes focused on health-service utilization were ICU and hospital length of stay (LOS), use of vasoactive medication, receipt of mechanical ventilation (MV), and discharge disposition. Study quality was assessed using the Newcastle-Ottawa Scale (NOS) for observational trials.
 
Results
Ten observational studies enrolling a total of 3030 patients (927 frail and 2103 non-frail patients) were included. The overall study quality on the NOS was moderate with 5 high, 5 moderate, and no low quality studies. There was a significantly increased risk of ICU mortality for frail patients (RR 1.51; 95% CI 1.31, 1.75; p < 0.00001, I2 = 8%). The mean difference among frail and fit patients for Hospital (3.39 days; 95% CI -0.33, 7.10; p = 0.07; I2 = 77%) and ICU (0.33 days; 95% CI -0.78, 1.44; p = 0.56; I273%) LOS was not statistically significant. There was no difference in the use of mechanical ventilation (80% vs. 82%, frail vs non-frail patients: RR 1.01; 95% CI 0.93, 1.10; p = 0.81, I2 = 67%) or vasoactive medication (58% vs 56%, frail vs non-frail patients: RR 1.05; 95% CI 0.88, 1.26; p = 0.57; I2 = 61%) in frail vs non-frail patients. Frail patients were less likely to be discharged to home than non-frail patients (RR 0.59; 95% CI 0.49, 0.71; p < 0.00001; I2= 12%).Two studies reported HRQL at 1 year which was reduced in frail patients due to poor physical function.
 
Conclusions
Frail patients are at increased risk of ICU mortality. Hospital LOS was longer for frail patients, although this was not statistically significant, and there was no difference in ICU LOS. There was no difference in the use of MV or vasoactive medication among frail and non-frail patients. Finally, frail patients are less likely to be discharged to home compared to non-frail patients. These data were unexpected, as we anticipated, based on the pathophysiology of frailty, that these patients would require prolonged hospital admission and weaning from supports provided in the ICU. As populations age, the prevalence of frailty increases (1), and studies are required to elaborate the determinants of these outcomes in frail critically ill patients, and to examine their economic impact.

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