gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Results of a cost-effectiveness analysis as a possible justification for withdrawal of ICU-treatment in older patients

Ergebnisse einer Kosten-Nutzen-Analyse als mögliche Rechtfertigung für das Vorenthalten von intensivmedizinischer Behandlung bei Patienten höheren Alters

Meeting Abstract

  • corresponding author Philip Kunkel - Neurochirurgische Klinik, Universitätskrankenhaus Eppendorf, Hamburg
  • J. Regelsberger - Neurochirurgische Klinik, Universitätskrankenhaus Eppendorf, Hamburg
  • C. Weber - Neurochirurgische Klinik, Universitätskrankenhaus Eppendorf, Hamburg
  • J. Köppen - Neurochirurgische Klinik, Universitätskrankenhaus Eppendorf, Hamburg
  • M. Westphal - Neurochirurgische Klinik, Universitätskrankenhaus Eppendorf, Hamburg

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocDI.01.07

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0149.shtml

Veröffentlicht: 23. April 2004

© 2004 Kunkel et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

As numerous technical advances and the refinement of surgical technique have extended the therapeutic possibilities in medical care to a maximum, economic aspects have become of crucial importance. Due to the often disappointing clinical course of elderly patients undergoing invasive surgical and intensive care procedures, a withdrawal of certain therapies for such patients might need to be considered.

Methods

We retrospectively analyzed the data of patients older than 70 years with the ICU as primary admission ward. Clinical course and costs were related to those of patients younger than 70 years.

Results

From 01/2001 to 11/2003, 48 patients over 70 years of age (mean 77.3yrs) were treated in our ICU as emergencies. Most frequent diagnoses included subdural hematoma (n=16), intracerebral hemorrhage (10), subarachnoid hemorrhage (8), brain tumour (4) and hydrocephalus (3). Nine of 48 (19%) patients died, 22 (46%) were discharged fully and are dependent on further geriatric care. 17 (35%) patients were disabled and are partly dependent. Only 6 of the 48 (12.5%) patients could resume an independent life at home again. Comparing these results with the under 70 years of age group, mortality (19 vs. 9.5%) and morbidity (68.5 vs. 30%) was significantly higher in the older patients. A favorable outcome with independency in daily activities was seen in 60.5% of the younger vs. 12.5% of the older patients. Days spend in intensive care therapy (17.4 vs. 12.5) was shorter for the younger age group. From 01/2001 to 11/2003, 4370 of 4650 (94%) patients were treated in our ICU for only postoperative monitoring reasons. Mean time of duration was 2.3 days with total costs of approximately 5 million Euro. In contrast 280 of 4650 (6%) patients were admitted by emergency criteria. Mean time of ICU treatment in this later group was 15 days, which built up to 4200 ICU-treatment days in total (29.5%) and costs of about 3.8 million Euro.

Conclusions

In our understanding, it would be problematic to base therapeutic decisions of such importance as, whether to treat a whole group of patients with an overall more unfavorable outcome in an ICU or not, on the basis of a cost-effectiveness analysis, given the fact that a good number (12.5%) of these patients clearly profit. Our decision has to be guided by the individual clinical course, and with respect to the patients presumed will.