Geographic differences in outcomes after emergency surgery in nonagenarians and centenarians admitted to intensive care in Australia: a population-based study.
8 affiliations
- 1Department of Anaesthesia, Austin Health, 154 Studley Road, Heidelberg, VIC, 3084, Australia.
- 2Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
- 3The Alfred Intensive Care Academic Centre, Bayside Health, Melbourne, VIC, 3004, Australia.
- 4The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation, 101 High Str. Prahran, Melbourne, VIC, 3004, Australia.
- 5The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
- 6Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea.
- 7Department of Anaesthesia, Austin Health, 154 Studley Road, Heidelberg, VIC, 3084, Australia. [email protected].
- 8Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia. [email protected].
Abstract
Introduction
Nonagenarian and centenarian patients increasingly undergo emergency surgery with subsequent intensive care unit (ICU) admission, but it remains unclear whether geographic disparities in outcomes arise during the index hospitalization or emerge after discharge in universal health systems.Methods
We conducted a national, population-based retrospective cohort study using linked data from the Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database and the Australian National Death Index. We included all nonagenarian and centenarian patients admitted to Australian ICUs after emergency surgery between January 1, 2018, and December 31, 2024. Geographic residence on ICU admission was classified with the Modified Monash Model as metropolitan (MMM1) or regional/remote (MMM2-7). Outcomes were ICU mortality, in-hospital mortality, and all-cause post-discharge mortality at 5 years among patients discharged alive. Cox proportional hazards regression was used to examine associations between geographic residence and post-discharge mortality, with adjustment for age, sex, Acute Physiology and Chronic Health Evaluation (APACHE) III score, Sequential Organ Failure Assessment (SOFA) score, major chronic comorbidities, and hospital type.Results
Among 4,887 patients admitted to ICUs after emergency surgery, ICU and hospital mortality did not differ meaningfully by geographic residence. In contrast, among patients discharged alive, regional or remote residence was independently associated with higher post-discharge mortality at 5 years (adjusted HR, 1.133, 95% CI 1.027-1.250, p = 0.013) compared with metropolitan residence. Survival curves diverged after hospital discharge and remained separated throughout follow-up. In a secondary cohort of 7,896 patients undergoing elective surgery, geographic residence was not associated with ICU, in-hospital, or post-discharge mortality.Conclusion
Among nonagenarian and centenarian patients admitted to ICUs after emergency surgery, geographic residence was not associated with mortality during the index hospitalization but was independently associated with higher long-term mortality after discharge. While no differences were observed during the acute care episode, patients residing in regional or remote areas experienced lower post-discharge survival compared with those living in metropolitan areas. These findings highlight potential geographic variation in long-term outcomes and support further investigation into factors influencing post-discharge care and survival among the oldest surgical patients.
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BibTeX
@article{suh2026geographic,
title = {{Geographic differences in outcomes after emergency surgery in nonagenarians and centenarians admitted to intensive care in Australia: a population-based study.}},
author = {Je Min Suh and Jacob Zand and Carl Reyneke and Nattaya Raykateeraroj and David Pilcher and Dong-Kyu Lee and Laurence Weinberg},
journal = {Critical care (London, England)},
year = {2026},
month = jul,
doi = {10.1186/s13054-026-06215-2},
url = {https://europepmc.org/article/MED/42902313},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Geographic differences in outcomes after emergency surgery in nonagenarians and centenarians admitted to intensive care in Australia: a population-based study.
AU - Je Min Suh
AU - Jacob Zand
AU - Carl Reyneke
AU - Nattaya Raykateeraroj
AU - David Pilcher
AU - Dong-Kyu Lee
AU - Laurence Weinberg
PY - 2026
DA - 2026/07/25
JO - Critical care (London, England)
DO - 10.1186/s13054-026-06215-2
UR - https://europepmc.org/article/MED/42902313
AB - Introduction Nonagenarian and centenarian patients increasingly undergo emergency surgery with subsequent intensive care unit (ICU) admission, but it remains unclear whether geographic disparities in outcomes arise during the index hospitalization or emerge after discharge in universal health systems.Methods We conducted a national, population-based retrospective cohort study using linked data from the Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database and the Australian National Death Index. We included all nonagenarian and centenarian patients admitted to Australian ICUs after emergency surgery between January 1, 2018, and December 31, 2024. Geographic residence on ICU admission was classified with the Modified Monash Model as metropolitan (MMM1) or regional/remote (MMM2-7). Outcomes were ICU mortality, in-hospital mortality, and all-cause post-discharge mortality at 5 years among patients discharged alive. Cox proportional hazards regression was used to examine associations between geographic residence and post-discharge mortality, with adjustment for age, sex, Acute Physiology and Chronic Health Evaluation (APACHE) III score, Sequential Organ Failure Assessment (SOFA) score, major chronic comorbidities, and hospital type.Results Among 4,887 patients admitted to ICUs after emergency surgery, ICU and hospital mortality did not differ meaningfully by geographic residence. In contrast, among patients discharged alive, regional or remote residence was independently associated with higher post-discharge mortality at 5 years (adjusted HR, 1.133, 95% CI 1.027-1.250, p = 0.013) compared with metropolitan residence. Survival curves diverged after hospital discharge and remained separated throughout follow-up. In a secondary cohort of 7,896 patients undergoing elective surgery, geographic residence was not associated with ICU, in-hospital, or post-discharge mortality.Conclusion Among nonagenarian and centenarian patients admitted to ICUs after emergency surgery, geographic residence was not associated with mortality during the index hospitalization but was independently associated with higher long-term mortality after discharge. While no differences were observed during the acute care episode, patients residing in regional or remote areas experienced lower post-discharge survival compared with those living in metropolitan areas. These findings highlight potential geographic variation in long-term outcomes and support further investigation into factors influencing post-discharge care and survival among the oldest surgical patients.
SN - 1364-8535
SN - 1466-609X
ER -