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Background <p>Demographic aging is expected to substantially affect intensive care medicine, with a growing proportion of elderly patients and increasing clinical complexity, while resources remain limited. It is therefore critical for clinicians and health systems to understand, how intensive care unit (ICU) admissions, outcomes, and treatment intensity across patients of differing age have evolved in recent years. Longitudinal data on these parameters are scarce on the population level.</p> Methods <p>We conducted a retrospective population-based analysis of all German inpatient cases from 2011–2022. Hospitalizations with ICU treatment ≥ 24&#xa0;h were included. Temporal trends in ICU admissions, in-hospital mortality, ICU-related deaths, and use of organ replacement therapies (ORT) were analyzed and stratified by age groups. ORTs comprised mechanical ventilation, renal replacement therapy, and extracorporeal membrane oxygenation.</p> Results <p>Overall, 8.4 million ICU admissions were analyzed. During the observation period, ICU admissions showed an overall decline of 12.6%, driven by reductions in patients aged 65–79&#xa0;years (− 18.1%) and ≥ 80&#xa0;years (− 24%), while remaining stable in younger patients. Despite fewer admissions, ICU-related mortality showed an overall increase from 14.4% to 18.9%, mainly in patients &lt; 80&#xa0;years. Overall, in-hospital deaths declined across all age groups, but the proportion of ICU-related deaths rose among patients &lt; 80&#xa0;years. ORT use increased across all age groups and was associated with persistently high mortality, particularly with combined ORTs (up to 79%). Patients aged 65–79&#xa0;years received combined ORTs most frequently. Patients ≥ 80&#xa0;years had the highest mortality.</p> Conclusions <p>ICU utilization and outcomes in Germany have shifted markedly over the past decade. Declining admissions among older patients, increasing ICU-related mortality in younger patients, and rising treatment intensity underscore age-specific differences in critical care delivery and outcomes, with important implications for ICU admission practices, treatment decisions and future resource planning.</p>

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Decreasing admissions in older and increasing mortality in younger patients: a nationwide observational study of all German ICU cases 2011–2022

  • 期刊论文

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  • 发表日期：

    2026年3月6日

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  • Sarah-Yasmin Thomsen,
  • Nassim Kakavand,
  • Friedrich Alexander von Samson-Himmelstjerna,
  • Ingo Eitel,
  • Christian Jung,
  • Roland Schmitt,
  • Kevin Schulte,
  • Benedikt Kolbrink

摘要

Background

Demographic aging is expected to substantially affect intensive care medicine, with a growing proportion of elderly patients and increasing clinical complexity, while resources remain limited. It is therefore critical for clinicians and health systems to understand, how intensive care unit (ICU) admissions, outcomes, and treatment intensity across patients of differing age have evolved in recent years. Longitudinal data on these parameters are scarce on the population level.

Methods

We conducted a retrospective population-based analysis of all German inpatient cases from 2011–2022. Hospitalizations with ICU treatment ≥ 24 h were included. Temporal trends in ICU admissions, in-hospital mortality, ICU-related deaths, and use of organ replacement therapies (ORT) were analyzed and stratified by age groups. ORTs comprised mechanical ventilation, renal replacement therapy, and extracorporeal membrane oxygenation.

Results

Overall, 8.4 million ICU admissions were analyzed. During the observation period, ICU admissions showed an overall decline of 12.6%, driven by reductions in patients aged 65–79 years (− 18.1%) and ≥ 80 years (− 24%), while remaining stable in younger patients. Despite fewer admissions, ICU-related mortality showed an overall increase from 14.4% to 18.9%, mainly in patients < 80 years. Overall, in-hospital deaths declined across all age groups, but the proportion of ICU-related deaths rose among patients < 80 years. ORT use increased across all age groups and was associated with persistently high mortality, particularly with combined ORTs (up to 79%). Patients aged 65–79 years received combined ORTs most frequently. Patients ≥ 80 years had the highest mortality.

Conclusions

ICU utilization and outcomes in Germany have shifted markedly over the past decade. Declining admissions among older patients, increasing ICU-related mortality in younger patients, and rising treatment intensity underscore age-specific differences in critical care delivery and outcomes, with important implications for ICU admission practices, treatment decisions and future resource planning.