Journal articles on the topic 'Older people Surgery Complications Japan'
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Hewitt, Jonathan, Margaret Marke, Calum Honeyman, Simon Huf, Aida Lai, Anni Dong, Tom Wright, et al. "Cognitive impairment in older patients undergoing colorectal surgery." Scottish Medical Journal 63, no. 1 (February 2018): 11–15. http://dx.doi.org/10.1177/0036933017750988.
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Background With increasing numbers of older people being referred for elective colorectal surgery, cognitive impairment is likely to be present and affect many aspects of the surgical pathway. This study is aimed to determine the prevalence of cognitive impairment and assess it against surgical outcomes. Methods The Montreal Cognitive Assessment (MoCA) was carried out in patients aged more than 65 years. We recorded demographic information. Data were collected on length of hospital stay, complications and 30-day mortality. Results There were 101 patients assessed, median age was 74 years (interquartile range = 68–80), 54 (53.5%) were women. In total, 58 people (57.4%) ‘failed’ the Montreal Cognitive Assessment test (score ≤ 25). There were two deaths (3.4%) within 30 days of surgery in the abnormal Montreal Cognitive Assessment group and none in the normal group. Twenty-nine (28.7%) people experienced a complication. The percentage of patients with complications was higher in the group with normal Montreal Cognitive Assessment (41.9%) than abnormal Montreal Cognitive Assessment (19.9%) ( p = 0.01) and the severity of those complications were greater (chi-squared for trend p = 0.01). The length of stay was longer in people with an abnormal Montreal Cognitive Assessment (mean 8.1 days vs. 5.8 days, p = 0.03). Conclusion Cognitive impairment was common, which has implications for informed consent. Cognitive impairment was associated with less postoperative complications but a longer length of hospital stay.
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Dhesi, Jugdeep. "Access to surgery: a geriatrician's perspective." Bulletin of the Royal College of Surgeons of England 94, no. 9 (October 1, 2012): 302–3. http://dx.doi.org/10.1308/147363512x13448516926829.
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Older people are less likely to have surgery than younger people. This is true even for conditions more prevalent in the older population. given that older surgical patients have higher rates of post-operative complications, longer lengths of stay and higher mortality than younger patients, these findings are not particularly surprising.
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Jennett, Bryan. "High Technology Therapies and Older People." Ageing and Society 15, no. 2 (June 1995): 185–98. http://dx.doi.org/10.1017/s0144686x00002361.
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ABSTRACTTherapies to save or sustain the lives of elderly patients are sometimes used when they can bring little benefit, and sometimes denied because of age to patients who could benefit. Selection for treatment should depend on balancing probable benefits and burdens for the patient and on the patient's preferences. Burdens include those of the treatment itself, the risk of complications and of extending life of poor quality. Factors to consider when deciding are illustrated by reference to intensive care, surgery, dialysis, cardiopulmonary resuscitation and tube feeding.
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Singh, Jagdeep, Anton Stift, Sarah Brus, Katharina Kosma, Martina Mittlböck, and Stefan Riss. "Rectal cancer surgery in older people does not increase postoperative complications - a retrospective analysis." World Journal of Surgical Oncology 12, no. 1 (2014): 355. http://dx.doi.org/10.1186/1477-7819-12-355.
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Kato, Yuki, Ken Muramatsu, Yoshinori Yamamoto, Yoshie Suzuki, and Ryo Momosaki. "Strategies for Effective Home Modification in Older Adults." Geriatric Orthopaedic Surgery & Rehabilitation 12 (January 1, 2021): 215145932110207. http://dx.doi.org/10.1177/21514593211020704.
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There are various barriers to home modifications to prevent falls among the older population. Several strategies may be necessary to overcome these barriers and implement effective home modifications. The need for home modification should be assessed, which requires a home evaluation by a specialist. In Japan, welfare housing environment coordinators have been trained to provide advice on home modifications suitable for people with disabilities. In addition, in Japan, home assessment and advice on home modification before discharge from acute care hospitals for older people is allowed as a medical reimbursement, and a system for effective home modification is well established. Human resource training and medical policy arrangements on home modifications could improve the cost-effectiveness. In Japan, a system has been established to support the costs of home modification and environmental maintenance. Financial support has reduced the barrier to home modification. Fixed grab bars or shower chairs can be rented, which may be more cost-effective than purchasing them and may shorten the time required for installation. There may be psychological barriers to home modification for older population. Since many older people do not recognize the importance of home modification, promotion to convey the value of home modification may be necessary. Training of staff to engage in home modification, public financial support for modification, and ideas for reducing psychological hesitation may help to reduce the barriers for home modification and to enable effective home modification.
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Maeda, Hiromichi, Takehiro Okabayashi, Kengo Ichikawa, Jyunichi Miyazaki, Kazuhiro Hanazaki, and Michiya Kobayashi. "Colorectal Cancer Surgery in Patients Older than 80 Years of Age: Experience at One Nonteaching Hospital in Japan." American Surgeon 77, no. 11 (November 2011): 1454–59. http://dx.doi.org/10.1177/000313481107701132.
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The safety and efficacy of surgical treatment for colorectal cancer in patients older than 80 years of age are seldom assessed. The aim of the present study was to compare short- and long-term outcomes after surgery between younger and elderly patients at a single nonteaching hospital. In all, 342 consecutive patients who underwent surgical resection for invasive primary colorectal cancer between April 1999 and April 2007 were included in the study. Patients were divided into two groups according to their age at the time of surgery, those younger than 79 years of age (n = 283) and those older than 80 years of age (n = 59). A greater proportion of elderly patients had concurrent disease before surgery, right-sided colon cancer, and postoperative complications. Cox proportional hazards model (multivariate analysis) identified three independent risk factors for a poor outcome after surgery (excluding death by other causes): 1) the presence of preoperative symptoms; 2) noncurative resection for colorectal cancer; and 3) the presence of lymph node metastases. Age older than 80 years was not a risk factor for a poor postoperative prognosis. At our nonteaching hospital, surgical resection appears to be a safe and beneficial treatment option for elderly patients (older than 80 years of age) who have colorectal cancer.
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Suzuki, Noriko, Masahiko Hashizume, and Hideyuki Shiotani. "Prevalence and Risk Factors of Postprandial Hypotension Among Japanese Older Adults in a Facility." Innovation in Aging 4, Supplement_1 (December 1, 2020): 222. http://dx.doi.org/10.1093/geroni/igaa057.716.
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Abstract Postprandial hypotension (PPH) is an unrecognized sudden drop of blood pressure (BP) after meals and a hidden problem among older people including those living in long-term care facilities (LTCFs). Though PPH causes dizziness, falls, and syncope, it has received little attention from¬¬¬ healthcare workers (HCW) including caregivers, nurses and physicians, and risk factors of PPH should be carefully assessed to improve quality of life. Therefore, we aimed to examine the prevalence and risk factors of PPH in a LTCF in Japan. Participants were 114 older adults living in a LTCF in Japan (mean age 85.9 years old; 85 female (74%)). To examine PPH, blood pressure (BP) was measured before and after lunch. BP after meal was measured four times every 30 minutes. PPH is defined as a BP drop of 20 mmHg or more and we also defined a BP drop within a range of 19 to 15 mmHg as potential-PPH. As risk factors, we compared systolic and diastolic BP at baseline, body mass index, pulse rate, disease and complications between groups with/without PPH. The prevalence of PPH was 41% (47/114) and 52% with potential-PPH; 11% (13/114) added. Among risk factors, systolic BP was significantly higher in those with PPH (142.6 vs 123.5 mmHg, p <0.001). This study revealed that PPH & potential-PPH occurred in half of the subjects in a LTCF in Japan. HCW need to focus on high systolic BP to predict PPH and future research is necessary to prevent and cope with PPH for older people.
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Khan, Mostafa Saidur Rahim, Pattaphol Yuktadatta, and Yoshihiko Kadoya. "Who Became Lonely during the COVID-19 Pandemic? An Investigation of the Socioeconomic Aspects of Loneliness in Japan." International Journal of Environmental Research and Public Health 19, no. 10 (May 20, 2022): 6242. http://dx.doi.org/10.3390/ijerph19106242.
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The COVID-19 pandemic has impacted social and economic aspects of people’s lives in different ways, causing them to experience different levels of loneliness. This study examines the extent of loneliness among men and women of various ages in Japan during the pandemic and attempts to determine the underlying causes. We used data from Hiroshima University’s nationwide survey conducted before and during the pandemic in Japan. The sample consists of 3755 participants, of which 67% are men and 33% are women with an average age of 51 years (SD = 13.64). Using mean comparison tests and probit regression models, we show that loneliness is a common occurrence among the Japanese population and that a significant number of people became lonely for the first time during the pandemic. In general, loneliness was greater among younger respondents, but older people became lonelier during the pandemic. Simultaneously, we observed significant differences in loneliness across age and gender subsamples. Although depression and subjective health status contributed to loneliness, we found no single explanation for the loneliness experienced by people during the pandemic; rather, subsample analysis revealed that the causes of loneliness for each group differed. Nevertheless, we discovered that older people are at a higher risk of developing loneliness during the pandemic due to a variety of socioeconomic and behavioral factors. The findings of this study suggest that health authorities should not generalize cases of loneliness, but rather intervene individually in each group to avoid further complications.
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Hagiwara, Yuriko, Kazumasa Harada, Joshua Nealon, Yasuyuki Okumura, Takeshi Kimura, and Sandra S. Chaves. "Seasonal influenza, its complications and related healthcare resource utilization among people 60 years and older: A descriptive retrospective study in Japan." PLOS ONE 17, no. 10 (October 3, 2022): e0272795. http://dx.doi.org/10.1371/journal.pone.0272795.
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Evidence suggests that older people aged ≥65 years and those aged 60–64 years with chronic medical conditions are at higher risk of developing severe complications due to influenza virus infection when compared with young, healthy adults. Although seasonal influenza is monitored through a nationwide passive surveillance in Japan, influenza related outcomes and medical resource consumption have not been fully documented. This retrospective database study aimed to describe the epidemiological and clinical characteristics of medically attended influenza cases aged ≥60 years and the associated medical resource consumption in Japan. We used clinically diagnosed influenza (CDI) based on the international classification of disease codes, and laboratory-confirmed influenza (LCI) based on influenza test results, to identify the patient population during a total of nine seasons (2010/2011 to 2018/2019). A total of 372,356 CDI and 31,122 LCI cases were identified from 77 medical institutions. The highest numbers of medically-attended influenza episodes were in patients aged 65–74 years and 75–84 years. On average, across seasons, 5.9% of all-cause hospitalizations were attributable to CDI and 0.4% were LCI. Influenza viruses type A and B co-circulated annually in varying degree of intensity and were associated with similar level of complications, including cardiovascular-related. Oxygen therapy increased with age; by contrast, mechanical ventilation, dialysis, blood transfusion, and intensive care unit admission were higher in the younger groups. In-hospital mortality for inpatients aged ≥ 85 years with CDI and LCI were 18.6% and 15.5%, respectively. Considering the burden associated with medically-attended influenza in this population, influenza prevention, laboratory confirmation and clinical management should be emphasized by general practicians and specialists like cardiologists to protect this aging population.
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McIsaac, Daniel I., Coralie A. Wong, Gregory L. Bryson, and Carl van Walraven. "Association of Polypharmacy with Survival, Complications, and Healthcare Resource Use after Elective Noncardiac Surgery." Anesthesiology 128, no. 6 (June 1, 2018): 1140–50. http://dx.doi.org/10.1097/aln.0000000000002124.
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Abstract Background Polypharmacy is increasingly prevalent in older patients and is associated with adverse events among medical patients. The impact of polypharmacy on outcomes after elective surgery is poorly described. The authors’ objective was to measure the association of polypharmacy with survival, complications, and resource use among older patients undergoing elective surgery. Methods After registration (NCT03133182), the authors identified all individuals older than 65 yr old having their first elective noncardiac surgery in Ontario, Canada, between 2002 and 2014. Using linked administrative data, the authors identified all prescriptions dispensed in the 90 days before surgery and classified people receiving five or more unique medications with polypharmacy. The associations of polypharmacy with 90-day survival (primary outcome), complications, length of stay, costs, discharge location, and readmissions were estimated after multilevel, multivariable adjustment for demographics, comorbidities, previous healthcare use, and surgical factors. Prespecified and post hoc sensitivity analyses were also performed. Results Of 266,499 patients identified, 146,026 (54.8%) had polypharmacy. Death within 90 days occurred in 4,356 (3.0%) patients with polypharmacy and 1,919 (1.6%) without (adjusted hazard ratio = 1.21; 95% CI, 1.14 to 1.27). Sensitivity analyses demonstrated no increase in effect when only high-risk medications were considered and attenuation of the effect when only prescriptions filled in the 30 preoperative days were considered (hazard ratio = 1.07). Associations were attenuated or not significant in patients with frailty and higher comorbidity scores. Conclusions Older patients with polypharmacy represent a high-risk stratum of the perioperative population. However, the authors’ findings call into question the causality and generalizability of the polypharmacy-adverse outcome association that is well documented in nonsurgical patients.
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Kitahara, Tomohiro, Taishi Hata, Mamoru Uemura, Naotsugu Haraguchi, Yoshiyuki Motoki, Satoshi Sugimoto, Junichi Nishimura, et al. "Short-Term Outcome of Laparoscopic Surgery in Elderly Colorectal Cancer Patients." International Surgery 104, no. 7-8 (July 1, 2019): 329–32. http://dx.doi.org/10.9738/intsurg-d-15-00108.1.
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We aimed to evaluate the short-term outcome of colorectal resection in very elderly patients, aged 85 years or older. As the population ages, the number of elderly patients with colorectal cancer (CRC) is increasing in Japan. At this time, it is unclear whether or not laparoscopic colorectal resection is safe for this very elderly patient population. From January 2005 to November 2014, a total of 20 patients aged 85 years or older underwent laparoscopic colorectal resection at Osaka University Hospital. Pre- and postoperative clinical data and outcomes were collected retrospectively. There were no intraoperative or postoperative deaths. In 2 cases, the laparoscopic procedure was converted to open surgery. Postoperative complications occurred in 6 patients. Two patients developed an infection at the surgical site. Among the 4 patients who underwent low anterior resection (LAR), 2 experienced postoperative anastomotic leakage. Two other patients developed a lung infection and urinary tract infection, respectively. Laparoscopic colectomy for very elderly patients with CRC appears to involve tolerable risk. However, special caution is advisable for patients who may undergo LAR.
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Kobayashi, Kazuyoshi, Shiro Imagama, Kei Ando, Naoki Ishiguro, Masaomi Yamashita, Yawara Eguchi, Morio Matsumoto, et al. "Risk Factors for Delirium After Spine Surgery in Extremely Elderly Patients Aged 80 Years or Older and Review of the Literature: Japan Association of Spine Surgeons with Ambition Multicenter Study." Global Spine Journal 7, no. 6 (April 11, 2017): 560–66. http://dx.doi.org/10.1177/2192568217700115.
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Study Design: Retrospective database analysis. Objective: Spine surgeries in elderly patients have increased in recent years due to aging of society and recent advances in surgical techniques, and postoperative complications have become more of a concern. Postoperative delirium is a common complication in elderly patients that impairs recovery and increases morbidity and mortality. The objective of the study was to analyze postoperative delirium associated with spine surgery in patients aged 80 years or older with cervical, thoracic, and lumbar lesions. Methods: A retrospective multicenter study was performed in 262 patients 80 years of age or older who underwent spine surgeries at 35 facilities. Postoperative complications, incidence of postoperative delirium, and hazard ratios of patient-specific and surgical risk factors were examined. Results: Postoperative complications occurred in 59 of the 262 spine surgeries (23%). Postoperative delirium was the most frequent complication, occurring in 15 of 262 patients (5.7%), and was significantly associated with hypertension, cerebrovascular disease, cervical lesion surgery, and greater estimated blood loss ( P < .05). In multivariate logistic regression using perioperative factors, cervical lesion surgery (odds ratio = 4.27, P < .05) and estimated blood loss ≥300 mL (odds ratio = 4.52, P < .05) were significantly associated with postoperative delirium. Conclusions: Cervical lesion surgery and greater blood loss were perioperative risk factors for delirium in extremely elderly patients after spine surgery. Hypertension and cerebrovascular disease were significant risk factors for postoperative delirium, and careful management is required for patients with such risk factors.
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Thillainadesan, Janani, Sarah Aitken, Sue Monaro, John Cullen, Richard Kerdic, Sarah Hilmer, and Vasi Naganathan. "Geriatric Comanagement Reduces Hospital-Acquired Geriatric Syndromes in Older Vascular Surgery Inpatients." Innovation in Aging 5, Supplement_1 (December 1, 2021): 324. http://dx.doi.org/10.1093/geroni/igab046.1261.
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Abstract Aims Based on our meta-analysis, surveys and qualitative studies of geriatricians in Australia and New Zealand, we designed and implemented a novel inpatient model to co-manage older vascular surgical inpatients at a tertiary academic hospital in Sydney. This model, called Geriatrics co-management of older vascular surgery patients (Gerico-V), embedded a geriatrician into the vascular surgery unit who introduced a range of interventions targeting older people. Here we evaluated this model of care. Methods We undertook a prospective before-and-after study of consecutive patients aged ≥65 years admitted under vascular surgery. One hundred and fifty-two GeriCO-V patients were compared with 150 patients in the pre- GeriCO-V group. The primary outcomes were hospital-acquired geriatric syndromes, delirium, and length of stay. Results The GeriCO-V group had more frail (43% vs 30%), urgently admitted (47% vs 37%), and non-operative patients (34% vs 22%). These differences were attributed to COVID-19. GeriCO-V patients had fewer hospital-acquired geriatric syndromes (49% vs 65%; P =.005) and incident delirium (3% vs 10%; P = .02), in unadjusted and adjusted analyses. Cardiac (5% vs 20%; P <.001) and infective complications (3% vs 8%]; P = .04) were fewer in the GeriCO-V group. LOS was unchanged. Frail patients in the GeriCO-V group experienced significantly less geriatric syndromes and delirium. Conclusions The Gerico-V model of care led to reductions in hospital-acquired geriatric syndromes, delirium, and cardiac and infective complications. These benefits were seen in frail patients. The intervention requires close collaboration between surgeons and geriatricians, and may be translated to other surgical specialties.
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Dobrinja, Chiara, Marta Silvestri, and Nicolò de Manzini. "Primary Hyperparathyroidism in Older People: Surgical Treatment with Minimally Invasive Approaches and Outcome." International Journal of Endocrinology 2012 (2012): 1–6. http://dx.doi.org/10.1155/2012/539542.
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Introduction. Elderly patients with primary hyperparathyroidism (pHPT) are often not referred to surgery because of their associated comorbidities that may increase surgical risk. The aim of the study was to review indications and results of minimally invasive approach parathyroidectomy in elderly patients to evaluate its impact on outcome.Materials and Methods. All patients of 70 years of age or older undergoing minimally approach parathyroidectomy at our Department from May 2005 to May 2011 were reviewed. Data collected included patients demographic information, biochemical pathology, time elapsed from pHPT diagnosis to surgical intervention, operative findings, complications, and results of postoperative biochemical studies.Results and Discussion. 37 patients were analysed. The average length of stay was 2.8 days. 11 patients were discharged within 24 hours after their operation. Morbidity included 6 transient symptomatic postoperative hypocalcemias while one patient developed a transient laryngeal nerve palsy. Time elapsed from pHPT diagnosis to first surgical visit evidences that the elderly patients were referred after their disease had progressed.Conclusions. Our data show that minimally invasive approach to parathyroid surgery seems to be safe and curative also in elderly patients with few associated risks because of combination of modern preoperative imaging, advances in surgical technique, and advances in anesthesia care.
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Oliveira, Denise Fornazari de, Rodrigo Pessoa Cavalcanti Lira, Álvaro Pedroso Carvalho Lupinacci, Marcelo Paccola, and Carlos Eduardo Leite Arieta. "Cataract surgery complications as a cause of visual impairment in a population aged 50 and over." Cadernos de Saúde Pública 24, no. 10 (October 2008): 2440–44. http://dx.doi.org/10.1590/s0102-311x2008001000024.
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The purpose of this study was to measure the extent to which complications relating to cataract surgery are a cause of visual impairment in a population aged 50 and over from the city of Campinas, São Paulo State, Brazil. An assessment of cataract surgery services was conducted using random cluster sampling, with the sample composed of 60 clusters of 40 people aged 50 years or older. Of the selected sample of 2,400 subjects, 92.67% were examined. Of these 2,224 examined subjects, 75 (3.37%) presented bilateral visual impairment and 164 unilateral, while a total of 314 (7.06%) eyes presented visual impairment. 352 eyes had undergone cataract surgery. The causes of visual impairment after surgery were concurrent eye disease (56%), surgical complications (28.8%) and refractive errors (15.2%). Cataract surgery complications represented the 5th most important cause of visual impairment. The other main causes were cataract, posterior segment disorders, diabetic retinopathy and glaucoma. These results suggest cataract surgery complications are a major cause of visual impairment in this population. Their prevention and treatment must be part of public health care policies.
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Cunha, Juliana Bento da, Maria Clara Pereira Fialho, Sergio Lincoln de Matos Arruda, Otávio Toledo Nóbrega, and Einstein Francisco Camargos. "Bariatric surgery as a safe and effective intervention for the control of comorbidities in older adults." Geriatrics, Gerontology and Aging 14, no. 3 (2020): 207–12. http://dx.doi.org/10.5327/z2447-212320202000037.
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INTRODUCTION: In addition to being associated with worsening of diseases related to metabolic syndrome and musculoskeletal disorders, obesity in older adults increases the risk of falls, frailty syndrome, depression, and dementia, with consequent functional loss. Among all treatments available, bariatric surgery is an option for eligible patients. OBJECTIVES: To discuss aspects related to the safety and benefits of bariatric surgery for the control or remission of comorbidities in older adults. METHODS: This literature review was carried out in databases, using the following keywords: bariatric surgery and elderly or aged or older adult and comorbidities or safety. We included clinical trials, observational studies, comparative studies, and reviews that evaluated the effect of bariatric surgery on the control or remission of comorbidities in older adults. RESULTS: In recent years, several studies have evidenced not only control or remission of comorbidities, such as diabetes, hypertension, and sleep apnea syndrome, but also a low rate of complications, similar to those observed in young people. CONCLUSIONS: Based on the results of these studies, bariatric surgical procedures can be indicated for eligible older adults, without age restriction, taking into account functional and life expectancy aspects.
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Daentzer, Dorothea, and Thilo Flörkemeier. "Conservative treatment of upper cervical spine injuries with the halo vest: an appropriate option for all patients independent of their age?" Journal of Neurosurgery: Spine 10, no. 6 (June 2009): 543–50. http://dx.doi.org/10.3171/2009.2.spine08484.
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Object Most upper cervical spine injuries are able to heal conservatively by halo vest application. The acceptance of the halo is different among patients due to the weight of the apparatus and the limited mobility it causes. Additionally, the fracture healing rate in older patients seems to be inferior to that in younger patients, which would make an operative stabilization procedure more appropriate for the elderly. Furthermore, the risk of complications is assumed to be higher in older people. The purpose of this retrospective study was to find out if there are differences in the clinical and radiological results and in complication rates between 2 patient groups with upper cervical spine injuries and halo vest treatment with special interest of their age group. Methods A total of 29 patients with upper cervical spine injuries were treated by halo vest application. The clinical and radiological results and the complication and revision surgery rates were identified. Patients were divided into 2 groups (18 patients were < 65 years and 11 were > 65 years), and the results were evaluated to examine whether there were any differences. Results The clinical and radiological results and the complication rate were not statistically significantly different between the 2 patient groups; however, there was a tendency for a longer time interval for fracture healing and more complications in the elderly people. Conclusions If the conditions for conservative treatment of upper cervical spine injuries with halo fixation are right, the clinical and radiological results are good and almost similar in patients regardless of their age, although there is a tendency for more complications in older people.
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Kobayashi, Kazuyoshi, Shiro Imagama, Kei Ando, Naoki Ishiguro, Masaomi Yamashita, Yawara Eguchi, Morio Matsumoto, et al. "Complications Associated With Spine Surgery in Patients Aged 80 Years or Older: Japan Association of Spine Surgeons with Ambition (JASA) Multicenter Study." Global Spine Journal 7, no. 7 (July 20, 2017): 636–41. http://dx.doi.org/10.1177/2192568217716144.
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Boumrah, T., J. Fahmy, S. Trippier, A. Hainsworth, J. Madigan, E. Pereira, P. Minhas, and A. Shtaya. "P112 Management and outcome of subarachnoid haemorrhage (SAH) in older people: a centre series." Journal of Neurology, Neurosurgery & Psychiatry 90, no. 3 (February 14, 2019): e51.3-e50. http://dx.doi.org/10.1136/jnnp-2019-abn.167.
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ObjectivesTo study the management and factors associated with outcomes in SAH in elderly over 80 years of age.DesignRetrospective records review.SubjectsAll Patients with SAH confirmed on head CT admitted Jan 2012-Dec 2017.MethodsWe admitted 1079 patients with SAH, 32 were aged ≥80 y (3%). We subdivided the patients into a poor outcome group (POG) (Modified Rankin Scale (mRS) 4–6), (n=24, 14F/10M, mean age 83.7±0.7 y) and good outcome group (GOG) (mRS 0–3) (n=8, 7F/1M, mean age 82.6±0.6 y). Spearman’s rank-order test evaluated correlation between outcome (mRS) and all other variables (WFNS grade, GCS, Motor score of GCS, age, sex, smoking, hypertension, intraventricular haemorrhage (IVH) and intracerebral haemorrhages (ICH)).Results9 patients (38%) of POG were WFNS grades IV – V versus 1 patient (13%) in GOG. More POG than GOG patients had IVH (83% vs 38%, rs=−0.44 p=0.011). 20% of POG had ICH vs none in GOG. GOG patients had better GCS (rs=−0.37, p=0.04), lower WFNS grade (rs=0.43, p=0.01) and did not need external ventricular drain (EVD) (rs=0.51, p=0.003). There was no significant correlation between outcome and sex, smoking, hypertension, size of aneurysm (4.9 mm ±1.0 in GOG vs 5.4 mm ±1.1 in POG, rs=−0.29, p=0.28), percentage receiving coiling or clipping, GCS motor score, procedure complications and general medical complications.Conclusions75% of patients’ aged ≥80 y with SAH had poor outcome. WFNS grade (I-III), higher GCS patients who did not need EVD had better outcome.
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Peltrini, Roberto, Nicola Imperatore, Filippo Carannante, Diego Cuccurullo, Gabriella Teresa Capolupo, Umberto Bracale, Marco Caricato, and Francesco Corcione. "Age and comorbidities do not affect short-term outcomes after laparoscopic rectal cancer resection in elderly patients. A multi-institutional cohort study in 287 patients." Updates in Surgery 73, no. 2 (February 14, 2021): 527–37. http://dx.doi.org/10.1007/s13304-021-00990-z.
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AbstractPostoperative complications and mortality rates after rectal cancer surgery are higher in elderly than in non-elderly patients. The aim of this study is to evaluate whether, like in open surgery, age and comorbidities affect postoperative outcomes limiting the benefits of a laparoscopic approach. Between April 2011 and July 2020, data of 287 patients with rectal cancer submitted to laparoscopic rectal resection from different institutions were collected in an electronic database and were categorized into two groups: < 75 years and ≥ 75 years of age. Perioperative data and short-term outcomes were compared between these groups. Risk factors for postoperative complications were determined on multivariate analysis, including age groups and previous comorbidities as variables. Seventy-seven elderly patients had both higher ASA scores (p < 0.001) and cardiovascular disease rates (p = 0.02) compared with 210 non-elderly patients. There were no significative differences between groups in terms of overall postoperative complications (p = 0.3), number of patients with complications (p = 0.2), length of stay (p = 0.2) and death during hospitalization (p = 0.9). The only independent variables correlated with postoperative morbidity were male gender (OR 2.56; 95% CI 1.53–3.68, p < 0.01) and low-medium localization of the tumor (OR 2.12; 75% CI 1.43–4.21, p < 0.01). Although older people are more frail patients, short-term postoperative outcomes in patients ≥ 75 years of age were similar to those of younger patients after laparoscopic surgery for rectal cancer. Elderly patients benefit from laparoscopic rectal resection as well as non-elderly patient, despite advanced age and comorbidities.
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Bondariev, R. V., L. Yу Markulan, V. M. Ivantsok, O. O. Bondarieva, and M. M. Levon. "NATURE OF POST-SURGERY COMPLICATIONS AFTER CHOLECYSTECTOMY OF DESTRUCTIVE CHOLECYSTITIS IN PATIENTS OF AN OLDER AGE GROUP WITH A ISCHEMIC HEART DISEASE." Kharkiv Surgical School, no. 4 (October 12, 2020): 15–19. http://dx.doi.org/10.37699/2308-7005.4.2020.03.
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Аbstract. The significance of the problem of acute cholecystitis in the elderly and senile is due to a high increase in the incidence, the presence of marked concomitant diseases.
There is no literature data on a comparative analysis of early post-surgery complications of acute destructive cholecystitis in elderly and senile patients with concomitant coronary heart disease after traditional cholecystectomy and laparoscopic cholecystectomy.
The Aim of the study is a comparative analysis of the nature of early post-surgery complications after traditional cholecystectomy and laparoscopic cholecystectomy of acute destructive cholecystitis in the elderly and senile with concomitant coronary heart disease.
Materials and methods of research. A comparative analysis of early post-surgery complications was performed in 392 patients aged 60 and over with concomitant coronary heart disease who underwent surgical treatment for acute destructive cholecystitis. Depending on the method of surgical treatment, patients were divided into two groups: the І group (n = 178) — surgical treatment was carried out in the amount of traditional cholecystectomy, sanitation of the abdominal cavity with saline and decasan solution; the ІІ group (n = 214) — surgical treatment included laparoscopic cholecystectomy, sanitation of the abdominal cavity with saline and «decasan» solution, extraction of the gallbladder in a rubber sterile container through a subxiphoid wound, which, after removal of the gallbladder, was sanitized with «decasan» solution.
Research results. Complications from the cardiovascular system in the 1st group were noted in 2.8 % of patients, pneumonia — 1.1 %, from the abdominal cavity — 8.5 %, wounds — 25.8 %, postoperative intestinal paresis — 19, 1 %, mortality — 1.1 %. In the 2nd group, complications from the cardiovascular system — 0.5 %, from the abdominal cavity — 4.7 %, wounds — 4.2 %, postoperative intestinal paresis — 8.4 %, mortality — 0.5 %. Complications related to bile leakage, the development of biloma or biliary peritonitis in the groups did not differ.
Conclusions. The use of laparoscopic cholecystectomy in acute destructive cholecystitis in elderly people with concomitant coronary heart disease has reduced the number of postoperative complications from the cardiovascular system compared with traditional cholecystectomy from 2.8 % to 0.5 %, from the abdominal cavity — from 8.5 to 4.7 %, from the side of the wound — from 25.8 to 4.2 %, reduce mortality from 1.1 to 0.5 %.
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Pignata, Giusto. "Laparoscopic treatment for acute diverticular disease." Acta chirurgica Iugoslavica 53, no. 3 (2006): 19–22. http://dx.doi.org/10.2298/aci0603019p.
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Diverticular disease of the sigmoid colon involves more than 50% of population over 60 years, and much more in people older than 80 years. Most patients remain asymptomatic, but, about 10-20% develop complications requiring surgery. Colonic diverticulitis represents an acute bowel inflammation, in many cases, confined only to the sigmoid and descending colon. Recurrent attacks and complications of diverticulitis require surgical procedure, although most cases can be managed medically. The cause of acute diverticulitis remains obscure. It has been speculated that obstruction at the mouth of the diverticulum results in diverticulitis, similar to appendicitis, but this is no longer the accepted theory, and some feel that chronic inflammation precedes clinical diverticulitis. .
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McIsaac, Daniel I., Dean A. Fergusson, Rachel Khadaroo, Amanda Meliambro, John Muscedere, Chelsia Gillis, Emily Hladkowicz, and Monica Taljaard. "PREPARE trial: a protocol for a multicentre randomised trial of frailty-focused preoperative exercise to decrease postoperative complication rates and disability scores." BMJ Open 12, no. 8 (August 2022): e064165. http://dx.doi.org/10.1136/bmjopen-2022-064165.
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IntroductionFrailty is a strong predictor of adverse postoperative outcomes. Prehabilitation may improve outcomes after surgery for older people with frailty by addressing physical and physiologic deficits. The objective of this trial is to evaluate the efficacy of home-based multimodal prehabilitation in decreasing patient-reported disability and postoperative complications in older people with frailty having major surgery.Methods and analysisWe will conduct a multicentre, randomised controlled trial of home-based prehabilitation versus standard care among consenting patients >60 years with frailty (Clinical Frailty Scale>4) having elective inpatient major non-cardiac, non-neurologic or non-orthopaedic surgery. Patients will be partially blinded; clinicians and outcome assessors will be fully blinded. The intervention consists of >3 weeks of prehabilitation (exercise (strength, aerobic and stretching) and nutrition (advice and protein supplementation)). The study has two primary outcomes: in-hospital complications and patient-reported disability 30 days after surgery. Secondary outcomes include survival, lower limb function, quality of life and resource utilisation. A sample size of 750 participants (375 per arm) provides >90% power to detect a minimally important absolute difference of 8 on the 100-point patient-reported disability scale and a 25% relative risk reduction in complications, using a two-sided alpha value of 0.025 to account for the two primary outcomes. Analyses will follow intention to treat principles for all randomised participants. All participants will be followed to either death or up to 1 year.Ethics and disseminationEthical approval has been granted by Clinical Trials Ontario (Project ID: 1785) and our ethics review board (Protocol Approval #20190409-01T). Results will be disseminated through presentation at scientific conferences, through peer-reviewed publication, stakeholder organisations and engagement of social and traditional media.Trial registration numberNCT04221295.
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Shlyafer, S. I., and I. B. Shikina. "EVALUATION OF INDICATORS CHARACTERIZING INPATIENT SURGICAL CARE DELIVERY TO OLDER PATIENTS IN THE RUSSIAN FEDERATION." Social Aspects of Population Health 67, no. 5 (2021): 5. http://dx.doi.org/10.21045/2071-5021-2021-67-5-5.
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Significance: Population ageing challanges the majority of the world including the Russian Federation. Older people are more subject to operative interventions, including high tech interventions. The purpose of the study is to analyze indicators characterizing the level of surgical care deivery to older patients in the Russian hospitals in 2011-2019. Material and methods. Indicators characterising surgical care delivery in hospitals were analyzed including: the number of patients operated; the number of operations performed, including high tech interventions; the number of deaths after surgery, including after high tech interventions; frequency of postoperative complications; postoperative mortality among older patients (women - 55 years and older, men - 60 years and older). The authors used data of the federal statistical observation form No. 14 "Information onabout performance of units of medical organizations providing inpatient medical care" for the period from 2011 to 2019. Statistical (calculations of extensive and intensive indicators) and analytical methods were applied. Results. The share of older patients out of all patients operated in 2019 in the Russian hospitals equalled to 35.2% (vs 23.1% in 2011), including high tech interventions (18.9% of all operations). Conclusion: among older patients the study has identified: an 18.8% increse in the number of patients discharged from hospitals; a 5.6% increase in the number of patients operated; a 63.5% increase in the number of operations in the hospital, including a 2.6 fold increase in the number of operations using high technologies; a 73.4 % increase in the number of operated patients who died in the hospital; including a 3.8 fold increase in the number of patients died after operations using high technologies; postoperative mortality rate of patients increased from 2.21 to 2.39%. The rate of postoperative complications associated with all operations decreased from 1.06 to 0.64%, including decrease from 1.74 to 0.97% in postoperative complications associated with operations using high technologies.
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Soutter, L., D. Sivapathasuntharam, C. Uff, and S. Yordanov. "435 THE IMPACT OF COMPREHENSIVE GERIATRIC ASSESSMENT IN THE OUTCOMES OF OLDER ACUTE NEUROSURGICAL PATIENTS." Age and Ageing 50, Supplement_2 (June 2021): ii8—ii13. http://dx.doi.org/10.1093/ageing/afab116.02.
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Abstract Introduction As the population ages, an increasing proportion of the neurosurgical caseload is comprised of older patients. This trend is reinforced by technical advances and anaesthetic considerations within the field, allowing a higher proportion of patients eligible for surgery. Comprehensive geriatric assessment (CGA) is the gold standard clinical approach for evaluating older patients. Peri-operative care of older people (POPS) has provided strong evidence that CGA services can result in fewer post-operative complications. However, this evidence stems largely from trauma and orthopaedic surgery. Currently, there is little evidence of the impact CGA has on older neurosurgical patients. The study aimed to investigate whether CGA for older neurosurgical patients improved outcomes such as thirty-day mortality and length of stay. Methods A control group was established by collecting retrospective data for all acute neurosurgical patients over the age of 65. This was then compared with an intervention group who received CGA in the form of regular geriatric consultant reviews. 49 patients were recruited into each group. Results Analysis showed that the interventional group had a significantly higher mean age and level of frailty. They also had more confirmed complications with a significant difference in the diagnosis of pneumonia (p = 0.05) and hyponatremia (p = 0.015). Despite this, the thirty-day mortality was lower and average length of stay was on average two days shorter compared to the control group, although this did not reach statistical significance (p = 0.701). The study showed that more patients who received a CGA were discharged home (p = 0.209). Conclusion Our findings suggest that CGA input for older neurosurgical patients improves outcomes and should be incorporated routinely into neurosurgical clinical pathways.
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Daykin, Harriet. "The efficacy and safety of intravenous lidocaine for analgesia in the older adult: a literature review." British Journal of Pain 11, no. 1 (October 24, 2016): 23–31. http://dx.doi.org/10.1177/2049463716676205.
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Opioids remain the mainstay of analgesia for the treatment of moderate to severe acute pain. Even in the young, the use of opioids can be associated with an increased incidence of post-operative complications such as respiratory depression, vomiting, pruritus, excessive sedation, slowing of gastrointestinal function, and urinary retention. The need to manage acute pain in the older patient is becoming more common as the population ages, and increasingly older patients are undergoing more major surgery. Medical conditions are more common in older people and can result in the requirement of systemic analgesia for fractures, malignancy, nociceptive or neuropathic pain and peripheral vascular disease. Effective pain control can be difficult in older patients as there is a higher incidence of coexistent diseases, polypharmacy and age-related changes in physiology, pharmacodynamics and pharmacokinetics. Consequently, due to the fear of respiratory depression in older people, this leads to inadequate doses of opioid being given for the treatment of their pain. Lidocaine has analgesic, anti-hyperalgesic and anti-inflammatory properties and is metabolized by the liver which is limited by perfusion, and heart failure or drugs can alter this, affecting its clearance. Therefore, there are concerns regarding safety in older patients as plasma concentrations have both intersubject and intrasubject variability. The aim of this literature review is to assess the efficacy and safety of intravenous lidocaine as an adjuvant in pain management for the older patient. In total, 12 studies fulfilled the criteria. Lidocaine infusions were found to reduce pain scores and be opioid sparing in abdominal and urological surgery, in patients with opioid-refractory malignancy pain, neuropathic pain and critical limb ischaemia. Patients with malignancy were more likely to develop adverse effects, but no patients required treatment for lidocaine toxicity.
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Radic, Nevenka, Kristina Radinovic, Mihailo Ille, Aleksandar Lesic, Mirjana Ljubicic-Stojanovic, and Marko Bumbasirevic. "The selection of best anesthesiological technique for hip fracture surgery in older high-risk patients." Acta chirurgica Iugoslavica 59, no. 3 (2012): 113–15. http://dx.doi.org/10.2298/aci1203113r.
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Introduction: Hip fracture is a pathological condition, more common in older age, i.e. in people over 65 years. The prevalence of this disorder is continuously increasing, simultaneously with higher age limit. In evaluation of risk for operation and anesthesia, older age itself represents higher risk and calls for special attention. In selection of anesthesiological technique, it is more usual to apply neuroaxial block or peripheral nerve block, which is more advantageous over general anesthesia. CASE REPORT: A female, 80-year old, patient B.D. was admitted to hospital for hip fracture, with the diagnosis of the right, lateral, basicervical femoral fracture. On admission, heart decompensation (decompensated dilated myocardiopathy), pulmonary edema and the left lateral pleural effusion were established. Due to high risk (ASA III) of intraoperative and postoperative complications, it was decided to apply combined peripheral nerve block. Using the neurostimulators, 3-in-1 block, lumbosacral block and sciatic nerve block were applied. During the operation, the patient was sedated by Propofol and had spontaneous respiration through the laryngeal mask. Intra- and postoperatively, the patient?s hemodynamics was stable. Conclusion: Peripheral nerve blocks are safe and effective anesthesiological technique, which may reduce the mortality in patients with the hip fracture and maintain the hemodynamic stability, both during and after the surgical intervention.
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Kim, Yu Jeong, Su Jin Park, Jong Yeon Lee, Dae Yeong Lee, and Dong Heun Nam. "Intraoperative Complications of Cataract Surgery Using Intracameral Illumination in the Elderly over 75 Years." Journal of Ophthalmology 2019 (January 10, 2019): 1–5. http://dx.doi.org/10.1155/2019/1594152.
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Purpose. To evaluate intraoperative complications and utilization of adjunctive devices between microscope and intracameral illuminations during cataract surgery in the elderly over 75 years. Design. A retrospective, consecutive, interventional case series Participants. Two hundred eighty-six eyes of 184 patients older than 75 years who underwent cataract surgery using microscope and intracameral illuminations. Methods. A chart review was performed on an advanced cataract surgery group of 141 consecutive cases in which the intracameral illumination was used and on a standard cataract surgery group of 145 consecutive cases in which the intracameral illumination was not used. Main Outcome Measures. Intraoperative complications (posterior capsule rupture, radial tear of the anterior capsule, dropped nucleus, or sulcus-implanted/sclera-fixated IOL) and utilization of adjunctive devices (pupil expansion device or anterior capsule staining). Results. The frequency of use of the pupil expansion device was lower in the advanced cataract surgery group than that in the standard cataract surgery group (0.7% vs 6.9%; p=0.007). Furthermore, the rates of a posterior capsule rupture and at least one intraoperative complication were lower in the advanced cataract surgery group than those in the standard cataract surgery group (0.7% vs 4.8%; p=0.067) (0.7% vs 7.6%; p=0.004). Conclusions. In the current cohort of patients over 75 years, the rate of intraoperative complications was lower when using the intracameral illumination than that when using the conventional method. Cataract surgery using intracameral illumination would be good option for elderly people.
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Partridge, Judith S. L., Andrew Healey, Bijan Modarai, Danielle Harari, Finbarr C. Martin, and Jugdeep K. Dhesi. "Preoperative comprehensive geriatric assessment and optimisation prior to elective arterial vascular surgery: a health economic analysis." Age and Ageing 50, no. 5 (June 11, 2021): 1770–77. http://dx.doi.org/10.1093/ageing/afab094.
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Abstract Background increasing numbers of older people are undergoing vascular surgery. Preoperative comprehensive geriatric assessment and optimisation (CGA) reduces postoperative complications and length of hospital stay. Establishing CGA-based perioperative services requires health economic evaluation prior to implementation. Through a modelling-based economic evaluation, using data from a single site clinical trial, this study evaluates whether CGA is a cost-effective alternative to standard preoperative assessment for older patients undergoing elective arterial surgery. Methods an economic evaluation, using decision-analytic modelling, comparing preoperative CGA and optimisation with standard preoperative care, was undertaken in older patients undergoing elective arterial surgery. The incremental net health benefit of CGA, expressed in terms of quality-adjusted life-years (QALYs), was used to evaluate cost-effectiveness. Results CGA is a cost-effective substitute for standard preoperative care in elective arterial surgery across a range of cost-effectiveness threshold values. An incremental net benefit of 0.58 QALYs at a cost-effectiveness threshold of £30k, 0.60 QALYs at a threshold of £20k and 0.63 QALYs at a threshold of £13k was observed. Mean total pre- and postoperative health care utilisation costs were estimated to be £1,165 lower for CGA patients largely accounted for by reduced postoperative bed day utilisation. Conclusion this study demonstrates a likely health economic benefit in addition to the previously described clinical benefit of employing CGA methodology in the preoperative setting in older patients undergoing arterial surgery. Further evaluation should examine whether CGA-based perioperative services can be effectively implemented and achieve the same clinical and health economic outcomes at scale.
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Sumin, A. N. "Assessment and Correction of the Cardiac Complications Risk in Non-cardiac Operations – What's New?" Rational Pharmacotherapy in Cardiology 18, no. 5 (November 5, 2022): 591–99. http://dx.doi.org/10.20996/1819-6446-2022-10-04.
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Cardiovascular complications after non-cardiac surgery are the leading cause of 30-day mortality. The need for surgical interventions is approximately 5,000 procedures per 100,000 population, according to experts, the risks of non-cardiac surgical interventions are markedly higher in the elderly. It should be borne in mind that the aging of the population and the increased possibilities of medicine inevitably lead to an increase in surgical interventions in older people. Recent years have been characterized by the appearance of national and international guidelines with various algorithms for assessing and correcting cardiac risk, as well as publications on the validation of these algorithms. The purpose of this review was to provide new information about the assessment and correction of the risk of cardiac complications in non-cardiac operations. Despite the proposed new risk assessment scales, the RCRI scale remains the most commonly used, although for certain categories of patients (with oncopathology, in older age groups) the possibility of using specific questionnaires has been shown. In assessing the functional state, it is proposed to use not only a subjective assessment, but also the DASI questionnaire, 6-minute walking test and cardiopulmonary exercise test). At the next stage, it is proposed to evaluate biomarkers, primarily BNP or NT-proBNP, with a normal level – surgery, with an increased level – either an additional examination by a cardiologist or perioperative troponin screening. Currently, the prevailing opinion is that there is no need to examine patients to detect hidden lesions of the coronary arteries (non-invasive tests, coronary angiography), since this leads to excessive examination of patients, delaying the implementation of non-cardiac surgery. The extent to which this approach has an advantage over the previously used one remains to be studied.
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Mori, Koreaki. "Management of idiopathic normal-pressure hydrocephalus: a multi-institutional study conducted in Japan." Journal of Neurosurgery 95, no. 6 (December 2001): 970–73. http://dx.doi.org/10.3171/jns.2001.95.6.0970.
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Object. A cooperative study was undertaken to identify factors that could be used to predict a favorable outcome after extracranial cerebrospinal fluid (CSF) diversion (shunting) in patients with suspected idiopathic normal-pressure hydrocephalus (NPH). Methods. Questionnaires concerning patients with suspected idiopathic NPH were sent to 14 members of the Committee for Scientific Research on Intractable Hydrocephalus, sponsored by the Ministry of Health and Welfare of Japan. After the questionnaires were returned, a retrospective analysis of the responses was undertaken. To be included in the study, patients had to be 65 years of age or older and had to have undergone surgery between October 1995 and October 1998. Clinical measures included degrees of gait disturbance, dementia, and urinary incontinence as evaluated before, 3 months after, and 3 years after shunt placement. Diagnostic tests in various combinations included lumbar puncture in which CSF was withdrawn; intracranial pressure monitoring; measurements of CSF outflow resistance, level of serum α-1-antichymotrypsin, cerebral arteriovenous differences of oxygen content, and cerebral blood flow; and computerized tomography cisternography. In this study, 120 patients were identified as having idiopathic NPH and these patients underwent placement of shunts. A ventriculoperitoneal shunt with a programmable valve was used in two thirds of the patients. At the end of 3 months (early assessment), there was an 80% overall rate of clinical improvement, which dropped to 73.3% of the 105 patients who could be evaluated at the end of the 3-year study. Of the three variables, gait disturbance was most improved, both at early and late testing periods. Shunt complications occurred in 22 (18.3%) of the patients. Conclusions. Patients suspected of having idiopathic NPH did not form a homogeneous group, making it difficult to select those who would most likely respond to CSF diversion. Of the diagnostic studies, the most reliable result was improvement in clinical symptoms following a lumbar puncture in which CSF was withdrawn. The use of a programmable valve is recommended because it offers advantages in preventing problems of over- and underdrainage.
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Wernio, Edyta, Sylwia Małgorzewicz, Jolanta Anna Dardzińska, Dariusz Jagielak, Jan Rogowski, Agnieszka Gruszecka, Andrzej Klapkowski, and Peter Bramlage. "Association between Nutritional Status and Mortality after Aortic Valve Replacement Procedure in Elderly with Severe Aortic Stenosis." Nutrients 11, no. 2 (February 20, 2019): 446. http://dx.doi.org/10.3390/nu11020446.
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Background: There is still a lack of data on the nutritional status of older people with aortic stenosis (AS) and the effect of poor nutrition on the occurrence of complications and mortality after an aortic valve replacement (AVR) procedure. The aim of this study was to assess the impact of selected nutritional status parameters in elderly patients with severe AS on the occurrence of postoperative complications and one-year mortality after the AVR procedure. Methods: 101 elderly patients with AS aged 74.6 ± 5.2 years who qualified for surgical treatment (aortic valve area [AVA] 0.73 ± 0.2 cm2) were enrolled in the study. A nutritional status assessment was performed before AVR surgery, and the frequency of postoperative complications occurring within 30 days of surgery was assessed. The one-year mortality rate was also captured. Results: Adverse events (both major and minor) up to 30 days occurred in 49.5% (n = 50) of the study population. Low Mini Nutritional Assessment (f-MNA) and Subjective Global Assessment (7-SGA) scores and low concentrations of total cholesterol, LDL-cholesterol, and prealbumin were associated with a higher risk of postoperative complications. The risk of complications increased 1.22 times (95% CI; 1.030–1.453; p = 0.019) with an impaired nutritional status. The annual mortality rate in the study group was 7.9%. Unintentional weight loss of >2.8% in the six months preceding surgery proved useful for predicting death within the first year after AVR surgery. Conclusions: The results indicate that poor nutritional status is an important factor affecting the adverse outcomes in elderly patients with severe aortic valve stenosis undergoing an AVR procedure.
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NASSIF, Paulo Afonso Nunes, Osvaldo MALAFAIA, Jurandir Marcondes RIBAS-FILHO, Nicolau Gregori CZECZKO, Rodrigo Ferreira GARCIA, and Bruno Luiz ARIEDE. "WHEN AND WHY OPERATE ELDERLY OBESE." ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) 28, suppl 1 (2015): 84–85. http://dx.doi.org/10.1590/s0102-6720201500s100022.
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Introduction : Concurrently with the pandemic obesity is observed global aging phenomenon, with a significant increase of obesity in the elderly population. Aim : To review the indications for bariatric surgery for the elderly, mainly focusing on the morbidity and mortality of procedures. Method : Review of the literature in PubMed/Medline and Scielo focusing on the relationship of risk factors with different techniques of bariatric surgery in the elderly. The following descriptors were crossed in the form of AND/OR: Obesity; Bariatric surgery; Complications; Elderly. Conclusion : In people older than 60 years bariatric procedures represent acceptable and effective treatment option. The elderly should be treated in specialized centers with experience in major surgical procedures and low morbimortality. Going in this way, they experience the benefits of bariatric surgery with acceptable morbidity and mortality. However, age alone should not be considered as an absolute impediment for surgical indication.
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Yamamoto, Michiro, James Curley, and Hitoshi Hirata. "Trends in Open vs. Endoscopic Carpal Tunnel Release: A Comprehensive Survey in Japan." Journal of Clinical Medicine 11, no. 17 (August 24, 2022): 4966. http://dx.doi.org/10.3390/jcm11174966.
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We analyzed trends in open and endoscopic carpal tunnel release (CTR) from 2014 to 2019 using the National Database of Health Insurance Claims and Specific Health Checkups in Japan (NDB). Japan has a universal health insurance system and more than 95% of all claims are searchable in the NDB open data repository. The results revealed that nearly 40,000 CTRs were performed annually in Japan, and open CTR was performed almost 4 times more often than endoscopic CTR. The crude annual incidence of CTR in the general population among people 20 years of age or older was 32.2 per 100,000. The incidence of open CTR peaked in the 80–84 age range for both males and females. The incidence of endoscopic CTR peaked at 80–84 years in females and at 75–79 years in males. There was a mild correlation coefficient between the endoscopic CTRs and the number of hand surgery specialists by prefecture per population (r = 0.32, p = 0.04). However, the number of hand surgeons per capita by region and open CTR per capita was not correlated (r = 0.06, p = 0.67). There were about twice as many outpatient as inpatient surgeries, reflecting a trend toward ambulatory treatment.
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Alnaser, Mumtaz Khudhur Hanna, Zuhair Basheer Kamal, Wissam Isam Wardia, and Bashar Hazim Basheer. "Thyroidectomy in elderly ; is it safe?" AL-Kindy College Medical Journal 18, no. 3 (December 31, 2022): 213–18. http://dx.doi.org/10.47723/kcmj.v18i3.878.
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Background: The prevalence of thyroid nodules rise with age and different data available about the risks of thyroid surgery in old age people. In general, old age could be a predictor of perioperative mortality and morbidity. The aim of this study is to prove if there is increased risk accompanying thyroidectomy in elderly patients. Subjects and Methods: Prospective study of one surgeon of study sample undergoing thyroid surgery at Al-Kindy teaching hospital and Saint Raphael hospital .This study was including two groups; group (A) involved patients 65 years and older, group (B) involved patients below 65 years old who were subjected to thyroidectomy. Taking in consideration histopathology results, indications of surgery (compressive symptoms, suspicious or confirmed malignancy, toxic goiter and recurrent goiter) and complications (including rates of temporary and permanent hypocalcaemia, temporary and permanent RLN paralysis, postoperative hematoma, wound infection and seroma), in addition to the risk of perioperative mortality. Results: There were 574 patients below 65 years and 127 elderly patients (>=65 years) who underwent thyroidectomy between January 2015 and December of 2018. There were no deaths in either group; no one had bilateral RLN paralysis. Old age patients had a lower frequency of complications in comparison to the younger counterparts, including transient hypocalcaemia (3.1% vs 14.8%, respectively) and temporary RLN injury (0% vs 0.69%, respectively), in addition to permanent RLN injury (0% vs 0.34%, respectively). Conclusions: Thyroidectomy in elderly is safe as compared to younger patients regarding perioperative complications
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Freter, Susan, and Susan K. Bowles. "Comparison of a Frail-Friendly Nomogram with Physician-Adjusted Warfarin Dosage for Prophylaxis after Orthopaedic Surgery on a Geriatric Rehabilitation Unit." Canadian Journal on Aging / La Revue canadienne du vieillissement 24, no. 4 (2005): 443–47. http://dx.doi.org/10.1353/cja.2006.0007.
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ABSTRACTWarfarin dosing for thromboprophylaxis in post-operative patients is time-consuming. Warfarin-dosing nomograms can be used in post-operative arthroplasty patients, but warfarin requirements are lower in frail older people. We modified an existing post-arthroplasty nomogram to a frail-friendly version and evaluated its performance in a frail elderly post-orthopaedic surgery on a geriatric rehabilitation ward to determine if it would improve quality indicators for oral anticoagulation. On a geriatric rehabilitation unit, post-operative orthopaedic patients were assigned to either physician-adjusted warfarin dosing or the nursing-administered nomogram. The proportion of days within target INR values was significantly higher in the nomogram group (77%, 95% CI 74% to 81%) compared to the physician-adjusted group (53%, 95% CI 46% to 60%), with no major bleeding or thromboembolic complications. The number of warfarin-related telephone calls to physicians was significantly reduced by tenfold. Use of a frail-friendly nomogram improved quality and efficiency of patient care on a geriatric rehabilitation unit.
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Li, Ting, Joyce Yeung, Jun Li, Yan Zhang, Teresa Melody, Ye Gao, Yi Wang, Qianquan Lian, and Fang Gao. "Comparison of regional with general anaesthesia on postoperative delirium (RAGA-delirium) in the older patients undergoing hip fracture surgery: study protocol for a multicentre randomised controlled trial." BMJ Open 7, no. 10 (October 2017): e016937. http://dx.doi.org/10.1136/bmjopen-2017-016937.
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IntroductionPostoperative delirium (POD) is a common serious postoperative complication especially in older people and is associated with increased mortality, morbidity and healthcare costs. There is no clear consensus which anaesthesia is associated with less incidence of POD for older patients. We aim to assess whether regional anaesthesia results in lower incidence of POD comparing with general anaesthesia (GA) among older patients undergoing hip fracture surgery.Methods and analysisRAGA-delirium is a pragmatic, multicentre, prospective, parallel grouped, randomised controlled clinical trial comparing RA or GA for hip fracture surgery. A total of 1000 patients who are 65 years or over and who are having planned hip fracture surgery in nine clinical trial centres of China will be randomised in a 1:1 ratio to receive either anaesthesia for the surgery. The primary endpoint will be the incidence of POD at day 7. The secondary endpoints will be the subtype, severity and duration of delirium, postoperative acute pain score, incidence of other postoperative non-delirium complications, quality of life and cost-effective outcomes. Randomisation will be performed at the patient level using computer-generated assignment. Outcome assessors will be blinded from intervention assignment. Assessments will be conducted before surgery, intraoperatively, postoperatively, during the hospital stay, at 30-day, 6-month and 1-year postoperative intervals.Potential impact of studyThis study will provide clinical evidence with a more robust methodology to help anaesthetists in selecting appropriate anaesthesia for older patients with high risk for POD. At the era of increasing emphasis on delirium prevention, this trial has the potential to inform the future national guideline to reduce POD.Ethics and disseminationEthical approved by the local institutional review board. Trial results will be presented at national and international academic conferences, and published in peer-reviewed journals.Trial registration numberClinicalTrials.gov (NCT02213380); pre-results.
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Okazaki, Kanako, Tetsuya Ohira, Akira Sakai, Michio Shimabukuro, Junichiro J. Kazama, Atsushi Takahashi, Hironori Nakano, et al. "Lifestyle Factors Associated with Undernutrition in Older People after the Great East Japan Earthquake: A Prospective Study in the Fukushima Health Management Survey." International Journal of Environmental Research and Public Health 19, no. 6 (March 14, 2022): 3399. http://dx.doi.org/10.3390/ijerph19063399.
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We conducted a longitudinal examination to assess the relationship between lifestyle habits, including exercise habits, and the incidence of undernutrition after the Great East Japan Earthquake in March 2011. Of the 31,411 participants aged ≥60 years who lived in the municipalities’ evacuation areas before the disaster and had undergone health examinations, 17,622 persons with a body mass index of 20–25 kg/m2 were followed up through the FY 2017 (a mean follow-up of 6.9 years). The analysis involved 13,378 individuals who could be followed. The associations between undernutrition after the disaster and lifestyle factors were estimated via multivariable-adjusted analysis using the Cox proportional hazard regression model. The dependent variable was the proportion of undernutrition after the disaster, whereas independent variables included evacuation, exercise habits/physical activity, alcohol consumption, smoking, meals before bedtime, gastrointestinal surgery history, history of lifestyle-related diseases, and two or more subjective symptoms. In total, 1712 of the 13,378 participants were newly undernourished after the disaster. The statistically significant variables influencing the occurrence of undernutrition were non-evacuation (hazard ratio (HR), 1.31; 95% confidence index (CI) 1.17–1.47), poor exercise habits (HR, 1.14; 95% CI 1.03–1.50), and poor physical activity (HR, 1.12; 95% CI 1.01–1.25). Other significant related variables were drinking habits, surgical history, lifestyle-related diseases, and two or more subjective symptoms. These results suggest that regular exercise and/or physical activity might be important in preventing undernutrition following a disaster, regardless of sex, other lifestyle habits, or past medical history.
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Quinn, Robert R., Pietro Ravani, Xin Zhang, Amit X. Garg, Peter G. Blake, Peter C. Austin, James M. Zacharias, et al. "Impact of Modality Choice on Rates of Hospitalization in Patients Eligible for Both Peritoneal Dialysis and Hemodialysis." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 34, no. 1 (January 2014): 41–48. http://dx.doi.org/10.3747/pdi.2012.00257.
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BackgroundHospitalization rates are a relevant consideration when choosing or recommending a dialysis modality. Previous comparisons of peritoneal dialysis (PD) and hemodialysis (HD) have not been restricted to individuals who were eligible for both therapies.MethodsWe conducted a multicenter prospective cohort study of people 18 years of age and older who were eligible for both PD and HD, and who started outpatient dialysis between 2007 and 2010 in four Canadian dialysis programs. Zero-inflated negative binomial models, adjusted for baseline patient characteristics, were used to examine the association between modality choice and rates of hospitalization.ResultsThe study enrolled 314 patients. A trend in the HD group toward higher rates of hospitalization, observed in the primary analysis, became significant when modality was treated as a time-varying exposure or when the population was restricted to elective outpatient starts in patients with at least 4 months of pre-dialysis care. Cardiovascular disease, infectious complications, and elective surgery were the most common reasons for hospital admission; only 23% of hospital stays were directly related to complications of dialysis or kidney disease.ConclusionsEfforts to promote PD utilization are unlikely to result in increased rates of hospitalization, and efforts to reduce hospital admissions should focus on potentially avoidable causes of cardiovascular disease and infectious complications.
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Aitken, SJ, V. Naganathan, and FM Blyth. "Aortic aneurysm trials in octogenarians: Are we really measuring the outcomes that matter?" Vascular 24, no. 4 (July 10, 2016): 435–45. http://dx.doi.org/10.1177/1708538115597079.
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Purpose This study is a systematic review to determine the types of outcomes reported in abdominal aortic aneurysm (AAA) studies of patients aged 80 and over. Specifically, it determines the types of patient-centered outcomes reported. Method MEDLINE and EMBASE were searched from 2000 to 2014 for studies on AAA surgery with outcome data on patients aged 80 and over. Outcomes were categorized according to Donabedian’s framework for health quality indicators, with further classification as procedural, complication, resource or patient-centered outcome indicators. Findings Forty studies were reviewed. Patient-centered outcomes were infrequently reported (13%, n=5), with limited outcomes specifically relevant to older patients. No studies reported physical function, activities of daily living or cognition using validated assessment methods. Short-term mortality (95%, n=38) and complications (85%, n=34) were reported most frequently. Conclusion Reporting of aortic surgery outcomes in patients aged 80 and over requires a focus upon outcomes of primary importance to people of this age.
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Fauzi, Ahmad, David Idrial, and Akbar Rizki Beni Asdi. "Clinical Importance of Sarcopenia And How It Impacts Orthopaedic-Trauma Patients and The Surgical Outcomes." Folia Medica Indonesiana 58, no. 4 (December 5, 2022): 355–63. http://dx.doi.org/10.20473/fmi.v58i4.35971.
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Highlights: Sarcopenia can cause deleterious effects on patients. The Asian Working Group for Sarcopenia (AWGS) and the European Working Group on Sarcopenia in Older People (EWGSOP) provide the most widely used criteria to diagnose sarcopenia. Knowledge of sarcopenia should be a trigger for clinicians and surgeons to evaluate the treatment plan and anticipate the implications experienced by the patients. Abstract: Sarcopenia is a condition of low muscle strength, mass, and low physical performance that is affected by age (primary sarcopenia) and one or combination of systemic diseases, physical inactivity, and insufficient intake of energy (secondary sarcopenia). This condition affects one in ten healthy adults aged ≥60 years. There are two widely used criteria to diagnose sarcopenia, the Asian Working Group for Sarcopenia (AWGS) and the European Working Group on Sarcopenia in Older People (EWGSOP). These working groups created algorithms to facilitate the diagnosis. Establishing the diagnosis is crucial because it has deleterious impacts on patients, such as increasing risks of mortality, morbidity, falls, complications during and after surgery, disability, prolonged hospitalization, and fractures. Sarcopenia is considered an independent mortality risk. It is paramount for physicians to assess this condition before treating the patients because it can predict the risk and plan better treatment options to achieve better outcomes. Early assessment is crucial, even for surgeons. Sarcopenia also negatively impacts patients who had surgery. Up to 44% patients who underwent orthopedic trauma surgery had sarcopenia. The high percentage was affected by the increased risk of falls and fractures. On that account, this condition needs to be treated. The main treatments for this condition are exercise dan adequate nutrition intake. The recommended exercise as a first-line treatment is resistance or strength training. Overall, knowledge on sarcopenia can prepare clinicians and surgeons in anticipating the implications of sarcopenia.
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Trofymovych, Ye O. "The state of platelet-vascular hemostasis in the preoperative period in the case of preservation with concomitant ischemia human disease." PROBLEMS OF UNINTERRUPTED MEDICAL TRAINING AND SCIENCE 40, no. 4 (December 2020): 78–81. http://dx.doi.org/10.31071/promedosvity2020.04.078.
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Recently, there has been a clear trend towards progressive population aging of the population both in Ukraine and in the world, which leads to an increase in the number of elderly and senile people. Many of them undergo surgery for various chronic cancers, which is often dangerous due to concomitant age-related pathology, reduced functional reserves and a high risk of perioperative complications. Among the variety of age-related diseases, the leading place is occupied by cardiovascular, first of all, coronary heart disease, which is the main part of concomitant pathology in patients preparing for surgery and is considered as a significant modified risk factor for perioperative complications. We conducted a study of hemocoagulation in 52 patients with concomitant coronary heart disease who were scheduled for abdominal surgery. The rates of platelet aggregation and coagulogram in the preoperative period were evaluated. Types of disorders of platelet-vascular hemostasis, which were associated with the age of patients and the duration of coronary heart disease, were identified. Patients with a longer duration of coronary heart disease and older age have a tendency to disturb primary hemostasis in the form of hyperaggression (18 patients; 35 %) or hypoaggregation (13 patients; 25 %). The coagulogram study revealed compensatory changes associated with impaired platelet aggregation. The importance of complex monitoring of the hemostasis system in these patients in the perioperative period for differentiated correction of established disorders is pointed out.
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Nishijima, Tomohiro F., Taito Esaki, Masaru Morita, and Yasushi Toh. "Preoperative frailty assessment with Robinson Frailty Score (RFS) and Edmonton Frail Scale (EFS) in older surgical patients with cancer." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e24033-e24033. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e24033.
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e24033 Background: In general geriatric surgical patients, frailty has been shown to predict higher rates of postoperative adverse outcomes. A little is known about how to optimally assess older adults with cancer for preoperative frailty. We evaluated the potential utility of the RFS [Robinson Am J Surg. 2013], EFS [Rolfson Age Ageing. 2006] and Geriatric 8 (G8) for prediction of postoperative adverse events. Methods: This cohort study included older adults who were prospectively evaluated by geriatric oncology service at Kyushu Cancer Center in Japan before undergoing oncological surgery between September 2018 and December 2019. The RFS measures cognition, function (activities of daily living (ADLs) and Timed Up & GO (TUG)), history of falls, comorbidity, albumin and hematocrit (score 0 to 1: fit (n = 71), 2 to 3: prefrail (n = 30) and 4 to 7: frail (n = 13)). The EFS evaluates cognition, function (IADLs and TUG), incontinence, self-perceived health, mood, nutrition, polypharmacy and social support (score 0 to 3: fit, 4 to 7: prefrail and 8 to 17: frail). G8 was dichotomized at previously studied cut-off value of 14. The primary outcome was composite adverse events (AEs), including 30-day postoperative complications (Clavien-Dindo grade ≥ 2) and discharge to an institutional care facility. Severity of surgery was assessed using the Operative Stress Score (OSS) [Shinall JAMA Surg. 2019]. Results: Of 114 patients (median age 80 years, range 72-96), surgery type was GI in 62%, HEENT in 20%, GYN in 8%, and other in 10%. 100 patients had ECOG PS 0 to 1. Using the OSS, surgical procedures were classified as very low to low stress (9%), moderate stress (31%), high stress (46%) and very high stress (15%). 45 patients had AEs. After adjusting for the OSS, preoperative frailty based on the RFS was associated with the occurrence of AEs (fit: 25%, prefrail: 49%, frail: 77%; p < 0.01). However, neither the EFS (fit: 30%, prefrail: 37%, frail: 60%; p = 0.14) nor G8 was significantly associated with a risk of AEs (score > 14: 17%, score ≤ 14: 41%; p = 0.07). Conclusions: Preoperative frailty status defined by the RFS is predictive of postoperative adverse outcomes in older adults undergoing elective surgery for cancer.
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Gupta, Bhaskar, James E. Neffendorf, Roger Wong, David A. H. Laidlaw, and Tom H. Williamson. "Ethnic Variation in Vitreoretinal Surgery: Differences in Clinical Presentation and Outcome." European Journal of Ophthalmology 27, no. 3 (October 22, 2016): 367–71. http://dx.doi.org/10.5301/ejo.5000894.
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Purpose The true prevalence of retinal detachment and other vitreoretinal disorders in different ethnic groups is not well-established. Understanding differences in vitreoretinal disease prevalence is important to appropriately allocate resources to meet demand where ethnic variation in the community exists. The aim of this study is to provide hospital-based data on the proportion of people with vitreoretinal disorders in the 3 main ethnic groups in the United Kingdom: Caucasian, Afro-Caribbean, and South Asian. Methods A retrospective study was performed on 3,262 patients undergoing vitreoretinal procedures for various indications between 2001 and 2014 from a single center in London, UK. Results The majority of patients with known ethnicity were Caucasian (80.19%) followed by Afro-Caribbean (12.31%) and Asian (5.20%). The mean age of the study population was 59.64 ± 15.75 years, with 57.28% males. Rhegmatogenous retinal detachment (RRD) was the common indication for surgery across all ethnic groups (54.83%). Caucasians were older, on average, compared to other ethnic groups at the time of surgery for RRD (p<0.05) and achieved higher success rates after primary surgery and were less likely to require silicone oil as primary tamponade. Macular hole was more common in the ethnic minorities with similar closure rates. Surgery for complications of diabetic retinopathy was more common in Afro-Caribbeans and Asians compared to Caucasians (28.07%, 24.02%, and 9.40%, p<0.05). Conclusions This study presents a large population-based data analysis on ethnic variation in vitreoretinal disorders. This may assist in predicting the requirement of vitreoretinal service provision depending on local ethnic variation.
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Arkley, James, Ján Dixon, Faye Wilson, Karl Charlton, Benjamin John Ollivere, and William Eardley. "Assessment of Nutrition and Supplementation in Patients With Hip Fractures." Geriatric Orthopaedic Surgery & Rehabilitation 10 (January 1, 2019): 215145931987980. http://dx.doi.org/10.1177/2151459319879804.
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Introduction: Malnutrition is common in older people, is known to interact with frailty, and is a risk factor for wound complications and poor functional outcomes postoperatively. Sustaining a hip fracture is a significant life event, often resulting in a decline in mobility and functional ability. A poor nutritional state may further impede recovery and rehabilitation, so strategies to improve perioperative nutrition are of considerable importance. We provide a review of nutritional supplement practices in this vulnerable and growing population. Method: Systematic review of preoperative oral nutritional supplementation (ONS) in hip fracture patients. Results: We identified 12 articles pertaining to this important area of perioperative care. The findings suggest postoperative ONS can improve postoperative outcomes in hip fracture patients, especially in terms of increasing total serum protein, improving nutritional status to near-optimum levels, and decreasing postoperative complications. Discussion: There is an absence of evidence specific to preoperative ONS in patients admitted following hip fracture. Literature relating to other populations is encouraging but is yet to be robustly studied. It is unclear whether these results are generalizable to the frailer hip fracture population. There is a need for studies clearly defining outcome measurement and complication assessment pertaining to preoperative ONS. The potential benefit is considerable, and this review will provide a means to inform the construction of meaningful trials in preoperative ONS of patients sustaining hip fracture. Conclusion: Oral nutritional supplementation in hip fracture patients may decrease postoperative complications while increasing elderly patient’s nutritional state to a near-optimum level. This is extrapolated from postoperative literature, however with a clear gap in research pertaining specifically to preoperative care. The need for well-constructed studies focused on the impact and assessment of early ONS in this population is transparent.
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Кантемирова, Р. К., С. В. Сердюков, З. Д. Фидарова, Т. С. Чернякина, and Ю. И. Кузнецова. "AGE-RELATED SPECIFICS OR DISEASES AND DISABILITY CAUSED BY DIGESTIVE DISORDERS AMONG ADULTS IN SAINT-PETERSBURG IN 2013-2017." Успехи геронтологии, no. 1 (April 12, 2020): 179–88. http://dx.doi.org/10.34922/ae.2020.33.1.024.
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В статье проведен ретроспективный анализ структуры и динамики заболеваемости и инвалидности при болезнях органов пищеварения у жителей Санкт-Петербурга. Представлены данные сравнительного анализа показателей инвалидности у лиц трудоспособного и пенсионного возраста Санкт-Петербурга в сопоставлении со средними российскими показателями в динамике за 2013- 2017 гг. Выявлены закономерности и различия в структуре и динамике болезней органов пищеварения у лиц 18 лет и старше, проявившиеся послеоперационными осложнениями, показателями смертности и инвалидизации. Результаты могут быть использованы для принятия управленческих решений на государственном уровне - как федеральном, так и региональном - по развитию системы профилактики, ранней диагностики болезней органов пищеварения и комплексной реабилитации инвалидов. The paper presents the retrospective analysis of the structure and dynamics of diseases and disability caused by digestive disorders in Saint Petersburg citizens. The paper presents the results of the comparative analysis of disability among people of active working and pension ages living in Saint Petersburg, versus Russia’s average 2013-2018 data. As a result, regularities and differences in the structure and dynamics of digestive disorders in people 18 years old and older, which manifested themselves in after-surgery complications, death rate, and disability rate. The results may be used as reference for making federal or regional-level decisions on developing the system for preventing and early diagnosis of digestive disorders and integrated rehabilitation of disabled persons.
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Petrov, Petar, Stefan Hristoforov, Ognyan Gatsev, Kremena Petkova, and Iliya Saltirov. "Outcomes of retrograde intrarenal surgery in elderly patients." Journal of Endourology and Minimally Invasive Surgery 9, no. 1 (November 1, 2021): 43–49. http://dx.doi.org/10.57045/jemis/911121.pp43-49.
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Introduction and objective: The development of medical technology, the improvement of flexible endoscopes and laser lithotripsy devices have led to an expansion of the indications for retrograde intrarenal surgery (RIRS) in the treatment of kidney stones. RIRS has an increased efficacy compared to extracorporeal shockwave lithotripsy (ESWL) and a lower complication rate compared to percutaneous nephrolithotomy (PCNL). With the increase in world’s population and age, the share of older people is increasing, especially in the Western countries. The aim of this study is to compare the efficacy and safety of RIRS in patients aged ≥ 65 years with those < 65 years. Material and methods: A retrospective study of 240 consecutive patients who underwent retrograde intrarenal surgery for renal stones, was performed. Patients were treated at the Clinic of Endourology and SWL of Military Medical Academy, Sofia, for a period from January 2019 to March 2021. 206 of patients were <65 years old (group I) and 34 patients were ≥ 65 years (group II). Preoperative characteristics, stone-free rates, operating times, rate of intra- and postoperative complications and rate of auxiliary procedures were compared. Results: Patients’ preoperative characteristics were comparable between groups, except for the preoperative anticoagulation therapy (6.3% for group I and 52.9% for group II; р<0.001) and the higher rate of preoperative renal insufficiency in group II (14,7% vs 8,3%; p=0.022). The majority of patients in group I had an ASA score I – 65.5% and the majority of patients in group II were classified as ASA score III - 52,9% (р<0.001). The predominant comorbidity in group I was hypertension – 19.9% and 63.1% of the patients had no comorbidities. In group II 26.5% of the patients had diabetes and hypertension, and 5.9% had no comorbidities (p<0.001). 47.6% of the patients in group I had Charlson comorbidity index CCI=0 and 35.9% had CCI >2 compared to CCI=0 in 8,8% and CCI>2 in 88.2% of group II (р<0.001). Stone free rate after single procedure was 90.8% and 85.3% for group I and II, respectively, (р=0.032). There were no statistically significant differences in mean operating times, type and severity of complications and mean hospital stay between the two groups. Postoperative fever rate was similar between groups (3.4% vs 5.9%, р=0.480). Conclusion: The results of this retrospective study suggest that RIRS is an appropriate, safe and effective method for the minimally invasive treatment for renal stones is patients aged ≥65 years. Ag
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Terai, Hidetomi, Yusuke Hori, Shinji Takahashi, Koji Tamai, Masayoshi Iwamae, Masatoshi Hoshino, Shoichiro Ohyama, Akito Yabu, and Hiroaki Nakamura. "Impact of the COVID-19 pandemic on the development of locomotive syndrome." Journal of Orthopaedic Surgery 29, no. 3 (September 2021): 230949902110609. http://dx.doi.org/10.1177/23094990211060967.
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Background The coronavirus disease 2019 (COVID-19) pandemic has affected people in various ways, including restricting their mobility and depriving them of exercise opportunities. Such circumstances can trigger locomotor deterioration and impairment, which is known as locomotive syndrome. The purpose of this study was to investigate the incidence of locomotive syndrome in the pandemic and to identify its risk factors. Methods: This was a multicenter questionnaire survey performed between 1 November 2020 and 31 December 2020 in Japan. Patients who visited the orthopedics clinic were asked to answer a questionnaire about their symptoms, exercise habits, and locomotor function at two time points, namely, pre-pandemic and post-second wave (current). The incidence of locomotive syndrome in the COVID-19 pandemic was investigated. Additionally, multiple logistic regression analysis was used to identify the risk factors for developing locomotive syndrome during the pandemic. Results: A total of 2829 patients were enrolled in this study (average age: 61.1 ± 17.1 years; 1532 women). The prevalence of locomotive syndrome was 30% pre-pandemic, which increased significantly to 50% intra-pandemic. Among the patients with no symptoms of locomotive syndrome, 30% developed it in the wake of the pandemic. In the multinomial logistic regression analysis, older age, deteriorated or newly occurring symptoms of musculoskeletal disorders, complaints about the spine or hip/knee joints, and no or decreased exercise habits were independent risk factors for developing locomotive syndrome. Conclusions: The prevalence of locomotive syndrome in patients with musculoskeletal disorders has increased during the COVID-19 pandemic. In addition to age, locomotor symptoms, especially spine or hip/knee joint complaints, and exercise habits were associated with the development of locomotive syndrome. Although the control of infection is a priority, the treatment of musculoskeletal disorders and ensuring exercise habits are also essential issues to address during a pandemic such as COVID-19.
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Finkbeiner, Rebekka, Sebastian Krinner, Andreas Langenbach, Manuel Besendörfer, and Stefan Schulz-Drost. "Age Distribution and Concomitant Injuries in Pulmonary Contusion: An Analysis Based on Routine Data." Thoracic and Cardiovascular Surgeon 66, no. 08 (August 24, 2018): 678–85. http://dx.doi.org/10.1055/s-0038-1667323.
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Background As the population ages, low-energy thoracic injuries are becoming increasingly relevant in individual injuries, particularly pulmonary contusions (PCs) and their common concomitant injuries. The objective of this study was to determine the prevalence and age distribution of thoracic trauma, especially PC, to make conclusions about common secondary diagnoses and developments in management. Methods A retrospective analysis of 209,820 cases, based on German routine data from the years 2009 to 2015, with a main diagnosis (MD) or secondary diagnosis (SD) of thoracic trauma (S27 according to ICD-10) was performed. The entire patient collective with a MD of S27 was examined as well as those with PCs (S27.31). Results In all 61,016 patients with a MD of S27, 7,558 (12.4%) had a MD of PC and among the 148,804 patients with a SD of S27, 58,247 patients (39.1%) had a SD of PC. PC occurs mostly in the age groups of 20 to 25, 45 to 50, and 70 to 75 years. The proportion of older people tends to be increasing. The most concomitant thoracic injuries were serial rib fractures (27.1%), pneumothorax (11.9%), and sternum fractures (6.2%). Computed tomography scan is the most common diagnostic tool in PC (MD >80%, SD >60%). Therapeutically, intensive care (>50%) and chest drainage are most important (MD: 12.5%, SD: 60.1%), while operative measures are rare (≤ 4%). Conclusion PC shows a marked increase in the incidence, especially in older patients and as a companion diagnosis in thoracic injuries. It should be diagnosed early as well as its concomitant injuries to avoid complications.
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Pass, Bastian, Fahd Malek, Moritz Rommelmann, Rene Aigner, Tom Knauf, Daphne Eschbach, Bjoern Hussmann, Alexander Maslaris, Sven Lendemans, and Carsten Schoeneberg. "The Influence of Malnutrition Measured by Hypalbuminemia and Body Mass Index on the Outcome of Geriatric Patients with a Fracture of the Proximal Femur." Medicina 58, no. 11 (November 7, 2022): 1610. http://dx.doi.org/10.3390/medicina58111610.
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Background and Objectives: Fractures of the proximal femur are a life-changing and life-threatening event for older people. Concomitant malnutrition has been described as an independent risk factor for complications and mortality. Therefore, we examined the influence of albumin and body mass index (BMI) as parameters for the nutritional state on the outcome after geriatric hip fracture surgery. Materials and Methods: Data were retrospectively collected from hospital information systems, and complications and all other parameters were obtained from patient charts. We included patients aged 70 years or above with a fracture of the proximal femur. We excluded periprosthetic and peri-implant fractures and patients with a missing BMI or albumin value. Results: Patients with a BMI below 20 kg/m2 were more likely to be female but did not differ from the normal BMI group in terms of baseline parameters. Patients with hypoalbuminemia had a higher ASA grade and Charlson Comorbidity Index, as well as a lower hemoglobin value and prothrombin time compared to those with normal albumin values and low BMI. Hypoalbuminemia was associated with significantly increased rates of complications (57.9% vs. 46.7%, p = 0.04) and mortality (10.3% vs. 4.1%, p = 0.02). Blood loss and transfusion rates were higher in the hypoalbuminemia group. Patients with a BMI below 20 kg/m2 had a higher risk of intraoperative cardiac arrest (2.6% vs. 0.4%, p = 0.05) but did not show higher mortality rates than patients with a BMI above 20 kg/m2. However, the outcome parameter could not be confirmed in the regression analysis. Conclusions: Hypoalbuminemia might be an indicator for more vulnerable patients with a compromised hemoglobin value, prothrombin time, and ASA grade. Therefore, it is also associated with higher mortality and postoperative complications. However, hypoalbuminemia was not an independent predictor for mortality or postoperative complications, but low albumin values were associated with a higher CCI and ASA grade than in patients with a BMI below 20 kg/m2.