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Schrag TA, Diarra D, Veser J. Prevention, diagnosis, and treatment of urolithiasis in geriatric patients - differences, similarities and caveats in comparison to the general population. Curr Opin Urol 2024; 34:154-165. [PMID: 38445376 DOI: 10.1097/mou.0000000000001173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
PURPOSE OF REVIEW Purpose of the review is to address management and prevention of urolithiasis in elderly patients examining the dynamic interplay between general measures, dietary adjustments, lifestyle modifications, and targeted pharmacological and/ or surgical interventions. The goal is to provide understanding of the evolving strategies required for effective urolithiasis prevention in the geriatric population. RECENT FINDINGS Age-specific diagnostic considerations are necessary because urolithiasis in the elderly population is characterized by bigger stones, greater peri-operative risks, and heightened symptom severity. When comorbidities are present, conservative treatments - especially analgesia - provide difficulties. Surgical procedures prove to be safe and effective, with complication rates and practical application comparable to younger cohorts. Prevention approaches that include lifestyle changes and the investigation of novel pharmaceutical options such as sodium-dependent glucose co-transporter 2 (SGLT-2)-inhibitors are promising in the management of urolithiasis in the elderly population. SUMMARY Our review offers a thorough investigation of urolithiasis in the elderly population, elucidating distinct clinical manifestations, complex diagnostic issues, and treatment implications. The safety and effectiveness of ureteroscopy in older patients, as well as the possible prophylactic function of SGLT-2-I, offer crucial insights for clinicians. Subsequent studies are necessary to enhance age-specific therapies, addressing the distinct obstacles presented by urolithiasis in the elderly population within this rapidly growing demographic.
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Lim KYY, Liew AN, Ling Z, Ranasinghe W, McCahy P. Modified Supine Percutaneous Nephrolithotomy in the Elderly: Outcomes and Safety. J Clin Med 2023; 12:4807. [PMID: 37510922 PMCID: PMC10381836 DOI: 10.3390/jcm12144807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/12/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
With increases in the aging population, conditions affecting older people and relevant surgical techniques are becoming more pertinent. Modified supine percutaneous nephrolithotomy (PCNL) is increasingly being adopted. There are limited data on the safety of this position in the elderly patient population. We describe our experience of the modified supine position in patients aged 70 years and older. Between April 2011 and March 2021, patients aged 70 years and older undergoing a modified supine PCNL performed by a single surgeon were prospectively evaluated. Data including patient age, operative time, complications, stone clearance, and length of stay were collected and analysed. Sixty-nine procedures were performed on 67 patients with a mean age was 76.5 years. Median total operative time was 95 min with 20 (29%) patients having a combined procedure with ureterorenoscopy. Preoperative mean stone burden was 23.5 mm and complete stone clearance was achieved in 46 (66.7%) patients. Twelve (17.4%) patients had complications during their hospitalisation. Six were Clavien-Dindo class II or less and one Clavien-Dindo class V. The modified supine position for PCNL is safe in the elderly patient population and has advantages including reduced handling of patients and achieving adequate stone-free rates. These benefits are particularly important in the elderly population, which frequently has a reduced tolerance to adaptation.
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Affiliation(s)
- Kylie Yen-Yi Lim
- Department of Urology, Monash Health, Melbourne, VIC 3168, Australia
| | | | - Zihui Ling
- School of Medicine, Monash University, Clayton, VIC 3800, Australia
| | | | - Philip McCahy
- Department of Urology, Monash Health, Melbourne, VIC 3168, Australia
- School of Clinical Sciences, Monash University, Clayton, VIC 3800, Australia
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Schulz AE, Green BW, Gupta K, Patel RD, Loloi J, Raskolnikov D, Watts KL, Small AC. Management of large kidney stones in the geriatric population. World J Urol 2023; 41:981-992. [PMID: 36856833 DOI: 10.1007/s00345-023-04333-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 02/08/2023] [Indexed: 03/02/2023] Open
Abstract
PURPOSE The aim of this review is to highlight the unique factors that predispose geriatric patients to nephrolithiasis and to compare the utility and efficacy of surgical techniques in this specific patient population. METHODS PubMed and EMBASE databases were reviewed, and studies were organized according to surgical treatments. RESULTS Few prospective studies exist comparing kidney stone removal in the elderly to younger cohorts. In addition, various age cut-offs were used to determine who was considered elderly. Most studies which analyzed Percutaneous Nephrolithotomy (PCNL) found a slightly higher rate of minor complications but comparable stone free rate and operative time. For ureteroscopy (URS) and extracorporeal shockwave lithotripsy (ESWL), there were minimal complications observed and no difference in clinical success in the elderly. All surgical techniques were presumed to be safe in the elderly and most found no difference in stone-free rates. CONCLUSIONS Unique attributes of the geriatric population contribute to stone formation and must be considered when determining appropriate management modalities. This review provides an overview of the utility and efficacy of PCNL, URS and ESWL in the elderly, as well as a porposed algorithm for management in this population.
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Affiliation(s)
| | | | - Kavita Gupta
- Montefiore Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Place, Bronx, NY, 10461, USA
| | - Rutul D Patel
- Montefiore Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Place, Bronx, NY, 10461, USA
| | - Justin Loloi
- Montefiore Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Place, Bronx, NY, 10461, USA
| | - Dima Raskolnikov
- Montefiore Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Place, Bronx, NY, 10461, USA
| | - Kara L Watts
- Montefiore Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Place, Bronx, NY, 10461, USA
| | - Alexander C Small
- Montefiore Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Place, Bronx, NY, 10461, USA.
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Haberal HB, Gudeloglu A, Deger M, Gulsen M, Izol V, Bostanci Y, Aridogan İA, Ozden E, Bilen CY. Percutaneous Nephrolithotomy in Young-Old, Old-Old, and Oldest-Old Patients: A Multicenter Study. J Laparoendosc Adv Surg Tech A 2021; 31:796-802. [DOI: 10.1089/lap.2020.0537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Ahmet Gudeloglu
- Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mutlu Deger
- Department of Urology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Murat Gulsen
- Department of Urology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Volkan Izol
- Department of Urology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Yakup Bostanci
- Department of Urology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | | | - Ender Ozden
- Department of Urology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Cenk Yucel Bilen
- Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Besiroglu H, Merder E, Dedekarginoglu G. Percutaneous nephrolithotomy is safe and effective in aging male patients: a single center experience. Aging Male 2020; 23:705-710. [PMID: 30857456 DOI: 10.1080/13685538.2019.1581756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To assess the safety and effectiveness of percutaneous nephrolithotomy in aging male patients. METHODS Two hundred eighty-three male patients over the years of forty undergoing percutaneous nephrolithotomy between December 2009 and September 2014 were evaluated, retrospectively. The patients were stratified by four age groups [40-49 (group-1), 50-59 (group-2), 60-69 (group-3), ≥70 years (group-4)]. The groups were compared regarding stone size, mean operation time, mean access number, mean nephrostomy removal time, hospitalization duration, stone-free rate, and complications rate. The patients were also evaluated with regard to glomerular filtration rate levels preoperatively and in the sixth month after surgery. RESULTS Mean stone size was 810 ± 490 mm2 in group-1, 840 ± 500 mm2 in group-2, 845 ± 480 mm2 in group-3, and 800 ± 460 mm2 in group-4 (p = .02). There was no statistical difference between the four groups in terms of mean operation time, access number, hemorrhage, nephrostomy removal time, and hospital stay duration (p > .05). After additional interventions; no significant difference was detected for final stone-free rates among the groups (p = .12). A significant improvement was detected in glomerular filtration rate levels in the sixth month after surgery in all groups (p < .05). CONCLUSION These results indicate that percutaneous nephrolithotomy is a safe and effective method in aging male patients.
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Affiliation(s)
| | - Erkan Merder
- Urology, Turkiye Cumhuriyeti Saglik Bakanligi Okmeydani Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - Galip Dedekarginoglu
- Urology, Turkiye Cumhuriyeti Saglik Bakanligi Okmeydani Egitim ve Arastirma Hastanesi, Istanbul, Turkey
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Besiroglu H, Merder E, Dedekarginoglu G. The safety and effectiveness of percutaneous nephrolithotomy in solitary kidney aging male patients: our single-center experience. Aging Male 2020; 23:1134-1140. [PMID: 31900026 DOI: 10.1080/13685538.2019.1708316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To assess the safety and effectiveness of percutaneous nephrolithotomy (PCNL) in aging male patients with a solitary kidney. METHODS Among the patients undergoing PCNL between December 2009 and September 2014, 16 patients with solitary kidney (group 1) over the age of 40 were included in the analysis. Twenty patients with bilateral kidney patients (group 2) were included in the analysis, which constituted an age-matched control group. The patients' characteristics, stone characteristics, intraoperative and postoperative outcomes, including bleeding and transfusion rates, operative time, complications, hospital stay, stone-free rates (SFR) and renal function were evaluated. RESULTS Mean age of the patients in groups 1 and 2 were 63.7 (range 48-73) and 64.8 (range 48-77). Mean stone size was 814 ± 390 mm2 in group 1, and 820 ± 405 mm2 in group 2 with no statistical significance (p = .35). The final SFR in the solitary kidney and bilateral kidney group was 87.5 and 90% (p = .07). Bleeding requiring transfusion, prolonged leakage from nephrostomy tract, mean operation time and access number were comparable between two groups (p > .05). However, the nephrostomy removal and hospital stay time were longer in the solitary kidney group (p < .05). The rate of perioperative DJ insertion was also higher in solitary kidney patients. A significant improvement was detected in creatinine and glomerular filtration rate levels in the sixth months after surgery in solitary kidney patients (p < .05). CONCLUSION These results indicate that PCNL is a safe and effective method in aging male patients with a solitary kidney.
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Affiliation(s)
- Huseyin Besiroglu
- Department of Urology, Catalca Ilyas Cokay State Hospital, Istanbul, Turkey
| | - Erkan Merder
- Department of Urology, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Galip Dedekarginoglu
- Department of Urology, Okmeydani Training and Research Hospital, Istanbul, Turkey
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Abedali ZA, Large T, Heiman JM, Bandali E, Anderson BB, Lingeman JE, Krambeck AE. Percutaneous Nephrolithotomy in the 80 Years of Age and Older Population. Urology 2019; 134:62-65. [PMID: 31536740 DOI: 10.1016/j.urology.2019.08.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate feasibility of percutaneous nephrolithotomy (PCNL) for complex nephrolithiasis in patients 80 years of age and older compared to younger individuals. METHODS From an institutional IRB-approved database, 1,647 patients were identified who underwent PCNL from 1999 to 2019. Patients were stratified by age: group 1 (20-59), group 2 (60-79), and group 3 (>80). Statistics were performed using chi-square and ANOVA to compare outcomes. RESULTS Of the 1,647 patients, median age was 46, 66, and 83, respectively (P <0.0001). Three patients within group 3 were 90 or older. Females made up 54%, 46%, 56% of patients (P = 0.02). Average stone size with SD was 2.6 ± 2.2, 2.5 ± 2.3, 2.2± 1.9 cm for each group (P = 0.06). Mean preoperative hemoglobin (Hgb) was significantly lower in the 80+ group (13.8, 13.4, 13.1 g/dL, P <.0001). Change in Hgb was not significantly different. There were more Clavien II-IV complications (10.4, 14.4, 28.8%; P = 0.02) and transfusions (2.3, 4.7, 10.2%; P <0.001) in the elderly. The most common complications in the 80+ group were bleeding related (10.1%). No difference in readmission rates or ICU admissions was noted. CONCLUSION PCNL is feasible in the extremely elderly; however with a higher rate of complications and longer hospitalizations. No long-term sequelae or deaths in the 80 and older cohort were seen. This study allows us to appropriately counsel older patients on a realistic postoperative course and supports use of PCNL as the best means of long-term survival.
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Affiliation(s)
- Zain A Abedali
- Department of Urology, Indiana University/IU Health Physicians, Indianapolis, IN
| | - Tim Large
- Department of Urology, Indiana University/IU Health Physicians, Indianapolis, IN
| | - Joshua M Heiman
- Department of Urology, Indiana University/IU Health Physicians, Indianapolis, IN
| | - Elhaam Bandali
- Department of Urology, Indiana University/IU Health Physicians, Indianapolis, IN
| | - Blake B Anderson
- Department of Urology, Indiana University/IU Health Physicians, Indianapolis, IN
| | - James E Lingeman
- Department of Urology, Indiana University/IU Health Physicians, Indianapolis, IN
| | - Amy E Krambeck
- Department of Urology, Indiana University/IU Health Physicians, Indianapolis, IN.
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Néphrolithotomie percutanée des calculs rénaux des personnes âgées : méta-analyse des résultats et complications. Prog Urol 2017; 27:58-67. [DOI: 10.1016/j.purol.2016.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 10/12/2016] [Accepted: 12/17/2016] [Indexed: 11/21/2022]
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Torricelli FCM, Monga M, Dall'Aqua V, Marchini GS, Vicentini FC, Danilovic A, Srougi M, Mazzucchi E. Percutaneous Nephrolithotomy in Immunocompromised Patients: Outcomes from a Matched Case-Control Study. J Endourol 2016; 30:1326-1331. [PMID: 27615116 DOI: 10.1089/end.2016.0496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To compare the outcomes of percutaneous nephrolithotomy (PCNL) in immunocompromised patients with those of PCNL in healthy population. PATIENTS AND METHODS A matched case-control study was performed from January 2009 through December 2014 using our prospectively collected kidney stone database. Patients with positive serology to human immunodeficiency virus (HIV), hepatitis C (cellular immune dysfunction), and patients on high dose of immunosuppressive drugs for treatment of autoimmune diseases composed the case group. Control group included patients with kidney stones and no other comorbidity. Patients were randomly matched based on Guy's score as a surrogate of case complexity. RESULTS Sixty-two patients were enrolled in this study, 21 cases and 42 controls. There were no significant differences in age, gender, and body mass index between groups. Regarding PCNL technique, there were no differences in patient positioning, number of accesses, and operative time. Complication rate was higher in the case group (38.1% vs 14.3%; p = 0.032); however, major complications, defined by Clavien score ≥3, were not statistically different (4.8% vs 2.4%; p = 0.611). There was a tendency of more postoperative urinary tract infection in the case group (19% vs 4.8%; p = 0.069). Mean decrease in hemoglobin level (3.3 vs 2.4 mg/dL; p = 0.037) and blood transfusion rate (23.8% vs 4.8%; p = 0.036) was significantly higher in the case group. Immunocompromised patients had a 2.8-fold increased risk of complications (odds ratio [OR] = 2.0, 95% confidence interval [CI] 1.01, 7.74) and a 5.8-fold increased risk of blood transfusion (OR = 5.8, 95% CI 1.29, 26.55). There were no differences in stone-free rate, nephrostomy tube time, and length of hospital stay. CONCLUSION Immunocompromised patients are at higher risk for complications such as bleeding after PCNL.
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Affiliation(s)
- Fábio C M Torricelli
- 1 Division of Urology, Department of Surgery, University of Sao Paulo Medical School , Sao Paulo, Brazil
| | - Manoj Monga
- 2 Glickman Urological & Kidney Institute , The Cleveland Clinic, Cleveland, Ohio
| | - Vinicius Dall'Aqua
- 1 Division of Urology, Department of Surgery, University of Sao Paulo Medical School , Sao Paulo, Brazil
| | - Giovanni S Marchini
- 1 Division of Urology, Department of Surgery, University of Sao Paulo Medical School , Sao Paulo, Brazil
| | - Fabio C Vicentini
- 1 Division of Urology, Department of Surgery, University of Sao Paulo Medical School , Sao Paulo, Brazil
| | - Alexandre Danilovic
- 1 Division of Urology, Department of Surgery, University of Sao Paulo Medical School , Sao Paulo, Brazil
| | - Miguel Srougi
- 1 Division of Urology, Department of Surgery, University of Sao Paulo Medical School , Sao Paulo, Brazil
| | - Eduardo Mazzucchi
- 1 Division of Urology, Department of Surgery, University of Sao Paulo Medical School , Sao Paulo, Brazil
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Abstract
PURPOSE OF THE REVIEW To highlight the progressive evolution of the issue of patient positioning for percutaneous nephrolithotomy (PNL), explain the history of the prone and supine positions, report respective advantages and drawbacks, critically interpret the past and current literature supporting such arguments, identify the best candidates for each position, and reflect on the future evolution of the two approaches. RECENT FINDINGS Positioning for PNL has become a matter of debate during the last decade. The traditional prone PNL position - most widely performed with good success and few complications, and exhibiting essentially no limits except for the treatment of pelvic kidneys - is nowadays flanked mainly by the supine and supine-modified positions, equally effective and probably safer from an anesthesiological point of view. Of course, both approaches have a number of advantages and drawbacks, accurately reported and critically sieved. SUMMARY The current challenge for endourologists is to be able to perform PNL in both prone and supine positions to perfectly tailor the procedure on any patient with any stone burden, including increasingly challenging cases and medically high-risk patients, according to the patient's best interest. Intensive training and experience is especially needed for supine PNL, still less popular and underperformed worldwide. VIDEO ABSTRACT http://links.lww.com/COU/A8.
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Kim S, Marsh AP, Rustowicz L, Roach C, Leng XI, Kritchevsky SB, Rejeski WJ, Groban L. Self-reported Mobility in Older Patients Predicts Early Postoperative Outcomes after Elective Noncardiac Surgery. Anesthesiology 2016; 124:815-25. [PMID: 26978144 DOI: 10.1097/aln.0000000000001011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Specific geriatric assessment tools may complement traditional perioperative risk stratification. The aim of this study was to evaluate whether self-reported mobility is predictive of postoperative outcomes in older patients undergoing elective noncardiac surgery. METHODS Patients aged 69 yr or older (n = 197) underwent (1) traditional risk assessments (American Society of Anesthesiologists physical status classification and Revised Cardiac Risk Index), (2) five-point frailty evaluation, (3) self-reported mobility assessment using the Mobility Assessment Tool-short form (range, 30.21 [poor] to 69.76 [excellent]), and (4) measurements of high-sensitivity C-reactive protein. Outcomes were postoperative complications, time to discharge, and nursing home placement (NHP). RESULTS In the sample of this study (mean age, 75 ± 5 yr; 51% women), 72% had intermediate- or high-risk surgery. Median time to discharge was 3 days (interquartile range, 1 to 4 days). Thirty patients (15%) developed postoperative complications, and 27 (13%) required NHP. After controlling for age, sex, body mass index, pain score, Revised Cardiac Risk Index, American Society of Anesthesiologist physical status, surgical risk, and high-sensitivity C-reactive protein, worse self-reported mobility (per 10-point decrease in Mobility Assessment Tool, which is equivalent to 1 SD) was associated with more postoperative complications (odds ratio [OR], 1.69; 95% CI, 1.05 to 2.73), later time to discharge (hazards ratio, 0.81; 95% CI, 0.68 to 0.96), and increased NHP (OR, 2.01; 95% CI, 1.13 to 3.56). By using the same model, intermediate frailty or frailty increased NHP (OR, 3.11; 95% CI, 1.02 to 9.54) but was not related to either postoperative complications or time to discharge. CONCLUSIONS Preoperative self-reported mobility using a novel and brief assessment may help identify elderly patients at risk for adverse postoperative events.
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Affiliation(s)
- Sunghye Kim
- From the Department of Internal Medicine, Section of General Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.K.); Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, North Carolina (A.P.M., X.I.L., S.B.K., W.J.R., L.G.); Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina (A.P.M., W.J.R.); Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina (L.R., C.R., L.G.); Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina (X.I.L.); Department of Internal Medicine, Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.B.K.); Department of Internal Medicine, Section of Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (L.G.); and Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina (L.G.)
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