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Kobayashi T, Kodama A, Okazaki T, Honma T, Yamada T, Ishibashi H, Komori K. Prognostic Significance of Preoperative Functional Independence Measure (FIM) on Long-Term Outcomes in Patients with Chronic Limb-Threatening Ischemia (CLTI). Ann Vasc Surg 2021; 83:275-283. [PMID: 34902471 DOI: 10.1016/j.avsg.2021.10.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the effect of preoperative motor and cognitive activities of daily living (ADL) on long-term outcomes of patients with chronic limb-threatening ischemia (CLTI) after distal bypass. METHODS A retrospective review was performed for patients who underwent distal bypass for CLTI from 2013 to 2019 at multiple centers in Japan. Comparisons were made among patients with high and low motor and cognitive ADL based on the functional independence measure (FIM). The primary endpoint was limb salvage and the secondary endpoints were survival, amputation free survival (AFS), major adverse limb events (MALE), readmission, and wound healing. RESULTS A total of 226 distal bypasses were performed in 185 patients (169 males; median age, 76 years; diabetes mellitus, 70%; end-stage renal disease with hemodialysis, 40%). The patients were divided into high (n = 93, 50%) and low (n = 92, 50%) FIM-motor cases, and high (n = 157, 85%) and low (n = 28, 15%) FIM-cognitive cases. FIM-motor (high vs. low) and FIM-cognitive (high vs. low) were not significantly associated with limb salvage, freedom from MALE, freedom from readmission, and wound healing. The 1- and 3-year survival rates were significantly lower in low FIM-motor cases (93% vs. 70% at 1 year, 73% vs. 46% at 3 years, P = 0.0011); and in low FIM-cognitive cases (87% vs. 50% at 1 year, 63% vs. 45% at 3 years, P < 0.001). The 1- and 3-year AFS rates were significantly lower in low FIM-motor cases (92% vs. 67% at 1 year, 69% vs. 44% at 3 years, P < 0.001); and in low FIM-cognitive cases (85% vs. 49% at 1 year, 59% vs. 44% at 3 years, P < 0.001). In multivariate analysis, independent risk factors for survival were hemodialysis (HR = 2.17; 95% confidence interval (CI), 1.23-3.83; P = .0078), low FIM-cognitive (HR = 3.45; 95% CI, 1.78-6.71; P < 0.001), and ejection fraction (HR = 0.98; 95% CI, 0.95-0.99; P = 0.019). CONCLUSIONS FIM-motor and FIM-cognitive were predictive factors for long-term survival and AFS of CLTI patients after distal bypass, but had no influence on limb salvage, MALE, readmission, and wound healing. These results suggest that the motor and cognitive status of ADL should be assessed using FIM before distal bypass for patients with CLTI.
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Affiliation(s)
- Taira Kobayashi
- Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hatsukaichi-shi, Hiroshima Japan.; Department of Rehabilitation, JA Hiroshima General Hospital, Hatsukaichi-shi, Hiroshima Japan..
| | - Akio Kodama
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University School of Medicine, Showa-ku, Nagoya, Aichi Japan
| | - Takanobu Okazaki
- Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hatsukaichi-shi, Hiroshima Japan
| | - Tomoaki Honma
- Department of Rehabilitation, JA Hiroshima General Hospital, Hatsukaichi-shi, Hiroshima Japan
| | | | | | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University School of Medicine, Showa-ku, Nagoya, Aichi Japan
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Mcswain JR, Sirianni JM, Wilson SH. Perioperative Considerations for Patients with a Known Diagnosis of Dementia. Adv Anesth 2021; 39:113-132. [PMID: 34715970 DOI: 10.1016/j.aan.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Julie R Mcswain
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, 25 Courtenay Drive, Suite 4200 MSC 240, Charleston, SC 29425, USA.
| | - Joel M Sirianni
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, 167 Ashley Avenue, Suite 301 MSC 912, Charleston, SC, USA
| | - Sylvia H Wilson
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, 167 Ashley Avenue, Suite 301 MSC 912, Charleston, SC, USA
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Monaro S, West S, Gullick J. Chronic limb-threatening ischaemia and reframing the meaning of 'end'. J Clin Nurs 2020; 30:687-700. [PMID: 33290625 DOI: 10.1111/jocn.15591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The possibility of amputation and/or death from chronic limb-threatening ischaemia (CLTI) is real, and deeper understandings of the person and family's capacity and preparedness for limb loss and clinical interventions (active or palliative) are required. BACKGROUND The lead-in period to the surgeon's recommendation for amputation for CLTI may be sudden or protracted; the number/invasiveness of previous revascularisation interventions varies, and limb loss and end-of-life considerations frame the experience. METHOD This prospective, longitudinal, interpretative phenomenological study in three vascular surgical units involved 19 CLTI journeys. Participants were interviewed when making decisions about amputation (15 patients, 12 family members) and, where applicable, 6-months postamputation (8 patients, 7 family members). Hermeneutic interpretation using Heidegger's philosophical construct of Being-towards-death guided the analysis. The COREQ checklist ensured rigour in research reporting. FINDINGS Some participants were unable to face the possibility of death and metaphorically 'fled', either through productive optimism or through hoping for more time (Heidegger's inauthentic positioning towards death). For others, authentic positionings of Being-towards-death were understood as: the confrontation of the certainty of their death by making choices about how to die; the indefiniteness of death where treatment choices influenced timing, yet the time for death remained unknown; the nonrelational nature of death, as the journey could only be lived by the person; and death as not to be outstripped, where for some, there was a freeing of oneself for amputation and/or death. DISCUSSION The term 'end of limb' to denote the futility of the limb is a useful marker that emphasises the noncurative nature of CLTI. This may help to instigate and support discussions about end of life to support palliation care planning and the person and family's existential preparation for death. CONCLUSION Death frames the experience of CLTI. Using 'end-of-limb' and 'end-of-life' terminology may facilitate a family/patient-centred approach to possible amputation and other conservative or palliative strategies. RELEVANCE TO CLINICAL PRACTICE Understanding of CLTI illness experience. Decisions about revascularisation, amputation or conservative care. End-of-life care for CLTI.
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Affiliation(s)
- Susan Monaro
- Concord Repatriation General Hospital, Sydney, NSW, Australia.,Faculty of Medicine and Health, Sydney Nursing School, University of Sydney, Sydney, NSW, Australia
| | - Sandra West
- Faculty of Medicine and Health, Sydney Nursing School, University of Sydney, Sydney, NSW, Australia
| | - Janice Gullick
- Faculty of Medicine and Health, Sydney Nursing School, University of Sydney, Sydney, NSW, Australia
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Wu YM, Kuo HC, Li CC, Wu HL, Chen JT, Cherng YG, Chen TJ, Dai YX, Liu HY, Tai YH. Preexisting Dementia Is Associated with Increased Risks of Mortality and Morbidity Following Major Surgery: A Nationwide Propensity Score Matching Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228431. [PMID: 33202564 PMCID: PMC7696268 DOI: 10.3390/ijerph17228431] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/12/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023]
Abstract
Patients with dementia are predisposed to multiple physiological abnormalities. It is uncertain if dementia associates with higher rates of perioperative mortality and morbidity. We used reimbursement claims data of Taiwan’s National Health Insurance and conducted propensity score matching analyses to evaluate the risk of mortality and major complications in patients with or without dementia undergoing major surgery between 2004 and 2013. We applied multivariable logistic regressions to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for the outcome of interest. After matching to demographic and clinical covariates, 7863 matched pairs were selected for analysis. Dementia was significantly associated with greater risks of 30-day in-hospital mortality (aOR: 1.71, 95% CI: 1.09–2.70), pneumonia (aOR: 1.48, 95% CI: 1.16–1.88), urinary tract infection (aOR: 1.59, 95% CI: 1.30–1.96), and sepsis (OR: 1.77, 95% CI: 1.34–2.34) compared to non-dementia controls. The mortality risk in dementia patients was attenuated but persisted over time, 180 days (aOR: 1.49, 95% CI: 1.23–1.81) and 365 days (aOR: 1.52, 95% CI: 1.30–1.78) after surgery. Additionally, patients with dementia were more likely to receive blood transfusion (aOR: 1.32, 95% CI: 1.11–1.58) and to need intensive care (aOR: 1.40, 95% CI: 1.12–1.76) compared to non-dementia controls. Senile dementia and Alzheimer’s disease were independently associated with higher rates of perioperative mortality and complications, but vascular dementia was not affected. We found that preexisting dementia was associated with mortality and morbidity after major surgery.
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Affiliation(s)
- Yu-Ming Wu
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (Y.-M.W.); (H.-C.K.); (C.-C.L.); (J.-T.C.); (Y.-G.C.); (H.-Y.L.)
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Hsien-Cheng Kuo
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (Y.-M.W.); (H.-C.K.); (C.-C.L.); (J.-T.C.); (Y.-G.C.); (H.-Y.L.)
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Chun-Cheng Li
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (Y.-M.W.); (H.-C.K.); (C.-C.L.); (J.-T.C.); (Y.-G.C.); (H.-Y.L.)
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Hsiang-Ling Wu
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
- School of Medicine, National Yang-Ming University, Taipei 11217, Taiwan; (T.-J.C.); (Y.-X.D.)
| | - Jui-Tai Chen
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (Y.-M.W.); (H.-C.K.); (C.-C.L.); (J.-T.C.); (Y.-G.C.); (H.-Y.L.)
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Yih-Giun Cherng
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (Y.-M.W.); (H.-C.K.); (C.-C.L.); (J.-T.C.); (Y.-G.C.); (H.-Y.L.)
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Tzeng-Ji Chen
- School of Medicine, National Yang-Ming University, Taipei 11217, Taiwan; (T.-J.C.); (Y.-X.D.)
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Ying-Xiu Dai
- School of Medicine, National Yang-Ming University, Taipei 11217, Taiwan; (T.-J.C.); (Y.-X.D.)
- Department of Dermatology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Hsin-Yi Liu
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (Y.-M.W.); (H.-C.K.); (C.-C.L.); (J.-T.C.); (Y.-G.C.); (H.-Y.L.)
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Ying-Hsuan Tai
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (Y.-M.W.); (H.-C.K.); (C.-C.L.); (J.-T.C.); (Y.-G.C.); (H.-Y.L.)
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Correspondence:
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Hasan TF, Kelley RE, Cornett EM, Urman RD, Kaye AD. Cognitive impairment assessment and interventions to optimize surgical patient outcomes. Best Pract Res Clin Anaesthesiol 2020; 34:225-253. [PMID: 32711831 DOI: 10.1016/j.bpa.2020.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/20/2020] [Indexed: 12/22/2022]
Abstract
For elderly patients undergoing elective surgical procedures, preoperative evaluation of cognition is often overlooked. Patients may experience postoperative delirium (POD) and postoperative cognitive decline (POCD), especially those with certain risk factors, including advanced age. Preoperative cognitive impairment is a leading risk factor for both POD and POCD, and studies have noted that identifying these deficiencies is critical during the preoperative period so that appropriate preventive strategies can be implemented. Comprehensive geriatric assessment is a useful approach which evaluates a patient's medical, psycho-social, and functional domains objectively. Various screening tools are available for preoperatively identifying patients with cognitive impairment. The Enhanced Recovery After Surgery (ERAS) protocols have been discussed in the context of prehabilitation as an effort to optimize a patient's physical status prior to surgery and decrease the risk of POD and POCD. Evidence-based protocols are warranted to standardize care in efforts to effectively meet the needs of these patients.
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Affiliation(s)
- Tasneem F Hasan
- Department of Neurology, Ochsner Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Roger E Kelley
- Department of Neurology, Ochsner Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Elyse M Cornett
- Department of Anesthesiology, Ochsner Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Boston, Massachussetts, 02115, USA.
| | - Alan D Kaye
- Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Ochsner Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71103, USA.
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D'Souza RS, Shen S, Ojukwu F, Gazelka HM, Pulos BP. Partnering with Palliative Care: A Case Report of Severe Pain in Critical Limb Ischemia Treated Successfully with a Continuous Popliteal Nerve Catheter. Case Rep Anesthesiol 2020; 2020:1054521. [PMID: 32318294 PMCID: PMC7166256 DOI: 10.1155/2020/1054521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 03/10/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Critical limb ischemia (CLI) is limb pain occurring at rest or impending limb loss as a result of lack of blood flow to the affected extremity. CLI pain is challenging to control despite multimodal pharmacologic analgesia and surgical intervention. We described the successful use of a continuous local anesthetic infusion via a popliteal nerve catheter to control severe refractory ischemic lower limb pain in a patient who failed surgical intervention and performed a brief narrative literature review on regional anesthesia for ischemic pain. Case Presentation. A 74-year-old female with acute myelogenous leukemia presented with CLI after experiencing left popliteal artery occlusion. Palliative medicine service was consulted for pain management in the setting of escalating narcotic dose requirements. She experienced a complicated hospital course with several failed attempts at surgical revascularization due to arterial rethrombosis. In accordance with the patient's goals of care, a continuous popliteal nerve catheter was placed, despite the high risk nature of an intervention in an immunocompromised patient with thrombocytopenia (platelet count of 30,000 platelets/microliter) and ongoing therapeutic anticoagulation. The patient experienced immediate relief while transitioning to comfort care. CONCLUSION This is the first report of successful analgesia for CLI via a continuous popliteal catheter in a patient with rethrombosis and failed surgical revascularization. Based on our collaborative experience, we recommend the development of partnerships between the acute pain service and palliative care service to facilitate the early evaluation and decision to utilize regional anesthesia for treatment of CLI.
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Affiliation(s)
- Ryan S. D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1 St SW, Rochester, MN 55904, USA
| | - Stephanie Shen
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1 St SW, Rochester, MN 55904, USA
| | - Frederick Ojukwu
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1 St SW, Rochester, MN 55904, USA
| | - Halena M. Gazelka
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, 200 1 St SW, Rochester, MN 55904, USA
- Center for Palliative Medicine, Mayo Clinic, 200 1 St SW, Rochester, MN 55904, USA
| | - Bridget P. Pulos
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1 St SW, Rochester, MN 55904, USA
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Monaro S, West S, Gullick J. The body with chronic limb‐threatening ischaemia: A phenomenologically derived understanding. J Clin Nurs 2020; 29:1276-1289. [DOI: 10.1111/jocn.15151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/31/2019] [Accepted: 11/24/2019] [Indexed: 01/25/2023]
Affiliation(s)
- Susan Monaro
- Concord Repatriation General Hospital Concord NSW Australia
- Faculty of Medicine and Health Sydney Nursing School University of Sydney Camperdown NSW Australia
| | - Sandra West
- Faculty of Medicine and Health Sydney Nursing School University of Sydney Camperdown NSW Australia
| | - Janice Gullick
- Faculty of Medicine and Health Sydney Nursing School University of Sydney Camperdown NSW Australia
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Abstract
PURPOSE OF REVIEW With the ageing population, there is an increasing number of patients with a neurocognitive disorder (NCD) who undergo surgical procedures. The aim of this review is to highlight the epidemiology of preoperative NCD. RECENT FINDINGS New guidelines have defined NCD into mild NCD and major NCD consistent with terminology from the wider clinical community. Several assessment tools have been used in the preoperative setting to identify patients with evidence of cognitive decline. NCD prior to surgery remains a major risk factor postoperative delirium. SUMMARY Cognitive dysfunction is common prior to surgery. Awareness of dysfunction, especially when taking care of older adults, is critical given the high risk of complications in this population.
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Duff S, Mafilios MS, Bhounsule P, Hasegawa JT. The burden of critical limb ischemia: a review of recent literature. Vasc Health Risk Manag 2019; 15:187-208. [PMID: 31308682 PMCID: PMC6617560 DOI: 10.2147/vhrm.s209241] [Citation(s) in RCA: 180] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/07/2019] [Indexed: 01/15/2023] Open
Abstract
Peripheral arterial disease is a chronic vascular disease characterized by impaired circulation to the lower extremities. Its most severe stage, known as critical limb ischemia (CLI), puts patients at an increased risk of cardiovascular events, amputation, and death. The objective of this literature review is to describe the burden of disease across a comprehensive set of domains—epidemiologic, clinical, humanistic, and economic—focusing on key studies published in the last decade. CLI prevalence in the United States is estimated to be approximately 2 million and is likely to rise in the coming years given trends in important risk factors such as age, diabetes, and smoking. Hospitalization for CLI patients is common and up to 60% are readmitted within 6 months. Amputation rates are unacceptably high with a disproportionate risk for certain demographic and socioeconomic groups. In addition to limb loss, CLI patients also have reduced life expectancy with mortality typically exceeding 50% by 5 years. Given the poor clinical prognosis, it is unsurprising that the quality of life burden associated with CLI is significant. Studies assessing quality of life in CLI patients have used a variety of generic and disease-specific measures and all document a substantial impact of the disease on the patient’s physical, social, and emotional health status compared to population norms. Finally, the poor clinical outcomes and increased medical resource use lead to a considerable economic burden for national health care systems. However, published cost studies are not comprehensive and, therefore, likely underestimate the true economic impact of CLI. Our summary documents a sobering assessment of CLI burden—a poor clinical prognosis translating into diminished quality of life and high costs for millions of patients. Continued prevention efforts and improved treatment strategies are the key to ameliorating the substantial morbidity and mortality associated with this disease.
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Affiliation(s)
- Steve Duff
- Veritas Health Economics Consulting , Carlsbad, CA, USA
| | | | - Prajakta Bhounsule
- Health Economics and Reimbursement, Abbott Vascular, Santa Clara, CA, USA
| | - James T Hasegawa
- Health Economics and Reimbursement, Abbott Vascular, Santa Clara, CA, USA
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Mii S, Guntani A, Kawakubo E, Shimazoe H, Ishida M. Impact of the Geriatric Nutritional Risk Index on the Long-Term Outcomes of Patients Undergoing Open Bypass for Intermittent Claudication. Circ J 2019; 83:1349-1355. [DOI: 10.1253/circj.cj-19-0005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shinsuke Mii
- Department of Vascular Surgery, Saiseikai Yahata General Hospital
| | - Atsushi Guntani
- Department of Vascular Surgery, Saiseikai Yahata General Hospital
| | - Eisuke Kawakubo
- Department of Vascular Surgery, Saiseikai Yahata General Hospital
| | | | - Masaru Ishida
- Department of Vascular Surgery, Steel Memorial Yawata Hospital
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White S, Griffiths R, Baxter M, Beanland T, Cross J, Dhesi J, Docherty AB, Foo I, Jolly G, Jones J, Moppett IK, Plunkett E, Sachdev K. Guidelines for the peri-operative care of people with dementia. Anaesthesia 2019; 74:357-372. [DOI: 10.1111/anae.14530] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2018] [Indexed: 12/24/2022]
Affiliation(s)
- S. White
- Royal Sussex County Hospital; Co-Chair, Association of Anaesthetists Working Party; Brighton UK
| | - R. Griffiths
- Peterborough and Stamford Hospitals Foundation NHS Trust; Co-Chair, Association of Anaesthetists Working Party; Peterborough UK
| | - M. Baxter
- University Hospital Southampton; British Geriatrics Society; UK
| | | | - J. Cross
- Guy's and St. Thomas’ Hospitals NHS Trust; Royal College of Nursing; London UK
| | - J. Dhesi
- Guy's and St. Thomas’ Hospitals NHS Trust; British Geriatrics Society; London UK
| | - A. B. Docherty
- Department of Anaesthesia and Critical Care; University of Edinburgh; UK
| | - I. Foo
- Western General Hospital; Age Anaesthesia Association; Edinburgh UK
| | | | | | - I. K. Moppett
- Anaesthesia and Peri-operative Medicine; University of Nottingham; Royal College of Anaesthetists; UK
| | - E. Plunkett
- University Hospitals Birmingham; Association of Anaesthetists Trainees; UK
| | - K. Sachdev
- Homerton University Hospital NHS Foundation Trust; London UK
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Kassahun WT, Staab H, Gockel I, Mehdorn M. Factors associated with morbidity and in-hospital mortality after surgery beyond the age of 90: Comparison with outcome results of younger patients matched for treatment. Am J Surg 2018; 216:1063-1069. [DOI: 10.1016/j.amjsurg.2017.11.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/09/2017] [Accepted: 11/28/2017] [Indexed: 10/18/2022]
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Quality of Life and Mortality after Endovascular, Surgical, or Conservative Treatment of Elderly Patients Suffering from Critical Limb Ischemia. Ann Vasc Surg 2018; 51:95-105. [DOI: 10.1016/j.avsg.2018.02.044] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 01/26/2018] [Accepted: 02/17/2018] [Indexed: 01/09/2023]
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Kassahun WT. The effects of pre-existing dementia on surgical outcomes in emergent and nonemergent general surgical procedures: assessing differences in surgical risk with dementia. BMC Geriatr 2018; 18:153. [PMID: 29970028 PMCID: PMC6029045 DOI: 10.1186/s12877-018-0844-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/25/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The aim was to assess the morbidity and in-hospital mortality that occur in surgical patients with pre-existing dementia compared with those outcomes in non-dementia patients following emergent and nonemergent general surgical operations. METHODS A total of 120 patients with dementia were matched for sex and type of surgery with 120 patients who did not have dementia, taken from a cohort of 15,295 patients undergoing surgery, in order to assess differences in surgical risk with dementia. Patient information was examined, including sex, body mass index (BMI), prevalence of individual comorbidities at admission, and several other variables that may be associated with postoperative outcomes as potential confounders. RESULTS Patients with dementia tended to have a higher overall complication burden compared to those without. This was evidenced by a higher average number of complications per patient (3.30 vs 2.36) and a higher average score on the comprehensive complication index (48.61 vs 37.60), values that were statistically significant for a difference between the two groups. The overall in-hospital mortality in patients with dementia was 28.3% (34 deaths out of 120 patients). During the same period, at our hospital, the overall in-hospital mortality in the control group was 20% (24 deaths out of 120 patients). Patient groups with and without dementia each had 3 and 5 associated risk factors for morbidity and 9 and 12 risk factors for mortality, respectively. CONCLUSIONS Patients with pre-existing dementia have a greater than average risk of early death after surgery, and their incidence of fatal complications is higher than that of surgical patients without dementia.
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Affiliation(s)
- Woubet Tefera Kassahun
- Clinic for Visceral, Transplantation, Thoracic and Vascular Surgery, University of Leipzig, Liebig Strasse 20, 04103, Leipzig, Germany.
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