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Tanos P, Ablett AD, Carter B, Ceelen W, Pearce L, Stechman M, McCarthy K, Hewitt J, Myint PK. SHARP risk score: A predictor of poor outcomes in adults admitted for emergency general surgery: A prospective cohort study. Asian J Surg 2022:S1015-9584(22)01483-X. [DOI: 10.1016/j.asjsur.2022.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/19/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
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Keon-Cohen ZM, Story DA, Moran JA, Jones DA. An audit of perioperative end-of-life care practices and documentation relating to patients who died in a surgical unit in three Victorian hospitals. Anaesth Intensive Care 2022; 50:234-242. [PMID: 35301860 DOI: 10.1177/0310057x211032652] [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: 11/17/2022]
Abstract
The number of older, frail patients undergoing surgery is increasing, prompting consideration of the benefits of intensive treatment. Despite collaborative decision-making processes such as advance care planning being supported by recent Australian legislation, their role in perioperative care is yet to be defined. Furthermore, there has been little evaluation of the quality of end-of-life care in the surgical population. We investigated documentation of the premorbid functional status, severity of illness, intensity of treatment, operative management and quality of end-of-life care in patients who died in a surgical unit, with a retrospective study of surgical mortality which was performed across three hospitals over a 23-month period in Victoria, Australia. Among 99 deceased patients in the study cohort, 68 had a surgical operation. Preoperative functional risk assessment by medical staff was infrequently documented in the medical notes (5%) compared with activities of daily living (69%) documented by nursing staff. Documented preoperative discussions regarding the risk of death were rarely and inconsistently done, but when done were extensive. Documented end-of-life care discussions were identified in 71%, but were frequently brief, inconsistent, and in 60% did not occur until 48 hours from death. In 35.4% of instances, documented discussions involved junior staff (registrars or residents), and 43.4% involved intensive care unit staff. Palliative or terminal care referrals also occurred late (1-2 days prior to death). Not-for-resuscitation orders were frequently changed when approaching the end of life. Overall, 57% of deceased patients had a documented opportunity for farewell with family. We conclude that discussions and documentation of end-of-life care practices could be improved and recommend that all surgical units undertake similar audits to ensure that end-of-life care discussions occur for high-risk and palliative care surgical patients and are documented appropriately.
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Affiliation(s)
- Zoe M Keon-Cohen
- Department of Anaesthesia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia.,Anaesthesia Department, Austin Health, Australia
| | - David A Story
- Anaesthesia Department, Austin Health, Australia.,Department of Critical Care, University of Melbourne, Melbourne, Australia
| | - Juli A Moran
- Department of Palliative Care, 3805Austin Health, Austin Health, Australia
| | - Daryl A Jones
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia.,Intensive Care Unit, Austin Health, Australia
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Applying Evidence-based Principles to Guide Emergency Surgery in Older Adults. J Am Med Dir Assoc 2022; 23:537-546. [PMID: 35304130 DOI: 10.1016/j.jamda.2022.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 12/24/2022]
Abstract
Although outcomes for older adults undergoing elective surgery are generally comparable to younger patients, outcomes associated with emergency surgery are poor. These adverse outcomes are in part because of the physiologic changes associated with aging, increased odds of comorbidities in older adults, and a lower probability of presenting with classic "red flag" physical examination findings. Existing evidence-based perioperative best practice guidelines perform better for elective compared with emergency surgery; so, decision making for older adults undergoing emergency surgery can be challenging for surgeons and other clinicians and may rely on subjective experience. To aid surgical decision making, clinicians should assess premorbid functional status, evaluate for the presence of geriatric syndromes, and consider social determinants of health. Documentation of care preferences and a surrogate decision maker are critical. In discussing the risks and benefits of surgery, patient-centered narrative formats with inclusion of geriatric-specific outcomes are important. Use of risk calculators can be meaningful, although limitations exist. After surgery, daily evaluation for common postoperative complications should be considered, as well as early discharge planning and palliative care consultation, if appropriate. The role of the geriatrician in emergency surgery for older adults may vary based on the acuity of patient presentation, but perioperative consultation and comanagement are strongly recommended to optimize care delivery and patient outcomes.
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Fornæss KM, Nome PL, Aakre EK, Hegvik T, Jammer I. Clinical frailty scale: Inter-rater reliability of retrospective scoring in emergency abdominal surgery. Acta Anaesthesiol Scand 2022; 66:25-29. [PMID: 34425015 DOI: 10.1111/aas.13974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/10/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Frailty is a complex syndrome shown to be an independent predictor of morbidity and mortality after surgery in older patients. Frailty scoring may, therefore, be important, for example, for pre-operative risk assessment and prognosis estimation. The Clinical Frailty Scale (CFS) has been developed to help operationalize frailty in the individual patient. However, the inter-rater reliability of retrospective CFS scoring through patient records by health care personnel is currently unknown in patients over 80 years of age undergoing emergency abdominal surgery. METHODS Retrospective review of electronic patient journal of 112 patients over 80 years of age undergoing emergency abdominal surgery between 2015 and 2016. Three researchers individually assigned each patient a CFS score. The inter-rater reliability was assessed using Cohen's weighted kappa for the comparison of pairs of assessors, as well as Kendall's coefficient of concordance for the comparison of all three raters simultaneously. RESULTS The agreement across raters was strong, with Cohen's kappa values ranging between 0.74 and 0.85 and a Kendall's coefficient of concordance of 0.86. CONCLUSIONS The inter-rater reliability of assigned CFS from patient journals seems acceptable. This could permit retrospective research utilizing CFS measures from several raters and across centers.
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Affiliation(s)
| | - Pia L. Nome
- Department of Clinical Medicine University of Bergen Bergen Norway
| | - Elin Kismul Aakre
- Department of Clinical Medicine University of Bergen Bergen Norway
- Department of Anaesthesia and Intensive Care Haukeland University Hospital Bergen Norway
| | - Tor‐Arne Hegvik
- Department of Biomedicine University of Bergen Bergen Norway
- Department of Breast and Endocrine Surgery Haukeland University Hospital Bergen Norway
| | - Ib Jammer
- Department of Anaesthesia and Intensive Care Haukeland University Hospital Bergen Norway
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Prevalence of preoperative cognitive impairment in older surgical patients.: A systematic review and meta-analysis. J Clin Anesth 2021; 76:110574. [PMID: 34749047 DOI: 10.1016/j.jclinane.2021.110574] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 12/23/2022]
Abstract
STUDY OBJECTIVE Older surgical patients with cognitive impairment are at an increased risk for adverse perioperative outcomes, however the prevalence of preoperative cognitive impairment is not well-established within this population. The purpose of this review is to determine the pooled prevalence of preoperative cognitive impairment in older surgical patients. DESIGN Systematic review and meta-analysis. SETTING MEDLINE (Ovid), PubMed (non-MEDLINE records only), Embase, Cochrane Central, Cochrane Database of Systematic Reviews, PsycINFO, and EMCare Nursing for relevant articles from 1946 to April 2021. PATIENTS Patients aged ≥60 years old undergoing surgery, and preoperative cognitive impairment assessed by validated cognitive assessment tools. INTERVENTIONS Preoperative assessment. MEASUREMENTS Primary outcomes were the pooled prevalence of preoperative cognitive impairment in older patients undergoing either elective (cardiac or non-cardiac) or emergency surgery. MAIN RESULTS Forty-eight studies (n = 42,498) were included. In elective non-cardiac surgeries, the pooled prevalence of unrecognized cognitive impairment was 37.0% (95% confidence interval [CI]: 30.0%, 45.0%) among 27,845 patients and diagnosed cognitive impairment was 18.0% (95% CI: 9.0%, 33.0%) among 11,676 patients. Within the elective non-cardiac surgery category, elective orthopedic surgery was analyzed. In this subcategory, the pooled prevalence of unrecognized cognitive impairment was 37.0% (95% CI: 26.0%, 49.0%) among 1117 patients, and diagnosed cognitive impairment was 17.0% (95% CI: 3.0%, 60.0%) among 6871 patients. In cardiac surgeries, the unrecognized cognitive impairment prevalence across 588 patients was 26.0% (95% CI: 15.0%, 42.0%). In emergency surgeries, the unrecognized cognitive impairment prevalence was 50.0% (95% CI: 35.0%, 65.0%) among 2389 patients. CONCLUSIONS A substantial number of surgical patients had unrecognized cognitive impairment. In elective non-cardiac and emergency surgeries, the pooled prevalence of unrecognized cognitive impairment was 37.0% and 50.0%. Preoperative cognitive screening warrants more attention for risk assessment and stratification.
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Mitigating the stress response to improve outcomes for older patients undergoing emergency surgery with the addition of beta-adrenergic blockade. Eur J Trauma Emerg Surg 2021; 48:799-810. [PMID: 33847766 PMCID: PMC9001541 DOI: 10.1007/s00068-021-01647-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/11/2021] [Indexed: 12/14/2022]
Abstract
As population age, healthcare systems and providers are likely to experience a substantial increase in the proportion of elderly patients requiring emergency surgery. Emergency surgery, compared with planned surgery, is strongly associated with increased risks of adverse postoperative outcomes due to the short time available for diagnosis, optimization, and intervention in patients presenting with physiological derangement. These patient populations, who are often frail and burdened with a variety of co-morbidities, have lower reserves to deal with the stress of the acute condition and the required emergency surgical intervention. In this review article, we discuss topical areas where mitigation of the physiological stress posed by the acute condition and asociated surgical intervention may be feasible. We consider the impact of the adrenergic response and use of beta blockers for these high-risk patients and discuss common risk factors such as frailty and delirium. A proactive multidisciplinary approach to peri-operative care aimed at mitigation of the stress response and proactive management of common conditions in the older emergency surgical patient could yield more favorable outcomes.
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Aakre EK, Ulvik A, Hufthammer KO, Jammer I. Mortality and complications after emergency laparotomy in patients above 80 years. Acta Anaesthesiol Scand 2020; 64:913-919. [PMID: 32270490 DOI: 10.1111/aas.13594] [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: 01/22/2020] [Revised: 03/17/2020] [Accepted: 03/21/2020] [Indexed: 12/22/2022]
Abstract
Emergency laparotomy (EL) is a high-risk procedure. However, available evidence regarding outcome after emergency surgery in very old patients is limited. The aim of this observational study was to investigate outcome following EL in patients ≥80 years of age. METHODS This single-center retrospective study was undertaken at Haukeland University Hospital, Norway. Demographic data, pre-operative risk assessment, surgical procedures, intrahospital logistics, complications, mortality, and discharge data were collected from the medical records. Primary outcome was 30-day mortality. Secondary outcomes were 90-day mortality, 1-year mortality, post-operative complications, and level of care at discharge. RESULTS One hundred and six patients aged 80-96 years underwent EL between 2015 and 2016. Of these, 58% had cardiopulmonary disease, and 16% lived in a nursing home before surgery. Resection of colon was performed in 26 cases, adhesiolysis was performed in 24, and resection of small intestine in 18. Within 30 days, 28 patients died (26%), 15 during the first post-operative week. For 82% of the patients, at least one complication occurred, and medical complications were far more frequent than surgical. Post-operatively, pulmonary morbidity was found in 51 patients (48%) and delirium in 42 (40%). The number of intrahospital deaths was 25 (24%). Among the 81survivors, 53 were discharged to a nursing home (65%). One-year mortality was 47% (50/106). CONCLUSIONS Mortality after EL in octo- and nonagenarians is very high. Medical complications are more common than surgical, and functional decline is frequent. Future studies should focus on the effect of a care bundle including geriatric intervention in these patients.
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Affiliation(s)
- Elin K. Aakre
- Department of Anaesthesia and Surgical Services Haukeland University Hospital Bergen Norway
| | - Atle Ulvik
- Department of Anaesthesia and Surgical Services Haukeland University Hospital Bergen Norway
| | - Karl O. Hufthammer
- Centre for Clinical Research Haukeland University Hospital Bergen Norway
| | - Ib Jammer
- Department of Anaesthesia and Surgical Services Haukeland University Hospital Bergen Norway
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Hanna K, Khan M, Ditillo M, Hamidi M, Tang A, Zeeshan M, Saljuqi AT, Joseph B. Prospective evaluation of preoperative cognitive impairment and postoperative morbidity in geriatric patients undergoing emergency general surgery. Am J Surg 2020; 220:1064-1070. [PMID: 32291074 DOI: 10.1016/j.amjsurg.2020.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 03/14/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Cognitive impairment (CI) is common in geriatric patients. We aimed to evaluate the prevalence and impact of CI on outcomes in geriatric patients undergoing emergency general surgery (EGS). METHODS We performed a (2017-2018) prospective analysis of patients (age ≥65y) who underwent EGS. Cognition was assessed using the Montreal Cognitive Assessment (MoCA). Patients were stratified into: CI (MoCA score<26) and no-CI (MoCA≥26). Outcomes were the prevalence of CI, in-hospital complications, discharged to rehab/skilled nursing facility (SNF), and mortality. RESULTS A total of 142 patients were enrolled. Overall prevalence of CI was 20%. Patients with CI had higher rates of complications (OR 1.6 [1.4-1.9]; p = 0.01), and discharge to rehab/SNF (OR 2.2 [2.0-2.5]; p = 0.03). There was no difference in mortality (OR 1.1 [0.6-1.8]; p = 0.24) between the 2 groups. CONCLUSION One in five geriatric EGS patients has CI. It is associated with higher complications and adverse discharge. Cognitive assessment should be included in preoperative risk stratification.
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Affiliation(s)
- Kamil Hanna
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Muhammad Khan
- Department of Surgery, Westchester Medical Center, Valhalla, NY, USA.
| | - Michael Ditillo
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Mohammad Hamidi
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Andrew Tang
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Muhammad Zeeshan
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Abdul Tawab Saljuqi
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Bellal Joseph
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
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Leclerc AA, Gillespie AI, Tadic SD, Smith LJ, Rosen CA. The prevalence of cognitive impairment in laryngology treatment-seeking patients. Laryngoscope 2019; 130:2003-2007. [PMID: 31654439 DOI: 10.1002/lary.28355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 09/12/2019] [Accepted: 09/19/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS The incidence of cognitive impairment (CI) in the elderly general population is 10% to 20%. The incidence of CI in the elderly laryngology treatment-seeking population is unknown, and CI may impact decision making for elective medical/surgical treatment and negatively impact the outcome of voice/swallowing therapy. We sought to determine the prevalence of CI in elderly patients who are seeking laryngology care and to evaluate the feasibility of administering a cognitive screening instrument. STUDY DESIGN Prospective, Cross-sectional. METHODS One hundred fifty patients (≥65 years old) without a previous diagnosis of CI, seeking laryngology evaluation, were administered the Montreal Cognitive Assessment (MoCA) test by a trained physician. Other members of the clinical team were blinded to the MoCA results. RESULTS Twenty-five percent of participants obtained a score diagnostic for at least mild CI. The results showed a correlation between the MoCA scores and 1) the time needed to complete the test, 2) participant age, and 3) participant education level. No differences were observed between gender, alcohol consumption, or use of medications that can affect cognition and MoCA score. CONCLUSION One in four elderly laryngology treatment-seeking patients were found to have undiagnosed CI. This finding warrants consideration for CI screening for these patients being evaluated for voice therapy and elective surgery. Treatment decision making in this population may benefit from additional family involvement. LEVEL OF EVIDENCE 2c Laryngoscope, 130: 2003-2007, 2020.
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Affiliation(s)
- Andrée-Anne Leclerc
- Division of Otolaryngology-Head and Neck Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Amanda I Gillespie
- Department of Otolaryngology, Emory Voice Center, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Stasa D Tadic
- Division of Geriatric Medicine and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Libby J Smith
- Department of Otolaryngology, University of Pittsburgh Voice Center, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Clark A Rosen
- UCSF Voice and Swallowing Center, Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
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The Prevalence of Delirium in An Older Acute Surgical Population and Its Effect on Outcome. Geriatrics (Basel) 2019; 4:geriatrics4040057. [PMID: 31623269 PMCID: PMC6960557 DOI: 10.3390/geriatrics4040057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/04/2019] [Accepted: 10/05/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND With an ageing population, an increasing number of older adults are admitted for assessment to acute surgical units. Older adults have specific factors that may influence outcomes, one of which is delirium (acute cognitive impairment). OBJECTIVES To establish the prevalence of delirium on admission in an older acute surgical population and its effect on mortality. Secondary outcomes investigated include hospital readmission and length of hospital stay. METHOD This observational multi-centre study investigated consecutive patients, ≥65 years, admitted to the acute surgical units of five UK hospitals during an eight-week period. On admission the Confusion Assessment Method (CAM) score was performed to detect delirium. The effect of delirium on important clinical outcomes was investigated using tests of association and logistic regression models. RESULTS The cohort consisted of 411 patients with a mean age of 77.3 years (SD 8.1). The prevalence of admission delirium was 8.8% (95% CI 6.2-11.9%) and cognitive impairment was 70.3% (95% CI 65.6-74.7%). The delirious group were not more likely to die at 30 or 90 days (OR 1.1, 95% CI 0.2 to 5.1, p = 0.67; OR 1.4, 95% CI 0.4 to 4.1. p = 0.82) or to be readmitted within 30 days of discharge (OR 0.9, 95% CI 0.4 to 2.2, p = 0.89). Length of hospital stay was significantly longer in the delirious group (median 8 vs. 5 days respectively, p = 0.009). CONCLUSION Admission delirium occurs in just under 10% of older people admitted to acute surgical units, resulting in significantly longer hospital stays.
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Lack of informed consent for surgical procedures by elderly patients with inability to consent: a retrospective chart review from an academic medical center in Norway. Patient Saf Surg 2019; 13:24. [PMID: 31285756 PMCID: PMC6588892 DOI: 10.1186/s13037-019-0205-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 06/11/2019] [Indexed: 11/12/2022] Open
Abstract
Background Respect for patient autonomy and the requirement of informed consent is an essential basic patient right. It is constituted through international conventions and implemented in health law in Norway and most other countries. Healthcare without informed consent is only allowed under specific exceptions, which requires a record in the patient charts. In this study, we investigated how surgeons recorded decisions in situations where the elderly patient’s ability to provide a valid informed consent was questionable or clearly missing. Method We investigated all medical records of patients admitted to surgical departments in a Norwegian large academic emergency hospital over a period of 38 days (approximately 5000 patients). We selected records of patients above the age of 70 (570 patients) and searched through these 570 medical records for any noted clear indications of inability to consent such as “do not understand”, “confused” etc. (102 patients). We read through all the medical records on these 102 patients noting any recordings on lack of informed consent, any recordings on reasoning and process hereto. We also took note whether there were clear indications on the use of coercion. Results None of the 102 included patients´ charts contained legally valid recorded assessments (for example related to the patients´ competence to consent) when patients without the ability to consent were admitted and provided healthcare. Some charts contained records that the patient resisted treatment, thus indicating treatment with coercion. In these situations, we did not find any documentation related to legal requirements that regulate the use of coercion. Discussion and conclusion We found a substantial lack of compliance with the legal requirements that apply when obtaining valid informed consent. There are many possible reasons for this: Lack of knowledge of the legal requirements, disagreement about the rules, or that it is simply not possible to comply with the extensive formal and material legal requirements in clinical practice. The results do not point out whether the appropriate measures are amending the law, educating and requiring more compliance from surgeons, or both.
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Ablett AD, McCarthy K, Carter B, Pearce L, Stechman M, Moug S, Hewitt J, Myint PK. Cognitive impairment is associated with mortality in older adults in the emergency surgical setting: Findings from the Older Persons Surgical Outcomes Collaboration (OPSOC): A prospective cohort study. Surgery 2019; 165:978-984. [DOI: 10.1016/j.surg.2018.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/30/2018] [Accepted: 10/13/2018] [Indexed: 12/29/2022]
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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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14
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Ablett AD, McCarthy K, Carter B, Pearce L, Stechman M, Moug S, Ceelen W, Hewitt J, Myint PK. A practical risk scale for predicting morbidity and mortality in the emergency general surgical setting: A prospective multi-center study. Int J Surg 2018; 60:236-244. [PMID: 30481611 DOI: 10.1016/j.ijsu.2018.11.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/30/2018] [Accepted: 11/19/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Low albumin is a prognostic factor associated with poor surgical outcomes. We aimed to examine the predicative ability of easily obtainable point-of-care variables in combination, to derive a practical risk scale for predicting older adults at risk of poor outcomes on admission to the emergency general surgical setting. METHODS This is an international multi-center prospective cohort study conducted as part of the Older Persons Surgical Outcomes Collaboration (www.OPSOC.eu). The effect of having hypoalbuminemia (defined as albumin ≤3.5 g/dL) on selected outcomes was examined using fully adjusted multivariable models. In a subgroup of patients with hypoalbuminemia, we observed four risk characteristics (Male, Anemia, Low albumin, Eighty-five and over [MALE]). Subsequently, the impact of incremental increase in MALE score (each characteristic scoring 1 point (maximum score 4) on measured outcomes was assessed. RESULTS The cohort consisted of 1406 older patients with median (IQR) age of 76 (70-83) years. In fully adjusted models, hypoalbuminemia was significantly associated with undergoing emergency surgery (1.32 (95%CI 1.03-1.70); p = 0.03), 30-day mortality (4.23 (2.22-8.08); p < 0.001), 90-day mortality (3.36 (2.14-5.28); p < 0.001) (primary outcome), and increased hospital length of stay, irrespective of whether a patient received emergency surgical intervention. Every point increase in MALE score was associated with higher odds of mortality, with a MALE score of 4 being associated with 30-day mortality (adjusted OR(95% CI) = 33.38 (3.86-288.7); p = 0.001) and 90-day mortality (11.37 (3.85-33.59); p < 0.001) compared to the reference category of those with MALE score 0. CONCLUSIONS The easy to use and practical MALE risk score calculated at point of care identifies older adults at a greater risk of poor outcomes, thereby allowing clinicians to prioritize patients who may benefit from early comprehensive geriatric assessment in the emergency general surgical setting.
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Affiliation(s)
- A D Ablett
- Institute of Applied Health Sciences, University of Aberdeen & Aberdeen Royal Infirmary, NHS Grampian, United Kingdom
| | - K McCarthy
- Department of General Surgery, King's College London, United Kingdom
| | - B Carter
- Department of Biostatistics and Health Informatics, Institute of Psychology Psychiatry and Neuroscience, King's College London, United Kingdom
| | - L Pearce
- Department of General Surgery, Manchester Royal Infirmary, United Kingdom
| | - M Stechman
- Department of General Surgery, University Hospital of Wales, United Kingdom
| | - S Moug
- Department of General Surgery, Royal Alexandra Hospital, Paisley, United Kingdom
| | - W Ceelen
- Department of GI Surgery, University Hospital, Ghent, Belgium
| | - J Hewitt
- Department of Population Medicine, Cardiff University, United Kingdom
| | - P K Myint
- Institute of Applied Health Sciences, University of Aberdeen & Aberdeen Royal Infirmary, NHS Grampian, United Kingdom.
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Abstract
Cognition is essential to all aspects of our everyday life. Although we take our cognitive function for granted, the perioperative period is prone to several aggressions that might impair it. Postoperative cognitive dysfunction, has been the aim of many studies recently, and was shown to be very common with an incidence that can reach 40%, yielding not only impairment in cognition, but also longer hospital stays, higher costs and greater mortality. While several studies have revealed some of the mechanisms contributing to postoperative cognitive dysfunction, the search for the perfect instrument to screen and measure cognitive (dys)function has proven more elusive. The present paper aims to review several cognitive evaluation methods, discussing their advantages and disadvantages as well as their potential clinical applications in evaluating the dynamics of the recovery of cognitive function after anesthesia and surgery. The current availability of easy to use computerized tests might provide the tools necessary to identify patients at risk, and promptly provide them with the adequate course of action.
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Affiliation(s)
- Sérgio Vide
- Hospital CLINIC de Barcelona, Anesthesiology Department, Systems Pharmacology Effect Control & Modeling (SPEC-M) Research Group, Barcelona, Spain; Hospital Pedro Hispano, Department of Anesthesia, Matosinhos, Portugal; Centro Hospitalar Universitário do Porto, Department of Anesthesiology, Center for Clinical Research in Anesthesia, Porto, Portugal
| | - Pedro L Gambús
- Hospital CLINIC de Barcelona, Anesthesiology Department, Systems Pharmacology Effect Control & Modeling (SPEC-M) Research Group, Barcelona, Spain; University of California San Francisco (UCSF), Department of Anesthesia and Perioperative Care, San Francisco, California, USA; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), NeuroImmunology Research Group, Barcelona, Spain.
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16
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Myint PK, Owen S, McCarthy K, Pearce L, Moug SJ, Stechman MJ, Hewitt J, Carter B. Is anemia associated with cognitive impairment and delirium among older acute surgical patients? Geriatr Gerontol Int 2018; 18:1025-1030. [PMID: 29498179 PMCID: PMC6099313 DOI: 10.1111/ggi.13293] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/12/2017] [Accepted: 01/24/2018] [Indexed: 12/31/2022]
Abstract
AIM The determinants of cognitive impairment and delirium during acute illness are poorly understood, despite being common among older people. Anemia is common in older people, and there is ongoing debate regarding the association between anemia, cognitive impairment and delirium, primarily in non-surgical patients. METHODS Using data from the Older Persons Surgical Outcomes Collaboration 2013 and 2014 audit cycles, we examined the association between anemia and cognitive outcomes in patients aged ≥65 years admitted to five UK acute surgical units. On admission, the Confusion Assessment Method was carried out to detect delirium. Cognition was assessed using the Montreal Cognitive Assessment, and two levels of impairment were defined as Montreal Cognitive Assessment <26 and <20. Logistic regression models were constructed to examine these associations in all participants, and individuals aged ≥75 years only. RESULTS A total of 653 patients, with a median age of 76.5 years (interquartile range 73.0-80.0 years) and 53% women, were included. Statistically significant associations were found between anemia and age; polypharmacy; hyperglycemia; and hypoalbuminemia. There was no association between anemia and cognitive impairment or delirium. The adjusted odds ratios of cognitive impairment were 0.95 (95% CI 0.56-1.61) and 1.00 (95% CI 0.61-1.64) for the Montreal Cognitive Assessment <26 and <20, respectively. The adjusted odds ratio of delirium was 1.00 (95% CI 0.48-2.10) in patients with anemia compared with those without. Similar results were observed for the ≥75 years age group. CONCLUSIONS There was no association between anemia and cognitive outcomes among older people in this acute surgical setting. Considering the retrospective nature of the study and possible lack of power, findings should be taken with caution. Geriatr Gerontol Int 2018; 18: 1025-1030.
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Affiliation(s)
- Phyo Kyaw Myint
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.,Department of Medicine for the Elderly, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Stephanie Owen
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - Kathryn McCarthy
- Department of General Surgery, North Bristol NHS Trust, Bristol, UK
| | - Lyndsay Pearce
- Department of General Surgery, Manchester Royal Infirmary, Manchester, UK
| | - Susan J Moug
- Department of General Surgery, Royal Alexandra Hospital, Paisley, Greater Glasgow, UK
| | - Michael J Stechman
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | | | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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17
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Hewitt J, Marke M, Honeyman C, Huf S, Lai A, Dong A, Wright T, Blake S, Fallaize R, Hughes JL, Pearce L, McCarthy K. Cognitive impairment in older patients undergoing colorectal surgery. Scott Med J 2018; 63:11-15. [DOI: 10.1177/0036933017750988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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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Affiliation(s)
- Jonathan Hewitt
- Division of Population Medicine, Cardiff University, University Hospital Wales, UK
| | | | | | - Simon Huf
- North Bristol NHS Trust, Bristol, UK
| | - Aida Lai
- North Bristol NHS Trust, Bristol, UK
| | - Anni Dong
- North Bristol NHS Trust, Bristol, UK
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18
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Berlin A, Hwang F, Singh R, Pentakota SR, Singh R, Chernock B, Mosenthal AC. Outcomes and palliative care utilization in patients with dementia and acute abdominal emergency: opportunities for surgical quality improvement. Surgery 2017; 163:444-449. [PMID: 29217285 DOI: 10.1016/j.surg.2017.09.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/31/2017] [Accepted: 09/16/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND When patients with dementia develop acute surgical abdomen, patients, surrogates, and surgeons need accurate prognostic information to facilitate goal-concordant decision making. Palliative care can assist with communication, symptom management, and family and caregiver support in this population. We aimed to characterize outcomes and patterns of palliative care utilization among patients with dementia, presenting with abdominal surgical emergency. METHOD We retrospectively queried the National Inpatient Sample for patients aged >50 years with dementia and acute abdominal emergency who were admitted nonelectively 2009-2013, utilizing ICD-9-CM codes for dementia and surgical indication. We characterized outcomes and identified predictors of palliative care utilization. RESULTS Among 15,209 patients, in-hospital mortality was 10.2%, the nonroutine discharge rate was 67.2%, and 7.5% received palliative care. Patients treated operatively were less likely to receive palliative care than those who did not undergo operation (adjusted OR = 0.50; 95% CI 0.41-0.62). Only 6.4% of patients discharged nonroutinely received palliative care. CONCLUSION Patients with dementia and acute abdominal emergency have considerable in-hospital mortality, a high frequency of nonroutine discharge, and low palliative care utilization. In this group, we discovered a large gap in palliative care utilization, particularly among those treated operatively and those who are discharged nonroutinely.
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Affiliation(s)
- Ana Berlin
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ.
| | - Franchesca Hwang
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Ranbir Singh
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Sri Ram Pentakota
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Roshansa Singh
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Brad Chernock
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Anne C Mosenthal
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
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19
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Needham M, Webb C, Bryden D. Postoperative cognitive dysfunction and dementia: what we need to know and do. Br J Anaesth 2017; 119:i115-i125. [DOI: 10.1093/bja/aex354] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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20
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Goeteyn J, Evans LA, De Cleyn S, Fauconnier S, Damen C, Hewitt J, Ceelen W. Frailty as a predictor of mortality in the elderly emergency general surgery patient. Acta Chir Belg 2017; 117:370-375. [PMID: 28602153 DOI: 10.1080/00015458.2017.1337339] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The number of surgical procedures performed in elderly and frail patients has greatly increased in the last decades. However, there is little research in the elderly emergency general surgery patient. The aim of this study was to assess the prevalence of frailty in the emergency general surgery population in Belgium. Secondly, we examined the length of hospital stay, readmission rate and mortality at 30 and 90 days. METHODS We conducted a prospective observational study at Ghent University Hospital. All patients older than 65 admitted to a general surgery ward from the emergency department were eligible for inclusion. Primary endpoint was mortality at 30 days. Secondary outcomes were mortality at 90 days, readmissions and length of stay. Cross-sectional observations were performed using the Fisher exact test, Mann-Whitney U-test, or one-way ANOVA. We performed a COX multivariable analysis to identify independent variables associated with mortality at 30 and 90 days as well as the readmission risk. RESULTS Data were collected from 98 patients in a four-month period. 23.5% of patients were deemed frail. 79% of all patients underwent abdominal surgery. Univariate analyses showed that polypharmacy, multimorbidity, a history of falls, hearing impairment and urinary incontinence were statistically significantly different between the non-frail and the group. Frail patients showed a higher incidence for mortality within 30 days (9% versus 1.3% (p = .053)). There were no differences between the two groups for mortality at 90 days, readmission, length of stay and operation. Frailty was a predictor for mortality at 90 days (p= .025) (hazard ratio (HR) 10.83 (95%CI 1.34-87.4)). Operation (p= .084) (HR 0.16 (95%CI 0.16-1.29)) and the presence of chronic cardiac failure (p= .049) (HR 0.38 (95%CI 0.14-0.99)) were protective for mortality at 90 days. CONCLUSION Frailty is a significant predictor for mortality for elderly patients undergoing emergency abdominal/general surgery. LEVEL OF EVIDENCE Level II therapeutic study.
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Affiliation(s)
- Jens Goeteyn
- Department of GI Surgery, University Hospital, Ghent, Belgium
| | - Louis A. Evans
- Department of Surgery, University Hospital Wales, Cardiff, UK
| | - Siem De Cleyn
- Department of GI Surgery, University Hospital, Ghent, Belgium
| | | | - Caroline Damen
- Department of GI Surgery, University Hospital, Ghent, Belgium
| | - Jonathan Hewitt
- Department of Population Medicine, Cardiff University, Cardiff, UK
| | - Wim Ceelen
- Department of GI Surgery, University Hospital, Ghent, Belgium
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21
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Puustinen J, Luostarinen L, Luostarinen M, Pulliainen V, Huhtala H, Soini M, Suhonen J. The Use of MoCA and Other Cognitive Tests in Evaluation of Cognitive Impairment in Elderly Patients Undergoing Arthroplasty. Geriatr Orthop Surg Rehabil 2016; 7:183-187. [PMID: 27847677 PMCID: PMC5098689 DOI: 10.1177/2151458516669203] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To examine the prevalence and effect of cognitive impairment on treatment outcomes in elderly patients undergoing arthroplasty and to describe the feasibility of cognitive tests. MATERIALS AND METHODS The participants were 52 patients with a mean age of 78 years 11 months (SD: 3.3), waiting for primary arthroplasty. We translated Montreal Cognitive Assessment (MoCA) into Finnish and compared it with Mini-Mental State Examination (MMSE), Mini-Cog, and clock-drawing tests prior to and 3 months after the surgery. The ability to perform activities of daily living, depression, quality of life, and years of education were evaluated. RESULTS The mean MoCA score on the first visit was 20.7 (SD: 4.1). The pre- and postoperative cognitive tests implied there were no changes in cognitive functioning. Unambiguous delirium was detected in 6 patients. Delirium was not systematically assessed and consequently hypoactive delirium cases were possibly missed. Both MMSE and Mini-Cog found 3/6 of those and clock drawing and MoCA 6/6. Low preoperative MoCA, MMSE, and Mini-Cog scores predicted follow-up treatment in health-care center hospitals (P = .02, .011, and .044, respectively). During the 5-year follow-up period, 11/52 patients died. Higher education was the only variable associated with survival. The survivors had attained the median of 8 (range: 4-19) years of education compared with 6 (range: 4-8) years among the deceased. CONCLUSION The prevalence of cognitive impairment among older patients presenting for arthroplasty is high and mostly undiagnosed. It is feasible to use the MoCA to identify cognitive impairment preoperatively in this group. The clock-drawing test was abnormal in all patients with postoperative delirium, which could be used as a screening test. Higher education predicted survival on a 5-year follow-up period.
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Affiliation(s)
| | | | | | | | - Heini Huhtala
- Tampereen yliopisto Laaketieteen yksikko, Tampere, Finland
| | - Marjo Soini
- Paijat-Hameen sosiaali ja terveysyhtyma, Lahti, Finland
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22
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Moug SJ, Stechman M, McCarthy K, Pearce L, Myint PK, Hewitt J. Frailty and cognitive impairment: Unique challenges in the older emergency surgical patient. Ann R Coll Surg Engl 2016; 98:165-9. [PMID: 26890834 DOI: 10.1308/rcsann.2016.0087] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Older patients (>65 years of age) admitted as general surgical emergencies increasingly require improved recognition of their specific needs relative to younger patients. Two such needs are frailty and cognitive impairment. These are evolving research areas that the emergency surgeon increasingly requires knowledge of to improve short- and long-term patient outcomes. METHODS This paper reviews the evidence for frailty and cognitive impairment in the acute surgical setting by defining frailty and cognitive impairment, introducing methods of diagnosis, discussing the influence on prognosis and proposing strategies to improve older patient outcomes. RESULTS Frailty is present in 25% of the older surgical population. Using frailty-scoring tools, frailty was associated with a significantly longer hospital stay and higher mortality at 30 and 90 days after admission to an acute surgical unit. Cognitive impairment is present in a high number of older acute surgical patients (approximately 70%), whilst acute onset cognitive impairment, termed delirium, is documented in 18%. However, patients with delirium had significantly longer hospital stays and higher in-hospital mortality than those with cognitive impairment. CONCLUSIONS Improved knowledge of frailty and delirium by the emergency surgeon allows the specialised needs of older surgical patients to be taken into account. Early recognition, and consideration of minimally invasive surgery or radiological intervention alongside potentially transferable successful elective interventions such as comprehensive geriatric assessment, may help to improve short- and long-term patient outcomes in this vulnerable population.
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Affiliation(s)
- S J Moug
- Royal Alexandra Hospital , Paisley , UK
| | - M Stechman
- University Hospital of Wales , Cardiff , UK
| | | | | | - P K Myint
- University of Aberdeen; Aberdeen Royal Infirmary , UK
| | - J Hewitt
- University Hospital Llandough , Cardiff , UK.,on behalf of The Older Persons Surgical Outcomes Collaboration (OPSOC)
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23
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Roberge G, Stortz SK, Frankel WC, Greene KL, Deng DY. Identifying Prevalence and Risk Factors for Mild Cognitive Impairment in Adults Presenting for Urological Evaluation. Urology 2016; 94:29-35. [DOI: 10.1016/j.urology.2016.03.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 03/11/2016] [Accepted: 03/29/2016] [Indexed: 11/27/2022]
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24
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Ali TF, Warkentin LM, Gazala S, Wagg AS, Padwal RS, Khadaroo RG. Self-Reported Outcomes in Individuals Aged 65 and Older Admitted for Treatment to an Acute Care Surgical Service: A 6-Month Prospective Cohort Study. J Am Geriatr Soc 2015; 63:2388-94. [DOI: 10.1111/jgs.13783] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Talal F. Ali
- Department of Surgery; University of Alberta; Edmonton Alberta Canada
| | | | - Sayf Gazala
- Department of Surgery; University of Alberta; Edmonton Alberta Canada
| | - Adrian S. Wagg
- Department of Medicine; University of Alberta; Edmonton Alberta Canada
| | - Raj S. Padwal
- Department of Medicine; University of Alberta; Edmonton Alberta Canada
| | - Rachel G. Khadaroo
- Department of Surgery; University of Alberta; Edmonton Alberta Canada
- Acute Care and Emergency Surgery; University of Alberta; Edmonton Alberta Canada
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25
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Berger M, Nadler JW, Browndyke J, Terrando N, Ponnusamy V, Cohen HJ, Whitson HE, Mathew JP. Postoperative Cognitive Dysfunction: Minding the Gaps in Our Knowledge of a Common Postoperative Complication in the Elderly. Anesthesiol Clin 2015; 33:517-50. [PMID: 26315636 DOI: 10.1016/j.anclin.2015.05.008] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Postoperative cognitive dysfunction (POCD) is a common complication associated with significant morbidity and mortality in elderly patients. There is much interest in and controversy about POCD, reflected partly in the increasing number of articles published on POCD recently. Recent work suggests surgery may also be associated with cognitive improvement in some patients, termed postoperative cognitive improvement (POCI). As the number of surgeries performed worldwide approaches 250 million per year, optimizing postoperative cognitive function and preventing/treating POCD are major public health issues. In this article, we review the literature on POCD and POCI, and discuss current research challenges in this area.
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Affiliation(s)
- Miles Berger
- Department of Anesthesiology, Duke University Medical Center, Duke South, Orange Zone, Room 4317, Durham, NC 27710, USA.
| | - Jacob W Nadler
- Department of Anesthesiology, Duke University Medical Center, Duke South, Orange Zone, Room 4317, Durham, NC 27710, USA
| | - Jeffrey Browndyke
- Department of Anesthesiology, Duke University Medical Center, Duke South, Orange Zone, Room 4317, Durham, NC 27710, USA
| | - Niccolo Terrando
- Department of Anesthesiology, Duke University Medical Center, Duke South, Orange Zone, Room 4317, Durham, NC 27710, USA
| | - Vikram Ponnusamy
- Department of Anesthesiology, Duke University Medical Center, Duke South, Orange Zone, Room 4317, Durham, NC 27710, USA
| | - Harvey Jay Cohen
- Department of Anesthesiology, Duke University Medical Center, Duke South, Orange Zone, Room 4317, Durham, NC 27710, USA
| | - Heather E Whitson
- Department of Anesthesiology, Duke University Medical Center, Duke South, Orange Zone, Room 4317, Durham, NC 27710, USA
| | - Joseph P Mathew
- Department of Anesthesiology, Duke University Medical Center, Duke South, Orange Zone, Room 4317, Durham, NC 27710, USA
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