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Santiago RACB, Ali A, Ibrahim B, Mandel M, Muhsen BA, Obrzut M, Ranjan S, Borghei-Razavi H, Adada B. Safety of craniotomy for brain tumor resection in octogenarians and older patients - a matched - cohort analysis. Int J Neurosci 2023:1-7. [PMID: 36724879 DOI: 10.1080/00207454.2023.2174866] [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: 05/26/2022] [Revised: 01/19/2023] [Accepted: 01/25/2023] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The incidence of brain tumors has increased in elderly population overtime. Their eligibility to a major surgery remains a questionable subject. This study evaluated prognostic factors and 30-days morbidity and mortality in octogenarian population who underwent craniotomy for resection of brain tumor. MATERIALS AND METHODS A total of 154 patients were divided into two different groups: patients above 80 years old and patients below 65 years old. In both groups, patients were stratified based on diagnosis with benign tumors [meningioma] and malignant tumors [high-grade gliomas and metastases]. Multivariable logistic regression model with backward elimination method was utilized to identify the independent risk factors for 30-days readmission and post-operative complications. RESULTS The analysis revealed no significant difference in 30-day readmission (p = 0.7329), 30-day mortality (0.6854) or in post-operative complication (p = 0.3291) between age ≥ 80 and age ≤ 65 groups. A longer length of stay (LOS) was observed in the older patients (p = 0.0479). There was a significant difference in the pre-post KPS between the two groups (p < 0.0001). ASA (p = 0.0315) and KPS (p = 0.071) were found as important prognostic factors associated with post-operative mortality in both groups. CONCLUSION Octogenarians can withstand craniotomy without any significant increase in 30-day readmission, 30-day mortality and post-operative complications as compared to patients younger than age 65. The ASA score (>3) and/or KPS (<70) were the most important prognostic factors for 30-days readmission and mortality.
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Affiliation(s)
| | - Assad Ali
- Department of Neurosurgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - Bilal Ibrahim
- Department of Neurosurgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - Mauricio Mandel
- Department of Neurosurgery, Cleveland Clinic Florida, Weston, Florida, USA
| | | | - Michal Obrzut
- Department of Neurosurgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - Surabhi Ranjan
- Department of Neurosurgery, Cleveland Clinic Florida, Weston, Florida, USA
| | | | - Badih Adada
- Department of Neurosurgery, Cleveland Clinic Florida, Weston, Florida, USA
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2
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Miranda-Ramos K, Millán-Linares MC, Haros CM. Effect of Chia as Breadmaking Ingredient on Nutritional Quality, Mineral Availability, and Glycemic Index of Bread. Foods 2020; 9:E663. [PMID: 32443838 PMCID: PMC7278786 DOI: 10.3390/foods9050663] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 12/17/2022] Open
Abstract
Chia seeds and chia flour could be used as ingredients to enrich foods owing to their high amount of nutrients. The goal of this investigation was to provide further information about how replacing wheat flour with chia ingredients (seeds, whole flour, semi-defatted, and low-fat flours) affects the nutritional and functional value of bread. The higher levels of proteins, lipids and minerals determined in raw chia flours directly affected the increase of these nutrients. High levels of phytates were found in chia ingredients (5.1-6.6 μmol/g d.b.), which affect Zn and Fe bioavailability, as predicted by phytate/mineral molar ratios. Bread with chia had a high amount of linoleic acid, especially in bread with chia seeds, owing to protection of seed integrity during baking. Chia ingredients did not show limiting essential amino acids such as lysine, which is deficient in cereals. Glycemic index was lower in bread with chia ingredients compared to control. The beneficial effects on glucose metabolism together with the nutritional and functional characteristics could be clinically important for prevention of metabolic diseases.
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Affiliation(s)
- Karla Miranda-Ramos
- Institute of Agrochemistry and Food Technology (IATA-CSIC), 46980 Valencia, Spain;
- Faculty of Chemical Engineering, University of Guayaquil, Cdla. Universitaria Salvador Allende Malecón del Salado entre Av. Delta y Av. Kennedy, 090510 Guayaquil, Ecuador
| | | | - Claudia Monika Haros
- Institute of Agrochemistry and Food Technology (IATA-CSIC), 46980 Valencia, Spain;
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Bell AF, Tapsell LC, Walton K, Batterham M. Unwrapping nutrition: Exploring the impact of hospital food and beverage packaging on plate waste/intake in older people. Appetite 2020; 144:104463. [PMID: 31542381 DOI: 10.1016/j.appet.2019.104463] [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: 01/09/2019] [Revised: 07/26/2019] [Accepted: 09/17/2019] [Indexed: 12/01/2022]
Abstract
Food and beverage packaging is increasingly used in hospital food service provision. Previous research has identified that the packaging used in New South Wales hospitals can be difficult to open by older adults. As older adults experience high rates of malnutrition, it is important to understand the effects of packaging on actual consumption of food and fluids. The aim of this study was to explore the impact of hospital food and beverage packaging on dietary intakes of 62 independently living older people (65 years and over) in a university simulated hospital ward in NSW, Australia. Participants were allocated to either a breakfast and snack meal or a lunch and snack meal on two occasions one week apart. Meals were served in a shared ward environment and each participant experienced a 'sealed' and 'pre-opened' meal and snack condition. The nutritional status of participants was measured using the Mini Nutritional Assessment - Short Form (MNA®-SF) and intake was estimated through an aggregated plate waste method. Overall findings were not significant for dietary intakes and the 'sealed' versus 'pre-opened' conditions. However, for the seven participants classified by the MNA®-SF as 'at risk' of malnutrition, packaging impeded intake for breakfast (η2 = -0.34) and the high protein snack (cheese and biscuits) (η2 = -0.24) meals. This finding has implications for the provision of packaged high protein snacks (cheese portions) and breakfast meals for the older inpatient. Further research is required for nutritionally compromised and frail older people in the hospital environment to investigate the impact of packaging on food and beverage consumption in detail.
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Affiliation(s)
- Alison F Bell
- School of Health & Society, Faculty of Social Science, University of Wollongong, NSW, 2522, Australia.
| | - Linda C Tapsell
- School of Medicine, Faculty of Science, Medicine & Health, University of Wollongong, NSW, 2522, Australia.
| | - Karen Walton
- School of Medicine, Faculty of Science, Medicine & Health, University of Wollongong, NSW, 2522, Australia.
| | - Marijka Batterham
- National Institute for Applied Statistics Research Australia, School of Mathematics & Applied Statistics, Faculty of Engineering & Information Sciences, University of Wollongong, NSW, 2522, Australia.
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4
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Isenberg SR, Crossnohere NL, Patel MI, Conca-Cheng A, Bridges JFP, Swoboda SM, Smith TJ, Pawlik TM, Weiss M, Volandes AE, Schuster A, Miller JA, Pastorini C, Roter DL, Aslakson RA. An advance care plan decision support video before major surgery: a patient- and family-centred approach. BMJ Support Palliat Care 2018; 8:229-236. [PMID: 29555812 DOI: 10.1136/bmjspcare-2017-001449] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/29/2018] [Accepted: 02/07/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Video-based advanc care planning (ACP) tools have been studied in varied medical contexts; however, none have been developed for patients undergoing major surgery. Using a patient- and family-centredness approach, our objective was to implement human-centred design (HCD) to develop an ACP decision support video for patients and their family members when preparing for major surgery. DESIGN AND METHODS The study investigators partnered with surgical patients and their family members, surgeons and other health professionals to design an ACP decision support video using key HCD principles. Adapting Maguire's HCD stages from computer science to the surgical context, while also incorporating Elwyn et al's specifications for patient-oriented decision support tool development, we used a six-stage HCD process to develop the video: (1) plan HCD process; (2) specify where video will be used; (3) specify user and organisational requirements; (4) produce and test prototypes; (5) carry out user-based assessment; (6) field test with end users. RESULTS Over 450 stakeholders were engaged in the development process contributing to setting objectives, applying for funding, providing feedback on the storyboard and iterations of the decision tool video. Throughout the HCD process, stakeholders' opinions were compiled and conflicting approaches negotiated resulting in a tool that addressed stakeholders' concerns. CONCLUSIONS Our patient- and family-centred approach using HCD facilitated discussion and the ability to elicit and balance sometimes competing viewpoints. The early engagement of users and stakeholders throughout the development process may help to ensure tools address the stated needs of these individuals. TRIAL REGISTRATION NUMBER NCT02489799.
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Affiliation(s)
- Sarina R Isenberg
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Family and Community Medicine - Division of Palliative Care, University of Toronto, Toronto, Ontario, Canada.,Division of Oncology, Stanford University School of Medicine, Stanford, California, USA.,Department of Anesthesiology, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA
| | - Norah L Crossnohere
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Manali I Patel
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | | | - Sandy M Swoboda
- Department of Medicine, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA.,Department of Oncology, Johns Hopkins Hospital and Health System, Baltimore, Maryland, USA
| | - Thomas J Smith
- Department of Surgery, Wexner Medical Center, Ohio State University, Columbus, Ohio, USA.,Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Timothy M Pawlik
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Matthew Weiss
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Angelo E Volandes
- Department of Anesthesiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Anne Schuster
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Patient/Family Member Co-investigator, Architecture by Design, Ellicott City, Maryland, USA.,Patient/Family Member Co-investigator, Baltimore, Maryland, USA
| | - Judith A Miller
- Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ontario, Canada
| | - Carolyn Pastorini
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Debra L Roter
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rebecca A Aslakson
- Patient/Family Member Co-investigator, Architecture by Design, Ellicott City, Maryland, USA
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Abstract
The doubling of the geriatric population over the next 20 years will challenge the existing health care system. Optimal care of geriatric trauma patients will be of paramount importance to the health care discussion in America. These patients warrant special consideration because of altered anatomy, physiology, and the resultant decreased ability to tolerate the stresses imposed by traumatic insult. Despite increased risk for worsened outcomes, nearly half of all geriatric trauma patients will be cared for at nondesignated trauma centers. Effective communication is crucial in determining goals of care and arriving at what patients would consider a meaningful outcome.
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Affiliation(s)
- Steven E Brooks
- Geriatric Trauma Unit, Division of Trauma, Surgical Critical Care, Acute Care Surgery, Department of Surgery, John A. Griswold Trauma Center, Texas Tech University Health Sciences Center, 3601 4th Street MS 8312, Lubbock, TX 79430, USA; Pediatric Intensive Care Unit, Division of Trauma, Surgical Critical Care, Acute Care Surgery, Department of Surgery, John A. Griswold Trauma Center, Texas Tech University Health Sciences Center, 3601 4th Street MS 8312, Lubbock, TX 79430, USA.
| | - Allan B Peetz
- Emergency General Surgery, Division of Trauma, Surgical Critical Care, Vanderbilt University Medical Center, Medical Arts Building Suite 404, 1211 21st Avenue South, Nashville, TN 37212, USA
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Aslakson RA, Isenberg SR, Crossnohere NL, Conca-Cheng AM, Yang T, Weiss M, Volandes AE, Bridges JFP, Roter DL. Utilising advance care planning videos to empower perioperative cancer patients and families: a study protocol of a randomised controlled trial. BMJ Open 2017; 7:e016257. [PMID: 28592584 PMCID: PMC5726140 DOI: 10.1136/bmjopen-2017-016257] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Despite positive health outcomes associated with advance care planning (ACP), little research has investigated the impact of ACP in surgical populations. Our goal is to evaluate how an ACP intervention video impacts the patient centredness and ACP of the patient-surgeon conversation during the presurgical consent visit. We hypothesise that patients who view the intervention will engage in a more patient-centred communication with their surgeons compared with patients who view a control video. METHODS AND ANALYSIS Randomised controlled superiority trial of an ACP video with two study arms (intervention ACP video and control video) and four visits (baseline, presurgical consent, postoperative 1 week and postoperative 1 month). Surgeons, patients, principal investigator and analysts are blinded to the randomisation assignment. SETTING Single, academic, inner city and tertiary care hospital. Data collection began July 16, 2015 and continues to March 2017. PARTICIPANTS Patients recruited from nine surgical oncology clinics who are undergoing major cancer surgery. INTERVENTIONS In the intervention arm, patients view a patient preparedness video developed through extensive engagement with patients, surgeons and other stakeholders. Patients randomised to the control arm viewed an informational video about the hospital surgical programme. MAIN OUTCOMES AND MEASURES Primary Outcome: Patient centredness and ACP of patient-surgeon conversations during the presurgical consent visit as measured through the Roter Interaction Analysis System. SECONDARY OUTCOMES patient Hospital Anxiety and Depression Scale score; patient goals of care; patient, companion and surgeon satisfaction; video helpfulness; medical decision maker designation; and the frequency patients watch the video. Intent-to-treat analysis will be used to assess the impact of video assignment on outcomes. Sensitivity analyses will assess whether there are differential effects contingent on patient or surgeon characteristics. ETHICS AND DISSEMINATION This study has been approved by the Johns Hopkins School of Medicine institutional review board and is registered on clinicaltrials.gov (NCT02489799, First received: July 1, 2015). TRIAL REGISTRATION NUMBER clinicaltrials.gov, NCT02489799.
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Affiliation(s)
- Rebecca A Aslakson
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Oncology and Palliative Care Program, Sidney Kimmel Comprehensive Cancer Center at The Johns Hopkins University, Baltimore, Maryland, USA
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Armstrong Institute for Patient Safety and Quality, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Sarina R Isenberg
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Norah L Crossnohere
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alison M Conca-Cheng
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ting Yang
- Armstrong Institute for Patient Safety and Quality, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Matthew Weiss
- Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Angelo E Volandes
- Department of Medicine, Massachusetts General Hospital, Boston, Maryland, USA
| | - John F P Bridges
- Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Debra L Roter
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Yeo HL, O'Mahoney PRA, Lachs M, Michelassi F, Mao J, Finlayson E, Abelson JS, Sedrakyan A. Surgical oncology outcomes in the aging US population. J Surg Res 2016; 205:11-8. [PMID: 27620993 DOI: 10.1016/j.jss.2016.04.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/06/2016] [Accepted: 04/15/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND As the population ages, an increasing number of older patients are undergoing major surgery. We examined the impact of advanced age on outcomes following major gastrointestinal cancer surgery in an era of improved surgical outcomes. MATERIALS AND METHODS This was a population-based, retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database. We evaluated patients undergoing major abdominal gastrointestinal cancer surgery from 2005-2012. Multivariable logistic regression was performed to determine the independent effect of advanced age on outcomes. Our primary outcome was 30-d mortality, and our secondary outcomes were 30-d major postoperative adverse events, discharge disposition, length of stay, reoperation, and readmission. RESULTS Elderly (≥65 y) patients were twice as likely to have multiple comorbidities as those <65 y but prevalence of comorbidities was similar across all older age groups. Mortality increased with age across all procedures (P < 0.05). The risk of advanced age on mortality was highest in hepatectomy (odds ratio = 5.17, 95% confidence interval = 2.19-12.20) and that for major postoperative adverse events was highest in proctectomy (odds ratio = 2.32, 95% confidence interval = 1.53-3.52). Patients were more likely to be discharged to an institutional care facility as age increased across all procedures (P < 0.01). CONCLUSIONS Despite being highly selected for surgery, elderly patients undergoing major gastrointestinal cancer surgery have substantially worse postoperative outcomes than younger patients (<65 y). The risk of age on postoperative outcomes was present across all operations but had its highest association with liver and rectal cancer resections.
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Affiliation(s)
- Heather L Yeo
- Department of Surgery, NewYork Presbyterian-Weill Cornell Medical College, New York, New York; Department of Healthcare Policy and Research, NewYork-Presbyterian-Weill Cornell Medical College, New York, New York.
| | - Paul R A O'Mahoney
- Department of Surgery, NewYork Presbyterian-Weill Cornell Medical College, New York, New York
| | - Mark Lachs
- Department of Geriatrics and Palliative Medicine, NewYork-Presbyterian-Weill Cornell Medical College, New York, New York
| | - Fabrizio Michelassi
- Department of Surgery, NewYork Presbyterian-Weill Cornell Medical College, New York, New York
| | - Jialin Mao
- Department of Healthcare Policy and Research, NewYork-Presbyterian-Weill Cornell Medical College, New York, New York
| | - Emily Finlayson
- Department of Surgery, University of California San Francisco Medical Center, San Francisco, California; Department of Medicine, University of California San Francisco Medical Center, San Francisco, California; Department of Health Policy, University of California San Francisco Medical Center, San Francisco, California
| | - Jonathan S Abelson
- Department of Surgery, NewYork Presbyterian-Weill Cornell Medical College, New York, New York
| | - Art Sedrakyan
- Department of Healthcare Policy and Research, NewYork-Presbyterian-Weill Cornell Medical College, New York, New York
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Abstract
PURPOSE OF REVIEW This article reviews the impact of ageing on the gastrointestinal tract, including effects on the absorption of nutrients and drugs and the gastrointestinal tract defence system against ingested pathogens. RECENT FINDINGS Recent publications support earlier observations of an age-related selective decline in gut function including changes in taste, oesophageal sphincter motility, gastric emptying, and neurons of the myenteric plexus related to gut transit which may impact the nutritional status. Ageing is also associated with structural and functional mucosal defence defects, diminished abilities to generate protective immunity, and increased incidence of inflammation and oxidative stress. A number of gastrointestinal disorders occur more frequently in the elderly population. SUMMARY Alterations in gut function with ageing have particular implications for oesophageal, gastric, and colonic motility. Older individuals are particularly susceptible to malnutrition, postprandial hypotension, dysphagia, constipation, and faecal incontinence. Decrease in the number of nerve cells of the myenteric plexus that impact digestive absorption and the surface area of the small intestine because of degeneration of villi may lead to blunted absorption of nutrients. Impairment of the intestinal immune system as a result of ageing, including the mucosal layer of the gastrointestinal tract, appears to be a significant contributor to the age-related increase in the incidence and severity of infections.
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Affiliation(s)
- Stijn Soenen
- National Health and Medical Research Council of Australia (NHMRC), Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Royal Adelaide Hospital, South Australia, Australia
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Desserud KF, Veen T, Søreide K. Emergency general surgery in the geriatric patient. Br J Surg 2015; 103:e52-61. [PMID: 26620724 DOI: 10.1002/bjs.10044] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 10/06/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Emergency general surgery in the elderly is a particular challenge to the surgeon in charge of their care. The aim was to review contemporary aspects of managing elderly patients needing emergency general surgery and possible alterations to their pathways of care. METHODS This was a narrative review based on a PubMed/MEDLINE literature search up until 15 September 2015 for publications relevant to emergency general surgery in the geriatric patient. RESULTS The number of patients presenting as an emergency with a general surgical condition increases with age. Up to one-quarter of all emergency admissions to hospital may be for general surgical conditions. Elderly patients are a particular challenge owing to added co-morbidity, use of drugs and risk of poor outcome. Frailty is an important potential risk factor, but difficult to monitor or manage in the emergency setting. Risk scores are not available universally. Outcomes are usually severalfold worse than after elective surgery, in terms of both higher morbidity and increased mortality. A care bundle including early diagnosis, resuscitation and organ system monitoring may benefit the elderly in particular. Communication with the patient and relatives throughout the care pathway is essential, as indications for surgery, level of care and likely outcomes may evolve. Ethical issues should also be addressed at every step on the pathway of care. CONCLUSION Emergency general surgery in the geriatric patient needs a tailored approach to improve outcomes and avoid futile care. Although some high-quality studies exist in related fields, the overall evidence base informing perioperative acute care for the elderly remains limited.
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Affiliation(s)
- K F Desserud
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - T Veen
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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