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Chang GJ, Gunn HJ, Barber AK, Lowenstein LM, Dohan D, Broering J, Dockter T, Tan AD, Dueck A, Chow S, Neuman H, Finlayson E. Improving Surgical Care and Outcomes in Older Cancer Patients Through Implementation of a Presurgical Toolkit (OPTI-Surg)-Final Results of a Phase III Cluster Randomized Trial (Alliance A231601CD). Ann Surg 2024; 280:623-632. [PMID: 39069901 DOI: 10.1097/sla.0000000000006458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To assess the effect of a practice-level preoperative frailty screening and optimization toolkit (OPTI-Surg) on postoperative functional recovery and complications in elderly cancer patients undergoing major surgery. BACKGROUND Frailty is common in older adults. It increases the risk of poor postoperative functional recovery and complications. The potential for a practice-level screening/optimization intervention to improve outcomes is unknown. METHODS Thoracic, gastrointestinal, and urologic oncological surgery practices within the National Cancer Institute Community Oncology Research Program (NCORP) were randomized 1:1:1 to usual care (UC), OPTI-Surg, or OPTI-Surg with an implementation coach. OPTI-Surg consisted of the Edmonton Frail Scale and guided recommendations for referral interventions. Patients 70 years old or above undergoing curative intent surgery were eligible. The primary outcome was 8 weeks postoperative function (kcal/wk). The key secondary outcome was complications within 90 days. Mixed models were used to compare UC to the 2 OPTI-Surg arms combined. RESULTS From July 2019 to September 2022, 325 patients were enrolled in 29 practices. One hundred ninety-nine (64 UC, 135 OPTI-Surg) and 279 (78 UC, 201 OPTI-Surg) were evaluable for primary and secondary analysis, respectively. UC and OPTI-Surg patients did not significantly differ in total caloric expenditure (2.2 UC, 2.0 OPTI-Surg) after adjusting for baseline function ( P =0.53). UC and OPTI-Surg patients did not significantly differ in postoperative complications (25.6% UC, 35.3% OPTI-Surg, P =0.5). CONCLUSIONS Frailty assessment was successfully performed, but the OPTI-Surg intervention did not improve postoperative function nor reduce postoperative complications compared with UC. Future analysis will explore practice-level factors associated with toolkit implementation and the differences between the coaching and noncoaching arms.
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Affiliation(s)
- George J Chang
- Department of Colon and Rectal Surgery, the University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Health Services Research, the University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Heather J Gunn
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | | | - Lisa M Lowenstein
- Department of Health Services Research, the University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Daniel Dohan
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA
| | | | - Travis Dockter
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | - Angelina D Tan
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | - Amylou Dueck
- Alliance Statistics and Data Management Center, Scottsdale, AZ
| | - Selina Chow
- Alliance Protocol Operations Office, University of Chicago, Chicago, IL
| | - Heather Neuman
- Department of Surgery, University of Wisconsin, Madison, WI
| | - Emily Finlayson
- Department of Surgery, University of California, San Francisco, CA
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Fadel A, Findlay BL, Ubl D, Warner JN, Viers BR, Anderson KT. Frailty Among Bladder Augmentation Patients: Healthcare Utilization and Perioperative Outcomes. Urology 2024:S0090-4295(24)00716-7. [PMID: 39208940 DOI: 10.1016/j.urology.2024.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 08/02/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To study the impact of frailty on healthcare utilization in patients undergoing benign pelvic reconstructive surgery; specifically, bladder augmentation. METHODS American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was queried for adults undergoing bladder augmentation between 2005 and 2022. The Five-Item Frailty Index (FFI) was used to assign a score from 0 to 6. Healthcare resource utilization (HRU) was defined by 4 metrics: prolonged length of stay (PLOS), 30-day postoperative readmissions (AR), discharge to continued care (ie, non-home location) (DCC), overall HRU which is a composite of the other 3 outcomes, and complications. Multivariable risk-adjusted regression models were generated. RESULTS Three hundred sixty-four patients were included, the majority being white (71%), female (52%), with a median age of 49 years. After controlling for baseline variables, higher FFI score (≥2) was independently associated with PLOS (OR 1.90 [1.02-3.53], P = .04), DCC (OR 2.76 [1.24-6.15], P = .01), and greater overall HRU (OR 2.64 [1.29-5.40], P = .008) but not AR (OR 2.27 [0.99-5.19], P = .05). Higher frailty (FFI ≥2) was independently associated with experiencing any complication (OR 2.32 [1.16-4.64], P = .02) as well as major complications (Clavien ≥3) (OR 2.56 [1.15-5.7] P = .02). CONCLUSION Frail adults undergoing bladder augmentation experience greater HRU and complications. This highlights the importance of frailty in benign pelvic reconstructive surgery and stresses the need for interventions to optimize frail patients.
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Affiliation(s)
| | | | - Daniel Ubl
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | | | - Boyd R Viers
- Department of Urology, Mayo Clinic, Rochester, MN
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Ekici HS, Collins J, Kafadar AH, Yildirim MC, Phillips BE, Gordon AL. The effect of pre-operative exercise training on post-operative cognitive function: a systematic review. Eur Geriatr Med 2024:10.1007/s41999-024-01028-4. [PMID: 39128969 DOI: 10.1007/s41999-024-01028-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 07/24/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND With population aging and advances in surgical and anesthetic procedures, the incidence of surgery in patients over the age of 65 years is increasing. One post-operative complication often encountered by older surgical patients is post-operative cognitive dysfunction (POCD). Preoperative exercise training can improve the overall physiological resilience of older surgical patients, yet its impact on post-operative cognition is less well-established. METHODS Six databases (Medline (OVID); EMBASE (OVID); EMCARE (OVID); CINAHL (EBSCOHost), the Cochrane Library, and PubMed) were searched for studies reporting the effect of pre-operative physical training on post-operative cognition. The quality of evidence was assessed using the Mixed Methods Assessment Tool. RESULTS A total of 3983 studies were initially identified, three of which met the inclusion criteria for this review. Two studies were pilot randomized trials, and one was a prospective randomized trial. Two of the studies were high-quality. Each study used a different type of physical exercise and cognition assessment tool. Across the studies, post-operative cognition (p = 0.005) and attention (p = 0.04) were found to be better in the intervention groups compared to control, with one study reporting no difference between the groups. CONCLUSION Preoperative physical training may improve post-operative cognitive function, although more research with a consistent endpoint is required. Future studies should focus on patients at high risk of POCD, such as older adults, and explore the impact of different exercise regimes, including frequency, intensity, time, and type.
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Affiliation(s)
- Hatice S Ekici
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK.
| | - Jemima Collins
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK
| | - Aysegul H Kafadar
- Academic Unit of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Mehmet C Yildirim
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK
| | - Bethan E Phillips
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK
- NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Adam L Gordon
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK
- NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK
- Department of Medicine of the Elderly, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, UK
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Covell MM, Roy JM, Gupta N, Raihane AS, Rumalla KC, Lima Fonseca Rodrigues AC, Courville E, Bowers CA. Frailty in intracranial meningioma resection: the risk analysis index demonstrates strong discrimination for predicting non-home discharge and in-hospital mortality. J Neurooncol 2024; 169:85-93. [PMID: 38713325 DOI: 10.1007/s11060-024-04703-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 04/30/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE Frailty is an independent risk factor for adverse postoperative outcomes following intracranial meningioma resection (IMR). The role of the Risk Analysis Index (RAI) in predicting postoperative outcomes following IMR is nascent but may inform preoperative patient selection and surgical planning. METHODS IMR patients from the Nationwide Inpatient Sample were identified using diagnostic and procedural codes (2019-2020). The relationship between preoperative RAI-measured frailty and primary outcomes (non-home discharge (NHD), in-hospital mortality) and secondary outcomes (extended length of stay (eLOS), complication rates) was assessed via multivariate analyses. The discriminatory accuracy of the RAI for primary outcomes was measured in area under the receiver operating characteristic (AUROC) curve analysis. RESULTS A total of 23,230 IMR patients (mean age = 59) were identified, with frailty statuses stratified by RAI score: 0-20 "robust" (R)(N = 10,665, 45.9%), 21-30 "normal" (N)(N = 8,895, 38.3%), 31-40 "frail" (F)(N = 2,605, 11.2%), and 41+ "very frail" (VF)(N = 1,065, 4.6%). Rates of NHD (R 11.5%, N 29.7%, F 60.8%, VF 61.5%), in-hospital mortality (R 0.5%, N 1.8%, F 3.8%, VF 7.0%), eLOS (R 13.2%, N 21.5%, F 40.9%, VF 46.0%), and complications (R 7.5%, N 11.6%, F 15.7%, VF 16.0%) significantly increased with increasing frailty thresholds (p < 0.001). The RAI demonstrated strong discrimination for NHD (C-statistic: 0.755) and in-hospital mortality (C-statistic: 0.754) in AUROC curve analysis. CONCLUSION Increasing RAI-measured frailty is significantly associated with increased complication rates, eLOS, NHD, and in-hospital mortality following IMR. The RAI demonstrates strong discrimination for predicting NHD and in-hospital mortality following IMR, and may aid in preoperative risk stratification.
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Affiliation(s)
- Michael M Covell
- School of Medicine, Georgetown University, 3900 Reservoir Road, 20007, Washington, DC, USA
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, 84070, Sandy, UT, USA
| | - Joanna M Roy
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, 84070, Sandy, UT, USA
| | - Nithin Gupta
- Campbell University School of Osteopathic Medicine, Lillington, NC, USA
| | - Ahmed Sami Raihane
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, 84070, Sandy, UT, USA
| | - Kranti C Rumalla
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, 84070, Sandy, UT, USA
| | | | - Evan Courville
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, 84070, Sandy, UT, USA
| | - Christian A Bowers
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, 84070, Sandy, UT, USA.
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Teh R, Teo S, Trivedi A, Kumarasinghe AP. Emergency laparotomy in older adults with geriatric medicine input: implications of demographics, frailty and comorbidities on outcomes. ANZ J Surg 2024; 94:1365-1372. [PMID: 38850119 DOI: 10.1111/ans.19107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND We (1) describe West Australian (WA) older adults undergoing emergency laparotomy (EL) in a tertiary-centre Acute Surgical Unit (ASU) with proactive geriatrician input and (2) explore the impact of Clinical Frailty Scale (CFS) and Charlson's Comorbidity Index (CCI) on patient outcomes. METHODS We performed a prospective cohort-study of older adults undergoing EL, between April 2021 and April 2022, in a tertiary ASU, with dedicated geriatrician-led perioperative care via the Older Adult Surgical Inpatient Service (OASIS). RESULTS Of 114 patients, average age was 76.7 ± 7.61 years-old (range 65-96), with 35.1% (n = 40) frail (CFS 5-7), 18.4% (n = 21) vulnerable (CFS 4) and 46.5% (n = 74) not frail (CFS 1-3). 61.4% (n = 70) were severely comorbid (CCI ≥5), 34.2% (n = 39) moderately comorbid (CCI 3-4), and 4.4% (n = 5) mildly comorbid (CCI 1-2). 95.9% (n = 109) EL patients were reviewed by OASIS. Inpatient mortality was 7.9% (n = 9) and 1-year mortality 16.7% (n = 19). Majority, 64.9% (n = 74), were discharged directly home with 17.5% (n = 20) discharged with in-home rehabilitation. Each increment in CCI was associated with increased in-hospital (HR 1.38, p = 0.034) and 1-year (HR 1.39, p = 0.006) mortality, and each increment in CFS with 1-year mortality (HR 1.62, p = 0.016). Higher CFS but not CCI was associated with increased level of care at discharge. Age was not statistically significant with any outcomes. CONCLUSION We describe demographics, frailty and comorbidity of 114 older adults undergoing EL in ASU. We suggest CFS and CCI as independent risk-stratification tools, and proactive management of both comorbidity, and frailty, should be incorporated into preoperative optimisation.
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Affiliation(s)
- Ryan Teh
- Acute Surgical Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Serene Teo
- Acute Surgical Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Anand Trivedi
- Acute Surgical Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Anuttara Panchali Kumarasinghe
- Acute Surgical Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Faculty of Health and Medical Sciences, The University of Western Australia, Nedlands, Western Australia, Australia
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Whalen A, Holla S, Renshaw S, Olson M, Sreevalsan K, Poulose BK, Collins CE. Outcomes and quality of life of frail patients following elective ventral hernia repair: Retrospective review of a national hernia collaborative. Am J Surg 2024; 233:65-71. [PMID: 38383165 DOI: 10.1016/j.amjsurg.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/25/2024] [Accepted: 02/07/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Ventral hernia repair (VHR) is one of the most common general surgery procedures among older adults but is often deferred due to a higher risk of complications. This study compares postoperative quality of life (QOL) and complications between frail and non-frail patients undergoing elective VHR. We hypothesized that frail patients would have higher complication rates and smaller gains in quality of life compared to non-frail patients. STUDY DESIGN Patients 65 years of age and older, undergoing elective VHR between 2018 and 2022 were selected from the ACHQC (Abdominal Core Health Quality Collaborative) and grouped based on frailty scores obtained using the Modified Frailty Index (mFI-5). Logistic regression adjusting for hernia characteristics (size, recurrent, parastomal, incisional) were performed for 30-day outcomes including surgical site infections (SSI), surgical site occurrences (SSO), surgical site infections/occurrences requiring procedural intervention (SSOPI), and readmission. Multivariable analyses controlling for patient and procedure characteristics were performed comparing QOL scores (HerQLes scale, 0-100) at baseline, 30 days, 6 months and 1 year postoperatively. RESULTS A total of 4888 patients were included, 29.17% non-frail, 47.87% frail, and 22.95% severely frail. On adjusted analysis, severely frail patients had higher odds of SSO (most commonly seroma formation) but no evidence of a difference in SSI, SSOPI, readmission or mortality. Severely frail patients had lower median QOL scores at baseline (48.3/100, IQR 26.1-71.7, p = 0.001) but reported higher QOL scores at both 30-days (68.3/100, IQR 41.7-88.3, p = 0.01) and 6-months (86.7/100, IQR 65.0-93.3, p = 0.005). CONCLUSION Severely frail patients reported similar increases in QOL and similar complications to their not frail counterparts. Our results demonstrate that appropriately selected older patients, even those who are severely frail, may benefit from elective VHR in the appropriate clinical circumstance.
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Affiliation(s)
- Alison Whalen
- The Center for Abdominal Core Health, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA; The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Sahana Holla
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Savannah Renshaw
- The Center for Abdominal Core Health, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA; The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Molly Olson
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Kavya Sreevalsan
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Benjamin K Poulose
- The Center for Abdominal Core Health, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA; The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Courtney E Collins
- The Center for Abdominal Core Health, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA; The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Chen Y, Teng Y, Peng X, Zhu T, Liu J, Ou M, Hao X. Combination of Creatinine with Inflammatory Biomarkers (PCT, CRP, hsCRP) for Predicting Postoperative ICU Admissions for Elderly Patients. Adv Ther 2024; 41:2776-2790. [PMID: 38743240 PMCID: PMC11213804 DOI: 10.1007/s12325-024-02874-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/09/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION The number of elderly patients who require surgery as their primary treatment has increased rapidly in recent years. Among 300 million people globally who underwent surgery every year, patients aged 65 years and over accounted for more than 30% of cases. Despite medical advances, older patients remain at higher risk of postoperative complications. Early diagnosis and effective prediction are essential requirements for preventing serious postoperative complications. In this study, we aim to provide new biomarker combinations to predict the incidence of postoperative intensive care unit (ICU) admissions > 24 h in elderly patients. METHODS This investigation was conducted as a nested case-control study, incorporating 413 participants aged ≥ 65 years who underwent non-cardiac, non-urological elective surgeries. These individuals underwent a 30-day postoperative follow-up. Before surgery, peripheral venous blood was collected for analyzing serum creatinine (Scr), procalcitonin (PCT), C-reactive protein (CRP), and high-sensitivity CRP (hsCRP). The efficacy of these biomarkers in predicting postoperative complications was evaluated using receiver operating characteristic (ROC) curve analysis and area under the curve (AUC) values. RESULTS Postoperatively, 10 patients (2.42%) required ICU admission. Regarding ICU admissions, the AUCs with 95% confidence intervals (CIs) for the biomarker combinations of Scr × PCT and Scr × CRP were 0.750 (0.655-0.845, P = 0.007) and 0.724 (0.567-0.882, P = 0.015), respectively. Furthermore, cardiovascular events were observed in 14 patients (3.39%). The AUC with a 95% CI for the combination of Scr × CRP in predicting cardiovascular events was 0.688 (0.560-0.817, P = 0.017). CONCLUSION The innovative combinations of biomarkers (Scr × PCT and Scr × CRP) demonstrated efficacy as predictors for postoperative ICU admissions in elderly patients. Additionally, the Scr × CRP also had a moderate predictive value for postoperative cardiovascular events. TRIAL REGISTRATION China Clinical Trial Registry, ChiCTR1900026223.
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Affiliation(s)
- Yali Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- Research Unit for Perioperative Stress Assessment and Clinical Decision, Chinese Academy of Medical Sciences (2018RU012), West China Hospital, Sichuan University, Chengdu, China
| | - Yi Teng
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- Research Unit for Perioperative Stress Assessment and Clinical Decision, Chinese Academy of Medical Sciences (2018RU012), West China Hospital, Sichuan University, Chengdu, China
| | - Xiran Peng
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- Research Unit for Perioperative Stress Assessment and Clinical Decision, Chinese Academy of Medical Sciences (2018RU012), West China Hospital, Sichuan University, Chengdu, China
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- Research Unit for Perioperative Stress Assessment and Clinical Decision, Chinese Academy of Medical Sciences (2018RU012), West China Hospital, Sichuan University, Chengdu, China
| | - Juan Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- Research Unit for Perioperative Stress Assessment and Clinical Decision, Chinese Academy of Medical Sciences (2018RU012), West China Hospital, Sichuan University, Chengdu, China
| | - Mengchan Ou
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
- Research Unit for Perioperative Stress Assessment and Clinical Decision, Chinese Academy of Medical Sciences (2018RU012), West China Hospital, Sichuan University, Chengdu, China.
| | - Xuechao Hao
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
- Research Unit for Perioperative Stress Assessment and Clinical Decision, Chinese Academy of Medical Sciences (2018RU012), West China Hospital, Sichuan University, Chengdu, China.
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Goh SSN, Zhao J, Drakeford PA, Chen Q, Lim WW, Li AL, Chan KS, Ong MW, Goo JTT. Assessing the impact of frailty in elderly patients undergoing emergency laparotomies in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2024; 53:352-360. [PMID: 38979991 DOI: 10.47102/annals-acadmedsg.2023155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Introduction The global rise in ageing populations poses challenges for healthcare systems. By 2030, Singapore anticipates a quarter of its population to be aged 65 or older. This study addresses the dearth of research on frailty's impact on emergency laparotomy (EL) outcomes in this demographic, emphasising the growing significance of this surgical intervention. Method Conducted at 2 tertiary centres in Singapore from January to December 2019, a retrospective cohort study examined EL outcomes in patients aged 65 or older. Frailty assessment, using the Clinical Frailty Scale (CFS), was integrated into demographic, diagnostic and procedural analyses. Patient data from Tan Tock Seng Hospital and Khoo Teck Puat Hospital provided a comprehensive view of frailty's role in EL. Results Among 233 participants, 26% were frail, revealing a higher vulnerability in the geriatric population. Frail individuals exhibited elevated preoperative risk, prolonged ICU stays, and significantly higher 90-day mortality (21.3% versus 6.4%). The study illuminated a nuanced connection between frailty and adverse outcomes, underlining the critical need for robust predictive tools in this context. Conclusion Frailty emerged as a pivotal factor influencing the postoperative trajectory of older adults undergoing EL in Singapore. The integration of frailty assessment, particularly when combined with established metrics like P-POSSUM, showcased enhanced predictive accuracy. This finding offers valuable insights for shared decision-making and acute surgical unit practices, emphasising the imperative of considering frailty in the management of older patients undergoing emergency laparotomy.
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Affiliation(s)
| | - Jiashen Zhao
- General Surgery, Ministry of Health Holdings, Singapore
| | | | | | - Woan Wui Lim
- General Surgery, Khoo Teck Puat Hospital, Singapore
| | | | - Kai Siang Chan
- General Surgery, Ministry of Health Holdings, Singapore
- General Surgery, Khoo Teck Puat Hospital, Singapore
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Dong X, Zhang X, Hu F, Yang S, Hong Z, Geng Q. Association of frailty with adverse outcomes in surgically treated geriatric patients with hip fracture: A meta-analysis and trial sequential analysis. PLoS One 2024; 19:e0305706. [PMID: 38905251 PMCID: PMC11192356 DOI: 10.1371/journal.pone.0305706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 06/04/2024] [Indexed: 06/23/2024] Open
Abstract
OBJECTIVE Some studies have associated frailty and prognostic outcomes in geriatric hip fracture patients, but whether frailty can predict postoperative outcomes remains controversial. This review aims to assess the relationship between frailty and adverse postoperative outcomes in geriatric patients with hip fracture. METHODS Based on electronic databases, including PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, Chinese National Knowledge Infrastructure, and WanFang Data, we systematically searched for studies that investigated the association between frailty and adverse outcomes among patients aged 60 or over after hip fracture surgery. Stata 17.0 and Trial Sequential Analysis viewer software were used to obtain pooled estimates and verify whether the sample size was sufficient and the evidence robust. RESULTS Twenty-one studies involving 49,196 patients were included for quantitative analysis. Compared with nonfrail patients, frail patients had a higher risk of inpatient mortality (risk ratio [RR] = 1.93, 95% confidence interval [CI]: 1.66-2.23), 30-day mortality (RR = 2.13, 95% CI: 1.23-3.70), and 1-year mortality (RR = 2.44, 95% CI: 1.47-4.04). Frailty can significantly predict postoperative complications (RR = 1.76, 95% CI: 1.38-2.23), including delirium, pneumonia, cardiac complications, urinary tract infection, and surgical site infection; the association between frailty and deep venous thrombosis/pulmonary embolism and acute kidney injury needs further analysis. Trial sequential analysis showed that the findings regarding mortality were reliable and robust. CONCLUSION This meta-analysis provides detailed information indicating that frailty is a substantial predictor of mortality and selected postoperative complications.
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Affiliation(s)
- Xiaomeng Dong
- Department of 2 Operating Room, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Xiuguo Zhang
- Department of Nursing, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Fang Hu
- Department of 2 Operating Room, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Shuhong Yang
- Department of 2 Operating Room, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Zengchao Hong
- Department of 2 Operating Room, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
| | - Qian Geng
- Department of Nursing, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China
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Thompson DT, Breyfogle EG, Tran CG, Suraju MO, Mishra A, Lanewalla HA, Goffredo P, Hassan I. NSQIP 5-factor modified frailty index and complications after ileal anal pouch anastomosis for ulcerative colitis. Surg Open Sci 2024; 19:95-100. [PMID: 38601734 PMCID: PMC11004715 DOI: 10.1016/j.sopen.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/04/2024] [Accepted: 03/25/2024] [Indexed: 04/12/2024] Open
Abstract
Background Frailty has been associated with worse postoperative outcomes. The 5-factor modified frailty index (mFI-5) is an objective measure although its validity in measuring frailty in patients undergoing ileal pouch-anal anastomosis (IPAA) for chronic ulcerative colitis (CUC) has not been reported. Methods This study used the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) targeted proctectomy database. The mFI-5 was calculated by five preoperative diagnoses: insulin-dependent or noninsulin-dependent diabetes, congestive heart failure, hypertension, chronic obstructive pulmonary disease, and dependent or partially dependent functional status. The impact of mFI-5 on minor and major postoperative morbidity in CUC patients undergoing IPAA was analyzed. Results The cohort included 1454 patients (median age 38 years, median body mass index [BMI] 26 kg/m2) of which 87 % had a mFI-5 = 0, 11 % had a mFI-5 = 1, and 2.5 % a mFI-5 ≥ 2. In multivariable logistic regression, mFI-5 ≥ 2 was significantly associated with minor complications (OR = 2.29, 95 % CI [1.00-5.22], p = 0.049), but not with major complications (p = 0.860). Conclusion IPAA for CUC is associated with high postoperative morbidity, however, the mFI-5 alone has limited utility in determining which patients are at a higher risk of complications due to frailty. These observations suggest there is a need for more relevant instruments to measure frailty in this patient cohort.
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Affiliation(s)
- Dakota T. Thompson
- Department of Surgery, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA 52241, United States of America
| | - Ethan G. Breyfogle
- Department of Surgery, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA 52241, United States of America
| | - Catherine G. Tran
- Department of Surgery, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA 52241, United States of America
| | - Mohammed O. Suraju
- Department of Surgery, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA 52241, United States of America
| | - Aditi Mishra
- Department of Surgery, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA 52241, United States of America
| | | | - Paolo Goffredo
- Division of Colon & Rectal Surgery, University of Minnesota, Minneapolis, MN, United States of America
| | - Imran Hassan
- Department of Surgery, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA 52241, United States of America
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Sakowitz S, Bakhtiyar SS, Curry J, Mallick S, Vadlakonda A, Ali K, Sanaiha Y, Benharash P. Off-Pump Coronary Artery Bypass Grafting Does Not Confer Superior Outcomes Among Frail Patients. Am J Cardiol 2024; 220:16-22. [PMID: 38527578 DOI: 10.1016/j.amjcard.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/17/2024] [Accepted: 03/17/2024] [Indexed: 03/27/2024]
Abstract
Off-pump coronary revascularization (OPCAB) has been proposed to benefit patients who are at a greater surgical risk because it avoids the use of extracorporeal circulation. Although, historically, older patients were considered high-risk candidates, recent studies implicate frailty as a more comprehensive measure of perioperative fitness. Yet, the outcomes of OPCAB in frail patients have not been elucidated. Thus, using a national cohort of frail patients, we assessed the impact of OPCAB relative to on-pump coronary revascularization (ONCAB). Patients who underwent first-time elective coronary revascularization were tabulated from the 2010 to 2020 Nationwide Readmissions Database. Frailty was assessed using the previously-validated Johns Hopkins Adjusted Clinical Groups indicator. Multivariable models were used to consider the independent associations between OPCAB and the key outcomes. Of ∼26,529 frail patients, 6,322 (23.8%) underwent OPCAB. After risk adjustment and compared with ONCAB, OPCAB was linked with similar odds of in-hospital mortality but greater likelihood of postoperative cardiac arrest (adjusted odds ratio [AOR] 1.53, confidence interval [CI] 1.13 to 2.07) and myocardial infarction (AOR 1.44, CI 1.23 to 1.69). OPCAB was further associated with greater odds of postoperative infection (AOR 1.22, CI 1.02 to 1.47) but decreased need for blood transfusion (AOR 0.68, CI 0.60 to 0.77). In addition, OPCAB faced a +0.86-day increase in length of stay (CI 0.21 to 1.51) but similar costs (β $1,610, CI -$1,240 to 4,460) relative to ONCAB. Although OPCAB was associated with no difference in mortality compared with ONCAB, it was linked with greater likelihood of postoperative cardiac arrest and myocardial infarction. Our findings demonstrate that ONCAB remains associated with superior outcomes, even in the growing population of frail patients who underwent coronary revascularization.
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Affiliation(s)
- Sara Sakowitz
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, University of California, Los Angeles, California
| | - Syed Shahyan Bakhtiyar
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, University of California, Los Angeles, California; Department of Surgery, University of Colorado, Aurora, Colorado
| | - Joanna Curry
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, University of California, Los Angeles, California
| | - Saad Mallick
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, University of California, Los Angeles, California
| | - Amulya Vadlakonda
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, University of California, Los Angeles, California
| | - Konmal Ali
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, University of California, Los Angeles, California
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, University of California, Los Angeles, California; Department of Surgery, Division of Cardiac Surgery, University of California, Los Angeles, California
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, University of California, Los Angeles, California; Department of Surgery, Division of Cardiac Surgery, University of California, Los Angeles, California.
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12
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Petersson RD, Fode M, Niebuhr MH, Rashu BS, Thomsen FF. Robot-assisted partial nephrectomy in patients aged 75 years or older - comparing the risk of complications with their younger counterparts. Aging Clin Exp Res 2024; 36:107. [PMID: 38714631 PMCID: PMC11076407 DOI: 10.1007/s40520-024-02751-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/28/2024] [Indexed: 05/10/2024]
Abstract
BACKGROUND & AIM More elderly patients are diagnosed with kidney tumors where partial nephrectomy is technically possible. We investigated whether patients ≥ 75 years old had an increased risk of complications following robot-assisted partial nephrectomy (RAPN) compared to younger patients. METHODS Retrospective, consecutive study including patients who underwent RAPN between May 2016 - April 2023. Preoperative data, operative data and complications within 90 days were recorded by patient record review. Complications were classified according to Clavien-Dindo (CD). RESULTS 451 patients underwent RAPN and a postoperative complication was recorded in 131 (29%) patients of which 28 (6%) were CD ≥ III. Any postoperative complication was recorded in 24/113 patients (21%) < 55 years, 40/127 patients (31%) 55-64 years, 45/151 patients (42%) 65-74 years, and 22/60 patients (37%) ≥ 75 years. Comparable numbers for a CD ≥ III postoperative complication were 2/113 (2%) < 55 years, 6/127 (7%) 55-64 years, 12/151 (8%) 65-74 years, and 5/60 (8%) ≥ 75 years. In multivariate logistic regression analysis, patients ≥ 75 years had a non-significant increased risk of complications when controlling for preoperative variables (OR 1.82 [95% CI 0.80-4.13]) or perioperative variables (OR 1.98 [95% CI 0.86-4.58]) compared to patients < 55 years. Two patients died postoperatively. Both were ≥ 75 years (2/60, 3%). DISCUSSION AND CONCLUSIONS Selected patients ≥ 75 years can undergo RAPN without a significantly increased risk of postoperative complications. However, a mortality rate of 3% in this age group indicates that these patients are frail when postoperative complications occur.
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Affiliation(s)
- Rasmus D Petersson
- Department of Urology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
- Department of Urology, Zealand University Hospital, Roskilde, Denmark
| | - Mikkel Fode
- Department of Urology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark.
| | - Malene H Niebuhr
- Department of Urology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Badal S Rashu
- Department of Urology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Frederik F Thomsen
- Department of Urology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
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Takahashi T, Maruno K, Hazama T, Yamada Y, Nakashima M, Kikkawa K, Tamaki M, Ito N. A case of successful treatment of Fournier's gangrene through conservative management and elective debridement. IJU Case Rep 2024; 7:217-220. [PMID: 38686076 PMCID: PMC11056266 DOI: 10.1002/iju5.12706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 02/05/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Fournier's gangrene refers to a necrotizing fasciitis that mainly affects the perineal region and a condition that requires immediate debridement. This case involved elective debridement of Fournier's gangrene after the general condition was improved through antibiotic treatment instead of requesting an emergency debridement. Case presentation The patient was an 85-year-old man with a performance status of 4 admitted to a nursing home. He was transferred by ambulance with a fever. Blood tests showed a markedly elevated inflammatory response, and computed tomography revealed widespread aerodermectasia around the right testis to the lower abdomen. The patient was diagnosed with Fournier's gangrene. However, his family declined emergency surgical debridement. The patient's general condition was improved with antibiotics, and debridement was eventually performed. After 52 days of hospitalization, the patient was transferred to another hospital. Conclusion This study describes the successful treatment of Fournier's gangrene through conservative treatment followed by elective debridement.
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Affiliation(s)
- Toshifumi Takahashi
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Kouhei Maruno
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Tatsuya Hazama
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Yuya Yamada
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Masakazu Nakashima
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Kazuro Kikkawa
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Masahiro Tamaki
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Noriyuki Ito
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
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14
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Zhu W, Wu L, Xie W, Zhang G, Gu Y, Hou Y, He Y. Comparison of morbidity and mortality after radical cystectomy between individuals older and younger than 80 years: a systematic review and meta-analysis. Int Urol Nephrol 2024; 56:1525-1535. [PMID: 38095810 DOI: 10.1007/s11255-023-03897-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/23/2023] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To compare outcomes related to survival and post-operative complications in individuals older and younger than 80 years with bladder cancer undergoing radical cystectomy (RC). METHODS We conducted a systematic search using three large databases: PubMed, EMBASE, and Scopus. We included observational studies comparing outcomes between individuals older than 80 years and younger patients undergoing RC. The outcomes of interest included overall survival, disease-specific survival, progression-free survival, and risk of post-operative complications. We applied a random effects model for the analysis and reported pooled effect sizes as odds ratios (ORs) or hazards ratios (HRs) along with 95% confidence intervals. RESULTS We analyzed 21 studies. Our results show that individuals older than 80 years had higher risks of mortality at 30 days (OR 2.82; 95% CI 1.97, 4.04), 90 days (OR 3.34; 95% CI 2.61, 4.27), 12 months (HR 3.03; 95% CI 2.64, 3.49), and 24 months (HR 3.54; 95% CI 2.27, 5.50) of the post-operative follow-up than younger individuals. In addition, individuals older than 80 years also had poor 5-year survivals (HR 2.17; 95% CI 1.64, 2.88), an increased risk of 5-year cancer-specific mortality (HR 1.58; 95% CI 1.24, 2.03), poor 5-year recurrence free survivals (HR 1.49; 95% CI 1.07, 2.08), and high complications risks (OR 1.20; 95% CI 1.02, 1.42) when compared to younger patients. CONCLUSION Individuals older than 80 years undergoing RC are likely to have poor survival-related outcomes and increased complications risks. Pre-planned comprehensive geriatric assessments (CGAs) may be needed to offer better peri- and post-operative care to improve the outcomes in this patient population.
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Affiliation(s)
- Wei Zhu
- Department of Urology, The First Hospital of Jiaxing andThe Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing City, 314000, Zhejiang Province, China
| | - Lingfeng Wu
- Department of Urology, The First Hospital of Jiaxing andThe Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing City, 314000, Zhejiang Province, China
| | - Wenhua Xie
- Department of Urology, The First Hospital of Jiaxing andThe Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing City, 314000, Zhejiang Province, China
| | - Gaoyue Zhang
- Department of Urology, The First Hospital of Jiaxing andThe Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing City, 314000, Zhejiang Province, China
| | - Yanqin Gu
- Department of Urology, The First Hospital of Jiaxing andThe Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing City, 314000, Zhejiang Province, China
| | - Yansong Hou
- Department of Urology, The First Hospital of Jiaxing andThe Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing City, 314000, Zhejiang Province, China
| | - Yi He
- Department of Urology, The First Hospital of Jiaxing andThe Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing City, 314000, Zhejiang Province, China.
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15
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Zhao Y, Ou M, Hao X, Zhu T. Metabolic change in monocytes and postoperative morbidity after major abdominal surgery in elderly patients: A prospective cohort study. Heliyon 2024; 10:e28137. [PMID: 38571614 PMCID: PMC10987940 DOI: 10.1016/j.heliyon.2024.e28137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/22/2024] [Accepted: 03/12/2024] [Indexed: 04/05/2024] Open
Abstract
Background Postoperative complications in aging patients remain a significant cause of increased costs, hospital length of stay, and patient distress. Although alterations in energy metabolism have been closely linked to aging process and surgery, it is still unclear whether metabolic changes during surgery is associated with postoperative complications in elderly patients. This study was conducted to investigate whether metabolic changes during surgery predicts postoperative complications in elderly patients. Methods We conducted a prospective single-center observational cohort study. 244 adults (aged ≥65 years) who were scheduled for elective major non-cardiac surgery were recruited. Blood samples for each patient were taken before and after surgery. All patients were randomly divided into two groups (122 in each group), then oxygen consumption rate (OCR) or extracellular acidification rate (ECAR) was measured on isolated monocytes in each group. Results 14 of 110 (12.7%) patients went through OCR measurement and 15 of 122 patients (12.3%) went through ECAR measurement experienced moderate to severe complications. Overall, there was an intensification of glycolysis in monocytes after surgery. Among all variables, only the change (preoperative -postoperative) of glycolytic reserve (GR)/glycolysis (G) and GR/non-glycolytic acidification (NG) were predictors of moderate to severe complications (AUC = 0.70; 95% CI, 0.56-0.81; P = 0.019 and AUC = 0.67; 95% CI, 0.55-0.80; P = 0.031). Decreased postoperative GR/G were associated with worse postoperative complications (RR = 9.08; 95% CI, 1.23-66.81; P = 0.024). Conclusions Compared with mitochondria function, the change of glycolytic function in monocyte was more valuable in predicting postoperative complications after major abdominal surgery. Our study gave us a new insight into identifying patients at high risk in aging patients.
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Affiliation(s)
| | | | - Xuechao Hao
- Department of Anesthesiology, and the Research Units of West China (2018RU012) - Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Sichuan University, Chengdu, China
| | - Tao Zhu
- Department of Anesthesiology, and the Research Units of West China (2018RU012) - Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Sichuan University, Chengdu, China
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16
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Ogawa M, Satomi-Kobayashi S, Hamaguchi M, Komaki K, Kusu H, Izawa KP, Miyahara S, Sakai Y, Hirata KI, Okada K. Impact of maximum phonation time on postoperative dysphagia and prognosis after cardiac surgery. JTCVS OPEN 2024; 18:123-137. [PMID: 38690425 PMCID: PMC11056463 DOI: 10.1016/j.xjon.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/13/2024] [Accepted: 01/25/2024] [Indexed: 05/02/2024]
Abstract
Objective The incidence of postoperative complications, including dysphagia, increases as the population undergoing cardiovascular surgery ages. This study aimed to explore the potential of maximum phonation time (MPT) as a simple tool for predicting postextubation dysphagia (PED) and major adverse cardiac and cerebrovascular events (MACCEs). Methods This retrospective study included 442 patients who underwent elective cardiac surgery at a university hospital. MPT was measured before surgery, and patients were stratified into 2 groups based on normal and abnormal MPTs. Postoperative complications, including PED and MACCEs, were also investigated. Swallowing status was assessed using the Food Intake Level Scale. Results MPT predicted PED with prevalence of 11.0% and 18.0% in the normal and abnormal MPT groups, respectively (P = .01). During the follow-up period, MACCEs developed in 17.0% of patients. Frailty, European System for Cardiac Operative Risk Evaluation II score, PED, and MPT were markedly associated with MACCEs (adjusted hazard ratios: 2.25, 1.08, 1.96, and 0.96, respectively). Mediation analysis revealed that MPT positively influenced PED and MACCEs, whereas PED positively influenced MACCEs. The trend in restricted cubic spline analysis indicated that the hazard ratio for MACCEs increased sharply when MPT was <10 seconds. Conclusions These findings underscore the potential of MPT as a valuable tool in the preoperative assessment and management of patients undergoing cardiac surgery. By incorporating MPT into routine preoperative evaluations, clinicians can identify patients at a higher risk of PED and MACCEs, allowing for targeted interventions and closer postoperative monitoring. This may improve patient outcomes and reduce the health care costs associated with these complications.
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Affiliation(s)
- Masato Ogawa
- Department of Rehabilitation Science, Osaka Health Science University, Osaka, Japan
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
- Department of Public Health, Kobe University Graduate School of Health Sciences, Hyogo, Japan
| | - Seimi Satomi-Kobayashi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Mari Hamaguchi
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Kodai Komaki
- Division of Rehabilitation Medicine, Kobe University Hospital, Hyogo, Japan
| | - Hifumi Kusu
- Division of Rehabilitation Medicine, Kobe University Hospital, Hyogo, Japan
| | - Kazuhiro P. Izawa
- Department of Public Health, Kobe University Graduate School of Health Sciences, Hyogo, Japan
| | - Shunsuke Miyahara
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Yoshitada Sakai
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Ken-ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Kenji Okada
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan
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17
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Martin FE, Hilton JA, Martin FC, Nath R, Partridge JSL, Dhesi JK. The functional trajectories of older women having surgery for gynaeoncology cancer: A single site prospective observational study. J Geriatr Oncol 2024; 15:101678. [PMID: 38113756 DOI: 10.1016/j.jgo.2023.101678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 06/25/2023] [Accepted: 11/22/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Population aging longevity and advances in robotic surgery suggest that increasing numbers of older women having gynaeoncological surgery is likely. Postoperative morbidity and mortality are more common in older than younger women with the age-associated characteristics of multimorbidity and frailty being generally predictive of worse outcome. Priorities that inform treatment decisions change during the life course: older patients often place greater' value on quality-of-life-years gained than on life expectancy following cancer treatments. However, data on post-operative cognition, frailty, or functional independence is sparse and not routinely collected. This study aimed to describe the clinical characteristics and trajectory of functional change of older women in the 12 months following gynaeoncological surgery and to explore the associations between them. MATERIALS AND METHODS The prospective observational cohort study recruited consecutive women aged 65 or over scheduled for major gynaeoncologic surgery between July 2017 and April 2019. Baseline data on cancer stage, multimorbidity, and geriatric syndromes including cognition, frailty, and functional abilities were collected using standardised tools. Delirium and post-operative morbidity were recorded. Post hospital assessments were collected at 3-, 6-, and 12-months. RESULTS Overall, of 103 eligible participants assessed pre-operatively, most (77, 70%) remained independent in personal care at all assessments from discharge to 12 months. Functional trajectories varied widely over the 12 months but overall there was no significant decline or improvement for the 85 survivors. Eleven experienced a clinically significant decline in function at six months. This was associated with baseline low mood (P < 0.05), albeit with small numbers (6 of 11). Cognitive impairment and frailty were associated with lower baseline function but not with subsequent functional decline. DISCUSSION There was no clear clinical profile to identify the minority of older adults who experienced a clinically significant decline six months after surgery and for most, the decline was transient. This may be helpful in enabling informed patient consent. Assessment for geriatric syndromes and frailty may improve individual care but our findings do not indicate criteria for segmenting the patient population for selective attention. Future work should focus on causal pathways to potentially avoidable decline in those patients where this is not determined by the cancer itself.
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Affiliation(s)
- Fionna E Martin
- Perioperative medicine for Older People undergoing Surgery office, C/O Older Person's Assessment Unit, Ground Floor Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK.
| | - James A Hilton
- Intensive Care Unit, Royal Surrey County Hospital, Egerton Rd, Guildford GU2 7XX, UK
| | - Finbarr C Martin
- Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, Guy's Hospital Campus, Great Maze Pond, London SE1 9RT, UK
| | - Rahul Nath
- Department of Gynaeoncology, 12th Floor North Wing, St Thomas' Hospital, Westminster Bridge Rd, London SE1 7EH, UK
| | - Judith S L Partridge
- Perioperative medicine for Older People undergoing Surgery office, C/O Older Person's Assessment Unit, Ground Floor Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK; Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, Guy's Hospital Campus, Great Maze Pond, London SE1 9RT, UK
| | - Jugdeep K Dhesi
- Perioperative medicine for Older People undergoing Surgery office, C/O Older Person's Assessment Unit, Ground Floor Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK; Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, Guy's Hospital Campus, Great Maze Pond, London SE1 9RT, UK; Research Dept of Targeted Intervention & Interventional Science, University College London - Bloomsbury campus, Gower Street, London WC1E 6BT, UK
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Wada H, Suzuki H, Sakairi Y, Tanaka K, Sata Y, Toyoda T, Inage T, Matsui Y, Yoshino I. Can modified frailty index predict postoperative complication after lung cancer surgery? Gen Thorac Cardiovasc Surg 2024; 72:176-182. [PMID: 37474741 DOI: 10.1007/s11748-023-01962-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/09/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE The impact of the modified frailty index (mFI) on postoperative complications after lung cancer surgery was investigated. METHODS Patients who underwent lung cancer surgery in 2017 were included. 30-day postoperative mortality and morbidity were evaluated according to their Clavien-Dindo classification. mFI values are presented as the sum of values of 11 included items. Logistic regression was used to assess the effect of mFI on postoperative severe complication incidence. RESULTS Among 190 patients considered, severe postoperative complications (Grade 3 or more) were observed in 30 (16%). No patients died within 30 days of surgery. The incidence of severe complications was 3.6% in patients with mFI of 0, 16.2% in patients with mFI of 1, 23.4% in patients with mFI of 2, and 31.6% in patients with mFI of 3 or more, and was correlated with the grade of mFI. Univariate and multivariate analyses showed that the high mFI was significantly predictive of postoperative complications. Frail patients of mFI ≥ 2 were at 3.0-fold greater risk of severe complications than non-frail patients of mFI 0 or 1. CONCLUSION mFI was associated with morbidity after lung cancer surgery. Preoperative frailty assessment and appropriate intervention to frail patients would be required to improve postoperative outcomes.
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Affiliation(s)
- Hironobu Wada
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
- Department of Thoracic Surgery, International University of Health and Welfare School of Medicine, 4-3, Kozunomori, Narita, 286-8686, Japan
| | - Hidemi Suzuki
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Yuichi Sakairi
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Kazuhisa Tanaka
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yuki Sata
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Takahide Toyoda
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Terunaga Inage
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yukiko Matsui
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
- Department of Thoracic Surgery, International University of Health and Welfare School of Medicine, 4-3, Kozunomori, Narita, 286-8686, Japan
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Buldo-Licciardi M, Rynecki ND, Rao N, Eskenazi J, Montgomery SR, Li ZI, Moore M, Alaia MJ, Strauss EJ, Jazrawi LM, Campbell KA. Psychological Readiness to Return to Sport (RTS) and RTS Rates Are Similar in Patients After Either Bilateral or Unilateral Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2024; 6:100823. [PMID: 38162590 PMCID: PMC10755276 DOI: 10.1016/j.asmr.2023.100823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 10/21/2023] [Indexed: 01/03/2024] Open
Abstract
Purpose To compare psychological readiness to return to sport (RTS), RTS rate, level of return, and time to return between patients who underwent bilateral anterior cruciate ligament reconstruction (ACLR) and those who underwent unilateral ACLR. Methods The electronic medical record at a single academic medical center was queried for patients who underwent ACLR from January 2012 to May 2020. The inclusion criteria were skeletally mature patients who underwent either single or sequential bilateral ACLR and who had undergone either the primary ACLR or second contralateral ACLR at least 2 years earlier. Bilateral ACLRs were matched 1:3 to unilateral reconstructions based on age, sex, and body mass index. Psychological readiness to RTS was assessed using the validated ACL Return to Sport After Injury (ACL-RSI) scale. This, along with time to return and level of RTS, was compared between the 2 cohorts. Results In total, 170 patients were included, of whom 44 underwent bilateral ACLR and 132 underwent unilateral ACLR. At the time of the first surgical procedure, patients in the unilateral cohort were aged 28.8 ± 9.4 years and those in the bilateral cohort were aged 25.7 ± 9.8 years (P = .06). The average time difference between the first and second surgical procedures was 28.4 ± 22.3 months. There was no difference in psychological readiness to RTS (50.5 in bilateral cohort vs 48.1 in unilateral cohort, P = .66), RTS rate (78.0% in unilateral cohort vs 65.9% in bilateral cohort, P = .16), percentage of return to preinjury sport level (61.2% in unilateral cohort vs 69.0% in bilateral cohort, P = .21), or time to return (41.2 ± 29.3 weeks in unilateral cohort vs 35.2 ± 23.7 weeks in bilateral cohort, P = .31) between the 2 cohorts. Conclusions Compared with patients who undergo unilateral ACLR, patients who undergo bilateral ACLR are equally as psychologically ready to RTS, showing equal rates of RTS, time to return, and level of return. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Michael Buldo-Licciardi
- Department of Orthopedic Surgery, New York University School of Medicine, New York, New York, U.S.A
| | - Nicole D. Rynecki
- Department of Orthopedic Surgery, New York University School of Medicine, New York, New York, U.S.A
| | - Naina Rao
- Department of Orthopedic Surgery, New York University School of Medicine, New York, New York, U.S.A
| | - Jordan Eskenazi
- Department of Orthopedic Surgery, New York University School of Medicine, New York, New York, U.S.A
| | - Samuel R. Montgomery
- Department of Orthopedic Surgery, New York University School of Medicine, New York, New York, U.S.A
| | - Zachary I. Li
- Department of Orthopedic Surgery, New York University School of Medicine, New York, New York, U.S.A
| | - Michael Moore
- Department of Orthopedic Surgery, New York University School of Medicine, New York, New York, U.S.A
| | - Michael J. Alaia
- Department of Orthopedic Surgery, New York University School of Medicine, New York, New York, U.S.A
| | - Eric J. Strauss
- Department of Orthopedic Surgery, New York University School of Medicine, New York, New York, U.S.A
| | - Laith M. Jazrawi
- Department of Orthopedic Surgery, New York University School of Medicine, New York, New York, U.S.A
| | - Kirk A. Campbell
- Department of Orthopedic Surgery, New York University School of Medicine, New York, New York, U.S.A
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Yoo JJ, Koo S, Choi GH, Lee MW, Ryoo S, Park J, Park DA. Radiofrequency Ablation versus Surgical Resection in Elderly Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis. Curr Oncol 2024; 31:324-334. [PMID: 38248106 PMCID: PMC10813859 DOI: 10.3390/curroncol31010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Although the disease burden of elderly cancer patients is rapidly increasing, reliable scientific information, value and preference information of domestic patients, and standardized guidelines for determining the treatment of elderly cancer patients are lacking. The aim of this study is to compare the therapeutic effects of radiofrequency ablation (RFA) and surgery in hepatocellular carcinoma (HCC) patients aged 65 years or older. For the meta-analysis, the databases including PubMed (MEDLINE), EMBASE, OVID Medline, and the Cochrane Library were systematically searched. After the abstract-based review by two investigators, selected manuscripts were read in detail. The surgery group showed higher overall survival (OS) (HR 1.44, 95% CI 1.22-1.70) and disease-free survival (DFS) (HR 1.40, 95% CI 1.00-1.97) than the RFA group. This was also shown in small HCC of less than 3 cm (OS, HR 1.42, 95% CI 1.00-2.03; DFS, HR 1.32, 95% CI 0.91-1.91). This might be related to the high local recurrence in the RFA group (OR 4.90, 95% 2.16-11.08). On the other hand, adverse events were significantly lower in the RFA group (OR 0.22, 95% CI 0.14-0.36), which led to a decrease in the duration of hospital stay (mean difference -14.88 days, 95% CI -22.44--7.32). In elderly HCC patients, survival in the surgery group was significantly higher than in the RFA group, but various complications tended to increase; so, appropriate patient selection is required.
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Affiliation(s)
- Jeong-Ju Yoo
- Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon 14584, Republic of Korea;
| | - Sujin Koo
- Graduate School of Converging Clinical and Public Health, Ewha Womans University, Seoul 03760, Republic of Korea;
| | - Gi Hong Choi
- Department of General Surgery, Yonsei University School of Medicine, Seoul 03722, Republic of Korea;
| | - Min Woo Lee
- Department of Radiology, Samgsung Medical Center, Sungkyunkwan University, Seoul 06171, Republic of Korea;
| | - Seungeun Ryoo
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul 04933, Republic of Korea; (S.R.); (J.P.)
| | - Jungeun Park
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul 04933, Republic of Korea; (S.R.); (J.P.)
| | - Dong Ah Park
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul 04933, Republic of Korea; (S.R.); (J.P.)
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21
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Zhang Y, Nosseir M, Dyer J. Analysing cause of death during follow-up for non-muscle-invasive bladder cancer: is there a role for watchful waiting? Ann R Coll Surg Engl 2024; 106:57-63. [PMID: 36239948 PMCID: PMC10757883 DOI: 10.1308/rcsann.2022.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION Non-muscle-invasive bladder cancer (NMIBC) patients often require multiple invasive procedures during follow-up. Surveillance guidelines do not adjust for increasing frailty or competing comorbidity. We aim to evaluate the influence of these factors on the natural history of NMIBC and whether this may have implications for appropriate follow-up schedules. METHODS NMIBC patients who died in a 3-year period while on cystoscopic surveillance were identified. Frailty was assessed using the Rockwood Clinical Frailty Scale (CFS): 1-3, no frailty; 4, vulnerable; 5-9, mild/severe frailty. Similarly, three-tier categorisations were performed for comorbidity (Charlson Comorbidity Index) and for anaesthetic risk (American Society of Anesthesiologists' [ASA] score). RESULTS Of the 69 patients, 26 were categorised as no frailty, 20 as vulnerable and 13 as frail. There was no difference in the proportions of those with higher risk NMIBC between the categories. Increasing frailty was associated with reduced overall survival (median 59, 29 and 13 months; p < 0.05) but not recurrence-free survival (p = 0.98) or progression-free survival (p = 0.58). Similar results were obtained using the Charlson Comorbidity Index or ASA score. No frail patients with low/intermediate-risk NMIBC had clinically significant disease progression prior to death. Frail patients with CFS ≥ 4 were found to have similar complications due to bladder cancer itself (p = 0.48) yet almost three times as many complications following cystoscopic procedures during follow-up (p < 0.05). CONCLUSIONS For frail patients with low risk of progression, protocol-driven cystoscopic surveillance may not improve survival and watchful waiting may be more appropriate. Further investigation is required to determine the feasibility of this approach.
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Affiliation(s)
- Y Zhang
- Stockport NHS Foundation Trust, UK
| | | | - J Dyer
- Stockport NHS Foundation Trust, UK
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22
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Jayasinghe G, Kumar R, Buckle C, Vinayakam P, Slack R. Patient mortality after total hip arthroplasty revision surgery. J Orthop 2024; 47:45-49. [PMID: 38022843 PMCID: PMC10679522 DOI: 10.1016/j.jor.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023] Open
Abstract
Background Complications following revision total hip arthroplasty can cause significant morbidity and have a high mortality rate. Patient age and American Society of Anaesthesiologists (ASA) physical status classification system score are important determinants of mortality following revision hip arthroplasty. There is a paucity of high-quality evidence assessing the risk of mortality following revision hip arthroplasty stratified by indications of surgery. The aim of this study is to compare survival of patients undergoing revision THA for different indications. Methods This retrospective case series reviewed the mortality rate following revision hip surgery performed by a single surgeon between 2009 and 2016 with a minimum 2 year follow up. Kaplan Meir analysis was performed using mortality as the end point. Log rank testing was used to determine if the indication for surgery conferred a difference in survival. Results One hundred and ninety-eight consecutive cases were done using a tapered modular uncemented stem in 183 patients and were followed up for a mean period of 51.8 months (range, 24-121). Sixty patients died (67 % survivorship) during the follow up period with a 5-year survival rate of 78 %. Revision surgery performed for aseptic loosening had the best survival and hemiarthroplasty had the worst and differences in survival were statistically significant (P = 0.000002). Conclusion The indication for revision surgery is an important criterion which must be given weightage along with age, functional status of patient and ASA physical status score while planning revision surgery and counselling patients.
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Affiliation(s)
- Gihan Jayasinghe
- Queen Elizabeth The Queen Mother Hospital, Ramsgate Road, Margate, CT9 4AN, UK
| | - Rohit Kumar
- William Harvey Hospital, Kennington Road, Willesborough, Ashford, TN24 0LZ, UK
| | - Chris Buckle
- Queen Elizabeth The Queen Mother Hospital, Ramsgate Road, Margate, CT9 4AN, UK
| | - Parthiban Vinayakam
- Queen Elizabeth The Queen Mother Hospital, Ramsgate Road, Margate, CT9 4AN, UK
| | - Richard Slack
- Queen Elizabeth The Queen Mother Hospital, Ramsgate Road, Margate, CT9 4AN, UK
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Huang J, Awad K, Harlow L, Toro CA, Brotto M, Cardozo CP. Effects of a Laparotomy on Targeted Lipidomics Profiles in a Mouse Model of Surgical Stress During Aging. Methods Mol Biol 2024; 2816:87-100. [PMID: 38977591 DOI: 10.1007/978-1-0716-3902-3_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Laparotomy (EL) is one of the most common procedures performed among surgical specialties. Previous research demonstrates that surgery is associated with an increased inflammatory response. Low psoas muscle mass and quality markers are associated with increased mortality rates after emergency laparotomy. Analysis of lipid mediators in serum and muscle by using liquid chromatography-mass spectrometry (LC-MS)-based lipidomics has proven to be a sensitive and precise technique. In this chapter, we describe an LC-MS/MS protocol for the profiling and quantification of signaling lipids formed from Eicosapentaenoic Acid (EPA) and Eicosatetranoic acid (ETA) by 5, 12, or 15 lipoxynases. This protocol has been developed for and validated in serum and muscle samples in a mouse model of surgical stress caused by laparotomy.
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Affiliation(s)
- Jian Huang
- Bone-Muscle Research Center, College of Nursing and Health Innovations, Department of Graduate Nursing, The University of Texas at Arlington, Arlington, TX, USA
| | - Kamal Awad
- Bone-Muscle Research Center, College of Nursing and Health Innovations, Department of Graduate Nursing, The University of Texas at Arlington, Arlington, TX, USA
| | - Lauren Harlow
- Spinal Cord Damage Research Center, James J. Peters VA Medical Center, Bronx, NY, USA
| | - Carlos A Toro
- Spinal Cord Damage Research Center, James J. Peters VA Medical Center, Bronx, NY, USA
- Departments of Medicine and Rehabilitation Medicine and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marco Brotto
- Bone-Muscle Research Center, College of Nursing and Health Innovations, Department of Graduate Nursing, The University of Texas at Arlington, Arlington, TX, USA
| | - Christopher P Cardozo
- Spinal Cord Damage Research Center, James J. Peters VA Medical Center, Bronx, NY, USA.
- Departments of Medicine and Rehabilitation Medicine and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Swarbrick C, Poulton T, Martin P, Partridge J, Moppett IK. Study protocol for a national observational cohort investigating frailty, delirium and multimorbidity in older surgical patients: the third Sprint National Anaesthesia Project (SNAP 3). BMJ Open 2023; 13:e076803. [PMID: 38135325 DOI: 10.1136/bmjopen-2023-076803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION Older surgical patients are more likely to be living with frailty and multimorbidity and experience postoperative complications. The management of these conditions in the perioperative pathway is evolving. In order to support objective decision-making for patients, services and national guidance, accurate, contemporary data are needed to describe the impact and associations between frailty, multimorbidity and healthcare processes with patient and service-level outcomes. METHODS AND ANALYSIS The study is comprised of an observational cohort study of approximately 7500 patients; an organisational survey of perioperative services and a clinician survey of the unplanned, medical workload generated from older surgical patients. The cohort will consist of patients who are 60 years and older, undergoing a surgical procedure during a 5-day recruitment period in participating UK hospitals. Participants will be assessed for baseline frailty and multimorbidity; postoperative morbidity including delirium; and quality of life. Data linkage will provide additional details about individuals, their admission and mortality.The study's primary outcome is length of stay, other outcome measures include incidence of postoperative morbidity and delirium; readmission, mortality and quality of life. The cohort's incidence of frailty, multimorbidity and delirium will be estimated using 95% CIs. Their relationships with outcome measures will be examined using unadjusted and adjusted multilevel regression analyses. Choice of covariates in the adjusted models will be prespecified, based on directed acyclic graphs.A parallel study is planned to take place in Australia in 2022. ETHICS AND DISSEMINATION The study has received approval from the Scotland A Research Ethics Committee and Wales Research Ethics Committee 7.This work hopes to influence the development of services and guidelines. We will publish our findings in peer-reviewed journals and provide summary documents to our participants, sites, healthcare policy-makers and the public. TRIAL REGISTRATION NUMBER ISRCTN67043129.
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Affiliation(s)
- Claire Swarbrick
- Anaesthesia & Critical Care, University of Nottingham, Nottingham, UK
- Anaesthesia, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Tom Poulton
- Anaesthesia, Perioperative Medicine, and Pain Medicine, Victorian Comprehensive Cancer Centre, University of Melbourne, Parkville, Victoria, Australia
- Critical Care, University College London, London, UK
| | - Peter Martin
- Applied Health Research, University College London, London, UK
| | - Judith Partridge
- Division of Health and Social Care Research, King's College London, London, UK
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Iain Keith Moppett
- Anaesthesia & Critical Care, University of Nottingham, Nottingham, UK
- Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK
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25
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Schaefer G, Regier D, Stout C. Palliative Emergency General Surgery. Surg Clin North Am 2023; 103:1283-1296. [PMID: 37838468 DOI: 10.1016/j.suc.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Acute care surgeons encounter patients experiencing surgical emergencies related to advanced malignancy, catastrophic vascular events, or associated with multisystem organ failure. The acute nature is a factor in establishing a relationship between surgeon, patient, and family. Surgeons must use effective communication skills, empathy, and a knowledge of legal and ethical foundations. Training in palliative care principles is limited in many medical school and residency curricula. We offer examples of clinical situations facing acute care surgeons and discuss evidence-based recommendations to facilitate successful treatment and outcomes.
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Affiliation(s)
- Gregory Schaefer
- Division of Trauma, Surgical Critical Care, and Acute Care Surgery, Surgical Critical Care, J.W. Ruby Memorial Hospital, West Virginia University Medicine, West Virginia University, Morgantown, WV, USA; Division of Military Medicine, J.W. Ruby Memorial Hospital, West Virginia University Medicine, West Virginia University, Morgantown, WV, USA; Department of Surgery, West Virginia University, Morgantown, WV, USA.
| | - Daniel Regier
- Department of Surgery, West Virginia University, Morgantown, WV, USA
| | - Conley Stout
- Department of Surgery, West Virginia University, Morgantown, WV, USA
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26
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Hughes LM, Power S, Irwin MG, Nestor CC. Sedatives and Postoperative Delirium: Comment. Anesthesiology 2023; 139:709. [PMID: 37589555 DOI: 10.1097/aln.0000000000004659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
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Reilly J, Ajitsaria P, Buckley L, Magnusson M, Darvall J. Interrater reliability of the Clinical Frailty Scale in the anesthesia preadmission clinic. Can J Anaesth 2023; 70:1726-1734. [PMID: 37934359 PMCID: PMC10656316 DOI: 10.1007/s12630-023-02590-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 02/12/2023] [Accepted: 02/21/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE As many as 30% of patients with frailty die, are discharged to a nursing home, or have a new disability after surgery. The 2010 United Kingdom National Confidential Enquiry into Patient Outcome and Death recommended that frailty assessment be developed and included in the routine risk assessment of older surgical patients. The Clinical Frailty Scale (CFS) is a simple, clinically-assessed frailty measure; however, few studies have investigated interrater reliability of the CFS in the surgical setting. The objective of this study was to determine the interrater reliability of frailty classification between anesthesiologists and perioperative nurses. METHODS We conducted a cohort study assessing interrater reliability of the CFS between perioperative nurses and anesthesiologists for elective surgical patients aged ≥ 65 yr, admitted to a large regional university-affiliated hospital in Australia between July 2020 and February 2021. Agreement was measured via Cohen's kappa. RESULTS Frailty assessment was conducted on 238 patients with a median [interquartile range] age of 74 [70-80] yr. Agreement was perfect between nursing and medical staff for CFS scores in 112 (47%) patients, with a further 99 (42%) differing by only one point. Interrater kappa was 0.70 (95% confidence interval, 0.63 to 0.77; P < 0.001), suggesting good agreement between anesthesiologists and perioperative nurses. CONCLUSION This study suggests that CFS assessment by either anesthesiologists or nursing staff is reliable across a population of patients from a range of surgical specialities, with an acceptable degree of agreement. The CFS measurement should be included in the normal preanesthesia clinic workflow.
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Affiliation(s)
- Jennifer Reilly
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia.
- Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, VIC, Australia.
| | - Pragya Ajitsaria
- Department of Anaesthesia, John Hunter Hospital, Newcastle, NSW, Australia
- Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Louise Buckley
- Department of Anaesthesia, John Hunter Hospital, Newcastle, NSW, Australia
- Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Monique Magnusson
- Department of Anaesthesia, John Hunter Hospital, Newcastle, NSW, Australia
| | - Jai Darvall
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
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28
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Chen Y, Zhao Y, Liu J, Teng Y, Ou M, Hao X. Predictive value of perioperative procalcitonin, C reactive protein and high-sensitivity C reactive protein for the risk of postoperative complications after non-cardiac surgery in elderly patients: a nested case-control study. BMJ Open 2023; 13:e071464. [PMID: 37832985 PMCID: PMC10583102 DOI: 10.1136/bmjopen-2022-071464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 09/14/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVE Little is known about the correlation between perioperative concentrations of inflammatory biomarkers and postoperative complications. This study explored whether the plasma concentrations and perioperative changes of procalcitonin (PCT), C reactive protein (CRP) and high-sensitivity CRP (hsCRP) could predict the risk of postoperative morbidity in elderly patients undergoing elective non-cardiac surgery. DESIGN A nested case-control study. SETTING A tertiary hospital in China. PARTICIPANTS A total of 498 patients aged ≥65 years from a prospective cohort who underwent elective non-cardiac surgery between June 2020 and April 2021. PRIMARY OUTCOME MEASURES The primary outcomes were the efficacy of plasma concentrations of PCT, CRP and hsCRP in predicting the risk of Clavien-Dindo Classification (CDC) ≥grade 3 and major complications. The major complications included mortality, an intensive care unit stay length >24 hour, cardiovascular events, acute kidney injury, postoperative cognitive dysfunction and infections. RESULTS For major complications, the area under the curve (AUC) (95% CI) of PCT-24 hours, PCT change and PCT change rate were 0.750 (0.698 to 0.803), 0.740 (0.686 to 0.795) and 0.711 (0.651 to 0.771), respectively. The AUC (95% CI) of CRP-24 hours, CRP change, CRP change rate and hsCRP baseline were 0.835 (0.789 to 0.881), 0.818 (0.770 to 0.867), 0.691 (0.625 to 0.756) and 0.616 (0.554 to 0.678), respectively. For complications ≥CDC grade 3, the AUC (95% CI) of PCT-24 hours, PCT change and PCT change rate were 0.662 (0.543 to 0.780), 0.643 (0.514 to 0.772) and 0.627 (0.494 to 0.761), respectively. The AUC (95% CI) of CRP-24 hours and hsCRP baseline were 0.649 (0.527 to 0.771) and 0.639 (0.530 to 0.748), respectively. CONCLUSIONS PCT-24 hours, CRP-24 hours, the change of perioperative PCT and CRP were valuable predictors of major complications occurring within 30 days after non-cardiac surgery in the elderly. TRIAL REGISTRATION NUMBER China Clinical Trial Registry: ChiCTR1900026223.
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Affiliation(s)
- Yali Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Research Unit for Perioperative Stress Assessment and Clinical Decision, Chinese Academy of Medical Sciences (2018RU012), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi Zhao
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Research Unit for Perioperative Stress Assessment and Clinical Decision, Chinese Academy of Medical Sciences (2018RU012), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Juan Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Research Unit for Perioperative Stress Assessment and Clinical Decision, Chinese Academy of Medical Sciences (2018RU012), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi Teng
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Research Unit for Perioperative Stress Assessment and Clinical Decision, Chinese Academy of Medical Sciences (2018RU012), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mengchan Ou
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Research Unit for Perioperative Stress Assessment and Clinical Decision, Chinese Academy of Medical Sciences (2018RU012), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xuechao Hao
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Research Unit for Perioperative Stress Assessment and Clinical Decision, Chinese Academy of Medical Sciences (2018RU012), West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Van Zundert TC, Gatt SP, van Zundert AA. Anesthesia and perioperative pain relief in the frail elderly patient. Saudi J Anaesth 2023; 17:566-574. [PMID: 37779574 PMCID: PMC10540986 DOI: 10.4103/sja.sja_628_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 10/03/2023] Open
Abstract
Demand for anesthesia and analgesia for the frail elderly is continuously increasing as the likelihood of encountering very elderly, very vulnerable, and very compromised patients has, ever so subtly, increased over the last three decades. The anesthesiologist has, increasingly, been obliged to offer professional services to frail patients. Fortunately, there has been a dramatic improvement in medications, methods of drug delivery, critical monitoring, and anesthesia techniques. Specific methodologies peculiar to the frail are now taught and practiced across all anesthesia subspecialties. However, administering anesthesia for the frail elderly is vastly different to giving an anesthetic to the older patient. Frail patients are increasingly cared for in specialized units-geriatric intensive therapy units, post-acute care services, palliative, hospices, and supportive care and aged care facilities. Several medications (e.g., morphine-sparing analgesics) more suited to the frail have become universally available in most centers worldwide so that best-practice, evidence-based anesthesia combinations of drugs and techniques are now increasingly employed. Every anesthetic and pain management techniques in the frail elderly patient are going to be discussed in this review.
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Affiliation(s)
| | - Stephen P Gatt
- Discipline of Anaesthesia, Critical Care and Emergency Medicine, University of New South Wales, Kensington, NSW, Australia and Udayana University, Bali, Indonesia
| | - André A.J. van Zundert
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital, and The University of Queensland, Brisbane, Queensland, Australia
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30
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Schipa C, Luca E, Ripa M, Sollazzi L, Aceto P. Preoperative evaluation of the elderly patient. Saudi J Anaesth 2023; 17:482-490. [PMID: 37779566 PMCID: PMC10540990 DOI: 10.4103/sja.sja_613_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 10/03/2023] Open
Abstract
Nowadays, the pre-operative evaluation of older patients is a critical step in the decision-making process. Clinical assessment and care planning should be considered a whole process rather than separate issues. Clinicians should use validated tools for pre-operative risk assessment of older patients to minimize surgery-related morbidity and mortality and enhance care quality. Traditional pre-operative consultation often fails to capture the pathophysiological and functional profiles of older patients. The elderly's pre-operative evaluation should be focused on determining the patient's functional reserve and reducing any possible peri-operative risk. Therefore, older adults may benefit from the Comprehensive Geriatric Assessment (CGA) that allows clinicians to evaluate several aspects of elderly life, such as depression and cognitive disorders, social status, multi-morbidity, frailty, geriatric syndromes, nutritional status, and polypharmacy. Despite the recognized challenges in applying the CGA, it may provide a realistic risk assessment for post-operative complications and suggest a tailored peri-operative treatment plan for older adults, including pre-operative optimization strategies. The older adults' pre-operative examination should not be considered a mere stand-alone, that is, an independent stage of the surgical pathway, but rather a vital step toward a personalized therapeutic approach that may involve professionals from different clinical fields. The aim of this review is to revise the evidence from the literature and highlight the most important items to be implemented in the pre-operative evaluation process in order to identify better all elderly patients' needs.
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Affiliation(s)
- Chiara Schipa
- Dipartimento di Scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome
- Università Cattolica del Sacro Cuore, Rome
| | - Ersilia Luca
- Dipartimento di Scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome
- Università Cattolica del Sacro Cuore, Rome
| | - Matteo Ripa
- Università Cattolica del Sacro Cuore, Rome
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Liliana Sollazzi
- Dipartimento di Scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome
- Università Cattolica del Sacro Cuore, Rome
| | - Paola Aceto
- Dipartimento di Scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome
- Università Cattolica del Sacro Cuore, Rome
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Au E, Shao I, Elias Z, Koivu A, Zabida A, Shih AW, Cserti-Gazdewich C, van Klei WA, Bartoszko J. Complications of Factor V Leiden in Adults Undergoing Noncardiac Surgical Procedures: A Systematic Review. Anesth Analg 2023; 137:601-617. [PMID: 37053508 DOI: 10.1213/ane.0000000000006483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Factor V Leiden is the commonest hereditary prothrombotic allele, affecting 1% to 5% of the world's population. The objective of this study was to characterize the perioperative and postoperative outcomes of patients with Factor V Leiden compared to patients without a diagnosis of hereditary thrombophilia. This was a focused systematic review of studies including adult (>18 years) patients with Factor V Leiden (heterozygous or homozygous) undergoing noncardiac surgery. Included studies were either randomized controlled trials or observational. The primary clinical outcomes of interest were thromboembolic events occurring from the perioperative period up to 1 year postoperatively, defined as deep venous thrombosis, pulmonary embolism, or other clinically significant thrombosis occurring during or after a surgical procedure. Secondary outcomes included cerebrovascular events, cardiac events, death, transplant-related outcomes, and surgery-specific morbidity. Pediatric and obstetrical patients were excluded, as were case reports and case series. Databases searched included MEDLINE and EMBASE from inception until August 2021. Study bias was assessed through the CLARITY (Collaboration of McMaster University researchers) Risk of Bias tools, and heterogeneity through analysis of study design and end points, as well as the I 2 statistic with its confidence interval and the Q statistic. A total of 5275 potentially relevant studies were identified, with 115 having full text assessed for eligibility and 32 included in the systematic review. On the whole, the literature suggests that patients with Factor V Leiden have an increased risk of perioperative and postoperative thromboembolic events compared to patients without the diagnosis. Increased risk was also seen in relation to surgery-specific morbidity and transplant-related outcomes, particularly arterial thrombotic events. The literature did not support an increased risk for mortality, cerebrovascular, or cardiac complications. Limitations of the data include predisposition toward bias due in many study designs and small sample sizes across the majority of published studies. Variable outcome definitions and durations of patient follow-up across different surgical procedures resulted in high study heterogeneity precluding the effective use of meta-analysis. Factor V Leiden status may confer additional risk for surgery-related adverse outcomes. Large, adequately powered studies are required to accurately estimate the degree of this risk by zygosity.
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Affiliation(s)
- Emily Au
- From the Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ian Shao
- From the Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Zeyad Elias
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Annabel Koivu
- Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland
| | - Amir Zabida
- Department of Anaesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, Ontario, Canada
| | - Andrew W Shih
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Blood Research, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Wilton A van Klei
- Department of Anaesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Anaesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Justyna Bartoszko
- Department of Anaesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Anaesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
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Kim KM, Muench U, Maki JE, Yefimova M, Oh A, Jopling JK, Rinaldo F, Shah NR, Giannitrapani KF, Williams MY, Lorenz KA. Racial disparities in inpatient palliative care consultation among frail older patients undergoing high-risk elective surgical procedures in the United States: a cross-sectional study of the national inpatient sample. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad026. [PMID: 38756238 PMCID: PMC10986263 DOI: 10.1093/haschl/qxad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/21/2023] [Accepted: 07/11/2023] [Indexed: 05/18/2024]
Abstract
Surgical interventions are common among seriously ill older patients, with nearly one-third of older Americans facing surgery in their last year of life. Despite the potential benefits of palliative care among older surgical patients undergoing high-risk surgical procedures, palliative care in this population is underutilized and little is known about potential disparities by race/ethnicity and how frailty my affect such disparities. The aim of this study was to examine disparities in palliative care consultations by race/ethnicity and assess whether patients' frailty moderated this association. Drawing on a retrospective cross-sectional study of inpatient surgical episodes using the National Inpatient Sample of the Healthcare Cost and Utilization Project from 2005 to 2019, we found that frail Black patients received palliative care consultations least often, with the largest between-group adjusted difference represented by Black-Asian/Pacific Islander frail patients of 1.6 percentage points, controlling for sociodemographic, comorbidities, hospital characteristics, procedure type, and year. No racial/ethnic difference in the receipt of palliative care consultations was observed among nonfrail patients. These findings suggest that, in order to improve racial/ethnic disparities in frail older patients undergoing high-risk surgical procedures, palliative care consultations should be included as the standard of care in clinical care guidelines.
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Affiliation(s)
- Kyung Mi Kim
- Office of Research Patient Care Services, Stanford Health Care,Menlo Park, CA 94025, United States
- Clinical Excellence Research Center, School of Medicine, Stanford University,Palo Alto, CA 94304, United States
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, CA 94143, United States
| | - Ulrike Muench
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, CA 94143, United States
- Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, San Francisco, CA 94143, United States
| | - John E Maki
- Saint Francis Memorial Hospital, San Francisco, CA 94109, United States
| | - Maria Yefimova
- Center for Nursing Excellence and Innovation, UCSF Health,San Francisco, CA 94143, United States
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA 94143, United States
| | - Anna Oh
- Office of Research Patient Care Services, Stanford Health Care,Menlo Park, CA 94025, United States
| | - Jeffrey K Jopling
- Clinical Excellence Research Center, School of Medicine, Stanford University,Palo Alto, CA 94304, United States
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, United States
| | - Francesca Rinaldo
- Clinical Excellence Research Center, School of Medicine, Stanford University,Palo Alto, CA 94304, United States
| | - Nirav R Shah
- Clinical Excellence Research Center, School of Medicine, Stanford University,Palo Alto, CA 94304, United States
| | - Karleen Frances Giannitrapani
- Center for Innovation to Implementation (Ci2i), Veterans Affairs Palo Alto Health Care System, US Department of Veterans Affairs,Palo Alto, CA 94304, United States
- Quality Improvement Resource Center for Palliative Care, Stanford University,Stanford, CA 94305, United States
- Primary Care and Population Health, School of Medicine, Stanford University,Stanford, CA 94305, United States
| | - Michelle Y Williams
- Office of Research Patient Care Services, Stanford Health Care,Menlo Park, CA 94025, United States
- Primary Care and Population Health, School of Medicine, Stanford University,Stanford, CA 94305, United States
| | - Karl A Lorenz
- Center for Innovation to Implementation (Ci2i), Veterans Affairs Palo Alto Health Care System, US Department of Veterans Affairs,Palo Alto, CA 94304, United States
- Quality Improvement Resource Center for Palliative Care, Stanford University,Stanford, CA 94305, United States
- Primary Care and Population Health, School of Medicine, Stanford University,Stanford, CA 94305, United States
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Kim TJ, Pyo JH, Lee H, Choi SC, Min YW, Min BH, Lee JH, Rhee PL, Song M, Choi YH, Kim JJ. Outcomes of Endoscopic Resection for Early Gastric Cancer in Very Elderly Patients: A Nationwide Population-Based Study. Gut Liver 2023; 17:529-536. [PMID: 36578192 PMCID: PMC10352067 DOI: 10.5009/gnl210430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 08/20/2022] [Accepted: 08/26/2022] [Indexed: 12/30/2022] Open
Abstract
Background/Aims Few studies have investigated the long-term outcomes of endoscopic resection for early gastric cancer (EGC) in very elderly patients. The aim of this study was to determine the appropriate treatment strategy and identify the risk factors for mortality in these patients. Methods Patients with EGC who underwent endoscopic resection from 2006 to 2017 were identified using National Health Insurance Data and divided into three age groups: very elderly (≥85 years), elderly (65 to 84 years), and non-elderly (≤64 years). Their long- and short-term outcomes were compared in the three age groups, and the survival in the groups was compared with that in the control group, matched by age and sex. We also evaluated the risk factors for long- and short-term outcomes. Results A total of 8,426 patients were included in our study: 118 very elderly, 4,583 elderly, and 3,725 non-elderly. The overall survival and cancer-specific survival rates were significantly lower in the very elderly group than in the elderly and the non-elderly groups. Congestive heart failure was negatively associated with cancer-specific survival. A significantly decreased risk for mortality was observed in all groups (p<0.001). The very elderly group had significantly higher readmission and mortality rates within 3 months of endoscopic resection than the non-elderly and elderly groups. Furthermore, the cerebrovascular disease was associated with mortality within 3 months after endoscopic resection. Conclusions Endoscopic resection for EGC can be helpful for very elderly patients, and it may play a role in achieving overall survival comparable to that of the control group.
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Affiliation(s)
- Tae Jun Kim
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeung Hui Pyo
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyuk Lee
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Chul Choi
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang Won Min
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Hoon Min
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Haeng Lee
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Poong-Lyul Rhee
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Minku Song
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
| | - Yoon-Ho Choi
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae J. Kim
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
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Khoma O, Wong NLJ, Mugino M, Khoma MJ, Van der Wall H, Falk GL. Dyspnoea improves following composite repair of giant paraoesophageal hernia. Ann R Coll Surg Engl 2023; 105:523-527. [PMID: 36374275 PMCID: PMC10313459 DOI: 10.1308/rcsann.2022.0124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 07/03/2024] Open
Abstract
INTRODUCTION Paraoesophageal hernias (PEH) are often symptomatic and can lead to life-threatening complications such as volvulus and ischaemia. Dyspnoea is one of the most prevalent symptoms of giant hiatus herniae. The primary outcome of this study is resolution of dyspnoea following composite repair of giant paraoesophageal hernia. Secondary outcomes include complications of surgery, hernia recurrence rates and effect of recurrence on dyspnoea. METHODS Data were extracted from a prospectively maintained single-surgeon database containing records of all patients undergoing composite repair of paraoesophageal hernia. Patients presenting with dyspnoea who underwent composite laparoscopic repair of giant (>30% of stomach above diaphragm) paraoesophageal hernia between March 2009 and December 2015 were included. RESULTS Inclusion criteria were met by 154 patients. The mean age at time of surgery was 71.2 years (range 49-93, SD 9.66) with an average BMI of 28 (range 19-38kg/m2, SD 4.1). On average hernia contained 64% of stomach (range 30-100%, SD 20.2). One procedure was converted to laparotomy. Surgery resulted in near complete resolution of dyspnoea (2.6% postoperatively, p<0.001). Recurrence rate was 24% and was not associated with persistent dyspnoea. There was one death and two significant complications. CONCLUSION Dyspnoea resolves following laparoscopic repair of giant paraoesophageal hernia. The presence of dyspnoea in patients with known large paraoesophageal hernia should be regarded as an indication for referral to a surgical service with expertise in hiatal hernia management.
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Affiliation(s)
- O Khoma
- University of Notre Dame, Chippendale, New South Wales, Australia
| | - NLJ Wong
- Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - M Mugino
- University of Notre Dame, Chippendale, New South Wales, Australia
| | - MJ Khoma
- Sydney Heartburn Clinic, Australia
| | - H Van der Wall
- University of Notre Dame, Chippendale, New South Wales, Australia
| | - GL Falk
- Concord Repatriation General Hospital, Concord, New South Wales, Australia
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Liu Y, Gao G, Liang Y, Li T, Li T. Safety and feasibility of robotic surgery for old rectal cancer patients. Updates Surg 2023:10.1007/s13304-023-01504-9. [PMID: 37233966 DOI: 10.1007/s13304-023-01504-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 03/20/2023] [Indexed: 05/27/2023]
Abstract
Robotic surgery is widely utilized for rectal cancer. Older patients are associated with comorbidity and diminished cardiopulmonary reserve, resulting in uncertainty and reluctance to perform robotic surgery in older patients. The aim of the study was to assess the safety and feasibility of robotic surgery in older rectal cancer patients. We collected the data of patients diagnosed with rectal cancer and operated at our hospital from May 2015 to January 2021. All patients undergoing robotic surgery were classified into two groups: the old group (≥ 70 years) and young group (< 70 years). Perioperative outcomes were analyzed and compared between the two groups. Risk factors related to postoperative complications were also explored. A total of old N = 114 and young N = 324 rectal patients were enrolled in our study. Older patients were prone to exhibit comorbidity than the young and had lower body mass index and higher scores of American Society of Anesthesiologists than the young. No statistical difference was found in operative time, estimated blood loss, lymph nodes retrieved, tumor size, pathological TNM stage, hospital stay after surgery and total hospital cost between the two groups. The incidence of postoperative complications did not show difference between the two groups. On multivariate analyses, male sex and longer operative time could predict postoperative complications, whereas old age was not an independent factor for postoperative complications. After careful preoperative evaluation, robotic surgery is a technically feasible and safe procedure for older rectal cancer patients.
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Affiliation(s)
- Yaxiong Liu
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi Province, China
- Department of Graduate School, Medical College of Nanchang University, No. 461 Bayi Avenue, Nanchang, 330006, Jiangxi Province, China
| | - Gengmei Gao
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi Province, China
- Department of Graduate School, Medical College of Nanchang University, No. 461 Bayi Avenue, Nanchang, 330006, Jiangxi Province, China
| | - Yahang Liang
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi Province, China
- Department of Graduate School, Medical College of Nanchang University, No. 461 Bayi Avenue, Nanchang, 330006, Jiangxi Province, China
| | - Tao Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi Province, China
- Department of Graduate School, Medical College of Nanchang University, No. 461 Bayi Avenue, Nanchang, 330006, Jiangxi Province, China
| | - Taiyuan Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi Province, China.
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Edmundson PM, Balogh R, Shelley JK, Shirvani A, Shah AH, Caero J, Thomas E, Reynolds M, McShan EE, Bennett MM, Warren AM, Foreman ML. Utilizing psoas muscle cross-sectional area to predict functional outcome. Proc AMIA Symp 2023; 36:468-472. [PMID: 37334081 PMCID: PMC10269380 DOI: 10.1080/08998280.2023.2207724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 06/20/2023] Open
Abstract
Background This study evaluated psoas muscle area (PMA) as a predictor of frailty and functional outcome in trauma patients. Methods The cohort included 211 trauma patients admitted to an urban level I trauma center from March 2012 to May 2014 who consented to participate in a longitudinal study and underwent abdominal-pelvic computed tomography scans during their initial evaluation. Physical component scores (PCS) of the Veterans RAND 12-Item Health Survey were administered to assess physical functionality at baseline and at 3, 6, and 12 months after injury. PMA in mm2 and Hounsfield units was calculated using the Centricity PACS system. Statistical models were stratified by injury severity score (ISS), <15 or ≥15, and adjusted for age, sex, and baseline PCS. Follow-up PCS were analyzed using general linear regression models. Results For participants with an ISS <15, increased PMA was significantly associated with higher PCS at 3 (P = 0.008), 6 (P = 0.02), and 12 months (P = 0.002), although this relationship was not statistically significant for ISS ≥15 (P = 0.85, 0.66, 0.61). Conclusion For mild to moderately injured (but not seriously injured) patients, those with larger psoas muscles experience better functional outcomes after injury.
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Affiliation(s)
| | - Ryan Balogh
- Baylor University Medical Center, Dallas, Texas
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Lee SW, Lee EH, Choi IC. An ensemble machine learning approach to predict postoperative mortality in older patients undergoing emergency surgery. BMC Geriatr 2023; 23:262. [PMID: 37131138 PMCID: PMC10155414 DOI: 10.1186/s12877-023-03969-0] [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: 12/14/2022] [Accepted: 04/13/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Prediction of preoperative frailty risk in the emergency setting is a challenging issue because preoperative evaluation cannot be done sufficiently. In a previous study, the preoperative frailty risk prediction model used only diagnostic and operation codes for emergency surgery and found poor predictive performance. This study developed a preoperative frailty prediction model using machine learning techniques that can be used in various clinical settings with improved predictive performance. METHODS This is a national cohort study including 22,448 patients who were older than 75 years and visited the hospital for emergency surgery from the cohort of older patients among the retrieved sample from the Korean National Health Insurance Service. The diagnostic and operation codes were one-hot encoded and entered into the predictive model using the extreme gradient boosting (XGBoost) as a machine learning technique. The predictive performance of the model for postoperative 90-day mortality was compared with those of previous frailty evaluation tools such as Operation Frailty Risk Score (OFRS) and Hospital Frailty Risk Score (HFRS) using the receiver operating characteristic curve analysis. RESULTS The predictive performance of the XGBoost, OFRS, and HFRS for postoperative 90-day mortality was 0.840, 0.607, and 0.588 on a c-statistics basis, respectively. CONCLUSIONS Using machine learning techniques, XGBoost to predict postoperative 90-day mortality, using diagnostic and operation codes, the prediction performance was improved significantly over the previous risk assessment models such as OFRS and HFRS.
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Affiliation(s)
- Sang-Wook Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Seoul, 05505, Songpa-gu, Republic of Korea
| | - Eun-Ho Lee
- University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Seoul, 05505, Songpa-gu, Republic of Korea
| | - In-Cheol Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Seoul, 05505, Songpa-gu, Republic of Korea.
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Fagard K, Deschodt M, Geyskens L, Willems S, Boland B, Wolthuis A, Flamaing J. Geriatric care for surgical patients: results and reflections from a cross-sectional survey in acute Belgian hospitals. Eur Geriatr Med 2023; 14:239-249. [PMID: 36690884 PMCID: PMC9870777 DOI: 10.1007/s41999-023-00748-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/10/2023] [Indexed: 01/25/2023]
Abstract
PURPOSE To explore geriatric care for surgical patients in Belgian hospitals and geriatricians' reflections on current practice. METHODS A web-based survey was developed based on literature review and local expertise, and was pretested with 4 participants. In June 2021, the 27-question survey was sent to 91 heads of geriatrics departments. Descriptive statistics and thematic analysis were performed. RESULTS Fifty-four surveys were completed, corresponding to a response rate of 59%. Preoperative geriatric risk screening is performed in 25 hospitals and systematically followed by geriatric assessment in 17 hospitals. During the perioperative hospitalisation, 91% of geriatric teams provide non-medical and 82% provide medical advice. To a lesser extent, they provide geriatric protocols, geriatric education and training, and attend multidisciplinary team meetings. Overall, time allocation of geriatric teams goes mainly to postoperative evaluations and interventions, rather than to preoperative assessment and care planning. Most surgical patients are hospitalised on surgical wards, with reactive (73%) or proactive (46%) geriatric consultation. In 36 hospitals, surgical patients are also admitted on geriatric wards, predominantly orthopaedic/trauma, abdominal and vascular surgery. Ninety-eight per cent of geriatricians feel that more geriatric input for surgical patients is needed. The most common reported barriers to further implement geriatric-surgical services are shortage of geriatricians and geriatric nurses, and unadjusted legislation and financing. CONCLUSION Geriatric care for surgical patients in Belgian hospitals is mainly reactive, although geriatricians favour more proactive services. The main opportunities and challenges for improvement are to resolve staff shortages in the geriatric work field and to update legislation and financing.
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Affiliation(s)
- Katleen Fagard
- Department of Geriatric Medicine, University Hospitals Leuven, Dienst Geriatrie UZ Leuven, Herestraat 49, Box 7003 35, 3000, Leuven, Belgium.
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Mieke Deschodt
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Competence Centre of Nursing, University Hospitals Leuven, Leuven, Belgium
| | - Lisa Geyskens
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Sarah Willems
- Department of Geriatric Medicine, University Hospitals Leuven, Dienst Geriatrie UZ Leuven, Herestraat 49, Box 7003 35, 3000, Leuven, Belgium
| | - Benoît Boland
- Department of Geriatric Medicine, University Hospital Saint-Luc, Brussels, Belgium
| | - Albert Wolthuis
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Johan Flamaing
- Department of Geriatric Medicine, University Hospitals Leuven, Dienst Geriatrie UZ Leuven, Herestraat 49, Box 7003 35, 3000, Leuven, Belgium
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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van Erck D, Dolman CD, Henriques JP, Schoufour JD, Delewi R, Scholte Op Reimer WJM, Snaterse M. Exploring barriers and facilitators of behavioural changes in dietary intake and physical activity: a qualitative study in older adults undergoing transcatheter aortic valve implantation. Eur Geriatr Med 2023:10.1007/s41999-023-00774-1. [PMID: 37004674 DOI: 10.1007/s41999-023-00774-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/22/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE The majority of older patients, scheduled for a cardiac procedure, do not adhere to international dietary intake and physical activity guidelines. The purpose of this study was to explore barriers and facilitators regarding dietary intake and physical activity behaviour change in older patients undergoing transcatheter aortic valve implantation (TAVI). METHODS We conducted a qualitative study using semi-structured interviews with patients undergoing TAVI. Interviews were analysed by two independent researchers using thematic analysis, the capability, opportunity and motivation behaviour model was used as a framework. RESULTS The study included 13 patients (82 ± 6 years old, 6 females) until data saturation was reached. Six themes were identified, which were all applicable to both dietary intake and physical activity. Three following themes were identified as barriers: (1) low physical capability, (2) healthy dietary intake and physical activity are not a priority at an older age and (3) ingrained habits and preferences. Three following themes were identified as facilitators: (1) knowledge that dietary intake and physical activity are important for maintaining health, (2) norms set by family, friends and caregivers and (3) support from the social environment. CONCLUSION Our study found that older patients had mixed feelings about changing their behaviour. The majority initially stated that dietary intake and physical activity were not a priority at older age. However, with knowledge that behaviour could improve health, patients also stated willingness to change, leading to a state of ambivalence. Healthcare professionals may consider motivational interviewing techniques to address this ambivalence.
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Affiliation(s)
- Dennis van Erck
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Christine D Dolman
- Department of Cardiothoracic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - José P Henriques
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Josje D Schoufour
- Faculty Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Ronak Delewi
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wilma J M Scholte Op Reimer
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Research Group Chronic Diseases, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Marjolein Snaterse
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Mothes AR, Kather A, Cepraga I, Esber A, Kwetkat A, Runnebaum IB. Robotic-assisted Gynecological Surgery in Older Patients - a Comparative Cohort Study of Perioperative Outcomes. Geburtshilfe Frauenheilkd 2023; 83:437-445. [PMID: 37153652 PMCID: PMC10155232 DOI: 10.1055/a-1902-4577] [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: 07/15/2022] [Accepted: 11/28/2022] [Indexed: 05/10/2023] Open
Abstract
Study design Because of current demographic developments, a hypothesis was proposed whereby older female patients aged > 65 years can be safely operated using minimally invasive, robotic-assisted surgery, despite having more preoperative comorbidities. A comparative cohort study was designed to compare the age group ≥ 65 years (older age group, OAG) with the age group < 65 years (younger age group, YAG) after robotic-assisted gynecological surgery (RAS) in two German centers. Patients and methods Consecutive RAS procedures performed between 2016 and 2021 at the Women's University Hospital of Jena and the Robotic Center Eisenach to treat benign or oncological indications were included in the study. The age groups were compared according to their preoperative comorbidities (ASA, Charlson comorbidity index [CCI], cumulative illness rating scale - geriatric version [CIRS-G]) and perioperative parameters such as Clavien-Dindo (CD) classification of surgical complications. Analysis was performed using Welch's t -test, chi 2 test, and Fisher's exact test. Results A total of 242 datasets were identified, of which 63 (73 ± 5 years) were OAG and 179 were YAG (48 ± 10 years). Patient characteristics and the percentage of benign or oncological indications did not differ between the two age groups. Comorbidity scores and the percentage of obese patients were higher in the OAG group: CCI (2.7 ± 2.0 vs. 1.5 ± 1.3; p < 0.001), CIRS-G (9.7 ± 3.9 vs. 5.4 ± 2.9; p < 0.001), ASA class II/III (91.8% vs. 74.1%; p = 0.004), obesity (54.1% vs. 38.2%; p = 0.030). There was no difference between age groups, even grouped for benign or oncological indications, with regard to perioperative parameters such as duration of surgery (p = 0.088; p = 0.368), length of hospital stay (p = 0.786; p = 0.814), decrease in Hb levels (p = 0.811; p = 0.058), conversion rate (p = 1.000; p = 1.000) and CD complications (p = 0.433; p = 0.745). Conclusion Although preoperative comorbidity was higher in the group of older female patients, no differences were found between age groups with regard to perioperative outcomes following robotic-assisted gynecological surgery. Patient age is not a contraindication for robotic gynecological surgery.
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Affiliation(s)
- Anke R. Mothes
- Klinik für Frauenheilkunde und Robotisches Zentrum, St. Georg Klinikum Eisenach, Akademisches Lehrkrankenhaus des Universitätsklinikums Jena, Eisenach, Germany
| | - Angela Kather
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Jena, Germany
| | - Irina Cepraga
- Klinik für Frauenheilkunde und Robotisches Zentrum, St. Georg Klinikum Eisenach, Akademisches Lehrkrankenhaus des Universitätsklinikums Jena, Eisenach, Germany
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Jena, Germany
| | - Anke Esber
- Klinik für Frauenheilkunde und Robotisches Zentrum, St. Georg Klinikum Eisenach, Akademisches Lehrkrankenhaus des Universitätsklinikums Jena, Eisenach, Germany
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Jena, Germany
| | - Anja Kwetkat
- Klinik für Geriatrie und Palliativmedizin, Klinikum Osnabrück GmbH, Osnabrück, Germany
| | - Ingo B. Runnebaum
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Jena, Germany
- Correspondence Prof. Dr. Ingo B. Runnebaum, MBA Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin,
Universitätsklinikum JenaAm Klinikum 107747
JenaGermany
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Zhao Z, Zhou S, Tang Y, Zhou L, Ji H, Tang Z, Dai R. Impact of age on short-term outcomes after pancreaticoduodenectomy: A retrospective case-control study of 260 patients. Front Surg 2023; 10:1031409. [PMID: 37066018 PMCID: PMC10097935 DOI: 10.3389/fsurg.2023.1031409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 03/13/2023] [Indexed: 03/31/2023] Open
Abstract
BackgroundAlthough the increase of perioperative complications in the elderly undergoing pancreaticoduodenectomy (PD) surgery has been recognized, the definition of the “old patient” of PD in the studies is different and there is no accepted cut-off value at present.Methods279 consecutive patients who have undergone PD in our center between January 2012 and May 2020 were analyzed. Demographic features, clinical-pathological data and short-term outcomes were collected. The patients were divided into two groups, and the cut-off value (62.5 years) is picked based on the highest Youden Index. Primary endpoints were perioperative morbidity and mortality, and complications were classified according to the Clavien-Dindo Score.ResultsA total of 260 patients with PD were included in this study. Postoperative pathology confirmed pancreatic tumors in 62 patients, bile duct tumor in 105, duodenal tumor in 90, and others in 3. Age (OR = 1.09, P < 0.01), and albumin (OR = 0.34, P < 0.05) were significantly correlated with postoperative Clavien-Dindo Score ≥3b. There were 173 (66.5%) patients in the younger group (<62.5 years) and 87 (33.5%) in the elderly group (≥62.5 years). Significant difference between two groups was demonstrated for Clavien-Dindo Score ≥3b (P < 0.01), postoperative pancreatic fistula (P < 0.05), and perioperative deceases (P < 0.05).ConclusionsAge and albumin were significantly correlated with postoperative Clavien-Dindo Score ≥3b, and there was no significant difference in predicting the grade of Clavien-Dindo Score. The cut-off value of elderly patients with PD was 62.5 years old and there were useful in predicting Clavien-Dindo Score ≥3b, pancreatic fistula, and perioperative death.
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Affiliation(s)
- Zhirong Zhao
- Hospital of Southwest Jiaotong University, The General Hospital of Western Theater Command, Chengdu, China
- General Surgery Center, General Hospital of Western Theater Command, Chengdu, China
| | - Shibo Zhou
- General Surgery Center, General Hospital of Western Theater Command, Chengdu, China
- College of Clinical MedicineSouthwest Medical University, Luzhou, China
| | - Yaping Tang
- Hospital of Southwest Jiaotong University, The General Hospital of Western Theater Command, Chengdu, China
- General Surgery Center, General Hospital of Western Theater Command, Chengdu, China
| | - Lichen Zhou
- General Surgery Center, General Hospital of Western Theater Command, Chengdu, China
- College of Clinical MedicineSouthwest Medical University, Luzhou, China
| | - Hua Ji
- General Surgery Center, General Hospital of Western Theater Command, Chengdu, China
- College of Clinical MedicineSouthwest Medical University, Luzhou, China
| | - Zheng Tang
- General Surgery Center, General Hospital of Western Theater Command, Chengdu, China
- College of Clinical MedicineSouthwest Medical University, Luzhou, China
| | - Ruiwu Dai
- Hospital of Southwest Jiaotong University, The General Hospital of Western Theater Command, Chengdu, China
- General Surgery Center, General Hospital of Western Theater Command, Chengdu, China
- College of Clinical MedicineSouthwest Medical University, Luzhou, China
- Pancreatic Injury and Repair Key Laboratory of Sichuan Province, General Hospital of Western Theater Command, Chengdu, China
- Correspondence: Dai Ruiwu
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Kweh BTS, Lee HQ, Tan T, Tew KS, Leong R, Fitzgerald M, Matthew J, Kambourakis A, Liew S, Hunn M, Tee JW. Risk Stratification of Elderly Patients Undergoing Spinal Surgery Using the Modified Frailty Index. Global Spine J 2023; 13:457-465. [PMID: 33745351 PMCID: PMC9972258 DOI: 10.1177/2192568221999650] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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
STUDY DESIGN Retrospective cohort. OBJECTIVES To validate the 11-item modified Frailty Index (mFI) as a perioperative risk stratification tool in elderly patients undergoing spine surgery. METHODS All consecutive cases of spine surgery in patients aged 65 years or older between July 2016 and June 2018 at a state-wide trauma center were retrospectively reviewed. The primary outcome was post-operative major complication rate (Clavien-Dindo Classification ≥ III). Secondary outcome measures included the rate of all complications, 6-month mortality and surgical site infection. RESULTS A total of 348 cases were identified. The major complication rate was significantly lower in patients with an mFI of 0 compared to ≥ 0.45 (18.3% versus 42.5%, P = .049). As the mFI increased from 0 to ≥ 0.45 there was a stepwise increase in risk of major complications (P < .001). Additionally, 6-month mortality rate was considerably lower when the mFI was 0 rather than ≥ 0.27 (4.2% versus 20.4%, P = .007). Multivariate analysis demonstrated an mFI ≥ 0.27 was significantly associated with an increased incidence of major complication (OR 2.80, 95% CI 1.46-5.35, P = .002), all complication (OR 2.93, 95% CI 1.70-15.11, P < .001), 6-month mortality (OR 7.39, 95% CI 2.55-21.43, P < .001) and surgical site infection (OR 4.43, 95% CI 1.71-11.51, P = .002). The American Society of Anesthesiologists' (ASA) index did not share a stepwise relationship with any outcome. CONCLUSION The mFI is significantly associated in a gradated fashion with increased morbidity and mortality. Patients with an mFI ≥ 0.27 are at greater risk of major complications, all-complications, 6-monthy mortality, and surgical site infection.
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Affiliation(s)
- Barry Ting Sheen Kweh
- National Trauma Research Institute,
Melbourne, Victoria, Australia,Department of Neurosurgery, The Alfred
Hospital, Melbourne, Victoria, Australia,Department of Neurosurgery, Royal
Melbourne Hospital, Parkville, Victoria, Melbourne,Barry Ting Sheen Kweh, National Trauma
Research Institute, 85-89 Commercial Road, Melbourne, Victoria 3004, Australia.
| | - Hui Qing Lee
- National Trauma Research Institute,
Melbourne, Victoria, Australia,Department of Neurosurgery, The Alfred
Hospital, Melbourne, Victoria, Australia
| | - Terence Tan
- National Trauma Research Institute,
Melbourne, Victoria, Australia,Department of Neurosurgery, The Alfred
Hospital, Melbourne, Victoria, Australia
| | - Kim Siong Tew
- Department of Geriatric and
Rehabilitation Medicine, Peninsula Health, Melbourne, Victoria, Australia
| | - Ronald Leong
- Department of Geriatric and
Rehabilitation Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Mark Fitzgerald
- National Trauma Research Institute,
Melbourne, Victoria, Australia,Emergency and Trauma Centre, The Alfred
Hospital, Melbourne, Victoria, Australia,Central Clinical School, Faculty of
Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria,
Australia
| | - Joseph Matthew
- National Trauma Research Institute,
Melbourne, Victoria, Australia,Emergency and Trauma Centre, The Alfred
Hospital, Melbourne, Victoria, Australia,Central Clinical School, Faculty of
Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria,
Australia
| | - Anthony Kambourakis
- Emergency and Trauma Centre, The Alfred
Hospital, Melbourne, Victoria, Australia,Central Clinical School, Faculty of
Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria,
Australia
| | - Susan Liew
- Department of Orthopaedics, The Alfred
Hospital, Melbourne, Victoria, Australia
| | - Martin Hunn
- Department of Neurosurgery, The Alfred
Hospital, Melbourne, Victoria, Australia,Central Clinical School, Faculty of
Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria,
Australia
| | - Jin Wee Tee
- National Trauma Research Institute,
Melbourne, Victoria, Australia,Department of Neurosurgery, The Alfred
Hospital, Melbourne, Victoria, Australia,Central Clinical School, Faculty of
Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria,
Australia
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Obed D, Knoedler S, Salim M, Gulbis N, Dastagir N, Dastagir K, Bingöl AS, Vogt PM. The modified 5-item frailty index as a predictor of complications in burn patients. JPRAS Open 2023; 36:62-71. [PMID: 37179743 PMCID: PMC10172613 DOI: 10.1016/j.jpra.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/05/2023] [Indexed: 03/16/2023] Open
Abstract
The modified 5-item frailty index (mFI-5), as a measure of frailty and biological age, has been shown to be a reliable predictor of complications and mortality in a variety of surgical specialties. However, its role in burn care remains to be fully elucidated. We, therefore, correlated frailty with in-hospital mortality and complications after burn injury. The medical charts of all burn patients admitted between 2007 and 2020 who had ≥ 10 % of their total body surface area affected were retrospectively reviewed. Data on clinical, demographic, and outcome parameters were collected and evaluated, and mFI-5 was calculated on the basis of the data obtained. Univariate and multivariate regression analyses were used to investigate the association between mFI-5 and medical complications and in-hospital mortality. A total of 617 burn patients were included in this study. Increasing mFI-5 scores were significantly associated with increased in-hospital mortality (p < 0.0001), myocardial infarction (p = 0.03), sepsis (p = 0.005), urinary tract infections (p = 0.006), and perioperative blood transfusions (p = 0.0004). They were also associated with an increase in the length of hospital stay and the number of surgical procedures, albeit without statistical significance. An mFI-5 score of ≥ 2 was a significant predictor of sepsis (odds ratio [OR] = 2.08; 95% confidence interval [CI]: 1.03 to 3.95; p = 0.04), urinary tract infection (OR = 2.82; 95% CI: 1.47 to 5.19; p = 0.002), and perioperative blood transfusions (OR = 2.61; 95% CI: 1.61 to 4.25; p = 0.0001). Multivariate logistic regression analysis revealed that an mFI-5 score of ≥ 2 was not an independent risk factor for in-hospital mortality (OR = 1.44; 95% CI: 0.61 to 3.37; p = 0.40). mFI-5 is a significant risk factor for only a few select complications in the burn population. It is not a reliable predictor of in-hospital mortality. Therefore, its utility as a risk stratification tool in the burn unit may be limited.
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Cancer Treatment Patterns and Factors Affecting Receipt of Treatment in Older Adults: Results from the ASPREE Cancer Treatment Substudy (ACTS). Cancers (Basel) 2023; 15:cancers15041017. [PMID: 36831362 PMCID: PMC9953887 DOI: 10.3390/cancers15041017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/19/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Cancer treatment planning in older adults is complex and requires careful balancing of survival, quality of life benefits, and risk of treatment-related morbidity and toxicity. As a result, treatment selection in this cohort tends to differ from that for younger patients. However, there are very few studies describing cancer treatment patterns in older cohorts. METHODS We used data from the ASPirin in Reducing Events in the Elderly (ASPREE) trial and the ASPREE Cancer Treatment Substudy (ACTS) to describe cancer treatment patterns in older adults. We used a multivariate logistic regression model to identify factors affecting receipt of treatment. RESULTS Of 1893 eligible Australian and United States (US) participants with incident cancer, 1569 (81%) received some form of cancer treatment. Non-metastatic breast cancers most frequently received treatment (98%), while haematological malignancy received the lowest rates of treatment (60%). Factors associated with not receiving treatment were older age (OR 0.94, 95% CI 0.91-0.96), residence in the US (OR 0.34, 95% CI 0.22-0.54), smoking (OR 0.57, 95% CI 0.40-0.81), and diabetes (OR 0.56, 95% CI 0.39-0.80). After adjustment for treatment patterns in sex-specific cancers, sex did not impact receipt of treatment. CONCLUSIONS This study is one of the first describing cancer treatment patterns and factors affecting receipt of treatment across common cancer types in older adults. We found that most older adults with cancer received some form of cancer treatment, typically surgery or systemic therapy, although this varied by factors such as cancer type, age, sex, and country of residence.
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Streid JL, Lee KC, Bader AM, Jarman MP, Rosenthal RA, Cooper Z, Lindvall C. Shared Decision Making in the Geriatric Surgery Verification Program: Assessing Baseline Performance. J Pain Symptom Manage 2023; 65:510-520.e3. [PMID: 36736861 DOI: 10.1016/j.jpainsymman.2023.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 02/04/2023]
Abstract
CONTEXT As part of the launch of the Geriatric Surgery Verification program in 2019, the American College of Surgeons issued care standards for older patients, including requirements for preoperative documentation of patients' goals. Hospital performance on these standards prior to the Geriatric Surgery Verification program is unknown. OBJECTIVES To assess baseline performance of the Geriatric Surgery Verification (GSV) standard for documentation of preoperative goals for older patients, and to determine factors associated with standard adherence. METHODS Using natural language processing, this study examines the electronic health records of patients aged 65 years or older who underwent coronary artery bypass grafts (CABG) or colectomies in 2017 or 2018 at three hospitals. The primary outcome was adherence to at least one of the three components of GSV Standard 5.1, which requires preoperative documentation of overall health goals, treatment goals, and patient-centered outcomes. RESULTS A total of 2630 operations and 2563 patients were included. At least one component of the standard was met in 307 (11.7%) operations and all three components were met in 5 (0.2%). Higher likelihood of meeting the standard was demonstrated for patients who were female (odds ratio [OR] 1.30; 95% CI 1.00-1.68), undergoing colectomy (OR 2.82; 95% CI 2.15-3.72), or with more comorbidities (Charlson scores >3 [OR 1.55; 95% CI 1.14-2.09]). CONCLUSION Before GSV program implementation, clinicians for two major operations almost never met the GSV standard for preoperative discussion of patient goals. Interdisciplinary teams will need to adjust clinical practice to meet best-practice communication standards for older patients.
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Affiliation(s)
- Jocelyn L Streid
- Center for Surgery and Public Health (J.L.S., K.C.L., A.M.B., M.P.J., Z.C.), Brigham and Women's Hospital, Boston, Massachusetts; Department of Anesthesiology, Perioperative and Pain Medicine (J.L.S., A.M.B.), Brigham and Women's Hospital, Boston, Massachusetts.
| | - Katherine C Lee
- Center for Surgery and Public Health (J.L.S., K.C.L., A.M.B., M.P.J., Z.C.), Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery (K.C.L.), University of California, San Diego, La Jolla, California
| | - Angela M Bader
- Center for Surgery and Public Health (J.L.S., K.C.L., A.M.B., M.P.J., Z.C.), Brigham and Women's Hospital, Boston, Massachusetts; Department of Anesthesiology, Perioperative and Pain Medicine (J.L.S., A.M.B.), Brigham and Women's Hospital, Boston, Massachusetts
| | - Molly P Jarman
- Center for Surgery and Public Health (J.L.S., K.C.L., A.M.B., M.P.J., Z.C.), Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Zara Cooper
- Center for Surgery and Public Health (J.L.S., K.C.L., A.M.B., M.P.J., Z.C.), Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery (Z.C.), Brigham and Women's Hospital, Boston, Massachusetts
| | - Charlotta Lindvall
- Division of Palliative Medicine, Department of Medicine (C.L.), Brigham and Women's Hospital, Boston, Massachusetts; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (C.L.), Boston, Massachusetts
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Tran KS, Lambrechts MJ, Issa TZ, Tecce E, Corr A, Toci GR, Wong A, DiMaria S, Kirkpatrick Q, Chu J, Gilmore G, Kurd MF, Rihn JA, Woods BI, Kaye ID, Canseco JA, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. Modified Frailty Index Does Not Provide Additional Value in Predicting Outcomes in Patients Undergoing Elective Transforaminal Lumbar Interbody Fusion. World Neurosurg 2023; 170:e283-e291. [PMID: 36356842 DOI: 10.1016/j.wneu.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the predictive value of the modified Frailty Index (mFI) in evaluating sarcopenia and clinical outcomes in patients undergoing 1-level or 2-level transforaminal lumbar interbody fusion (TLIF). METHODS Patients who underwent a 1-level or 2-level TLIF between 2012 and 2020 were retrospectively identified. Frailty was compared among groups using mFI, and sarcopenia was classified by the psoas muscle cross-sectional area. Bivariate statistics compared demographics, comorbidities, and clinical outcomes. A linear regression model was developed using the Charlson Comorbidity Index (CCI) or mFI as independent variables to determine potential predictors for improvement in 1-year patient-reported outcomes. RESULTS Of 488 included patients, 60 were severely frail and 60 patients had sarcopenia, but sarcopenia was not associated with patient frailty (P = 0.469). Severely frail patients had worse baseline Oswestry Disability Index (ODI) (P < 0.001), Mental Component Score-12 (P = 0.001), and Physical Component Score-12 (P < 0.001), and worse improvement in ODI (P = 0.037), Physical Component Score-12 (P < 0.001), and visual analog scale (VAS) back (P = 0.007). mFI was an independent predictor of poorer improvement in VAS back and ODI, whereas age + CCI in addition predicted poorer improvement in VAS leg. Patients with higher mFI experienced longer length of stay, less frequent home discharge, and higher rates of complications, but similar readmission and reoperation rates. CONCLUSIONS Frailer patients experience poorer improvement in back pain, physical functioning, and disability after TLIF. mFI and the combination of age and CCI comparably predict patient-reported outcomes but do not correlate to baseline sarcopenia. Frailty increased the risk of complications, length of hospital stay, and risk of nonhome discharge.
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Affiliation(s)
- Khoa S Tran
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mark J Lambrechts
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| | - Tariq Z Issa
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Eric Tecce
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Andrew Corr
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gregory R Toci
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ashley Wong
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Stephen DiMaria
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Quinn Kirkpatrick
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Justin Chu
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Griffin Gilmore
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mark F Kurd
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jeffery A Rihn
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Barrett I Woods
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ian David Kaye
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Chen S, Dunn R, Jackson M, Morley N, Sun J. Frailty score and outcomes of patients undergoing vascular surgery and amputation: A systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1065779. [PMID: 36798484 PMCID: PMC9928186 DOI: 10.3389/fcvm.2023.1065779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
Introduction Frailty is associated with adverse postoperative health outcomes, including increased mortality, longer length of stay, higher rehospitalization, and other complications. There are many frailty assessment tools are to assess the level of frailty in vascular surgery patients. The aim of this study was to perform a systematic review and meta-analysis to assess the association between the frailty levels described by different frailty scores and adverse postoperative health outcomes among hospitalized vascular surgery patients and patients undergoing amputation. Methods Studies utilizing frailty scores and similar frailty assessment tools to describe frailty and investigate the association between frailty and health outcomes were searched. The primary outcomes of this study were in-hospital mortality, postdischarge mortality, length of hospital stay, rehospitalization, and discharge location. Additional outcomes included postoperative myocardial infarction, postoperative renal failure, cerebrovascular accident and stroke, comorbidities, and estimated glomerular filtration rate (eGFR) levels. Joanna Briggs Institute (JBI) Critical Appraisal Tools were used for quality assessment. Results In total, 24 studies with 1,886,611 participants were included in the final analysis. The overall results found that higher in-hospital mortality and postdischarge mortality were significantly associated with frailty. Frailty was also found to be significantly associated with a longer length of hospital stay, higher rehospitalization, and higher likelihood of non-home discharge. In addition, the results also showed that frailty was significantly associated with all kinds of comorbidities investigated, except chronic kidney disease. However, lower eGFR levels were significantly associated with frailty. Conclusion Among patients who underwent all types of vascular surgery and those who underwent amputations, assessment of frailty was significantly associated with adverse postoperative outcomes and multiple comorbidities. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=336374, identifier CRD42022336374.
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Affiliation(s)
- Shujie Chen
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
| | - Riley Dunn
- School of Pharmacy and Medical Sciences, Griffith University, Nathan, QLD, Australia
| | - Mark Jackson
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia,Department of Vascular Surgery, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Nicola Morley
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia,Department of Vascular Surgery, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Jing Sun
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia,Institute for Integrated and Intelligent Systems, Griffith University, Gold Coast, QLD, Australia,*Correspondence: Jing Sun,
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Vigneron E, Leclerc J, Chanty H, Germain A, Ayav A. Is pancreatic head surgery safe in the elderly? HPB (Oxford) 2023; 25:425-430. [PMID: 36740565 DOI: 10.1016/j.hpb.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/30/2022] [Accepted: 12/31/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND During the last century, life expectancy has doubled. As a result, senior patients with cancer are more frequently referred for possible surgery. Pancreatic surgery is a complex surgery associated with significant postoperative morbidity. Surgical decision-making in the elderly population can be difficult because outcomes in the elderly are poorly defined. Our objective is to characterize differences in mortality and morbidity for pancreatic surgery in the elderly population. METHODS A retrospective review of all patients undergoing pancreatic head surgery in our tertiary referral center from 2015 to 2021 was conducted. Analysis was performed for the entire cohort, classifying patients into three age groups: <70 years, 70-79 years, and ≥80 years. Data from these three groups were compared, including comorbidity, oncologic outcomes and postoperative complications. RESULTS A total of 326 patients underwent pancreatic head resection. The 90-day mortality increased from 2.9% to 5.3% to 15.4% with increasing age (p = 0,015). There were no differences among the three groups in terms of postoperative morbidity. There was no difference in disease-free survival (DFS), but overall survival was better in patients under 70 years (p = 0,046). CONCLUSION Compared to younger patients, patients over 80 years old have a higher risk of mortality despite similar postoperative morbidity.
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Affiliation(s)
- Estelle Vigneron
- Department of Digestive Surgery, University Hospital of Nancy-Brabois, Vandoeuvre-les-Nancy, France.
| | - Julie Leclerc
- Department of Digestive Surgery, University Hospital of Nancy-Brabois, Vandoeuvre-les-Nancy, France
| | - Hervé Chanty
- Department of Digestive Surgery, University Hospital of Nancy-Brabois, Vandoeuvre-les-Nancy, France
| | - Adeline Germain
- Department of Digestive Surgery, University Hospital of Nancy-Brabois, Vandoeuvre-les-Nancy, France
| | - Ahmet Ayav
- Department of Digestive Surgery, University Hospital of Nancy-Brabois, Vandoeuvre-les-Nancy, France
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Andersson M, Egenvall M, Danielsson J, Thorell A, Sturesson C, Soop M, Nygren-Bonnier M, Rydwik E. CANOPTIPHYS study protocol: Optimising PHYSical function before CANcer surgery: effects of pre-operative optimisation on complications and physical function after gastrointestinal cancer surgery in older people at risk-a multicentre, randomised, parallel-group study. Trials 2023; 24:41. [PMID: 36658653 PMCID: PMC9850586 DOI: 10.1186/s13063-022-07026-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 12/15/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND This multicentre study explores the effects of pre-operative exercise on physical fitness, post-operative complications, recovery, and health-related quality of life in older individuals with low pre-operative physical capacity scheduled to undergo surgery for colorectal cancer. We hypothesise that this group of patients benefit from pre-operative exercise in terms of improved pre-operative physical function and lower rates of post-operative complications after surgery compared to usual care. Standardised cancer pathways in Sweden dictate a timeframe of 14-28 days from suspicion of cancer to surgery for colorectal cancer. Therefore, an exercise programme aimed to enhance physical function in the limited timeframe requires a high-intensity and high-frequency approach. METHODS Participants will be included from four sites in Stockholm, Sweden. A total of 160 participants will be randomly assigned to intervention or control conditions. Simple randomisation (permuted block randomisation) is applied with a 1:1 allocation ratio. The intervention group will perform home-based exercises (inspiratory muscle training, aerobic exercises, and strength exercises) supervised by a physiotherapist (PT) for a minimum of 6 sessions in the pre-operative period, complemented with unsupervised exercise sessions in between PT visits. The control group will receive usual care with the addition of advice on health-enhancing physical activity. The physical activity behaviour in both groups will be monitored using an activity monitor. The primary outcomes are (1) change in physical performance (6-min walking distance) in the pre-operative period and (2) post-operative complications 30 days after surgery (based on Clavien-Dindo surgical score). DISCUSSION If patients achieve functional benefits by exercise in the short period before surgery, this supports the implementation of exercise training as a clinical routine. If such benefits translate into lower complication rates and better post-operative recovery or health-related quality of life is not known but would further strengthen the case for pre-operative optimisation in colorectal cancer. TRIAL REGISTRATION ClinicalTrials.gov NCT04878185. Registered on 7 May 2021. https://clinicaltrials.gov/ct2/home.
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Affiliation(s)
- Mikael Andersson
- grid.4714.60000 0004 1937 0626Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Monika Egenvall
- grid.4714.60000 0004 1937 0626Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Department of Pelvic Cancer, Colorectal Surgery Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Johanna Danielsson
- grid.4714.60000 0004 1937 0626Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Anders Thorell
- grid.4714.60000 0004 1937 0626Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden ,grid.414628.d0000 0004 0618 1631Department of Surgery, Ersta Hospital, Stockholm, Sweden
| | - Christian Sturesson
- grid.24381.3c0000 0000 9241 5705Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Mattias Soop
- grid.4714.60000 0004 1937 0626Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden ,grid.414628.d0000 0004 0618 1631Department of Surgery, Ersta Hospital, Stockholm, Sweden
| | - Malin Nygren-Bonnier
- grid.4714.60000 0004 1937 0626Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Theme Women’s Health and Allied Health Professionals, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Elisabeth Rydwik
- grid.4714.60000 0004 1937 0626Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Theme Women’s Health and Allied Health Professionals, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden ,Stockholm Region Council, FOU nu, Research and Development Unit for the Elderly, Järfälla, Sweden
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Niegowska W, Szydlik J, Barszczewska M, Grodzka O, Czapski P, Januszewska K, Sawicka A, Jankowski P, Kupisz-Urbańska M. ANALYSIS OF FACTORS ASSOCIATED WITH FRAILTY SYNDROME IN PATIENTS WITH HEART FAILURE. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2023; 51:216-220. [PMID: 37589105 DOI: 10.36740/merkur202303105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
OBJECTIVE Aim: Determination of factors associated with frailty syndrome (FS) in patients with heart failure (HF). PATIENTS AND METHODS Materials and methods: Consecutive patients hospitalized in the department were assessed for the presence of FS using L. Fried criteria, Edmonton Frail Scale (EFS) and Tilburg Frailty Indicator (TFI). Presence of arterial hypertension, diabetes, obesity, chronic obstructive pulmonary disease (COPD), and heart failure was included in the analysis based on patients' medical history and findings from current hospitalization. Patients were assessed for the presence of depression using Beck's Depression Inventory (BDI). Physical capacity was assessed using NYHA classification. RESULTS Results: 87 patients (mean age 81.4±6.7; 57 women; 11 HFrEF, mean NYHA 2.36±1.21; 11 HFmrEF, mean NYHA 2.18±1.08; 65 HFpEF mean NYHA 1.94±1.09) were included in the analysis. Multivariable analysis showed significant relationship between FS assessed with EFS and age (β=0.316, SE=0.08; p=0.0001), arterial hypertension (β=-0.194, SE=0.08; p=0.0173), COPD (β=0.176, SE=0.08; p=0.0300) and depression (β=0.565, SE=0.08; p=0.0000). FS assessed with L. Fried criteria was significantly related to age (β=0.359, SE=0.09; p= 0.0001), NYHA classification (β= 0.336, SE=0.09; p=0.0002) and depression (β=0.297, SE=0.09; p=0.0010). Age (β=0.251, SE=0.10; p=0.0114) and depression (β=0.375, SE=0.1; p=0.0002) were significantly related to FS assessed using TFI. In multivariable analysis HF phenotype was not significantly related to FS. CONCLUSION Conclusions: Age and depression assessed with BDI are related to FS in patients with HF. Arterial hypertension and COPD are linked to FS assessed using EFS, whereas NYHA classification is linked to FS assessed with L. Fried criteria. No statistically significant relationship was found between FS and HF phenotype.
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Affiliation(s)
- Wiktoria Niegowska
- DEPARTMENT OF INTERNAL MEDICINE AND GERIATRIC CARDIOLOGY, CENTRE OF POSTGRADUATE MEDICAL EDUCATION, WARSAW, POLAND
| | - Julia Szydlik
- DEPARTMENT OF INTERNAL MEDICINE AND GERIATRIC CARDIOLOGY, CENTRE OF POSTGRADUATE MEDICAL EDUCATION, WARSAW, POLAND
| | - Marcelina Barszczewska
- DEPARTMENT OF INTERNAL MEDICINE AND GERIATRIC CARDIOLOGY, CENTRE OF POSTGRADUATE MEDICAL EDUCATION, WARSAW, POLAND
| | - Olga Grodzka
- DEPARTMENT OF INTERNAL MEDICINE AND GERIATRIC CARDIOLOGY, CENTRE OF POSTGRADUATE MEDICAL EDUCATION, WARSAW, POLAND
| | - Piotr Czapski
- DEPARTMENT OF INTERNAL MEDICINE AND GERIATRIC CARDIOLOGY, CENTRE OF POSTGRADUATE MEDICAL EDUCATION, WARSAW, POLAND
| | - Katarzyna Januszewska
- DEPARTMENT OF INTERNAL MEDICINE AND GERIATRIC CARDIOLOGY, CENTRE OF POSTGRADUATE MEDICAL EDUCATION, WARSAW, POLAND
| | - Ada Sawicka
- DEPARTMENT OF INTERNAL MEDICINE AND GERIATRIC CARDIOLOGY, CENTRE OF POSTGRADUATE MEDICAL EDUCATION, WARSAW, POLAND
| | - Piotr Jankowski
- DEPARTMENT OF INTERNAL MEDICINE AND GERIATRIC CARDIOLOGY, CENTRE OF POSTGRADUATE MEDICAL EDUCATION, WARSAW, POLAND
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