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Soto Mejía KL, Luján Hernández I. [Thickness of the rectus femorius muscle and vastus intermedium muscle in older Mexican adults with frailty and sarcopenia]. Rev Esp Geriatr Gerontol 2024; 60:101557. [PMID: 39368252 DOI: 10.1016/j.regg.2024.101557] [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: 03/05/2024] [Revised: 07/02/2024] [Accepted: 08/14/2024] [Indexed: 10/07/2024]
Abstract
BACKGROUND AND OBJECTIVE Frailty in older adults is a geriatric syndrome that has gained importance in the last decade. However, there is still no consolidated information regarding diagnostic tools that allow timely identification, and therefore, provide an appropriate therapeutic approach. The objective is to determine the Thickness of the Rectus Femoris Muscle (GMRF) and Thickness of the Vastus Intermedius Muscle (GMVI) in older Mexican adults with frailty and sarcopenia. MATERIAL AND METHODS Cross-sectional, descriptive and comparative study in patients ≥65 years of age, admitted to the geriatrics service. The selection was according to the FRAIL (frail vs. non-frail) and SARC-F (high risk vs. low risk) classification; evaluating GMRF and GMVI by ultrasound. The data were analyzed through the statistical software Statistical Package for Social Sciences (SPSS) ver. 25. RESULTS The number of patients evaluated in the study and control group were 136 respectively. Significant differences were found regarding frailty status in age (years) (Frail: 75.06±7.92 vs. Non-frail: 71.60±5.56; P<.001), GMRF (mm) (Frail: 8.41±3.08 vs. Non-frail: 11.03±3.50; P<.001) and GMVI (mm) (Frail: 6.53±2.64 vs. Non-frail: 8.66±2.68; P<.001); Considering sarcopenia, there were differences in age (years) (High risk sarcopenia: 75.17±7.84: vs low risk sarcopenia; 71.49±5.60; P<.001), GMRF (mm) (high risk sarcopenia: 8.45±3.11 vs low risk sarcopenia: 10.98±3.50; P<.001) and GMVI (mm) (High risk Sarcopenia: 6.67±2.63 vs Low risk Sarcopenia: 8.52±2.79; P<.001). CONCLUSIONS The results found show that there is a significant difference in GMRF and GMVI in Mexican older adults with respect to frailty and sarcopenia. In this way, the present investigation establishes clinical bases for the use of ultrasonography assessments in the geriatric population.
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Affiliation(s)
- Karen Lizeth Soto Mejía
- Instituto Mexicano del Seguro Social, Hospital general de Zona No 16, Torreón, Coahuila, México.
| | - Iván Luján Hernández
- Instituto Mexicano del Seguro Social, Hospital general de Zona No 16, Torreón, Coahuila, México
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Dong B, Yu D, Zhang H, Li P, Li Y, Li C, Li J. Association between preoperative sarcopenia and postoperative delirium in older patients undergoing gastrointestinal cancer surgery. Front Aging Neurosci 2024; 16:1416569. [PMID: 39144259 PMCID: PMC11322050 DOI: 10.3389/fnagi.2024.1416569] [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: 04/18/2024] [Accepted: 07/19/2024] [Indexed: 08/16/2024] Open
Abstract
Background Postoperative delirium (POD) is a usual neurological complication, often leading to poor prognoses. Early identification of high-risk patients is crucial for preventing POD. Sarcopenia is an age-related geriatric syndrome characterized by the loss of skeletal muscle mass and function, and previous studies indicated that preoperative low muscle mass might be a predictor for POD. However, the association between preoperative sarcopenia and POD remains to be fully elucidated. This study was to explore the correlation between preoperative sarcopenia and POD following gastrointestinal cancer surgery in older patients. Methods Older patients (≥60 years) undergoing gastrointestinal cancer surgery were enrolled. Sarcopenia was defined based on the Special Interest Group on sarcopenia of the International Society of Physical and Rehabilitation Medicine (ISarcoPRM), which combined the loss of muscle mass (evaluated by ultrasound) and function (assessed by chair stand test and handgrip strength) before surgery. POD assessment was performed using the Confusion Assessment Method (CAM) or CAM for the intensive care unit (CAM-ICU) during the first 7 days after surgery or before discharge. Multivariate logistic regression analysis examined the correlation between preoperative sarcopenia and POD. Moreover, the receiver operator characteristic (ROC) curve was applied to analyze the predictive effect of the preoperative sarcopenia in POD. Results One hundred and thirty patients were finally included, of which 43 patients presented with sarcopenia before surgery. Twenty-four patients ultimately developed POD, and the incidence was 18.5%. The results of the multivariate analyses demonstrated that preoperative sarcopenia was still independently associated with POD after adjusting for age ≥70 years, preoperative Mini-Mental State Examination score, and intraoperative blood transfusion. The area under the ROC curve of preoperative sarcopenia in predicting POD was 0.680 (95% confidence interval 0.557-0.804). Conclusion Preoperative sarcopenia defined by ISarcoPRM criteria was independently associated with POD in geriatric patients after gastrointestinal cancer surgery.
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Affiliation(s)
- Bo Dong
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
- Graduate Faculty, Hebei North University, Zhangjiakou, China
| | - Dongdong Yu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Huanhuan Zhang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Pan Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Yi Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Chong Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Jianli Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
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An SM, Lee HJ, Woo JH, Chae JS, Shin SJ. Predictive Value of Ultrasound-Measured Quadriceps Depth and Frailty Status for Hypotension in Older Patients Undergoing Reverse Total Shoulder Arthroplasty in the Beach Chair Position under General Anesthesia. J Pers Med 2024; 14:642. [PMID: 38929863 PMCID: PMC11204871 DOI: 10.3390/jpm14060642] [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: 05/15/2024] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
The beach chair position (BCP) is widely used in shoulder surgery; however, it frequently leads to hypotension. Hypotension in BCP is prevalent among older patients who are at risk of secondary complications such as ischemic injuries. Therefore, this prospective study aimed to investigate the association and predictive value of frailty, as assessed by ultrasound-measured quadriceps depth and questionnaire, in patients aged ≥65 years undergoing elective shoulder surgery under general anesthesia. A multivariable logistic regression analysis was performed to identify independent risk factors for hypotension in BCP under general anesthesia. Receiver operating characteristic curves were constructed to assess the predictive values of various parameters. The results indicated that a quadriceps depth < 2.3 cm and BCP for an extended period significantly increased the risk of hypotension. The combined consideration of quadriceps depth < 2.3 cm and frailty demonstrated markedly superior predictive power compared with each factor individually. In conclusion, the study findings facilitate the screening and identification of risk factors for older patients undergoing surgery in BCP, thereby enhancing perioperative management.
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Affiliation(s)
- Sang-Mee An
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
| | - Hyun Jung Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
| | - Jae Hee Woo
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
| | - Ji Seon Chae
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
| | - Sang-jin Shin
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
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Yau DKW, Griffith JF, Underwood MJ, Joynt GM, Lee A. Preoperative rectus femoris muscle ultrasound, its relationship with frailty scores, and the ability to predict recovery after cardiac surgery: a prospective cohort study. Perioper Med (Lond) 2024; 13:45. [PMID: 38783315 PMCID: PMC11112902 DOI: 10.1186/s13741-024-00401-y] [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: 04/25/2023] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Frailty is common in patients undergoing cardiac surgery and is associated with poorer postoperative outcomes. Ultrasound examination of skeletal muscle morphology may serve as an objective assessment tool as lean muscle mass reduction is a key feature of frailty. METHODS This study investigated the association of ultrasound-derived muscle thickness, cross-sectional area, and echogenicity of the rectus femoris muscle (RFM) with preoperative frailty and predicted subsequent poor recovery after surgery. Eighty-five patients received preoperative RFM ultrasound examination and frailty-related assessments: Clinical Frailty Scale (CFS) and 5-m gait speed test (GST5m). Association of each ultrasound measurement with frailty assessments was examined. Area under receiver-operating characteristic curve (AUROC) was used to assess the discriminative ability of each ultrasound measurement to predict days at home within 30 days of surgery (DAH30). RESULTS By CFS and GST5m criteria, 13% and 34% respectively of participants were frail. RFM cross-sectional area alone demonstrated moderate predictive association for frailty by CFS criterion (AUROC: 0.76, 95% CI: 0.66-0.85). Specificity improved to 98.7% (95% CI: 93.6%-100.0%) by utilising RFM cross-sectional area as an 'add-on' test to a positive gait speed test, and thus a combined muscle size and function test demonstrated higher predictive performance (positive likelihood ratio: 40.4, 95% CI: 5.3-304.3) for frailty by CFS criterion than either test alone (p < 0.001). The combined 'add-on' test predictive performance for DAH30 (AUROC: 0.90, 95% CI: 0.81-0.95) may also be superior to either CFS or gait speed test alone. CONCLUSIONS Preoperative RFM ultrasound examination, especially when integrated with the gait speed test, may be useful to identify patients at high risk of frailty and those with poor outcomes after cardiac surgery. TRIAL REGISTRATION The study was registered on the Chinese Clinical Trials Registry (ChiCTR2000031098) on 22 March 2020.
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Affiliation(s)
- Derek King Wai Yau
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR.
| | - James Francis Griffith
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, G/F Prince of Wales Hospital, Shatin, NT, Hong Kong SAR
| | - Malcolm John Underwood
- Cardiovascular Services, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Gavin Matthew Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR
| | - Anna Lee
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR
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Prell T, Grimm A, Axer H. Uncovering sarcopenia and frailty in older adults by using muscle ultrasound-A narrative review. Front Med (Lausanne) 2024; 11:1333205. [PMID: 38828232 PMCID: PMC11140070 DOI: 10.3389/fmed.2024.1333205] [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: 11/04/2023] [Accepted: 04/30/2024] [Indexed: 06/05/2024] Open
Abstract
Muscle ultrasound is a valuable non-invasive and cost-effective method in assessing muscle mass and structure, both of which are significant indicators for the development of sarcopenia and frailty in elderly individuals. Sarcopenia refers to the loss of muscle mass and strength that occurs with age, whereas frailty is a complex geriatric syndrome characterized by reduced physical function and an increased susceptibility to negative health outcomes. Both conditions are prevalent in older adults and are associated with higher risks of falls, disability, and mortality. By measuring muscle size and structure and several other ultrasound parameters, including muscle thickness, cross-sectional area, echogenicity (brightness in the ultrasound image), pennation angle, and fascicle length ultrasound can assist in identifying sarcopenia and frailty in older adults. In addition, ultrasound can be used to evaluate muscle function such as muscle contraction and stiffness, which may also be affected in sarcopenia and frailty. Therefore, muscle ultrasound could lead to better identification and tracking of sarcopenia and frailty. Such advancements could result in the implementation of earlier interventions to prevent or treat these conditions, resulting in an overall improvement in the health and quality of life of the elderly population. This narrative review describes the benefits and challenges when using ultra-sound for the evaluation of frailty and sarcopenia.
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Affiliation(s)
- Tino Prell
- Department of Geriatrics, Halle University Hospital, Halle, Germany
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Alexander Grimm
- Department of Neurology, Tübingen University Hospital, Tübingen, Germany
| | - Hubertus Axer
- Department of Neurology, Jena University Hospital, Jena, Germany
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Demirel C, Halavina K, Hamzaraj K, Klement J, El-Shaer M, Hemetsberger R, Winter MP, Koschatko S, Jantsch C, Andreas M, Loewe C, Kammerlander A, Hengstenberg C, Bartko PE. Low Bone Mineral Density on Computed Tomography: Association with Poor Survival after Transcatheter Aortic Valve Replacement. J Clin Med 2024; 13:2698. [PMID: 38731227 PMCID: PMC11084390 DOI: 10.3390/jcm13092698] [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: 04/04/2024] [Revised: 04/25/2024] [Accepted: 05/01/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has evolved as first-line therapy for severe aortic valve stenosis (AS), with pre-procedural computed tomography (CT) providing critical anatomical information. While primarily used for anatomical planning, TAVR-CT also offers an opportunity to assess low bone mineral density (BMD), a known indicator of frailty. Despite this, the prognostic role of BMD in TAVR patients remains unknown. This study aimed to evaluate BMD on routine TAVR-CT and its impact on long-term survival. Methods: In this retrospective study, 770 consecutive TAVR patients (mean age 80.7 ± 6.7 years, 54.0% males) between November 2015 and March 2022 were included. BMD was measured from a single axial image at the thoracic vertebral level on unenhanced CT scans. Cox regression models assessed the impact of BMD on mortality, and Restricted Cubic Spline models identified potential mortality thresholds. Results: The mean BMD value, as measured on non-contrast CT, was 147.5 ± 5.4 Hounsfield units, demonstrating a noteworthy association with mortality (adjusted hazard ratio per 100 HU decrease: 1.27 [95%CI: 1.01-1.59], p = 0.041). Restricted cubic spline analysis indicated that BMD below 200 HU was linked to a substantial increase in mortality risk. Upon crude Cox regression analysis, every 100 HU decrease was associated with a 32% increase in risk for death (HR 1.32 [95%CI: 1.068-1.65)], p = 0.010). Conclusions: In conclusion, low BMD on TAVR-CT is independently associated with reduced survival, suggesting its potential as a tool for comprehensive frailty assessment and improved risk prediction in TAVR patients.
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Affiliation(s)
- Caglayan Demirel
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (K.H.); (K.H.); (J.K.); (M.E.-S.); (R.H.); (M.P.W.); (S.K.); (A.K.); (C.H.)
| | - Kseniya Halavina
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (K.H.); (K.H.); (J.K.); (M.E.-S.); (R.H.); (M.P.W.); (S.K.); (A.K.); (C.H.)
| | - Kevin Hamzaraj
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (K.H.); (K.H.); (J.K.); (M.E.-S.); (R.H.); (M.P.W.); (S.K.); (A.K.); (C.H.)
| | - Johanna Klement
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (K.H.); (K.H.); (J.K.); (M.E.-S.); (R.H.); (M.P.W.); (S.K.); (A.K.); (C.H.)
| | - Manar El-Shaer
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (K.H.); (K.H.); (J.K.); (M.E.-S.); (R.H.); (M.P.W.); (S.K.); (A.K.); (C.H.)
| | - Rayyan Hemetsberger
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (K.H.); (K.H.); (J.K.); (M.E.-S.); (R.H.); (M.P.W.); (S.K.); (A.K.); (C.H.)
| | - Max Paul Winter
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (K.H.); (K.H.); (J.K.); (M.E.-S.); (R.H.); (M.P.W.); (S.K.); (A.K.); (C.H.)
| | - Sophia Koschatko
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (K.H.); (K.H.); (J.K.); (M.E.-S.); (R.H.); (M.P.W.); (S.K.); (A.K.); (C.H.)
| | - Charlotte Jantsch
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (K.H.); (K.H.); (J.K.); (M.E.-S.); (R.H.); (M.P.W.); (S.K.); (A.K.); (C.H.)
| | - Martin Andreas
- Department of Internal Medicine II, Clinical Division of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria;
| | - Christian Loewe
- Department of Radiology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Andreas Kammerlander
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (K.H.); (K.H.); (J.K.); (M.E.-S.); (R.H.); (M.P.W.); (S.K.); (A.K.); (C.H.)
| | - Christian Hengstenberg
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (K.H.); (K.H.); (J.K.); (M.E.-S.); (R.H.); (M.P.W.); (S.K.); (A.K.); (C.H.)
| | - Philipp E. Bartko
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (K.H.); (K.H.); (J.K.); (M.E.-S.); (R.H.); (M.P.W.); (S.K.); (A.K.); (C.H.)
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Li H, Li J, Huang X, Bhushan S, Yang J. The impact of frailty as a critical mediator causing postoperative neurocognitive disorders in postoperative cardiac patients. Curr Probl Cardiol 2024; 49:102528. [PMID: 38492615 DOI: 10.1016/j.cpcardiol.2024.102528] [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: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 03/18/2024]
Abstract
Frailty is prevalent in elderly cardiac patients and may be a critical predictor of post-operative neurocognitive disorders (PND). The aim of this review was to demonstrate the correlation of frailty with PND in postsurgical elder patients. A review of published literature and bibliometric analysis was undertaken. Electronic databases from 2009 to 2022 were searched to identify articles that evaluated the relationship between frailty and PND in aging populations. Demographic data, type of surgery performed, frailty measurement, and impact of frailty on PND were extracted from the selected studies. The quality of the studies and risk of bias were assessed by the Newcastle-Ottawa Quality Assessment Scale, and the included articles were assessed as medium to high quality. Eighty-one studies were selected for the Bibliometric review in terms of research trends and hotpots. Additionally, 35 observational studies (prospective and retrospective cohorts) were selected for this review. The mean age ranged from 63 to 84 years and included patients undergoing cardiac, orthopedic, and other surgeries who had cardiac symptoms. Regardless of how frailty was measured, the strongest evidence in terms of numbers of studies, consistency of results, and study quality was for associations between frailty and PND. This analysis found a steadily growing focus on frailty and PND research in cardiac and other patients. The observational studies account for the majority of this area, and frailty occurred in the older cardiac patients over 60 years of age, and pre-screening of frailty can be predictive of PND and mortality.
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Affiliation(s)
- Hu Li
- Department of Anesthesiology, West China Hospital of Sichuan University, No. 37 Wainan Guoxue Road, Chengdu, Sichuan 610041, China; Department of Anesthesiology, School of Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan 610072, China
| | - Jinfeng Li
- Department of Anesthesiology, Chengdu Seventh People's Hospital, Chengdu, Sichuan 610072, China
| | - Xin Huang
- Department of Anesthesiology, West China Hospital of Sichuan University, No. 37 Wainan Guoxue Road, Chengdu, Sichuan 610041, China
| | - Sandeep Bhushan
- Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan 610017, China
| | - Jing Yang
- Department of Anesthesiology, West China Hospital of Sichuan University, No. 37 Wainan Guoxue Road, Chengdu, Sichuan 610041, China.
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Hernández-Aguiar Y, Becerra-Bolaños Á, Rodríguez-Pérez A. Preoperative diagnosis of frailty. J Int Med Res 2024; 52:3000605241251705. [PMID: 38818532 PMCID: PMC11143825 DOI: 10.1177/03000605241251705] [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: 01/16/2024] [Accepted: 04/14/2024] [Indexed: 06/01/2024] Open
Abstract
The aging world population obliges physicians to establish measures to optimize and estimate the outcomes of increasingly frail patients. Thus, in the last few years there has been an increase in the application of frailty indices. Multiple scales have emerged that can be applied in the perioperative setting. Each one has demonstrated some utility, either by way of establishing postoperative prognosis or as a method for the clinical optimization of patient care. Anaesthesiologists are offered a wide choice of scales, the characteristics and appropriate management of which they are often unaware. This narrative review aims to clarify the concept of frailty, describe its importance in the perioperative setting and evaluate the different scales that are most applicable to the perioperative setting. It will also establish paths for the future optimization of patient care.
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Affiliation(s)
- Yanira Hernández-Aguiar
- Department of Anaesthesiology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
- Department of Medical and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Ángel Becerra-Bolaños
- Department of Anaesthesiology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
- Department of Medical and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Aurelio Rodríguez-Pérez
- Department of Anaesthesiology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
- Department of Medical and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Yurumez B, Metin Y, Atmis V, Karadavut M, Ari S, Gemci E, Yigit S, Ozalp Ates FS, Gozukara MG, Kaplankiran C, Cosarderelioglu C, Yalcin A, Aras S, Varli M. A new possible marker: can pennation angle defined by ultrasound predict the frailty? Aging Clin Exp Res 2024; 36:53. [PMID: 38438616 PMCID: PMC10912255 DOI: 10.1007/s40520-023-02663-w] [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: 08/28/2023] [Accepted: 11/17/2023] [Indexed: 03/06/2024]
Abstract
BACKGROUND Frailty indicates older people who are vulnerable to stressors. The relation between ultrasonographic parameters of muscle and frailty among older people has yet to be investigated. AIMS The aim of the study is to investigate the relationship between frailty and the ultrasonographic measurements of the rectus femoris muscle (RFM). METHODS This cross-sectional study included 301 participants who were ≥65 years. The FRAIL questionnaire assessed frailty. The thickness, cross-sectional area (CSA), fascicle length, pennation angle (PA), stiffness, and echogenicity of RFM were assessed by ultrasound. The accuracy of parameters in predicting the frailty was evaluated by ROC analysis. RESULTS Of all 301 participants, 24.6% were frail. Pre-frail and frail participants had significantly lower thickness (p = 0.002), CSA (p = 0.009), and fascicle length (p = 0.043) of RFM compared to robust. PA was significantly lowest in frails (p < 0.001). The multivariate logistic regression analysis showed that PA values lower than 10.65 degrees were an independent predictor of frailty (OR = 0.83, 95% Cl: 0.70-0.97, p = 0.019). Results of ROC analysis demonstrated a satisfactory result between the PA and frailty (AUC = 0.692, p < 0.001). DISCUSSION Thickness, CSA, and PA of RFM were found to be lower in frail subjects, which may indicate the changes in muscle structure in frailty. Among all parameters, lower PA values were independent predictors of frailty. These findings may indicate a novel ultrasound-based method in frailty, that is more objective and unrelated to the cross-sectional evaluation. CONCLUSIONS Ultrasonographic measurements of RFM, especially the lower PA may predict frailty in older people. As an objective and quantitative method, PA may be used to define frailty with acceptable sensitivity.
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Affiliation(s)
- Busra Yurumez
- Division of Geriatrics, Department of Internal Medicine, Ankara University Faculty of Medicine, Ibn-I Sina Hospital, Altindag, Ankara, Turkey
| | - Yavuz Metin
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Volkan Atmis
- Division of Geriatrics, Department of Internal Medicine, Ankara University Faculty of Medicine, Ibn-I Sina Hospital, Altindag, Ankara, Turkey.
| | - Mursel Karadavut
- Division of Geriatrics, Department of Internal Medicine, Ankara University Faculty of Medicine, Ibn-I Sina Hospital, Altindag, Ankara, Turkey
| | - Sinan Ari
- Division of Geriatrics, Department of Internal Medicine, Ankara University Faculty of Medicine, Ibn-I Sina Hospital, Altindag, Ankara, Turkey
| | - Emine Gemci
- Division of Geriatrics, Department of Internal Medicine, Ankara University Faculty of Medicine, Ibn-I Sina Hospital, Altindag, Ankara, Turkey
| | - Seher Yigit
- Division of Geriatrics, Department of Internal Medicine, Ankara University Faculty of Medicine, Ibn-I Sina Hospital, Altindag, Ankara, Turkey
| | - Funda Seher Ozalp Ates
- Department of Biostatistics and Medical Informatics, Manisa Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | | | - Ceren Kaplankiran
- Division of Geriatrics, Department of Internal Medicine, Ankara University Faculty of Medicine, Ibn-I Sina Hospital, Altindag, Ankara, Turkey
| | - Caglar Cosarderelioglu
- Division of Geriatrics, Department of Internal Medicine, Ankara University Faculty of Medicine, Ibn-I Sina Hospital, Altindag, Ankara, Turkey
| | - Ahmet Yalcin
- Division of Geriatrics, Department of Internal Medicine, Ankara University Faculty of Medicine, Ibn-I Sina Hospital, Altindag, Ankara, Turkey
| | - Sevgi Aras
- Division of Geriatrics, Department of Internal Medicine, Ankara University Faculty of Medicine, Ibn-I Sina Hospital, Altindag, Ankara, Turkey
| | - Murat Varli
- Division of Geriatrics, Department of Internal Medicine, Ankara University Faculty of Medicine, Ibn-I Sina Hospital, Altindag, Ankara, Turkey
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10
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Ben-Menachem E, Ashes C, Lepar G, Deacon J, Glavan N, Molan V, Watson A. Smaller rectus femoris size measured by ultrasound is associated with poorer outcomes after cardiac surgery. J Thorac Cardiovasc Surg 2024; 167:1115-1122.e5. [PMID: 35995604 DOI: 10.1016/j.jtcvs.2022.07.005] [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: 12/06/2021] [Revised: 06/17/2022] [Accepted: 07/03/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE We sought to evaluate the association of low rectus femoris cross-sectional area (RFCSA) with hospital length of stay and poorer outcomes in patients undergoing cardiac surgery. METHODS A single right-leg RFCSA was measured with ultrasound preoperatively and baseline characteristics, clinical data, and outcomes recorded. Patients were categorized as low rectus femoris muscle size (lowRF) or normal rectus femoris muscle size (normalRF), if they were in the lowest quartile or not, respectively. All analyses were performed on both body surface area (BSA)- and sex-adjusted RFCSA. RESULTS One hundred eight-four patients had a RFCSA measured with a mean of 5.01 cm2 (1.41 cm2), and range of 0.71 to 8.77 cm2. When analyzing the BSA-adjusted RFCSA, we found the lowRF group had a longer hospital stay, 11.0 days [7.0-16.3] versus 8.0 days [6.0-10.0] for the normalRF group (P < .001), and a greater proportion of extended hospital stay (≥18.5 days) of 19.6% compared with 6.2% (P = .010). When the RFCSA was adjusted for sex, the lowRF group had a greater length of hospital stay, 9.0 days [7.0-14.5] versus 8.0 days [6.0-11.0] (P = .049). In both the BSA- and sex-adjusted RFCSA, the lowRF group suffered greater morbidity and were more likely discharged to a destination other than home. In multivariate analyses adjusting for European System for Cardiac Operative Risk Evaluation II, BSA-adjusted lowRF but not sex-adjusted lowRF was independently associated with log-transformed hospital length of stay. LowRF was not independently associated with increased major morbidity and death for both BSA and sex-adjusted RFCSA. CONCLUSIONS Low RFCSA has a significant association with increased hospital length of stay, morbidity, and nonhome discharge in patients undergoing cardiac procedures. TRIAL REGISTRY NUMBER ACTRN12620000678998.
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Affiliation(s)
- Erez Ben-Menachem
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia; Notre Dame School of Medicine, Sydney, Australia; St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia.
| | - Catherine Ashes
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia; St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia
| | - Gila Lepar
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia
| | - James Deacon
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia; St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia
| | - Nicole Glavan
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia
| | - Veronique Molan
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia
| | - Alasdair Watson
- St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia; Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, Australia
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11
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Demirel C, Rothenbühler CF, Huber M, Schweizer M, Todorski I, Gloor DA, Windecker S, Lanz J, Stortecky S, Pilgrim T, Erdoes G. Total Muscle Area and Visceral Adipose Tissue Measurements for Frailty Assessment in TAVR Patients. J Clin Med 2024; 13:1322. [PMID: 38592183 PMCID: PMC10932166 DOI: 10.3390/jcm13051322] [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: 01/14/2024] [Revised: 01/31/2024] [Accepted: 02/09/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is a treatment option for severe aortic valve stenosis. Pre-TAVR assessments, extending beyond anatomy, include evaluating frailty. Potential frailty parameters in pre-TAVR computed tomography (CT) scans are not fully explored but could contribute to a comprehensive frailty assessment. The primary objective was to investigate the impact of total muscle area (TMA) and visceral adipose tissue (VAT) as frailty parameters on 5-year all-cause mortality in patients undergoing TAVR. Methods: Between 01/2017 and 12/2018, consecutive TAVR patients undergoing CT scans enabling TMA and VAT measurements were included. Results: A total of 500 patients qualified for combined TMA and VAT analysis. Age was not associated with a higher risk of 5-year mortality (HR 1.02, 95% CI: 0.998-1.049; p = 0.069). Body surface area normalized TMA (nTMA) was significantly associated with 5-year, all-cause mortality (HR 0.927, 95% CI: 0.927-0.997; p = 0.033), while VAT had no effect (HR 1.002, 95% CI: 0.99-1.015; p = 0.7). The effect of nTMA on 5-year, all-cause mortality was gender dependent: the protective effect of higher nTMA was found in male patients (pinteraction: sex × nTMA = 0.007). Conclusions: Normalized total muscle area derived from a routine CT scan before transcatheter aortic valve replacement complements frailty assessment in patients undergoing TAVR.
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Affiliation(s)
- Caglayan Demirel
- Department of Cardiology, Inselspital, University of Bern, 3012 Bern, Switzerland
| | | | - Markus Huber
- Department of Anaesthesiology and Pain Medicine, Inselspital, University of Bern, 3012 Bern, Switzerland
| | - Michelle Schweizer
- Department of Radiology, Inselspital, University of Bern, 3012 Bern, Switzerland
| | - Inga Todorski
- Department of Radiology, Inselspital, University of Bern, 3012 Bern, Switzerland
| | | | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, 3012 Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, University of Bern, 3012 Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, University of Bern, 3012 Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University of Bern, 3012 Bern, Switzerland
| | - Gabor Erdoes
- Department of Anaesthesiology and Pain Medicine, Inselspital, University of Bern, 3012 Bern, Switzerland
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12
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Martis WR. The potential use of perioperative rectus femoris ultrasonography in guiding prehabilitation strategies. J Clin Anesth 2024; 92:111302. [PMID: 37862865 DOI: 10.1016/j.jclinane.2023.111302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 10/22/2023]
Affiliation(s)
- W R Martis
- Anaesthesia Fellow, Department of Anaesthetics, Perioperative Medicine, and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia.
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13
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Xin C, Ma M, Wang Q, Li T, Sun Q, Jiang M, Du J, Li Z, Ma J. Correlation of ultrasound measurement of limb muscle thickness and echo intensity with frailty assessment in elderly patients undergoing malignancies surgery. Heliyon 2024; 10:e24017. [PMID: 38230231 PMCID: PMC10789593 DOI: 10.1016/j.heliyon.2024.e24017] [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: 04/01/2023] [Revised: 12/07/2023] [Accepted: 01/02/2024] [Indexed: 01/18/2024] Open
Abstract
Introduction It remains controversial which frailty score correlates with adverse outcomes. Instead of these subjective and time consuming scores, we studied whether ultrasound guided lower extremity thickness measurements more closely are associated with adverse outcomes. Method Patients undergoing gastrointestinal malignancy surgery were included as study subjects. Frailty was identified using the FRAIL scale assessment. Ultrasound measured the muscle thickness and echo intensity of the patient's upper and lower limbs. ANOVA was used to analyze the relationship between muscle data and frailty assessment. Significant indicators from the one-way analysis were included in the multivariate logistic regression equation. Results A total of 160 study subjects were included, 52 in the normal group, 78 in the prefrailty group, and 30 in the frailty group. The ANOVA showed that there were significant differences in age, hemoglobin, albumin, history of hypertension, history of coronary artery disease, the history of cerebrovascular disease, rate of postoperative complications, rate of transferring to intensive care unit, time out of bed, length of hospitalization, thickness and echo intensity of quadriceps femoris the vastus lateralis and the tibialis anterior, echo intensity of the medial gastrocnemius among the three groups (P < 0.05). Pearson's correlation analysis showed FRAIL score was correlated with muscle thickness and echo intensity of the lower limbs. Multifactor logistic regression analysis showed that the prefrailty group was positively correlated with age(β = 0.146, P = 0.004), echo intensity of the medial gastrocnemius (β = 0.055, P = 0.031), and rate of postoperative complications(β = 1.439, P = 0.021), also negatively correlated with muscle thickness of the tibialis anterior(β = -2.124, P = 0.007). The frailty group was positively correlated with age(β = 0.22, P = 0.005), tibialis anterior echo intensity (β = 0.082, P = 0.015), medial gastrocnemius echo intensity (β = 0.089, P = 0.026), cerebrovascular disease history (β = 2.311, P = 0.04), and postoperative complication rate (β = 2.684, P = 0.003). It was negatively correlated with albumin (β = -0.26, P = 0.017), quadriceps muscle thickness (β = -2.257, P = 0.017), and tibialis anterior muscle thickness (β = -5.408, P = 0.001). Conclusion Ultrasound measurement of lower (not upper) extremity muscle thickness and echo intensity was significantly associated with discriminating severity of frailty and postoperative outcomes than frailty scores in elderly patients.
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Affiliation(s)
- Chengjian Xin
- School of Anesthesiology, Weifang Medical University, Weifang, China
| | - Mengzhuo Ma
- School of Clinical Medicine, Xi'an Medical University, Xi'an, China
| | - Qian Wang
- Department of Anesthesia, Yuhuangding Hospital, Yaitai, China
| | - Tao Li
- Department of Anesthesia, Yuhuangding Hospital, Yaitai, China
| | - Qiaoxia Sun
- Department of Anesthesia, Yuhuangding Hospital, Yaitai, China
| | - Meiru Jiang
- Department of Anesthesia, Yuhuangding Hospital, Yaitai, China
| | - Juan Du
- Department of Anesthesia, Yuhuangding Hospital, Yaitai, China
| | - Zhi Li
- Department of Anesthesia, Yuhuangding Hospital, Yaitai, China
| | - Jiahai Ma
- Department of Anesthesia, Yuhuangding Hospital, Yaitai, China
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14
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Kim H, Kwon S, Kim Y, Bae J, Yoo S, Lim YJ, Kim JT. Preoperative frailty assessment with ultrasound in elderly patients scheduled for total knee arthroplasty. Minerva Anestesiol 2024; 90:59-67. [PMID: 38415511 DOI: 10.23736/s0375-9393.23.17713-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Frailty, a decline in physical and cognitive reserve capacity, renders patients susceptible to various stressors and has been linked to adverse outcomes and increased healthcare utilization. This study aimed to determine whether ultrasound measurements of the rectus abdominis (RA) and biceps brachii (BB) could predict frailty in patients scheduled for total knee arthroplasty. METHODS Frailty was assessed using the Clinical Frailty Scale in adults aged ≥60 years. Ultrasound measurements of the rectus abdominis, BB, and quadriceps femoris muscles, along with thigh circumference measurements, were obtained before surgery. The predictive ability of the unadjusted and BMI- and body surface area (BSA)-adjusted measurements were evaluated using receiver operating characteristic curve analysis and area under the curve (AUC) values. Postoperative outcomes, such as admission to the intensive care unit or skilled nursing facility, delirium, falls, re-hospitalization, and 30-day mortality were recorded. RESULTS We analyzed data from 148 patients. BB thickness provided a fair prediction of frailty. Average measurements of both BB adjusted for BMI (0.708, 95% CI 0.602-0.814; P<0.001), and BSA (0.708, 95% CI 0.598-0.817; P<0.001) had the highest AUC values. RA muscle measurements could not discriminate frailty. The BMI-adjusted measurements for: right quadriceps femoris thickness (AUC 0.614, 95% CI 0.503-0.725; P=0.044), left thigh circumference (AUC 0.648, 95% CI 0.528-0.769; P=0.016), and average thigh circumference (AUC 0.630, 95% CI 0.511-0.750; P=0.033) had statistically significant but poor AUC values. CONCLUSIONS Preoperative ultrasound measurements of the bilateral BB can fairly predict frailty in patients scheduled for total knee arthroplasty.
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Affiliation(s)
- Hansol Kim
- Department of Anesthesiology and Pain Medicine, National University Hospital of Seoul, Seoul, South Korea
| | - Seokmin Kwon
- Department of Anesthesiology and Pain Medicine, National University Hospital of Seoul, Seoul, South Korea
| | - Youngwon Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jinyoung Bae
- Department of Anesthesiology and Pain Medicine, Ajou University Hospital, Suwon-si, South Korea
| | - Seokha Yoo
- Department of Anesthesiology and Pain Medicine, National University Hospital of Seoul, Seoul, South Korea
| | - Young-Jin Lim
- Department of Anesthesiology and Pain Medicine, National University Hospital of Seoul, Seoul, South Korea
- Department of Anesthesiology and Pain Medicine, National University College of Medicine of Seoul, Seoul, South Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, National University Hospital of Seoul, Seoul, South Korea -
- Department of Anesthesiology and Pain Medicine, National University College of Medicine of Seoul, Seoul, South Korea
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
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15
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Lai YH, Latmore M, Joo SS, Hong J. Regional anesthesia for the geriatric patient: a narrative review and update on hip fracture repair. Int Anesthesiol Clin 2024; 62:79-85. [PMID: 37955145 DOI: 10.1097/aia.0000000000000422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Affiliation(s)
- Yan H Lai
- Department of Anesthesiology, Pain, and Perioperative Medicine, Mount Sinai West and Morningside Hospitals, Icahn School of Medicine, New York, NY
| | - Malikah Latmore
- Department of Anesthesiology, Pain, and Perioperative Medicine, Mount Sinai West and Morningside Hospitals, Icahn School of Medicine, New York, NY
| | - Sarah S Joo
- Department of Anesthesiology, Pain, and Perioperative Medicine, Mount Sinai West and Morningside Hospitals, Icahn School of Medicine, New York, NY
| | - Janet Hong
- Department of Anesthesiology, Pain, and Perioperative Medicine, Mount Sinai West and Morningside Hospitals, Icahn School of Medicine, New York, NY
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16
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Reider L, Owen EC, Dreyer HC, Fitton LS, Willey MC. Loss of Muscle Mass and Strength After Hip Fracture: an Intervention Target for Nutrition Supplementation. Curr Osteoporos Rep 2023; 21:710-718. [PMID: 38019345 DOI: 10.1007/s11914-023-00836-0] [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] [Accepted: 11/03/2023] [Indexed: 11/30/2023]
Abstract
PURPOSEOF REVIEW To summarize what is known about the deleterious effect of hip fracture on muscle mass and strength as well as the scientific evidence for post-surgical nutrition supplementation to maintain muscle and improve function. RECENT FINDINGS This review provides a discussion of the relationship between muscle mass, strength, and physical function following hip fracture, briefly describes the approaches to measuring lean mass, discusses prevalence of sarcopenia and malnutrition among older men and women with hip fracture, and reviews the effects of essential amino acids on muscle. Loss of muscle mass and strength following hip fracture is substantial with consequences for recovery of functional independence. EAA-based nutrition supplementation, which directly effects muscle, has potential to improve outcomes.
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Affiliation(s)
- Lisa Reider
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Street, Room 648, Baltimore, MD, 21205, USA.
| | | | - Hans C Dreyer
- Department of Human Physiology, University of Oregon, Eugene, OR, 97403, USA
| | - Lori S Fitton
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Michael C Willey
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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17
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Nagae M, Umegaki H, Yoshiko A, Fujita K. Muscle ultrasound and its application to point-of-care ultrasonography: a narrative review. Ann Med 2023; 55:190-197. [PMID: 36538042 PMCID: PMC9788691 DOI: 10.1080/07853890.2022.2157871] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Technological advances of hand-held ultrasound devices and educational programmes for their use, such as point-of-care ultrasonography (POCUS) training, have contributed to the increasing application of these devices in clinical practice. With the greater impact of frailty and sarcopenia in aging societies, attention is being focused on the use of ultrasound for skeletal muscle assessment. In this narrative review, we discuss how ultrasound can be applied to skeletal muscle assessment, especially that of the quadriceps muscle, in clinical practice. Muscle thickness by ultrasound has been shown to have good reliability and validity for the evaluation of muscle size, and echo intensity has been used to evaluate muscle quality. Muscle ultrasound has not only been useful to diagnose sarcopenia in various settings, but has also been validated to predict health-related outcomes such as death and functional disability. Recommended methods for muscle ultrasound was published recently, and the results of future studies are expected to be comparable. Although several challenging issues with muscle ultrasound remain, if it could be incorporated into educational programmes such as POCUS training, more clinicians may be able to use ultrasound for skeletal muscle assessment in the future.KEY MESSAGESThe evolution of hand-held ultrasound devices enables physicians to perform ultrasound at the bedside as part of regular medical examinations.Muscle ultrasound is considered an effective tool for evaluating muscle size and quality, and has been studied in various settings.More clinicians may be able to evaluate skeletal muscle assessment with the development of educational programmes on muscle ultrasound in the future.
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Affiliation(s)
- Masaaki Nagae
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Hiroyuki Umegaki
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Akito Yoshiko
- Faculty of Liberal Arts and Sciences, Chukyo University, Aichi, Japan
| | - Kosuke Fujita
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
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18
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Tian JY, Hao XY, Cao FY, Liu JJ, Li YX, Guo YX, Mi WD, Tong L, Fu Q. Preoperative Frailty Assessment Predicts Postoperative Mortality, Delirium and Pneumonia in Elderly Lung Cancer Patients: A Retrospective Cohort Study. Ann Surg Oncol 2023; 30:7442-7451. [PMID: 37326809 DOI: 10.1245/s10434-023-13696-w] [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: 02/20/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the predictive value of the 5-factor modified frailty index (mFI-5) for postoperative mortality, delirium and pneumonia in patients over 65 years of age undergoing elective lung cancer surgery. METHODS Data were collected from a single-center retrospective cohort study conducted in a general tertiary hospital from January 2017 to August 2019. In total, the study included 1372 elderly patients aged over 65 who underwent elective lung cancer surgery. They were divided into frail group (mFI-5, 2-5), prefrail group (mFI-5, 1) and robust group (mFI-5, 0) on the basis of mFI-5 classification. The primary outcome was postoperative 1-year all-cause mortality. Secondary outcomes were postoperative pneumonia and postoperative delirium. RESULTS Frailty group had the highest incidence of postoperative delirium (frailty 31.2% versus prefrailty 1.6% versus robust 1.5%, p < 0.001), postoperative pneumonia (frailty 23.5% versus prefrailty 7.2% versus robust 7.7%, p < 0.001), and postoperative 1-year mortality (frailty 7.0% versus prefrailty 2.2% versus robust 1.9%. p < 0.001). Frail patients have significantly longer length of hospitalization than those in the robust group and prefrail patients (p < 0.001). Multivariate analysis showed a clear link between frailty and increased risk of postoperative delirium (aOR 2.775, 95% CI 1.776-5.417, p < 0.001), postoperative pneumonia (aOR 3.291, 95% CI 2.169-4.993, p < 0.001) and postoperative 1-year mortality (aOR 3.364, 95% CI, 1.516-7.464, p = 0.003). CONCLUSIONS mFI-5 has potential clinical utility in predicting postoperative death, delirium and pneumonia incidence in elderly patients undergoing radical lung cancer surgery. Frailty screening of patients (mFI-5) may provide benefits in risk stratification, targeted intervention efforts, and assist physicians in clinical decision-making.
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Affiliation(s)
- Jing-Yang Tian
- Department of Anesthesia, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Xin-Yu Hao
- Department of Anesthesia, The First Medical Center of Chinese, PLA General Hospital, Beijing, China
| | - Fu-Yang Cao
- Department of Anesthesia, The Six Medical Center of Chinese, PLA General Hospital, Beijing, China
| | - Jing-Jing Liu
- Department of Anesthesia, The First Medical Center of Chinese, PLA General Hospital, Beijing, China
| | - Yan-Xiang Li
- Department of Anesthesia, The First Medical Center of Chinese, PLA General Hospital, Beijing, China
| | - Yong-Xin Guo
- Department of Anesthesia, The First Medical Center of Chinese, PLA General Hospital, Beijing, China
| | - Wei-Dong Mi
- Department of Anesthesia, The First Medical Center of Chinese, PLA General Hospital, Beijing, China
| | - Li Tong
- Department of Anesthesia, The First Medical Center of Chinese, PLA General Hospital, Beijing, China.
| | - Qiang Fu
- Department of Anesthesia, The First Medical Center of Chinese, PLA General Hospital, Beijing, China.
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Dunlop RAN, Van Zundert A. A systematic review of predictive accuracy via c-statistic of preoperative frailty tests for extended length of stay, post-operative complications, and mortality. Saudi J Anaesth 2023; 17:575-580. [PMID: 37779562 PMCID: PMC10540983 DOI: 10.4103/sja.sja_358_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: 05/01/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 10/03/2023] Open
Abstract
Frailty, as an age-related syndrome of reduced physiological reserve, contributes significantly to post-operative outcomes. With the aging population, frailty poses a significant threat to patients and health systems. Since 2012, preoperative frailty assessment has been recommended, yet its implementation has been inhibited by the vast number of frailty tests and lack of consensus. Since the anesthesiologist is the best placed for perioperative care, an anesthesia-tailored preoperative frailty test must be simple, quick, universally applicable to all surgeries, accurate, and ideally available in an app or online form. This systematic review attempted to rank frailty tests by predictive accuracy using the c-statistic in the outcomes of extended length of stay, 3-month post-operative complications, and 3-month mortality, as well as feasibility outcomes including time to completion, equipment and training requirements, cost, and database compatibility. Presenting findings of all frailty tests as a future reference for anesthesiologists, Clinical Frailty Scale was found to have the best combination of accuracy and feasibility for mortality with speed of completion and phone app availability; Edmonton Frailty Scale had the best accuracy for post-operative complications with opportunity for self-reporting. Finally, extended length of stay had too little data for recommendation of a frailty test. This review also demonstrated the need for changing research emphasis from odds ratios to metrics that measure the accuracy of a test itself, such as the c-statistic.
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Affiliation(s)
- Richard A. N. Dunlop
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital and The University of Queensland, Brisbane, QLD, Australia
| | - André Van Zundert
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital and The University of Queensland, Brisbane, QLD, Australia
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Nguyen M, Boudina Y, Dransart-Raye O, Perrot J, Ouahrani A, Guinot PG, Bouhemad B. Expiratory abdominal muscle thickness, a new point of care ultrasound measure for respiratory muscle mass in the intensive care unit: a prospective observational cohort study. Anaesth Crit Care Pain Med 2023; 42:101252. [PMID: 37244470 DOI: 10.1016/j.accpm.2023.101252] [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] [Received: 01/04/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Even if expiratory muscles are key muscles in intensive care unit (ICU) patients, the association between their thickness and mortality has never been assessed. This study aimed to determine whether expiratory abdominal muscle thickness assessed by ultrasonography (US) was associated with 28-day mortality in ICU patients. BASIC PROCEDURES US expiratory abdominal muscle thickness was measured within the first 12 h after ICU admission. The primary endpoint was 28-day mortality. MAIN FINDINGS In 310 analyzed patients, a thinner total abdominal expiratory muscle thickness at admission was associated with 28-day mortality (median value with interquartile range: 10.8 [10; 14.6] versus 16.5 [13.4; 20.7] mm). Total abdominal expiratory muscle thickness had an area under the curve of 0.78 [0.71;0.86] to discriminate 28-day mortality. CONCLUSIONS US expiratory abdominal muscle thickness was associated with 28-day mortality, supporting its use in predicting ICU patient outcome.
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Affiliation(s)
- Maxime Nguyen
- Department of Anesthesiology and Intensive Care, Dijon University Hospital, F-21000 Dijon, France; University of Burgundy and Franche-Comté, LNC UMR1231, F-21000 Dijon, France; INSERM, LNC UMR1231, F-21000 Dijon, France; FCS Bourgogne-Franche Comté, LipSTIC LabEx, F-21000 Dijon, France.
| | - Yoann Boudina
- Department of Anesthesiology and Intensive Care, Dijon University Hospital, F-21000 Dijon, France
| | - Ophélie Dransart-Raye
- Department of Anesthesiology and Intensive Care, Dijon University Hospital, F-21000 Dijon, France
| | - Justine Perrot
- Department of Anesthesiology and Intensive Care, Dijon University Hospital, F-21000 Dijon, France
| | - Ayoub Ouahrani
- Department of Anesthesiology and Intensive Care, Dijon University Hospital, F-21000 Dijon, France
| | - Pierre-Grégoire Guinot
- Department of Anesthesiology and Intensive Care, Dijon University Hospital, F-21000 Dijon, France; University of Burgundy and Franche-Comté, LNC UMR1231, F-21000 Dijon, France; INSERM, LNC UMR1231, F-21000 Dijon, France; FCS Bourgogne-Franche Comté, LipSTIC LabEx, F-21000 Dijon, France
| | - Bélaïd Bouhemad
- Department of Anesthesiology and Intensive Care, Dijon University Hospital, F-21000 Dijon, France; University of Burgundy and Franche-Comté, LNC UMR1231, F-21000 Dijon, France; INSERM, LNC UMR1231, F-21000 Dijon, France; FCS Bourgogne-Franche Comté, LipSTIC LabEx, F-21000 Dijon, France
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Gogtay M, Choudhury RS, Williams JP, Mader MJ, Murray KJ, Haro EK, Drum B, O'Brien E, Khosla R, Boyd JS, Bales B, Wetherbee E, Sauthoff H, Schott CK, Basrai Z, Resop D, Lucas BP, Sanchez-Reilly S, Espinosa S, Soni NJ, Nathanson R. Point-of-care ultrasound in geriatrics: a national survey of VA medical centers. BMC Geriatr 2023; 23:605. [PMID: 37759172 PMCID: PMC10537073 DOI: 10.1186/s12877-023-04313-2] [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: 02/17/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) can aid geriatricians in caring for complex, older patients. Currently, there is limited literature on POCUS use by geriatricians. We conducted a national survey to assess current POCUS use, training desired, and barriers among Geriatrics and Extended Care ("geriatric") clinics at Veterans Affairs Medical Centers (VAMCs). METHODS We conducted a prospective observational study of all VAMCs between August 2019 and March 2020 using a web-based survey sent to all VAMC Chiefs of Staff and Chiefs of geriatric clinics. RESULTS All Chiefs of Staff (n=130) completed the survey (100% response rate). Chiefs of geriatric clinics ("chiefs") at 76 VAMCs were surveyed and 52 completed the survey (68% response rate). Geriatric clinics were located throughout the United States, mostly at high-complexity, urban VAMCs. Only 15% of chiefs responded that there was some POCUS usage in their geriatric clinic, but more than 60% of chiefs would support the implementation of POCUS use. The most common POCUS applications used in geriatric clinics were the evaluation of the bladder and urinary obstruction. Barriers to POCUS use included a lack of trained providers (56%), ultrasound equipment (50%), and funding for training (35%). Additionally, chiefs reported time utilization, clinical indications, and low patient census as barriers. CONCLUSIONS POCUS has several potential applications for clinicians caring for geriatric patients. Though only 15% of geriatric clinics at VAMCs currently use POCUS, most geriatric chiefs would support implementing POCUS use as a diagnostic tool. The greatest barriers to POCUS implementation in geriatric clinics were a lack of training and ultrasound equipment. Addressing these barriers systematically can facilitate implementation of POCUS use into practice and permit assessment of the impact of POCUS on geriatric care in the future.
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Affiliation(s)
- Maya Gogtay
- South Texas Veterans Health Care System, Department of Geriatrics, Gerontology and Palliative Medicine, San Antonio, TX, USA.
| | - Ryan S Choudhury
- South Texas Veterans Health Care System, Department of Geriatrics, Gerontology and Palliative Medicine, San Antonio, TX, USA
| | - Jason P Williams
- Division of Hospital Medicine, Emory School of Medicine, Atlanta, GA, USA
- Medicine Service, Atlanta VA Medical Center, Atlanta, GA, USA
| | - Michael J Mader
- South Texas Veterans Health Care System, Research Service, San Antonio, TX, USA
| | - Kevin J Murray
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Elizabeth K Haro
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Brandy Drum
- Health Analysis and Information Group, Department of Veterans Affairs, Milwaukee, WI, USA
| | - Edward O'Brien
- Health Analysis and Information Group, Department of Veterans Affairs, Milwaukee, WI, USA
| | - Rahul Khosla
- Pulmonary and Critical Care Medicine, Veterans Affairs Medical Center, Washington, DC, USA
- Department of Pulmonary, Critical Care and Sleep Medicine, The George Washington University, Washington, DC, USA
| | - Jeremy S Boyd
- Department of Emergency Medicine, VA Tennessee Valley Healthcare System-Nashville, Nashville, TN, USA
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brain Bales
- Department of Emergency Medicine, VA Tennessee Valley Healthcare System-Nashville, Nashville, TN, USA
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Erin Wetherbee
- Pulmonary Section, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Harald Sauthoff
- Medicine Service, VA NY Harbor Healthcare System, New York, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Christopher K Schott
- Critical Care Service, VA Pittsburgh Health Care Systems, Pittsburgh, PA, USA
- Departments of Critical Care Medicine and Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zahir Basrai
- Emergency Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Dana Resop
- Department of Emergency Medicine, University of Wisconsin, Madison, WI, USA
- Emergency Department, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Brian P Lucas
- Medicine Service, White River Junction VA Medical Center, White River Junction, VT, USA
- Department of Medicine, Dartmouth Geisel School of Medicine, Hanover, NH, USA
| | - Sandra Sanchez-Reilly
- South Texas Veterans Health Care System, Department of Geriatrics, Gerontology and Palliative Medicine, San Antonio, TX, USA
| | - Sara Espinosa
- South Texas Veterans Health Care System, Department of Geriatrics, Gerontology and Palliative Medicine, San Antonio, TX, USA
| | - Nilam J Soni
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Division of Hospital Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Robert Nathanson
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of Hospital Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
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Osuru HP, Ikeda K, Atluri N, Thiele RH. Moderate exercise-induced dynamics on key sepsis-associated signaling pathways in the liver. Crit Care 2023; 27:266. [PMID: 37407986 DOI: 10.1186/s13054-023-04551-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/25/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND There is a clear relationship between quantitative measures of fitness (e.g., VO2 max) and outcomes after surgical procedures. Whether or not fitness is a modifiable risk factor and what underlying biological processes drive these changes are not known. The purpose of this study was to evaluate the moderate exercise training effect on sepsis outcomes (survival) as well as the hepatic biological response. We chose to study the liver because it plays a central role in the regulation of immune defense during systemic infection and receives blood flow directly from the origin of infection (gut) in the cecal ligation and puncture (CLP) model. METHODS We randomized 50 male (♂) and female (♀) Sprague-Dawley rats (10 weeks, 340 g) to 3 weeks of treadmill exercise training, performed CLP to induce polymicrobial "sepsis," and monitored survival for five days (Part I). In parallel (Part II), we randomized 60 rats to control/sedentary (G1), exercise (G2), exercise + sham surgery (G3), CLP/sepsis (G4), exercise + CLP [12 h (G5) and 24 h (G6)], euthanized at 12 or 24 h, and explored molecular pathways related to exercise and sepsis survival in hepatic tissue and serum. RESULTS Three weeks of exercise training significantly increased rat survival following CLP (polymicrobial sepsis). CLP increased inflammatory markers (e.g., TNF-a, IL-6), which were attenuated by exercise. Sepsis suppressed the SOD and Nrf2 expression, and exercise before sepsis restored SOD and Nrf2 levels near the baseline. CLP led to increased HIF1a expression and oxidative and nitrosative stress, the latter of which were attenuated by exercise. Haptoglobin expression levels were increased in CLP animals, which was significantly amplified in exercise + CLP (24 h) rats. CONCLUSIONS Moderate exercise training (3 weeks) increased the survival in rats exposed to CLP, which was associated with less inflammation, less oxidative and nitrosative stress, and activation of antioxidant defense pathways.
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Affiliation(s)
- Hari Prasad Osuru
- Department of Anesthesiology, University of Virginia School of Medicine, P.O. Box 800710-0710, Charlottesville, VA, 22908-0710, USA.
| | - Keita Ikeda
- Department of Anesthesiology, University of Virginia School of Medicine, P.O. Box 800710-0710, Charlottesville, VA, 22908-0710, USA
| | - Navya Atluri
- Department of Anesthesiology, University of Virginia School of Medicine, P.O. Box 800710-0710, Charlottesville, VA, 22908-0710, USA
| | - Robert H Thiele
- Department of Anesthesiology, University of Virginia School of Medicine, P.O. Box 800710-0710, Charlottesville, VA, 22908-0710, USA.
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Boncompte G, Sun H, Elgueta MF, Benavides J, Carrasco M, Morales MI, Calderón N, Contreras V, Westover MB, Cortínez LI, Akeju O, Pedemonte JC. Intraoperative electroencephalographic marker of preoperative frailty: A prospective cohort study. J Clin Anesth 2023; 86:111069. [PMID: 36738630 PMCID: PMC10074446 DOI: 10.1016/j.jclinane.2023.111069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Gonzalo Boncompte
- Neurodynamics of Cognition Laboratory, Department of Psychiatry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Haoqi Sun
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Henry and Allison McCance Center for Brain Health, Boston, MA, USA; Clinical Data Animation Center (CDAC), Massachusetts General Hospital, Boston, MA, USA
| | - María F Elgueta
- División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javiera Benavides
- División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcela Carrasco
- Sección de Geriatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María I Morales
- Sección de Geriatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Natalia Calderón
- División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Victor Contreras
- División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Departamento del Adulto, Escuela de Enfermería, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M Brandon Westover
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Henry and Allison McCance Center for Brain Health, Boston, MA, USA; Clinical Data Animation Center (CDAC), Massachusetts General Hospital, Boston, MA, USA
| | - Luis I Cortínez
- División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Oluwaseun Akeju
- Department of Anesthesia, Critical Care and Pain Medicine, Boston, MA, USA; Henry and Allison McCance Center for Brain Health, Boston, MA, USA
| | - Juan C Pedemonte
- División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Programa de Farmacología y Toxicología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Khoche S, Ellis J, Poorsattar SP, Kothari P, Oliver A, Whyte A, Maus TM. The Year in Perioperative Echocardiography: Selected Highlights From 2022. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00260-4. [PMID: 37208207 DOI: 10.1053/j.jvca.2023.04.023] [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: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/21/2023]
Abstract
THIS SPECIAL article is part of an annual series for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the editor-in-chief, Dr. Kaplan, and the Editorial Board for the opportunity to continue this series, which focuses on the past year's research highlights that pertain to perioperative echocardiography in relation to cardiothoracic and vascular anesthesia. The major selected themes for 2022 include (1) updates on mitral valve assessments and interventions, (2) training and simulation updates, (3) outcomes and complications of transesophageal echocardiography, and (4) point-of-care cardiac ultrasound. The themes selected for this special article are just a sample of the advances in perioperative echocardiography during 2022. An appreciation and understanding of these highlights will help to ensure and improve the perioperative outcomes for patients with cardiovascular disease undergoing cardiac surgery.
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Affiliation(s)
- Swapnil Khoche
- Department of Anesthesiology, UCSD Medical Center-Sulpizio Cardiovascular Center, La Jolla, California
| | - Jon Ellis
- Department of Anesthesiology, UCSD Medical Center-Sulpizio Cardiovascular Center, La Jolla, California
| | - Sophia P Poorsattar
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, California
| | - Perin Kothari
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Ashley Oliver
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, California
| | - Alice Whyte
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Timothy M Maus
- Department of Anesthesiology, UCSD Medical Center-Sulpizio Cardiovascular Center, La Jolla, California.
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25
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Lee YY, Woo JH, Yoon IY, Lee HJ, Ahn SM, Chae JS, Kim YJ. Predictability of Radiologically Measured Psoas Muscle Area for Intraoperative Hypotension in Older Adult Patients Undergoing Femur Fracture Surgery. J Clin Med 2023; 12:jcm12041691. [PMID: 36836226 PMCID: PMC9959025 DOI: 10.3390/jcm12041691] [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: 01/04/2023] [Revised: 02/07/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
This retrospective study aimed to determine the predictive value of radiologically measured psoas muscle area (PMA) for intraoperative hypotension (IOH) using receiver operating characteristic (ROC) curves in older adult patients with hip fractures. The cross-sectional axial area of the psoas muscle was measured by CT at the level of the 4th lumbar vertebrae and normalized by body surface area (BSA). The modified frailty index (mFI) was used to assess frailty. IOH was defined as an absolute threshold of mean arterial blood pressure (MAP) < 65 mmHg or a relative decrease in MAP > 30% from baseline MAP. Among the 403 patients, 286 (71.7%) had developed IOH. PMA normalized by BSA in male patients was 6.90 ± 0.73 in the no-IOH group and 4.95 ± 1.20 in the IOH group (p < 0.001). PMA normalized by BSA in female patients was 5.18 ± 0.81 in the no-IOH group and 3.78 ± 0.75 in the IOH group (p < 0.001). The ROC curves showed that the area under the curve for PMA normalized by BSA and modified frailty index (mFI) were 0.94 for male patients, 0.91 for female patients, and 0.81 for mFI (p < 0.001). In multivariate logistic regression, low PMA normalized by BSA, high baseline systolic blood pressure, and old age were significant independent predictors of IOH (adjusted odds ratio: 3.86, 1.03, and 1.06, respectively). PMA measured by computed tomography showed an excellent predictive value for IOH. Low PMA was associated with developing IOH in older adult patients with hip fractures.
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Affiliation(s)
- Youn Young Lee
- Department of Anesthesiology and Pain Medicine, Ewha Womans University Seoul Hospital, Seoul 07804, Republic of Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
| | - Jae Hee Woo
- Department of Anesthesiology and Pain Medicine, Ewha Womans University Seoul Hospital, Seoul 07804, Republic of Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
- Correspondence: ; Tel.: +82-2-6986-4300
| | - In-Young Yoon
- Department of Anesthesiology and Pain Medicine, Ewha Womans University Mokdong Hospital, Seoul 07985, Republic of Korea
| | - Hyun Jung Lee
- Department of Anesthesiology and Pain Medicine, Ewha Womans University Seoul Hospital, Seoul 07804, Republic of Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
| | - Sang-Mee Ahn
- Department of Anesthesiology and Pain Medicine, Ewha Womans University Seoul Hospital, Seoul 07804, Republic of Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
| | - Ji Seon Chae
- Department of Anesthesiology and Pain Medicine, Ewha Womans University Seoul Hospital, Seoul 07804, Republic of Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
| | - Youn Jin Kim
- Department of Anesthesiology and Pain Medicine, Ewha Womans University Seoul Hospital, Seoul 07804, Republic of Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
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Yao X, Zhou Y, Wang Y, Li Z. Cross-disciplinary training of nursing informatics and nursing engineering at the postgraduate level: A feasibility analysis based on the qualitative method. NURSE EDUCATION TODAY 2023; 121:105708. [PMID: 36634504 DOI: 10.1016/j.nedt.2023.105708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 12/06/2022] [Accepted: 01/01/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND The trend of interdisciplinary education is becoming increasingly prominent. Nursing informatics and nursing engineering have received much attention and development at different levels of nursing education in many Western countries. Meanwhile, in China, the cultivation of interdisciplinary nursing talents has either not been initiated or has only entered an initial stage. OBJECTIVES This study aims to explore experts' opinions from nursing, informatics and engineering on the feasibility of interdisciplinary education at graduate master's level in nursing through interview. DESIGN This was a descriptive qualitative study. SETTING Interviews were conducted online or face to face. PARTICIPANTS Experts in the fields of nursing, informatics, and engineering who met the study qualifications were enrolled. METHODS This study used a purposive sampling method and collected data via semi-structured interviews. A total of 14 experts were involved based on data saturation, which eight were interviewed face-to-face and six were interviewed online. A content analysis method was used to summarize and analyze the attitudes, opinions, and suggestions of experts. RESULTS A total of 579 min of interviews with 66,387 words were transcribed and analyzed after 30-50 min time range of each interview, and 4 themes were established. A consensus was obtained on the necessity and importance of interdisciplinary education. Policy guidance, financial support, and mutual recognition were the prerequisites for the cultivation. Moreover, feasibility of interdisciplinary education depends on multi-cooperation, including society, university, and hospital. Finally, a linkage mechanism among relevant stakeholders was required. CONCLUSION The necessity and feasibility of such integrated training was concluded. Learning from the experience of relevant countries, China should launch an interdisciplinary training model suitable for its national condition.
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Affiliation(s)
- Xiuyu Yao
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100144, China.
| | - Ying Zhou
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100144, China
| | - Yidan Wang
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100144, China
| | - Zheng Li
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100144, China.
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27
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Zhao W, Li J. Letter to the editor: "Association of preoperative frailty with postoperative delirium in elderly orthopedic trauma patients". Aging Clin Exp Res 2023; 35:215. [PMID: 36371752 DOI: 10.1007/s40520-022-02284-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 10/14/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Weihong Zhao
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, 050000, Hebei, China.,Graduate School of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Jianli Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, 050000, Hebei, China.
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Gottesman D, McIsaac DI. Frailty and emergency surgery: identification and evidence-based care for vulnerable older adults. Anaesthesia 2022; 77:1430-1438. [PMID: 36089855 DOI: 10.1111/anae.15860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 11/30/2022]
Abstract
Frailty is a multidimensional state related to accumulation of age- and disease-related deficits across multiple domains. Older people represent the fastest growing segment of the peri-operative population, and 25-50% of older surgical patients live with frailty. When frailty is present before surgery, adjusted rates of morbidity and mortality increase at least two-fold; the odds of delirium and loss of independence are increased more than four- and five-fold, respectively. Care of the older person with frailty presenting for emergency surgery requires individualised and evidence-based care given the high-risk and complex nature of their presentations. Before surgery, frailty should be assessed using a multidimensional frailty instrument (most likely the Clinical Frailty Scale), and all members of the peri-operative team should be aware of each patient's frailty status. When frailty is present, pre-operative care should focus on documenting and communicating individualised risk, considering advanced care directives and engaging shared decision-making when feasible. Shared multidisciplinary care should be initiated. Peri-operatively, analgesia that avoids polypharmacy should be provided, along with delirium prevention strategies and consideration of postoperative care in a monitored environment. After the acute surgical episode, transition out of hospital requires that adequate support be in place, along with clear discharge instructions, and review of new and existing prescription medications. Advanced care directives should be reviewed or initiated in case of readmission. Overall, substantial knowledge gaps about the optimal peri-operative care of older people with frailty must be addressed through robust, patient-oriented research.
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Affiliation(s)
- D Gottesman
- Departments of Anesthesiology and Pain Medicine, University of Ottawa and Ottawa Hospita, Ottawa, ON, Canada
| | - D I McIsaac
- Departments of Anesthesiology and Pain Medicine, University of Ottawa and Ottawa Hospital, School of Epidemiology and Public Health, University of Ottawa, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Spiegowski D, Metzger L, Jain A, Inchiosa MA, Weber G, Abramowicz AE. The Utility of Grip Strength as a Simplified Measure of Frailty in the Older Adult in the Preoperative Clinic. Cureus 2022; 14:e28747. [PMID: 36211090 PMCID: PMC9529157 DOI: 10.7759/cureus.28747] [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] [Accepted: 09/03/2022] [Indexed: 01/15/2023] Open
Abstract
Objective The aim of this study was to compare the measure of grip strength against other validated methods of measuring frailty. Materials and methods This was a single-center, cross-sectional study that took place at the Westchester Medical Center Pre-Procedural Testing Clinic. The patient population included n = 73 patients ≥65 years of age evaluated for elective surgery. During the study, patients’ grip strength, CFS-I (Clinical Frailty Score of Investigator), CFS-P (Clinical Frailty Score of Participant), and FRAIL (Fatigue, Resistance, Aerobic capacity, Illnesses, and Loss of weight) scores were measured. Results Grip strength correlated negatively with the CFS-I, CFS-P, and FRAIL scores for females. Reduced grip strength in females correlated with higher frailty scores and vice versa. Male grip strength showed no significant relationship with the frailty scales. In addition, multivariate linear regression analysis revealed that the independent measure that demonstrated a significant inverse association with grip strength was age (β= -0.43, p = <0.001). Conclusions There exists a difference in the utility of grip strength as a measure of frailty between males and females.
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Point-of-Care Ultrasound Frailty Assessments: Reply. Anesthesiology 2022; 137:374-375. [PMID: 35834767 PMCID: PMC9869919 DOI: 10.1097/aln.0000000000004301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Raveh Y, Raveh D, Nicolau-Raducu R. Point-of-Care Ultrasound Frailty Assessments: Comment. Anesthesiology 2022; 137:372-373. [PMID: 35834776 DOI: 10.1097/aln.0000000000004299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Yehuda Raveh
- University of Miami/Jackson Memorial Hospital, Miami, Florida (Y.R.).
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Yang TR, Luo K, Deng X, Xu L, Wang RR, Ji P. Effect of sarcopenia in predicting postoperative mortality in emergency laparotomy: a systematic review and meta-analysis. World J Emerg Surg 2022; 17:36. [PMID: 35752855 PMCID: PMC9233792 DOI: 10.1186/s13017-022-00440-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/14/2022] [Indexed: 02/08/2023] Open
Abstract
Background While emergency laparotomy has been associated with high rates of postoperative mortality and adverse events, preoperative systematic evaluation of patients may improve perioperative outcomes. However, due to the critical condition of the patient and the limited operation time, it is challenging to conduct a comprehensive evaluation. In recent years, sarcopenia is considered a health problem associated with an increased incidence of poor prognosis. This study aimed to investigate the effect of sarcopenia on 30-day mortality and postoperative adverse events in patients undergoing emergency laparotomy. Methods We systematically searched databases including PubMed, Embase, and Cochrane for all studies comparing emergency laparotomy in patients with and without sarcopenia up to March 1, 2022. The primary outcome was of 30-day postoperative mortality. Secondary outcomes were the length of hospital stay, the incidence of adverse events, number of postoperative intensive care unit (ICU) admissions, and ICU length of stay. Study and outcome-specific risk of bias were assessed using the Quality in Prognosis Studies (QUIPS) tool. We rated the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Result A total of 11 eligible studies were included in this study. The results showed that patients with sarcopenia had a higher risk of death 30 days after surgery (OR = 2.42, 95% CI = 1.93–3.05, P < 0.00001). More patients were admitted to ICU after surgery (OR = 1.58, 95% CI = 1.11–2.25, P = 0.01). Both the ICU length of stay (MD = 0.55, 95% CI = 0.05–1.06, P = 0.03) and hospital length of stay (MD = 2.33, 95% CI = 1.33–3.32, P < 0.00001) were longer in the sarcopenia group. The incidence of postoperative complications was also significantly higher in patients with sarcopenia (OR = 1.78, 95% CI = 1.41–2.26, P < 0.00001). Conclusion In emergency laparotomy, sarcopenia was associated with increased 30-day postoperative mortality. Both the lengths of stay in the ICU and the total length of hospital stay were significantly higher than those in non-sarcopenic patients. Therefore, we concluded that sarcopenia can be used as a tool to identify preoperative high-risk patients, which can be considered to develop new postoperative risk prediction models. Registration number Registered on Prospero with the registration number of CRD42022300132. Supplementary Information The online version contains supplementary material available at 10.1186/s13017-022-00440-0.
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Affiliation(s)
- Tao-Ran Yang
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37, Guoxue Xiang, Chengdu, 610041, Sichuan, China
| | - Kai Luo
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37, Guoxue Xiang, Chengdu, 610041, Sichuan, China
| | - Xiao Deng
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Le Xu
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37, Guoxue Xiang, Chengdu, 610041, Sichuan, China
| | - Ru-Rong Wang
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37, Guoxue Xiang, Chengdu, 610041, Sichuan, China
| | - Peng Ji
- Department of Critical Care Medicine, West China Hospital, Sichuan University, No. 37, Guoxue Xiang, Chengdu, 610041, Sichuan, China.
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Addressing comorbidities in the perioperative setting and optimizing perioperative medicine education. Curr Opin Anaesthesiol 2022; 35:376-379. [PMID: 35671028 DOI: 10.1097/aco.0000000000001124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Preoperative clinics and patient optimization are examples of collaborative, multidisciplinary care pathways that create value. This article reviews current literature to demonstrate the importance of preoperative enhancement of patients' cognitive and functional status. This article underscores the importance of formal training in multidisciplinary topics, such as frailty, brain health, and shared decision-making for anesthesiology house staff. RECENT FINDINGS Preoperative cognitive screening of older patients is a valuable metric for risk stratification and detection of patients at risk of postoperative delirium. Frailty is another syndrome that can be identified and optimized preoperatively. Sarcopenia has been shown to correlate with frailty; this shows promise as a method to detect frailty preoperatively. SUMMARY Anesthesiologists as perioperative physicians are in a unique position to lead and coordinate interdisciplinary conversations that incorporate patient goal concordant care and realistic assessment of perioperative complications. Formal house staff training in early recognition and management of patients at risk of adverse outcomes in the short and long term postoperatively improves patient outcomes and decreases healthcare spending.
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Measuring Up: Frailty Scales. Anesthesiology 2022. [DOI: 10.1097/aln.0000000000004126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fang J, Ren J, Ren L, Qiu X, Yuan S, Wang W, Wang J. Perceived Social Support and Associated Factors Among Community-Dwelling Older Adults With Frailty and Pre-frailty in Hangzhou, China. Front Psychiatry 2022; 13:944293. [PMID: 35911254 PMCID: PMC9329702 DOI: 10.3389/fpsyt.2022.944293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 06/20/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES The present study aimed to explore the social support among community-dwelling older adults with frailty and pre-frailty and to ascertain associated factors. METHODS The frailty status of the participant was assessed via the Chinese FRAIL Scale. The dependent variable, level of social support, was evaluated using the Social Support Rating Scale (range: 12-66). This study explored the influencing factors from three aspects containing sociodemographic characteristics, family environment, and community environment. Independent-sample t-test, Analysis of Variance, and multiple linear regression analyses were conducted to examine determinants of social support. RESULTS There were significant differences in overall social support between non-frail, pre-frail, and frail participants [38.01 (SD = 6.48) vs. 33.62 (SD = 6.25) vs. 30.50 (SD = 6.68), F = 62.157, p < 0.001]. Older adults with frailty and pre-frailty who were single would have lower levels of overall social support. In the pre-frail group, living alone was associated with lower overall social support. In contrast, the relationship with children and the availability of recreational activities were associated factors for the frail group. CONCLUSIONS The level of social support among frail and pre-frail community-dwelling older adults was lower than the robust older adults and influenced by different factors according to the frailty category, which suggests taking targeted measures for social support improvement.
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Affiliation(s)
- Juan Fang
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Jianping Ren
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Lixian Ren
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Xiantao Qiu
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Shuang Yuan
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Wenting Wang
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Jinjing Wang
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
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Preoperative Frailty Assessment: An Opportunity to Add Value to Perioperative Care. Anesthesiology 2021; 136:255-257. [PMID: 34964819 DOI: 10.1097/aln.0000000000004080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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