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Peters XD, Zhang LM, Liu Y, Cohen ME, Rosenthal RA, Ko CY, Russell MM. Octogenarians unable to return home by postoperative-day 30. Am J Surg 2024; 238:115926. [PMID: 39303481 DOI: 10.1016/j.amjsurg.2024.115926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 08/15/2024] [Accepted: 08/21/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND For older adults undergoing surgery, returning home is instrumental for functional independence. We quantified octogenarians unable to return home by POD-30, assessed geriatric factors in a predictive model, and identified risk factors to inform decision-making and quality improvement. METHODS This retrospective cohort study examined patients ≥80 years old from the ACS NSQIP Geriatric Surgery Pilot, using sequential logistic regression modelling. The primary outcome was non-home living location at POD-30. RESULTS Of 4946 patients, 19.8 % lived in non-home facilities at POD-30. Increased odds of non-home living location were seen in patients with preoperative fall history (OR 2.92, 95%CI 2.06-4.14) and new postoperative pressure ulcer (OR 2.66, 95%CI 1.50-4.71) Other significant geriatric-specific risk factors included mobility aid use, surrogate-signed consent, and postoperative delirium, with odds ratios ranging from 1.42 (1.19-1.68) to 1.97 (1.53-2.53). CONCLUSIONS These geriatric-specific risk factors highlight the importance of preoperative vulnerability screening and intervention to inform surgical decision-making.
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Affiliation(s)
- Xane D Peters
- American College of Surgeons, Division of Research and Optimal Patient Care, Chicago, IL, USA; Loyola University Medical Center, Department of Surgery, Maywood, IL, USA.
| | - Lindsey M Zhang
- American College of Surgeons, Division of Research and Optimal Patient Care, Chicago, IL, USA; University of Chicago Medical Center, Department of Surgery, Chicago, IL, USA; Washington University School of Medicine, Department of Surgery, St. Louis, MO, USA
| | - Yaoming Liu
- American College of Surgeons, Division of Research and Optimal Patient Care, Chicago, IL, USA
| | - Mark E Cohen
- American College of Surgeons, Division of Research and Optimal Patient Care, Chicago, IL, USA
| | - Ronnie A Rosenthal
- Yale University, Department of Surgery, New Haven, CT, USA; Veteran Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Clifford Y Ko
- American College of Surgeons, Division of Research and Optimal Patient Care, Chicago, IL, USA; David Geffen School of Medicine at the University of California Los Angeles, Department of Surgery, Los Angeles, CA, USA; VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Marcia M Russell
- David Geffen School of Medicine at the University of California Los Angeles, Department of Surgery, Los Angeles, CA, USA; VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Wang M, Long F, Liu D, Zhuo Y, Tian L, Liang H. Application of WeChat-Utilized Mobile Health in Transitional Care Among Patients Undergoing Hepatectomy: A Pilot Study. Clin Nurs Res 2023; 32:298-305. [PMID: 36514816 DOI: 10.1177/10547738221143664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This study aimed to investigate whether mobile health (mHealth)-based transitional care, which utilized WeChat, could benefit patients undergoing hepatectomy. From January 2019 to December 2020, 807 patients who underwent hepatectomy in a tertiary care hospital were included in the study. Patients were divided into a transitional care group (TC group) (n = 238) and a control group (n = 569) based on whether they participated in mHealth-based transitional care, which utilized the WeChat application. Depending on the type of variables, t-tests, χ2 tests, and other statistical methods were used to compare differences between groups. Propensity score matching analysis was conducted for factors that differed in basic characteristics. After 1:1 matching, 238 patients were included in each group. Less readmission within 90 days of discharge, better quality of life, and higher satisfaction were found in the TC group both before and after matching (p < .05). This study showed the potential of applying mHealth-based transitional care among post-hepatectomy patients.
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Affiliation(s)
- Meng Wang
- Department of Traditional Chinese Medicine, General Hospital of Western Theater Command (Chengdu Military General Hospital), China
| | - Fei Long
- Department of General Surgery, General Hospital of Western Theater Command (Chengdu Military General Hospital), China
| | - Defang Liu
- Department of Traditional Chinese Medicine, General Hospital of Western Theater Command (Chengdu Military General Hospital), China
| | - Yue Zhuo
- Department of Traditional Chinese Medicine, General Hospital of Western Theater Command (Chengdu Military General Hospital), China
| | - Lijuan Tian
- Department of Traditional Chinese Medicine, General Hospital of Western Theater Command (Chengdu Military General Hospital), China
| | - Hongyin Liang
- Department of General Surgery, General Hospital of Western Theater Command (Chengdu Military General Hospital), China
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Federico P, Giunta EF, Pappalardo A, Tufo A, Marte G, Attademo L, Fabbrocini A, Petrillo A, Daniele B. How to Treat Hepatocellular Carcinoma in Elderly Patients. Pharmaceuticals (Basel) 2021; 14:233. [PMID: 33800217 PMCID: PMC8001824 DOI: 10.3390/ph14030233] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 02/08/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the primary tumour of the liver with the greatest incidence, particularly in the elderly. Additionally, improvements in the treatments for chronic liver diseases have increased the number of elderly patients who might be affected by HCC. Little evidence exists regarding HCC in old patients, and the elderly are still underrepresented and undertreated in clinical trials. In fact, this population represents a complex subgroup of patients who are hard to manage, especially due to the presence of multiple comorbidities. Therefore, the choice of treatment is mainly decided by the physician in the clinical practice, who often tend not to treat elderly patients in order to avoid the possibility of adverse events, which may alter their unstable equilibrium. In this context, the clarification of the optimal treatment strategy for elderly patients affected by HCC has become an urgent necessity. The aim of this review is to provide an overview of the available data regarding the treatment of HCC in elderly patients, starting from the definition of "elderly" and the geriatric assessment and scales. We explain the possible treatment choices according to the Barcelona Clinic Liver Cancer (BCLC) scale and their feasibility in the elderly population.
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Affiliation(s)
- Piera Federico
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (E.F.G.); (A.P.); (L.A.); (A.F.); (A.P.); (B.D.)
| | - Emilio Francesco Giunta
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (E.F.G.); (A.P.); (L.A.); (A.F.); (A.P.); (B.D.)
- Department of Precision Medicine, School of Medicine, University of Study of Campania “L. Vanvitelli”, 80131 Napoli, Italy
| | - Annalisa Pappalardo
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (E.F.G.); (A.P.); (L.A.); (A.F.); (A.P.); (B.D.)
- Department of Precision Medicine, School of Medicine, University of Study of Campania “L. Vanvitelli”, 80131 Napoli, Italy
| | - Andrea Tufo
- Surgical Unit, Ospedale del Mare, 80147 Napoli, Italy; (A.T.); (G.M.)
| | - Gianpaolo Marte
- Surgical Unit, Ospedale del Mare, 80147 Napoli, Italy; (A.T.); (G.M.)
| | - Laura Attademo
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (E.F.G.); (A.P.); (L.A.); (A.F.); (A.P.); (B.D.)
| | - Antonietta Fabbrocini
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (E.F.G.); (A.P.); (L.A.); (A.F.); (A.P.); (B.D.)
| | - Angelica Petrillo
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (E.F.G.); (A.P.); (L.A.); (A.F.); (A.P.); (B.D.)
- Department of Precision Medicine, School of Medicine, University of Study of Campania “L. Vanvitelli”, 80131 Napoli, Italy
| | - Bruno Daniele
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (E.F.G.); (A.P.); (L.A.); (A.F.); (A.P.); (B.D.)
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Liver resections for colorectal liver metastases in elderly patients. Eur Surg 2020. [DOI: 10.1007/s10353-020-00685-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Lallement M, Maulat C, Suc B, Péré G, Lozano S, Bérard E, Muscari F. Short-term autonomy and survival after hepatectomy in the elderly. J Visc Surg 2020; 157:378-386. [PMID: 31980381 DOI: 10.1016/j.jviscsurg.2020.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AIM To study morbi-mortality, survival after hepatectomy in elderly patients, and influence on their short-term autonomy. PATIENTS AND METHODS This is a retrospective study conducted between 2002 and 2017 comparing patients less than 65 years old (controls) to those more than 65 years old (cases) from a prospective database, with retrospective collection of geriatric data. Cases were divided into three sub-groups (65-70 years, 70-80 years and>80 years). RESULTS Four hundred and eighty-two patients were included. There was no age difference in number of major hepatectomies (P=0.5506), length of stay (P=0.3215), mortality at 90 days (P=0.3915), and surgical complications (P=0.1467). There were more Grade 1 Clavien medical complications among the patients aged over 65 years (P=0.1737). There was no difference in overall survival (P=0.460) or disease-free survival (P=0.108) according to age after adjustment for type of disease and hepatectomy. One-third of patients had geriatric complications. The "home discharge" rate decreased significantly with age from 92% to 68% (P=0.0001). Early loss of autonomy after hospitalization increased with age, 16% between 65 and 70 years, 23% between 70 and 80 years and 36% after 80 years (P=0.10). We identified four independent predictors of loss of autonomy: age>70 years, cholangiocarcinoma, length of stay>10 days, and metachronous colorectal cancer. CONCLUSIONS Elderly patients had the same management as young patients, with no difference in surgery or survival, but with an increase in early loss of autonomy.
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Affiliation(s)
- M Lallement
- Unité hépato-bilio-pancréatique et transplantation, département de chirurgie et de transplantation d'organes, CHU Rangueil, Toulouse, France.
| | - C Maulat
- Unité hépato-bilio-pancréatique et transplantation, département de chirurgie et de transplantation d'organes, CHU Rangueil, Toulouse, France
| | - B Suc
- Unité hépato-bilio-pancréatique et transplantation, département de chirurgie et de transplantation d'organes, CHU Rangueil, Toulouse, France
| | - G Péré
- Unité hépato-bilio-pancréatique et transplantation, département de chirurgie et de transplantation d'organes, CHU Rangueil, Toulouse, France
| | - S Lozano
- Unité de gériatrie et oncogériatrie, CHU Purpan, Toulouse, France
| | - E Bérard
- Service d'épidémiologie, pôle santé publique et médecine sociale, département d'épidémiologie, économie de la santé et santé publique, CHU de Toulouse, Inserm UMR 1027, Toulouse, France
| | - F Muscari
- Unité hépato-bilio-pancréatique et transplantation, département de chirurgie et de transplantation d'organes, CHU Rangueil, Toulouse, France
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Longbotham D, Young A, Nana G, Feltbower R, Hidalgo E, Toogood G, Lodge PA, Attia M, Rajendra Prasad K. The impact of age on post-operative liver function following right hepatectomy: a retrospective, single centre experience. HPB (Oxford) 2020; 22:151-160. [PMID: 31337601 DOI: 10.1016/j.hpb.2019.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/30/2019] [Accepted: 06/20/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND An increasing number of patients undergoing liver resection are of advancing age. The impact of ageing on liver regeneration and post-operative outcomes following a major resection are uncertain. We aimed to investigate risk factors for patients who developed Post Hepatectomy Liver Failure (PHLF) following right hepatectomy with age as the primary risk-factor. METHOD Patients undergoing right hepatectomy between July 2004-July 2018 were included. ROC analysis was performed to identify at which age PHLF development-risk increased. Secondary endpoints were length of stay (LOS), complications, and cost. RESULTS 332-patients were included. ROC demonstrated a cut-off age of 75-years in which PHLF risk increased. >75 there was an increased risk of PHLF (35% >75yrs vs. 7% <75yrs (p = <0.001), OR = 8.8 (95% CI = 3.6-21)) There was no difference between the age groups for any other PHLF risk factor. Patients >75yrs had longer LOS (11-days vs. 7-days (p = 0.04). Patients who developed PHLF had increased hospital costs: £10,987.50 (£6175-£46,050) vs. £2575 (£900-£46,050 p = 0.01). CONCLUSIONS Patients >75yrs have increased risk of developing PHLF after right hepatectomy, contributing to increased mortality and economic burden. Pre-operatively identifying patients at-risk of PHLF is important to consider liver volume optimization strategies and improve outcomes.
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Affiliation(s)
- David Longbotham
- Division of Surgery, Department of Hepatobiliary and Transplantation Surgery St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, United Kingdom
| | - Alastair Young
- Division of Surgery, Department of Hepatobiliary and Transplantation Surgery St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, United Kingdom
| | - Gael Nana
- Division of Surgery, Department of Hepatobiliary and Transplantation Surgery St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, United Kingdom
| | - Richard Feltbower
- Division of Epidemiology and Biostatistics, University of Leeds, Leeds, LS2 9JT, United Kingdom
| | - Ernest Hidalgo
- Division of Surgery, Department of Hepatobiliary and Transplantation Surgery St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, United Kingdom
| | - Giles Toogood
- Division of Surgery, Department of Hepatobiliary and Transplantation Surgery St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, United Kingdom
| | - Peter A Lodge
- Division of Surgery, Department of Hepatobiliary and Transplantation Surgery St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, United Kingdom
| | - Magdy Attia
- Division of Surgery, Department of Hepatobiliary and Transplantation Surgery St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, United Kingdom.
| | - K Rajendra Prasad
- Division of Surgery, Department of Hepatobiliary and Transplantation Surgery St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, United Kingdom
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Preoperative Risk Assessment for Loss of Independence Following Hepatic Resection in Elderly Patients: A Prospective Multicenter Study. Ann Surg 2019; 274:e253-e261. [PMID: 31460876 DOI: 10.1097/sla.0000000000003585] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To establish a preoperative risk assessment method for loss of independence after hepatic resection. SUMMARY BACKGROUND DATA Hepatic resection often results in loss of independence in preoperatively self-sufficient elderly people. Elderly patients should therefore be carefully selected for surgery. METHODS In this prospective, multicenter study, 347 independently-living patients aged ≥65 years, scheduled for hepatic resection, were divided into study (n = 232) and validation (n = 115) cohorts. We investigated the risk factors for postoperative loss of independence in the study cohort and verified our findings with the validation cohort. Loss of independence was defined as transfer to a rehabilitation facility, discharge to residence with home-based healthcare, 30-day readmission for poor functionality, and 90-day mortality (except for cancer-related deaths). RESULTS In the study cohort, univariate and multivariate analyses indicated that frailty, age ≥ 76 years, and open surgery were independent risk factors for postoperative loss of independence. Proportions of patients with postoperative loss of independence in the study and validation cohorts were respectively 3.0% and 0% among those with no applicable risk factors, 8.1% and 12.5% among those with 1 applicable risk factor, 25.5% and 25.0% among those with 2 applicable risk factors, and 56.3% and 50.0% among those with all 3 factors applicable (P < 0.001 for both cohorts). Areas under the receiver operating characteristic curves for the study and validation groups were 0.777 and 0.783, respectively. CONCLUSIONS Preoperative risk assessments using these 3 factors may be effective in predicting and planning for postoperative loss of independence after hepatic resection in elderly patients.
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Katz M, Silverstein N, Coll P, Sullivan G, Mortensen EM, Sachs A, Gross JB, Girard E, Liang J, Ristau BT, Stevenson C, Smith PP, Shames BD, Millea R, Ali I, Poulos CM, Ramaraj AB, Otukoya AO, Nolan J, Wahla Z, Hardy C, Al-Naggar I, Bliss LA, McFadden DW. Surgical care of the geriatric patient. Curr Probl Surg 2019; 56:260-329. [DOI: 10.1067/j.cpsurg.2019.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 03/13/2019] [Indexed: 12/15/2022]
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Tufo A, Dunne DFJ, Manu N, Lacasia C, Jones L, de Liguori Carino N, Malik HZ, Poston GJ, Fenwick SW. Changing outlook for colorectal liver metastasis resection in the elderly. Eur J Surg Oncol 2019; 45:635-643. [DOI: 10.1016/j.ejso.2018.11.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/01/2018] [Accepted: 11/30/2018] [Indexed: 12/14/2022] Open
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Sotiropoulos GC, Machairas N, Kostakis ID. Case Report: Laparoscopic hepatectomy in an elderly patient with major comorbidities. F1000Res 2018; 6:1286. [PMID: 29333234 DOI: 10.12688/f1000research.12078.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2017] [Indexed: 01/22/2023] Open
Abstract
Surgeons have been hesitant to proceed to hepatectomy in elderly patients, due to the higher rate of comorbidities and the reduced reserves. An 81-year-old male with hepatocellular carcinoma in the segment VI of the liver and several major cardiovascular, pulmonary and metabolic comorbid illnesses was referred to our department for treatment. He underwent transarterial chemoembolization of the liver tumor and afterwards he underwent laparoscopic resection of the hepatic segment VI, with an uneventful postoperative course. This case indicates that laparoscopic liver resections could be applied even to elderly patients with major comorbidities after optimization of their medical status.
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Affiliation(s)
- Georgios C Sotiropoulos
- Second Department of Propedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Nikolaos Machairas
- Second Department of Propedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Ioannis D Kostakis
- Second Department of Propedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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11
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Sotiropoulos GC, Machairas N, Kostakis ID. Case Report: Laparoscopic hepatectomy in an elderly patient with major comorbidities. F1000Res 2018; 6:1286. [PMID: 29333234 PMCID: PMC5747337 DOI: 10.12688/f1000research.12078.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2017] [Indexed: 11/20/2022] Open
Abstract
Surgeons have been hesitant to proceed to hepatectomy in elderly patients, due to the higher rate of comorbidities and the reduced reserves. An 81-year-old male with hepatocellular carcinoma in the segment VI of the liver and several major cardiovascular, pulmonary and metabolic comorbid illnesses was referred to our department for treatment. He underwent transarterial chemoembolization of the liver tumor and afterwards he underwent laparoscopic resection of the hepatic segment VI, with an uneventful postoperative course. This case indicates that laparoscopic liver resections could be applied even to elderly patients with major comorbidities after optimization of their medical status.
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Affiliation(s)
- Georgios C Sotiropoulos
- Second Department of Propedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Nikolaos Machairas
- Second Department of Propedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Ioannis D Kostakis
- Second Department of Propedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Orcutt ST, Massarweh NN, Li LT, Artinyan A, Richardson PA, Albo D, Anaya DA. Patterns of Care for Colorectal Liver Metastasis Within an Integrated Health System: Secular Trends and Outcomes. Ann Surg Oncol 2016; 24:23-30. [PMID: 27342829 DOI: 10.1245/s10434-016-5351-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Utilization of evidence-based treatments for patients with colorectal liver metastasis (CRC-LM) outside high-volume centers is not well-characterized. We sought to describe trends in treatment and outcomes, and identify predictors of therapy within a nationwide integrated health system. METHODS Observational cohort study of patients with CRC-LM treated within the Veterans Affairs (VA) health system (1998-2012). Secular trends and outcomes were compared on the basis of treatment type. Multivariate regression was used to identify predictors of no treatment (chemotherapy or surgery). RESULTS Among 3270 patients, 57.3 % received treatment (chemotherapy and/or surgery) during the study period. The proportion receiving treatment doubled (38 % in 1998 vs. 68 % in 2012; trend test, p < 0.001), primarily driven by increased use of chemotherapy (26 vs. 57 %; trend test, p < 0.001). Among patients having surgery (16 %), the proportion having ablation (10 vs. 61.9 %; trend test, p < 0.001) and multimodality therapy (15 vs. 67 %; trend test, p < 0.001) increased significantly over time. Older patients [65-75 years: odds ratio (OR) 1.65, 95 % confidence interval (CI) 1.39-1.97; >75 years: OR 3.84, 95 % CI 3.13-4.69] and those with high comorbidity index (Charlson ≥3: OR 1.47, 95 % CI 1.16-1.85) were more likely to be untreated. Overall survival was significantly different based on treatment strategy (log-rank p < 0.001). CONCLUSIONS The proportion of CRC-LM patients receiving treatment within the largest integrated health system in the US (VA health system) has increased substantially over time; however, one in three patients still does not receive any treatment. Future initiatives should focus on increasing treatment among older patients as well as on evaluating reasons leading to the no-treatment approach and increased use of ablation procedures.
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Affiliation(s)
- Sonia T Orcutt
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Nader N Massarweh
- Veterans Affairs Health Services Research & Development Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Linda T Li
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Avo Artinyan
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Peter A Richardson
- Veterans Affairs Health Services Research & Development Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Daniel Albo
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Daniel A Anaya
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA. .,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
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13
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Shutt TA, Philips P, Scoggins CR, McMasters KM, Martin RCG. Permanent Loss of Preoperative Independence in Elderly Patients Undergoing Hepatectomy: Key Factor in the Informed Consent Process. J Gastrointest Surg 2016; 20:936-44. [PMID: 26811246 DOI: 10.1007/s11605-015-3069-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 12/29/2015] [Indexed: 01/31/2023]
Abstract
PURPOSE Major (>3 segments of the liver) or minor hepatectomy has been demonstrated to provide the most definitive chance for long-term remission and disease-free survival in hepatic malignancies. However, concerns remain in regards to the ability of the elderly (>70 years old) and older (>80 years old) patients to "tolerate" this type of resection. Thus, the aim of this study was to determine the short- and long-term effects of hepatectomies in the elderly patient population. METHODS An Institutional Review Board approved a prospectively maintained, single-institution HPB database with 663 consecutive hepatectomies from 2003 to 2013 was reviewed. Patients were separated into elderly (>70 years old) and older. Short-term effects were defined as a 30-day morbidity/mortality, and long-term effects were defined as a 90-day morbidity/mortality and the ability to regain preoperative functional independence. Comorbidities were compared using the Charleston Comorbidity Index (CCI). The log-rank and Wilcoxon tests were used to evaluate postoperative outcomes. RESULTS A total of 663 patients were reviewed, 480 < 70y/o, 183 were 70 or older, 104 were 75 or older, and 41 were 80 or older. Patients over 70, 75, and 80 years of age showed a higher incidence of preoperative comorbidities than younger patients when compared using CCI (P < 0.05). Non-elderly patients had more liver lesions than elderly patients (median numbers only 3 vs. 1, P = 0.005). Patients over 70, 75, and 80 years old showed a higher 90-day mortality rate patients (11, 13, 17 %, respectively) to patients less than 70, 75 and 80 (3, 5, 5 %, respectively, P < 0.05) (Table). Patients over 70, 75, and 80 years old showed increased morbidity (53, 57, 66 %, respectively) than patients less than 70, 75, and 80 (39, 34, 41 %, respectively, P < 0.05). The severity of complication in elderly patients was similar to younger patients. Patients older than 70, 75, and 80 years showed an increased incidence of discharge to rehabilitation facilities (13, 15, 17 %, respectively) than patients less than 70, 75, and 80 (2, 3, 5 %, respectively, P = <0.001). Logistic regression demonstrated a significant risk of morbidity with an inability to return to preoperative function with a CCI > 5, major hepatectomy, and >75 years of age (HR 3.8, CI 2.1-5.6) CONCLUSIONS: This study demonstrates an increased rate of a 30- and 90-day postoperative mortality in >75-year old patients. Permanent loss of preoperative function (i.e., ability to live independently or alone) remains a significant risk and a subset of older patients. Communicating this loss of function as well as morbidity/mortality is key to the informed consent process for older patients as well as their families.
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Affiliation(s)
- Travis A Shutt
- School of Medicine, University of Louisville, Louisville, KY, USA
| | - Prejesh Philips
- Department of Surgery, Division of Surgical Oncology, University of Louisville, Louisville, KY, USA
| | - Charles R Scoggins
- Department of Surgery, Division of Surgical Oncology, University of Louisville, Louisville, KY, USA
| | - Kelly M McMasters
- Department of Surgery, Division of Surgical Oncology, University of Louisville, Louisville, KY, USA
| | - Robert C G Martin
- Department of Surgery, Division of Surgical Oncology, University of Louisville, Louisville, KY, USA.
- Division of Surgical Oncology, Upper GI and HPB Multi-Disciplinary Clinic, University of Louisville, 315 E. Broadway-M10-Rm #312, Louisville, KY, 40202, USA.
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Massarweh NN, Li LT, Sansgiry S, Berger DH, Anaya DA. Primary Tumor Resection and Multimodality Treatment for Patients with Metastatic Colon Cancer. Ann Surg Oncol 2016; 23:1815-23. [DOI: 10.1245/s10434-015-5073-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Indexed: 12/16/2022]
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