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Li S, Ren W, Ye X, Zhang L, Song B, Guo Z, Bian Q. An online-predictive model of acute kidney injury after pancreatic surgery. Am J Surg 2024; 228:151-158. [PMID: 37716826 DOI: 10.1016/j.amjsurg.2023.09.006] [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: 07/13/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVE Acute kidney injury(AKI) after pancreatic surgery is associated with increased mortality, longer hospital stays and poor prognosis. This study aims to identify the risk factors and establish an easy-to-use prediction calculator by the nomogram to predict the risk of AKI after pancreatic surgery. METHODS From January 2016 to June 2018, 1504 patients who underwent pancreatic surgery in our center were included in this retrospective analysis and randomly assigned to primary (1054 patients) and validation (450 patients) cohorts. The independent risk factors of AKI were identified using univariate and multivariate analyses. A risk-predicted nomogram for AKI was developed through multivariate logistic regression analysis in the primary cohort while the nomogram was evaluated in the validation cohort. Nomogram discrimination and calibration were assessed using C-index and calibration curves in the primary and validation cohorts. The clinical utility of the final nomogram was evaluated using decision curve analysis. RESULTS The overall incidence of AKI after pancreatic surgery was 5.3% (79/1504). Independent risk factors including smoking history, cardiovascular disease, ASA score, baseline eGFR, bilirubin>2 mg/dL, undergoing pancreaticoduodenectomy, and intraoperative blood loss>400 mL were identified by multivariate analysis. Nomogram revealed moderate discrimination and calibration in estimating the risk of AKI, with an unadjusted C-index of 0.79 (95 %CI, 0.73-0.85). Application of the nomogram in the validation cohort provided moderate discrimination (C-index,0.80 [95% CI, 0.72-0.88]) and good calibration. Besides, the decision curve analysis (DCA) confirmed the clinical usefulness of the nomogram. CONCLUSIONS An easy-to-use online prediction calculator comprised of preoperative and intraoperative factors was able to individually predict the occurrence risk of AKI among patients with pancreatic surgery, which may help identify reasonable risk judgments and develop proper treatment strategies to a certain extent.
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Affiliation(s)
- Siqian Li
- Department of Nephrology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Weifu Ren
- Department of Nephrology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Xiaofei Ye
- Department of Health Statistics, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Linyan Zhang
- Department of Nephrology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Bin Song
- Department of Hepatopancreatobiliary Surgery, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Zhiyong Guo
- Department of Nephrology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Qi Bian
- Department of Nephrology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China.
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Fantone S, Piani F, Olivieri F, Rippo MR, Sirico A, Di Simone N, Marzioni D, Tossetta G. Role of SLC7A11/xCT in Ovarian Cancer. Int J Mol Sci 2024; 25:587. [PMID: 38203758 PMCID: PMC10779187 DOI: 10.3390/ijms25010587] [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: 11/18/2023] [Revised: 12/21/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
Ovarian cancer is one of the most dangerous gynecologic cancers worldwide and has a high fatality rate due to diagnosis at an advanced stage of the disease as well as a high recurrence rate due to the occurrence of chemotherapy resistance. In fact, chemoresistance weakens the therapeutic effects, worsening the outcome of this pathology. Solute Carrier Family 7 Member 11 (SLC7A11, also known as xCT) is the functional subunit of the Xc- system, an anionic L-cystine/L-glutamate antiporter expressed on the cell surface. SLC7A11 expression is significantly upregulated in several types of cancers in which it can inhibit ferroptosis and favor cancer cell proliferation, invasion and chemoresistance. SLC7A11 expression is also increased in ovarian cancer tissues, suggesting a possible role of this protein as a therapeutic target. In this review, we provide an overview of the current literature regarding the role of SLC7A11 in ovarian cancer to provide new insights on SLC7A11 modulation and evaluate the potential role of SLC7A11 as a therapeutic target.
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Affiliation(s)
- Sonia Fantone
- Scientific Direction, IRCCS INRCA, 60124 Ancona, Italy; (S.F.); (F.O.)
| | - Federica Piani
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy;
| | - Fabiola Olivieri
- Scientific Direction, IRCCS INRCA, 60124 Ancona, Italy; (S.F.); (F.O.)
- Department of Clinical and Molecular Sciences, DISCLIMO, Università Politecnica delle Marche, 60126 Ancona, Italy;
| | - Maria Rita Rippo
- Department of Clinical and Molecular Sciences, DISCLIMO, Università Politecnica delle Marche, 60126 Ancona, Italy;
| | - Angelo Sirico
- Obstetrics and Gynecology Unit, Sant’Anna e San Sebastiano Hospital, 81100 Caserta, Italy;
| | - Nicoletta Di Simone
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Daniela Marzioni
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, 60126 Ancona, Italy;
| | - Giovanni Tossetta
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, 60126 Ancona, Italy;
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3
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So KA, Shim SH, Lee SJ, Kim TJ. Surgical Treatment Outcomes of Gynecologic Cancer in Older Patients: A Retrospective Study. J Clin Med 2023; 12:jcm12072518. [PMID: 37048601 PMCID: PMC10094859 DOI: 10.3390/jcm12072518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/15/2023] [Accepted: 03/26/2023] [Indexed: 03/29/2023] Open
Abstract
This study aimed to evaluate oncologic characteristics and surgical outcomes in older patients with gynecologic cancers. This retrospective study included patients aged ≥65 years who were diagnosed with gynecologic cancers and underwent surgical treatment between 2005 and 2020. We reviewed the medical records for age at diagnosis, body mass index, American Society of Anesthesiologists score, comorbidities, postoperative complications, cancer stage, histologic type, surgical treatment, postoperative outcome, and survival rate. Data were compared between groups according to the age at the time of diagnosis: <75 years (young-old) and ≥75 years (old-old). In total, 131 patients were identified: 53 (40.5%) with ovarian or primary peritoneal cancer (OC), 44 (33.6%) with endometrial cancer (EC), 30 (22.9%) with cervical cancer, and 4 (3.1%) with leiomyosarcoma. The patients’ mean age was 70 (range, 65–83) years; 106 (80.9%) were young-old and 25 (19.1%) were old-old. Postoperative complications occurred in 19 (14.5%) patients. Four patients died within six months after surgery, and three died because of disease progression. There was no difference in the survival rates between the two groups among those with OC and EC. Older patients with gynecologic cancers showed good surgical outcomes and tolerable postoperative complications. Therefore, we can safely offer surgical treatment to older patients.
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Jiao P, Wu F, Wu J, Sun Y, Tian W, Yu H, Huang C, Li D, Wu Q, Ma C, Tong H. Surgical safety analysis and clinical experience sharing of myasthenia gravis patients aged 65 and over. Thorac Cancer 2023; 14:717-723. [PMID: 36691325 PMCID: PMC10008675 DOI: 10.1111/1759-7714.14799] [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: 11/04/2022] [Revised: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND To evaluate the surgical safety in myasthenia gravis (MG) patients aged 65 and over. METHODS A total of 564 patients with MG who underwent surgery in the Department of Thoracic Surgery of Beijing Hospital from November 2011 to March 2022 were included in the study and divided into two groups taking the age of 65 as the boundary. Perioperative data of patients were recorded and statistically analyzed. RESULTS Compared with young patients, FEV1, FEV1% and MVV in lung function of elderly MG patients were worse (p < 0.001, p < 0.001, p = 0.002). Postoperative drainage time was longer (p < 0.001), combined with more drainage volume (p = 0.002). The American Society of Anesthesiologists (ASA) score of elderly MG patients was higher (p < 0.001). Complications were more likely to occur (p = 0.008) after surgery and Clavien-Dindo classification (CDC) of postoperative complications was also higher (p = 0.003). Meanwhile, postoperative myasthenic crisis (POMC) was more likely to occur (p = 0.038). Logistic regression showed that lower DLCO% (p = 0.049) was an independent risk factor for postoperative complications. CONCLUSIONS Surgical indications should be considered in each elderly MG patient on an individual basis. Moreover, most elderly MG patients safely survive the perioperative period and benefit from surgery through individualized consideration.
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Affiliation(s)
- Peng Jiao
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Fanjuan Wu
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiangyu Wu
- Department of medicine, Peking University, Beijing, China
| | - Yaoguang Sun
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Wenxin Tian
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Hanbo Yu
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Chuan Huang
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Donghang Li
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Qingjun Wu
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Chao Ma
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongfeng Tong
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Jiao P, Wu F, Liu Y, Wu J, Sun Y, Tian W, Yu H, Huang C, Li D, Wu Q, Ma C, Tong H. Analysis of influencing factors of perioperative myasthenic crisis in 387 myasthenia gravis patients without thymoma in a single center. J Cardiothorac Surg 2023; 18:20. [PMID: 36635776 PMCID: PMC9835247 DOI: 10.1186/s13019-023-02136-1] [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: 09/10/2022] [Accepted: 01/03/2023] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To study the influencing factors of myasthenic crisis in non-thymoma myasthenia gravis (MG) patients during perioperative period. METHODS We retrospectively analyzed a total of 387 non-thymoma MG patients who underwent extended thymoma resection in the Department of Thoracic Surgery of Beijing Hospital from February 2011 to December 2021, recorded ASA score, Osserman classification, preoperative course, pyridostigmine dosage, operation method, operation time, and intraoperative blood loss, then analyzed the factors associated with postoperative myasthenic crisis by univariate and multivariate logistic regression. RESULTS Osserman classification IIB + III + IV (P < 0.001), history of myasthenic crisis (P = 0.013), pyridostigmine dosage greater than 240 (P < 0.001), ASA score 2 and 3 (P = 0.001) are independent risk factors for myasthenic crisis. CONCLUSION Patients with poor Osserman classification, history of myasthenic crisis before surgery, larger preoperative dosage of pyridostigmine, and higher ASA scores should be highly alert to the occurrence of postoperative myasthenic crisis.
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Affiliation(s)
- Peng Jiao
- grid.506261.60000 0001 0706 7839Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Fanjuan Wu
- grid.506261.60000 0001 0706 7839Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Yuxing Liu
- grid.11135.370000 0001 2256 9319Department of Medicine, Peking University, Beijing, China
| | - Jiangyu Wu
- grid.11135.370000 0001 2256 9319Department of Medicine, Peking University, Beijing, China
| | - Yaoguang Sun
- grid.506261.60000 0001 0706 7839Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Wenxin Tian
- grid.506261.60000 0001 0706 7839Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Hanbo Yu
- grid.506261.60000 0001 0706 7839Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Chuan Huang
- grid.506261.60000 0001 0706 7839Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Donghang Li
- grid.506261.60000 0001 0706 7839Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Qingjun Wu
- grid.506261.60000 0001 0706 7839Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Chao Ma
- grid.506261.60000 0001 0706 7839Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Hongfeng Tong
- grid.506261.60000 0001 0706 7839Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
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Jiao P, Wu F, Liu Y, Wu J, Sun Y, Tian W, Yu H, Huang C, Li D, Wu Q, Ma C, Tong H. Analysis of influencing factors of postoperative myasthenic crisis in 564 patients with myasthenia gravis in a single center. Thorac Cancer 2023; 14:517-523. [PMID: 36594520 PMCID: PMC9925341 DOI: 10.1111/1759-7714.14774] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To study the influencing factors of myasthenic crisis in patients with myasthenia gravis during perioperative period. METHODS A total of 564 myasthenia gravis (MG) patients who underwent standard expanded resection of thymoma/thymoma in the Department of Thoracic Surgery of Beijing Hospital from January 2011 to March 2022 were retrospectively included in the study. Clinical indicators such as gender, age, thymoma, American Society of Anesthesiologists (ASA) score, operation time, intraoperative blood loss, and some others were recorded. RESULTS Osserman-stages IIB + III + IV (odds ratio [OR] 16.091, 95% confidence interval [CI] 5.170-50.076, p value < 0.001), the dosage of pyridostigmine bromide more than 240 mg (OR 6.462, 95% CI 3.110-13.427, p value < 0.001), ASA score 2 and 3 (OR 3.203, 95% CI 1.461-7.020, p value = 0.004), low diffusion lung capacity for carbon monoxide (DLCO%) (OR 0.981, 95% CI 0.963-1.000 p value = 0.049), and blood loss greater than 1000 ml (OR 16.590, 95% CI 1.911-144.011, p value = 0.011) were independent risk factors for myasthenic crisis. CONCLUSIONS Patients with poor Osserman stages, higher preoperative dosage of pyridostigmine bromide, higher ASA score, poor pulmonary function (low DLCO%), and more intraoperative bleeding should be highly vigilant for the occurrence of postoperative myasthenic crisis.
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Affiliation(s)
- Peng Jiao
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Fanjuan Wu
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Yuxing Liu
- Department of MedicinePeking UniversityBeijingChina
| | - Jiangyu Wu
- Department of MedicinePeking UniversityBeijingChina
| | - Yaoguang Sun
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Wenxin Tian
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Hanbo Yu
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Chuan Huang
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Donghang Li
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Qingjun Wu
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Chao Ma
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Hongfeng Tong
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
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Influence of interdisciplinary frailty screening on perioperative complication rates in elderly ovarian cancer patients: results of a retrospective observational study. Arch Gynecol Obstet 2022; 307:1929-1940. [PMID: 36434440 PMCID: PMC10147799 DOI: 10.1007/s00404-022-06850-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/06/2022] [Indexed: 11/27/2022]
Abstract
Abstract
Purpose
Frailty is a frequent and underdiagnosed multidimensional age-related syndrome, involving decreased physiological performance reserves and marked vulnerability against major stressors. To standardize the preoperative frailty assessment and identify patients at risk of adverse surgical outcomes, commonly used global health assessment tools were evaluated. We aimed to assess three interdisciplinary preoperative screening assessments to investigate the influence of frailty status with in-hospital complications irrespective of surgical complexity and radicality in older women with ovarian cancer (OC).
Methods
Preoperative frailty status was examined by the G8 geriatric screening tool (G8 Score-geriatric screening), Eastern Cooperative Oncology Group performance status (ECOG PS-oncological screening), and American Society of Anesthesiologists Physical Status System (ASA PS-anesthesiologic screening). The main outcome measures were the relationship between perioperative laboratory results, intraoperative surgical parameters and the incidence of immediate postoperative in-hospital complications with the preoperative frailty status.
Results
116 consecutive women 60 years and older (BMI 24.8 ± 5.2 kg/m2) with OC, who underwent elective oncological surgery in University Medical Center Mainz between 2008 and 2019 were preoperatively classified with the selected global health assessment tools as frail or non-frail. The rate of preoperative anemia (hemoglobin ≤ 12 g/dl) and perioperative transfusions were significantly higher in the G8-frail group (65.9% vs. 34.1%; p = 0.006 and 62.7% vs. 41.8%, p = 0.031; respectively). In addition, patients preoperatively classified as G8-frail exhibited significantly more postoperative clinical in-hospital complications (27.8% vs. 12.5%, p = 0.045) independent of chronological age and BMI. In contrast, ECOG PS and ASA PS did not predict the rates of postoperative complications (all p values > 0.05). After propensity score matching, the complication rate in the G8-frail cohort was approximately 1.7 times more common than in the G8-non-frail cohort.
Conclusion
Preoperative frailty assessment with the G8 Score identified elderly women with OC recording a significantly higher rate of postoperative in-hospital complications. In G8-frail patients, preoperative anemia and perioperative transfusions were significantly more recorded, regardless of chronological age, abnormal BMI and surgical complexity. Standardized preoperative frailty assessment should be added to clinical routine care to enhance risk stratification in older cancer individuals for surgical patient-centered decision-making.
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Luzarraga-Aznar A, Teixeira N, Luna-Guibourg R, Español P, Soler-Moreno C, Rovira R. Surgical treatment in older patients with endometrial cancer: A retrospective study. Surg Oncol 2022; 44:101852. [PMID: 36126351 DOI: 10.1016/j.suronc.2022.101852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/25/2022] [Accepted: 09/09/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Older patients (OP) diagnosed with endometrial cancer (EC) are less likely to receive an optimal surgical treatment compared with non-older patients (NOP). This undertreatment along with the presence of more aggressive tumours at diagnosis can explain the worse prognosis of EC in OP. There is limited evidence comparing perioperative outcomes between OP and NOP, and the benefit of applying complex procedures to OP is still controversial. The primary objective of the study was to compare intraoperative and postoperative complications between NOP and OP with EC that underwent primary surgery. Secondary objectives were to compare surgical management and survival rates. METHODS This is a retrospective single-centre observational study including women undergoing surgery for EC between 2010 and 2019. Patients were classified according to age as NOP (younger than 75 years) or OP (75 years or older). Basal characteristics and surgical outcomes of groups were compared using Chi-square, Fisher's exact tests, student T-tests or Mann Whitney tests. Kaplan Meier analysis was used to evaluate survival. RESULTS In total 281 patients underwent primary surgery for EC between 2010 and 2019 in our centre. At diagnosis, 184 patients were younger than 75 years while 97 were 75 and older. No differences were found in disease characteristics. Most of our patients (83,3%) underwent laparoscopic surgery. Pelvic (58,2% vs. 37,1%, p = 0,001) and para-aortic (46,7% vs. 23,7%, p < 0,001) lymphadenectomies were performed more frequently in NOP compared with OP. Rates of intra-operative (6,5% vs. 12,4%, p = 0,116) and post-operative (13,0% vs. 20,6%, p = 0,120) complications were not statistically different between NOP and OP, and neither was the rate of severe complications according to Clavien-Dindo classification (5,4% vs. 8,2% of complications grade III-V respectively, p = 0,387). The 5-year disease-specific survival (DSS) rate tended to be lower in the OP than in the NOP (74,8% vs. 82,5%, p = 0,071). Considering only patients in whom complete surgical staging was performed, OP presented similar DSS to NOP, with comparable complication rate. CONCLUSIONS OP do not present a significantly higher rate of perioperative complications compared to NOP. However, they underwent fewer lymphadenectomies and tended to present poorer DSS. Further studies are needed to standardize the surgical management of these patients.
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Affiliation(s)
- Ana Luzarraga-Aznar
- Department of Gynecology and Obstetrics, Hospital de la Santa Creu i de Sant Pau, C/Sant Quintí 89, 08041, Barcelona, Spain
| | - Natalia Teixeira
- Department of Gynecology and Obstetrics, Hospital de la Santa Creu i de Sant Pau, C/Sant Quintí 89, 08041, Barcelona, Spain
| | - Rocío Luna-Guibourg
- Department of Gynecology and Obstetrics, Hospital de la Santa Creu i de Sant Pau, C/Sant Quintí 89, 08041, Barcelona, Spain.
| | - Pia Español
- Department of Gynecology and Obstetrics, Hospital de la Santa Creu i de Sant Pau, C/Sant Quintí 89, 08041, Barcelona, Spain
| | - Cristina Soler-Moreno
- Department of Gynecology and Obstetrics, Hospital de la Santa Creu i de Sant Pau, C/Sant Quintí 89, 08041, Barcelona, Spain
| | - Ramon Rovira
- Department of Gynecology and Obstetrics, Hospital de la Santa Creu i de Sant Pau, C/Sant Quintí 89, 08041, Barcelona, Spain
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Sun Q, Jiang X, Qin R, Yang Y, Gong Y, Wang K, Peng J. Sarcopenia among older patients with cancer: A scoping review of the literature. J Geriatr Oncol 2022; 13:924-934. [DOI: 10.1016/j.jgo.2022.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/21/2022] [Accepted: 03/28/2022] [Indexed: 12/25/2022]
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10
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Damanti S, Colloca GF, Ferrini A, Consonni D, Cesari M. Sarcopenia (and sarcopenic obesity) in older patients with gynecological malignancies. J Geriatr Oncol 2020; 12:467-469. [PMID: 32994139 DOI: 10.1016/j.jgo.2020.09.014] [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] [Received: 04/17/2020] [Revised: 07/10/2020] [Accepted: 09/10/2020] [Indexed: 01/30/2023]
Abstract
Cancer is often complicated by the deterioration of both muscle mass and function, which may be more pronounced in older people. The prevalence of sarcopenia varies according to tumour type, stage and sarcopenia definition; in gynaecologic malignancies it ranges from 25 to 50%. Unfortunately, sarcopenia is often underdiagnosed especially in overweight and obese patients. The consequences of sarcopenia are serious: shorter time of tumour progression, increased chemotherapy-related toxicity, post-operative complications, poor functional status, hospitalisation, increased length of hospital stay, high 30-day readmission rate and mortality. Therefore, its precocious recognition and treatment is of paramount importance. We demonstrated that obesity can mask sarcopenia, taking into consideration a sample of older patient with cancer, unless body composition evaluation and comprehensive geriatric assessment, including measures of muscle strength and performance, is executed. Our work underlines the importance of a multidisciplinary approach to older patients with cancer to optimize their management.
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Affiliation(s)
- Sarah Damanti
- Nutritional Sciences PhD, University of Milan, Via Francesco Sforza 35, 20100 Milan, Italy; Unit of General Medicine and Advanced Care, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Giuseppe Ferdinando Colloca
- U.O.C. di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica e Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Alessandro Ferrini
- Area di Geriatria, Policlinico Universitario Campus Biomedico, Rome, Italy
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
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11
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Vitale SG, Capriglione S, Zito G, Lopez S, Gulino FA, Di Guardo F, Vitagliano A, Noventa M, La Rosa VL, Sapia F, Valenti G, Rapisarda AMC, Peterlunger I, Rossetti D, Laganà AS. Management of endometrial, ovarian and cervical cancer in the elderly: current approach to a challenging condition. Arch Gynecol Obstet 2018; 299:299-315. [PMID: 30542793 DOI: 10.1007/s00404-018-5006-z] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Gynaecological cancer management in older people represents a current challenge. Therefore, in the present paper, we aimed to gather all the evidence reported in the literature concerning gynecological cancers in the elderly, illustrating the state of art and the future perspectives. METHODS We searched MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials, IBECS, BIOSIS, Web of Science, SCOPUS and Grey literature (Google Scholar; British Library) from January 1952 to May 2017, using the terms "ovarian cancer", "endometrial cancer", "cervical cancer", "gynecological cancers" combined with 'elderly', 'cancer', 'clinical trial' and 'geriatric assessment'. RESULTS The search identified 81 citations, of which 65 were potentially relevant after initial evaluation and met the criteria for inclusion and were analyzed. We divided all included studies into three different issue: "Endometrial cancer", "Ovarian cancer" and "Cervical cancer". CONCLUSIONS The present literature review shows that, in spite of the higher burden of comorbidities, elderly patients can also benefit from standard treatment to manage their gynecological cancers. It is important to overcome the common habit of undertreating the elderly patients because they are more fragile and with a lower life expectancy than their younger counterpart. Further trials with elderly women are warranted.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Stella Capriglione
- Department of Obstetrics and Gynecology, Istituto per la Sicurezza Sociale, 47893, Cailungo-Borgo Maggiore, Republic of San Marino.
| | - Gabriella Zito
- Department of Obstetrics and Gynecology, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137, Trieste, Italy
| | - Salvatore Lopez
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, 06520, USA.,Department of Experimental and Clinical Medicine, Magna Graecia University, 88100, Catanzaro, Italy
| | | | - Federica Di Guardo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Via Tindaro 2, 95124, Catania, Italy
| | - Amerigo Vitagliano
- Department of Woman and Child Health, University of Padua, Via Giustiniani 3, 35128, Padua, Italy
| | - Marco Noventa
- Department of Woman and Child Health, University of Padua, Via Giustiniani 3, 35128, Padua, Italy
| | - Valentina Lucia La Rosa
- Unit of Psychodiagnostics and Clinical Psychology, University of Catania, Via Santa Sofia 78, 95124, Catania, Italy
| | - Fabrizio Sapia
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Via Santa Sofia 78, 95124, Catania, Italy
| | - Gaetano Valenti
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Via Santa Sofia 78, 95124, Catania, Italy
| | - Agnese Maria Chiara Rapisarda
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Via Santa Sofia 78, 95124, Catania, Italy
| | - Isabel Peterlunger
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy
| | - Diego Rossetti
- Unit of Gynecology and Obstetrics, Desenzano del Garda Hospital, Section of Gavardo, Via A. Gosa 74, 25085, Gavardo, Brescia, Italy
| | - Antonio Simone Laganà
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
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Safety of Immediate Posterior Trunk Soft-Tissue Reconstruction in Older Adults. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1326. [PMID: 28607854 PMCID: PMC5459637 DOI: 10.1097/gox.0000000000001326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/13/2017] [Indexed: 12/24/2022]
Abstract
Background: Older patients, especially those older than 65 years, are accounting for an ever-increasing share of hospital costs, especially surgical procedures. Studies regarding the safety of surgery in these patients have been widespread in the past decade. Despite these efforts, there is a paucity of information regarding the safety of reconstruction following spinal surgery in older patients. Methods: We conducted a retrospective cohort study of patients undergoing soft-tissue reconstruction of the posterior trunk after oncologic spine surgery. Demographic, medical, and surgical variables were measured. The primary outcome variable was the development of a medical or surgical complication postoperatively. Other secondary outcomes included development of a medical complication alone, specific surgical complications (seroma, hematoma, infection, wound dehiscence, and (cerebrospinal fluid leak), unplanned reoperation, and 60-day operative mortality. Results: A priori power analysis suggested 205 cases would be needed. The study included 286 cases in 256 patients. The cohorts were similar in terms of demographic, surgical, and medical variables, though the older cohort had higher mean American Society of Anesthesiologists score (2.09 versus 1.65; P < 0.0001). We found no correlation between increasing age and increased rates of medical or surgical complications (35.9% for older patients versus 44.7% for younger patients; P = 0.31). However, mean American Society of Anesthesiologists score did correlate with complications (1.88 for patients with complications versus 1.69 for patients without; P = 0.04). Conclusions: We demonstrated no increased risk for complications among older patients. Complex soft-tissue reconstruction of the posterior trunk is safe in elderly patients undergoing oncologic spinal surgery.
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Bourgin C, Saidani M, Poupon C, Cauchois A, Foucher F, Leveque J, Lavoue V. Endometrial cancer in elderly women: Which disease, which surgical management? A systematic review of the literature. Eur J Surg Oncol 2016; 42:166-75. [DOI: 10.1016/j.ejso.2015.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/13/2015] [Accepted: 11/01/2015] [Indexed: 02/02/2023] Open
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Endometrial Cancer Surgery for Elderly Women--The Early Postoperative Period. Int J Gynecol Cancer 2015; 25:1652-5. [PMID: 26332393 DOI: 10.1097/igc.0000000000000545] [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] Open
Abstract
OBJECTIVE The aim of this study was to examine the early postoperative period and assess whether elderly patients recuperate differently than do their younger counterparts after surgery for endometrial cancer. METHODS This retrospective chart review comprised all women older than 75 years who underwent laparotomy for endometrial cancer staging at our center from January 2005 through December 2010 and a consecutive control group of women younger than 74 years. Parameters included demographic variables, surgical procedure/findings, postoperative morbidity, and pathology. RESULTS Ninety patients older than 75 years and 88 younger patients were identified. The elderly patients had a statistically significant prolonged wait for bowel movement (5.9 vs 3.1 days, P = 0.002) and ambulated later (4.1 vs 1.1 days, P < 0.001). Postoperative hospital stay was similar in both groups (5.8 vs 4.2 days, P = 0.37). Early postoperative complications (fever, bowel, wound, eventration, cardiopulmonary) occurred at a similar rate in both groups. CONCLUSIONS Elderly patients after laparotomy for endometrial cancer staging ambulated later and recovered bowel function later than did the younger patients. This did not translate into prolonged hospital stay or excessive complications. Earlier intervention with physical therapy and stool softeners can possibly close this gap in recovery.
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Longer Operative Time During Benign Laparoscopic and Robotic Hysterectomy Is Associated With Increased 30-Day Perioperative Complications. J Minim Invasive Gynecol 2015; 22:1049-58. [DOI: 10.1016/j.jmig.2015.05.022] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 05/24/2015] [Accepted: 05/28/2015] [Indexed: 11/19/2022]
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Perioperative and postoperative morbidity after sacrocolpopexy according to age in Korean women. Obstet Gynecol Sci 2015; 58:59-64. [PMID: 25629020 PMCID: PMC4303754 DOI: 10.5468/ogs.2015.58.1.59] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/20/2014] [Accepted: 08/07/2014] [Indexed: 11/13/2022] Open
Abstract
Objective This study aimed to compare perioperative and postoperative morbidity of older and younger women undergoing sacrocolpopexy (SCP). Methods A retrospective study included 271 patients who underwent laparotomic SCP for symptomatic pelvic organ prolapse from November 2008 to June 2013 at our institution. By the review of medical records, perioperative and postoperative data including the length of the surgery, estimated blood loss, blood transfusion, the length of hospital stay, wound complications and febrile morbidity were collected. In addition, cardiovascular, pulmonary, gastrointestinal, genitourinary, or neurological adverse events were retrieved. The need for an indwelling urinary catheter or performance of clean intermittent self-catheterization, mesh erosion rate and the number of days required for each were included in the postoperative outcomes. For the outcome variable analyzed in this study, the patients was dichomotized into women aged 65 and older and those younger than 65. Results One hundred and thirty-five (49.8%) patients were younger than 65 and 136 (50.2%) were aged 65 and older. Older women had higher body mass index, vaginal parity and prior surgery for hysterectomy than younger women (P<0.05). And older women had higher baseline comorbidities, such as hypertension, diabetes, cardiac disease (P<0.05), and their American society of Anesthesiologist class was higher (P<0.001). In the perioperative and postoperative complication, older group showed no differences in most of the operation-related complication rates, but gastrointestinal complication rate. Also, mesh erosion rate was not found to be significantly different between the two groups at the last visit. Conclusion Older women undergoing laparotomic SCP have similar perioperative and postoperative morbidities as younger women, suggesting surgeons can counsel older and younger women similarly in terms of operative risks.
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Surgical treatment of elderly patients with endometrial cancer (≥65years). J Geriatr Oncol 2013; 4:368-73. [DOI: 10.1016/j.jgo.2013.07.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 02/26/2013] [Accepted: 07/11/2013] [Indexed: 11/18/2022]
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Greer JA, Northington GM, Harvie HS, Segal S, Johnson JC, Arya LA. Functional Status and Postoperative Morbidity in Older Women with Prolapse. J Urol 2013; 190:948-52. [DOI: 10.1016/j.juro.2013.03.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 03/01/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Joy A. Greer
- Division of Urogynecology, Department of Obstetrics and Gynecology and Division of Geriatric Medicine, Department of Internal Medicine, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, and Departments of Obstetrics and Gynecology and Surgery, University of Medicine and Dentistry of New Jersey, New
| | - Gina M. Northington
- Division of Urogynecology, Department of Obstetrics and Gynecology and Division of Geriatric Medicine, Department of Internal Medicine, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, and Departments of Obstetrics and Gynecology and Surgery, University of Medicine and Dentistry of New Jersey, New
| | - Heidi S. Harvie
- Division of Urogynecology, Department of Obstetrics and Gynecology and Division of Geriatric Medicine, Department of Internal Medicine, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, and Departments of Obstetrics and Gynecology and Surgery, University of Medicine and Dentistry of New Jersey, New
| | - Saya Segal
- Division of Urogynecology, Department of Obstetrics and Gynecology and Division of Geriatric Medicine, Department of Internal Medicine, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, and Departments of Obstetrics and Gynecology and Surgery, University of Medicine and Dentistry of New Jersey, New
| | - Jerry C. Johnson
- Division of Urogynecology, Department of Obstetrics and Gynecology and Division of Geriatric Medicine, Department of Internal Medicine, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, and Departments of Obstetrics and Gynecology and Surgery, University of Medicine and Dentistry of New Jersey, New
| | - Lily A. Arya
- Division of Urogynecology, Department of Obstetrics and Gynecology and Division of Geriatric Medicine, Department of Internal Medicine, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, and Departments of Obstetrics and Gynecology and Surgery, University of Medicine and Dentistry of New Jersey, New
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Byeon JS, Mann NK, Jamil LH, Lo SK. Double balloon enteroscopy can be safely done in elderly patients with significant co-morbidities. J Gastroenterol Hepatol 2012; 27:1831-6. [PMID: 23034065 DOI: 10.1111/j.1440-1746.2012.07284.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Performance of double balloon enteroscopy (DBE) on older patients with comorbidities is a matter of safety. We aimed to investigate the utility and safety of DBE in older patients. METHODS We retrospectively reviewed the medical records of patients 75 years or older who underwent DBE in our open-access endoscopy unit in a tertiary center. We analyzed the diagnostic yield, therapeutic intervention, and safety including complications of DBE. RESULTS Four scheduled DBEs were canceled because of poor conditions. Two hundred and fourteen DBEs were performed in 167 elderly patients. All DBEs were performed under monitored anesthesia care using intravenous propofol administered by anesthesiologists. One half of the patients were male (female : male = 80:87). The mean age of patients was 80.1 ± 3.7 years. Co-morbidity of significant chronic diseases was noted in 208 (97.2%) DBEs. Fifty-one (23.8%) DBEs were performed in patients with American Society of Anesthesiologists (ASA) physical status II, 151 (70.6%) DBEs with ASA class III, and 12 (5.6%) DBEs with ASA class IV. The most common indication was obscure gastrointestinal bleeding. The mean DBE procedure time was 131 ± 51 min. Abnormalities were detected in 129 (60.3%) DBEs with therapeutic interventions performed in 83 (38.8%) cases. Pancreatitis, hypoxia, and aspiration pneumonia developed after three (1.4%), three (1.4%), and two (0.9%) DBEs, respectively, all of which resolved with conservative care. CONCLUSIONS Double balloon enteroscopy can be done with acceptable safety in the elderly with high ASA class. DBE shows a high diagnostic yield and can deliver many therapeutic applications.
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Affiliation(s)
- Jeong-Sik Byeon
- David Geffen School of Medicine at UCLA, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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HITOS K, WAIN GV, FLETCHER JP. Venous thromboembolism following gynaecological surgery for suspected or confirmed malignancy. Aust N Z J Obstet Gynaecol 2011; 52:23-7. [DOI: 10.1111/j.1479-828x.2011.01353.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Clinical aspects of the management of elderly women diagnosed with gynecologic malignancies: Treatment decisions and choices. J Geriatr Oncol 2011. [DOI: 10.1016/j.jgo.2010.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Jeon SW, Choi JS, Lee JH, Son CE, Bae JW, Hong JH, Lee YS. Is laparoscopic surgery safe in women over 70 years old with benign gynecological disease? J Obstet Gynaecol Res 2011; 37:601-5. [DOI: 10.1111/j.1447-0756.2010.01465.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Malviya S, Voepel-Lewis T, Chiravuri SD, Gibbons K, Chimbira WT, Nafiu OO, Reynolds PI, Tait AR. Does an objective system-based approach improve assessment of perioperative risk in children? A preliminary evaluation of the 'NARCO'. Br J Anaesth 2011; 106:352-8. [PMID: 21258074 DOI: 10.1093/bja/aeq398] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study evaluated whether an objective tool would provide a more reliable and valid assessment of perioperative risk compared with the ASA-physical status (ASA-PS) in children. METHODS A system-based risk assessment tool was developed using these categories: Neurological, Airway, Respiratory, Cardiovascular, and Other (NARCO) with a subcomponent grading surgical severity (SS). Anaesthesiologists reviewed the preoperative assessments and assigned NARCO, SS, and ASA-PS scores independently. Perioperative outcomes were recorded by trained observers. Validity and reliability of the tools were evaluated. RESULTS NARCO correlated with ASA-PS (ρ=0.664; P<0.01) supporting its criterion validity. Inter-rater reliability of the measures was supported (intraclass correlation coefficients 0.71-0.96; κ 0.43-0.87) except for the Airway category. Measures of exact agreement were slightly better for NARCO compared with ASA-PS. NARCO, SS, and ASA-PS scores correlated significantly with perioperative escalation of care, adverse events (AE), hospital length of stay, and admission status. Correlations between NARCO and ASA-PS and outcomes improved when SS was factored into their coding. There were significant, but low, correlations between all measures and mortality. The odds of having escalation of care, AE, and mortality were 5-47 times greater among children with higher risk scores. CONCLUSIONS Findings suggest that all measures of outcome have acceptable to excellent reliability with a slight improvement in agreement for the NARCO compared with the ASA-PS. This study supports the validity of both the NARCO and the ASA-PS in predicting perioperative risk in children with a slight improvement in correlations when combined with the SS score.
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Affiliation(s)
- S Malviya
- The University of Michigan Health System, F3900 C.S. Mott Hospital SPC 5211, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5211, USA.
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Quality of life and mortality assessment in patients with major cardiac events in the postoperative period. Rev Bras Anestesiol 2011; 60:268-84. [PMID: 20682159 DOI: 10.1016/s0034-7094(10)70035-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Accepted: 02/08/2010] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Cardiovascular complications in the postoperative period are associated with high mortality and morbidity. Few studies have assessed the degree of dependence in these patients and their perception of health. The objective of this study was to assess the mortality and the quality of life in patients who developed major cardiac events (MCE) in the postoperative period. METHOD Retrospective study carried out in a Surgical Intensive Care Unit (SICU), between March 2006 and March 2008. The patients were assessed regarding the occurrence of CE. Six months after the hospital discharge, the Short-Form-36 (SF-36) questionnaire was filled out and dependence was assessed in relation to activities of daily living (ADL). The comparisons between independent groups of patients were carried out using Student's t test. The comparison between each variable and the occurrence of CE was carried out by logistic regression and included all patients. RESULTS Of the 1,280 patients that met the inclusion criteria, 26 (2%) developed MCE. The univariate analysis identified as independent determinants for the development of major cardiac events: ASA physical status, hypertension, ischemic heart disease, congestive heart disease and score of the Revised Cardiac Risk Index (RCRI). The six-month mortality after the SICU discharge was 35%. Of the 17 surviving patients, 13 completed the questionnaires. Thirty-one percent of them reported that their general health was better on the day they answered the questionnaire, when compared to 12 months before. Sixty-nine percent of the patients were dependent in instrumental ADL e 15% in personal ADL. CONCLUSIONS The development of MCE has a significant impact on the duration of hospital stay and mortality rates. Six months after the discharge from the SICU, more than 50% of the patients were dependent in at least one instrumental ADL.
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Age as a Risk Factor for Perioperative Complications in Women Undergoing Pelvic Reconstructive Surgery. Female Pelvic Med Reconstr Surg 2010; 16:290-5. [DOI: 10.1097/spv.0b013e3181e128b6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vaknin Z, Ben-Ami I, Schneider D, Pansky M, Halperin R. A Comparison of Perioperative Morbidity, Perioperative Mortality, and Disease-Specific Survival in Elderly Women (≥70 Years) Versus Younger Women (<70 Years) With Endometrioid Endometrial Cancer. Int J Gynecol Cancer 2009; 19:879-83. [DOI: 10.1111/igc.0b013e3181a73a12] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abelha FJ, Botelho M, Fernandes V, Barros H. Determinants of postoperative acute kidney injury. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2009; 13:R79. [PMID: 19463152 PMCID: PMC2717442 DOI: 10.1186/cc7894] [Citation(s) in RCA: 207] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 04/21/2009] [Accepted: 05/22/2009] [Indexed: 02/08/2023]
Abstract
Introduction Development of acute kidney injury (AKI) during the perioperative period is associated with increases in morbidity and mortality. Our aim was to evaluate the incidence and determinants of postoperative AKI after major noncardiac surgery in patients with previously normal renal function. Methods This retrospective cohort study was carried out in the multidisciplinary Post-Anaesthesia Care Unit (PACU) with five intensive care beds. The study population consisted of 1166 patients with no previous renal insufficiency who were admitted to these intensive care unit (ICU) beds over 2 years. After admission patients were followed for the development of AKI, defined as proposed by The Acute Kidney Injury Network (increment of serum creatinine [greater than or equal to] 0.3 mg/dL or 50% from baseline within 48 hours or urine output < 0.5 mL/kg/hr for > 6 hours despite fluid resuscitation when applicable). Patient preoperative characteristics, intraoperative management and outcome were evaluated for associations with acute kidney injury using an univariate and multiple logistic regression model. Results A total of 1597 patients were admitted to the PACU and of these, 1166 met the inclusion criteria. Eighty-seven patients (7.5%) met AKI criteria. Univariate analysis identified age, American Society of Anesthesiologists (ASA) physical status, emergency surgery, high risk surgery, ischemic heart disease, congestive heart disease and Revised Cardiac Risk Index (RCRI) score as independent preoperative determinants for AKI in the postoperative period. Multivariate analysis identified ASA physical status, RCRI score, high risk surgery and congestive heart disease as preoperative determinants for AKI in the postoperative period. Patients that developed AKI had higher Simplified Acute Physiology Score (SAPS) II and Acute Physiology and Chronic Health Evaluation (APACHE) II, higher PACU length of stay (LOS), higher PACU mortality, higher hospital mortality and higher mortality at 6 months follow-up. AKI was an independent risk factor for hospital mortality (OR 3.12, 95% CI 1.41 to 6.93, P = 0.005). Conclusions This study shows that age, emergency and high risk surgery, ischemic heart disease, congestive heart disease, ASA physical status and RCRI score were considered risk factors for the development of AKI, in patients needing intensive care after surgery. AKI has serious impact on PACU length of stay and mortality. AKI was an independent risk factor for hospital mortality.
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Affiliation(s)
- Fernando José Abelha
- Department of Anesthesiology, Hospital de São João, Alameda Professor Hernani Monteiro, Porto 4202-451, Portugal.
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Chiang S, Gerten KA, Granieri E, Richter HE. Pharmacologic management of the older woman undergoing surgery. WOMEN'S HEALTH (LONDON, ENGLAND) 2009; 5:205-19. [PMID: 19245357 PMCID: PMC3664943 DOI: 10.2217/17455057.5.2.205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Surgical intervention for both emergency and elective surgeries will increase as women live longer and maintain active lifestyles. Older women with operable conditions tolerate elective gynecologic and other nonvascular surgery with acceptable morbidity and mortality. However, increased medical comorbidities, with their associated increase in polypharmacy and perioperative risks as women age, make it important to a priori optimize perioperative medical conditions and medication management. Other considerations include assessing functional and cognitive status, since these may be impaired acutely with increased prevalence of drug use during surgical hospitalization. With aging and postmenopausal status, changes associated with aging appear to play a greater role than gender in pharmacologic responses. Surgical outcomes should be optimized to maintain and even improve women's quality of life.
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Affiliation(s)
- Seine Chiang
- University of Washington, Department of Obstetrics & Gynecology, Seattle, WA, USA.
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Rizwan ul Hasan M. The significance of the American Society of Anesthesiologists Physical Status classification in obstetrics and gynaecology. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.ogrm.2008.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abelha FJ, Santos CC, Barros H. Quality of life before surgical ICU admission. BMC Surg 2007; 7:23. [PMID: 17997828 PMCID: PMC2194661 DOI: 10.1186/1471-2482-7-23] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2007] [Accepted: 11/12/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Examining the quality of life (QOL) of patients before ICU admission will allow outcome variables to be compared and analyzed in relation to it. The objective of this study was to analyze QOL of patients before admission to a surgical ICU and to study its relationship to outcome and to the baseline characteristics of the patients. METHODS All adult patients consecutively admitted to the surgical ICU between November 2004 and April 2005, who underwent non-cardiac surgery, were enrolled in this observational and prospective study. The following patient characteristics were recorded: age, gender, body mass index, ASA physical status, type and magnitude of surgical procedure, length of stay (LOS), in ICU and in hospital, mortality, Simplified Acute Physiology Score II (SAPS), history of co-morbidities and quality of life survey score (QOLSS). The relationships between QOLSS and ICU variables and outcome were evaluated. The relationship between the total QOLSS and each variable or outcome was assessed by multiple linear regression. RESULTS One hundred eighty seven patients completed the study. The preadmission QOLSS of the patients studied was 4.43 +/- 4.90; 28% of patients had a normal quality of life (0 points), 38% had between 1 and 5 points (considered mild deterioration), 21% had between 6 and 10 points (moderate deterioration), 10% had between 11 and 15 points (considered major deterioration) and 3% had more than 15 points (severe limitation of quality of life). A worse preadmission QOLSS was associated with higher SAPS II scores, with older patients (age> 65 years) and with ASA physical status (ASA III/IV). Total QOLSS was significantly worse in elderly patients and in patients with co-morbidities and in patients more severely ill at ICU admission. Patients who died in the ICU and in hospital had worse QOLSS scores compared to those who survived. However, no statistical differences in QOLSS were found in relation to longer ICU stays (ICU LOS). CONCLUSION Preadmission QOL correlates with age and severity of illness. Patients with co-morbidities and those who died during ICU or hospital stay had worse QOLSS scores.
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Affiliation(s)
- Fernando J Abelha
- Department of Anesthesia and Intensive Care, Hospital de São João, Porto, Portugal.
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A review of the literature on post-operative pain in older cancer patients. Eur J Cancer 2007; 43:2222-30. [DOI: 10.1016/j.ejca.2007.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Revised: 08/01/2007] [Accepted: 08/01/2007] [Indexed: 10/22/2022]
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Abelha FJ, Santos CC, Maia PC, Castro MA, Barros H. Quality of life after stay in surgical intensive care unit. BMC Anesthesiol 2007; 7:8. [PMID: 17650325 PMCID: PMC1949812 DOI: 10.1186/1471-2253-7-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Accepted: 07/24/2007] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In addition to mortality, Health Related Quality of Life (HRQOL) has increasingly been claimed as an important outcome variable. The aim of this study was to assess HRQOL and independence in activities of daily living (ADL) six months after discharge from an Intensive Care Unit (ICU), and to study its determinants. METHODS All post-operative adult patients admitted to a surgical ICU between October 2004 and July 2005, were eligible for the study. The following variables were recorded on admission: age, gender, American Society of Anesthesiologists physical status (ASA-PS), type and magnitude of surgical procedure, ICU and hospital length of stay (LOS), mortality and Simplified Acute Physiology Score II (SAPS II). Six months after discharge, a Short Form-36 questionnaire (SF-36) and a questionnaire to assess dependency in ADL were sent to all survivors. Descriptive statistics was used to summarize data. Patient groups were compared using non-parametric tests. A logistic regression analysis was performed to identify covariate effects of each variable on dependency in personal and instrumental ADL, and for the change-in-health question of SF-36. RESULTS Out of 333 hospital survivors, 226 completed the questionnaires. Fifty-nine percent reported that their general level of health was better on the day they answered the questionnaire than 12 months earlier. Patients with greater co-morbidities (ASA-PS III/IV), had lower SF-36 scores in all domains and were more frequently dependent in instrumental and personal ADL. Logistic regression showed that SAPS II was associated with changes in general level of health (OR 1.06, 95%CI, 1.01-1.11, p = 0,016). Six months after ICU discharge, 60% and 34% of patients, respectively, were dependent in at least one activity in instrumental ADL (ADLI) and personal ADL (ADLP). ASA-PS (OR 3.00, 95%CI 1.31-6.87, p = 0.009) and age (OR 2.36, 95%CI, 1.04-5.34, p = 0.04) were associated with dependency in ADLI. For ADLP, only ASA-PS (OR 4.58, 95%CI, 1.68-12.46, p = 0.003) was associated with higher dependency. CONCLUSION ASA-PS, age, type of surgery, ICU LOS and SAPS II could be seen as determinants of HRQOL.
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Affiliation(s)
- Fernando J Abelha
- Department of Anesthesia and Intensive Care, Hospital de São João, Porto, Portugal
| | - Cristina C Santos
- Biostatistics and Medical Informatics Department, University of Porto Medical School, Porto, Portugal
| | - Paula C Maia
- Department of Anesthesia and Intensive Care, Hospital de São João, Porto, Portugal
| | - Maria A Castro
- Department of Anesthesia and Intensive Care, Hospital de São João, Porto, Portugal
| | - Henrique Barros
- Department of Hygiene and Epidemiology, University of Porto Medical School, Porto, Portugal
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Friedman WH, Gallup DG, Burke JJ, Meister EA, Hoskins WJ. Outcomes of octogenarians and nonagenarians in elective major gynecologic surgery. Am J Obstet Gynecol 2006; 195:547-52; discussion 552-3. [PMID: 16890555 DOI: 10.1016/j.ajog.2006.03.085] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Revised: 03/13/2006] [Accepted: 03/21/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether age is a risk factor for perioperative and postoperative complications. STUDY DESIGN This was a retrospective case-control study of 120 women over age 79 (group 1) compared with 1,497 younger patients 50-79 (group 2) undergoing major elective gynecologic surgery. RESULTS Mean length of stay was 4.8 days for group 1, compared with 3.8 for group 2 (P = .018). Patients hospitalized longer than 1 week was higher (P < .01) among group 1. There were statistically significant increases in UTI, psychiatric events, pulmonary edema, respiratory failure, sepsis, and hypovolemic shock. No significant difference in mortality rate was noted (group 1: 0.83%, n = 1 vs group 2: 0.47%, n = 7). CONCLUSION Although length of stay for the elderly is slightly increased, mortality and complication rates are comparable to younger patients with few exceptions. We conclude that age need not be the sole determinant in the decision to undergo major elective gynecologic surgery.
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Affiliation(s)
- Wayne H Friedman
- Department of Obstetrics and Gynecology, Memorial Health University Medical Center, Savannah, GA, USA.
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Davenport DL, Bowe EA, Henderson WG, Khuri SF, Mentzer RM. National Surgical Quality Improvement Program (NSQIP) risk factors can be used to validate American Society of Anesthesiologists Physical Status Classification (ASA PS) levels. Ann Surg 2006; 243:636-41; discussion 641-4. [PMID: 16632998 PMCID: PMC1570549 DOI: 10.1097/01.sla.0000216508.95556.cc] [Citation(s) in RCA: 206] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the relationship between the American Society of Anesthesiologists' Physical Status (ASA PS) classifications and the other National Surgical Quality Improvement Program (NSQIP) preoperative risk factors. BACKGROUND The ASA PS has been shown to predict morbidity and mortality in surgical patients but is inconsistently applied and clinically imprecise. It is desirable to have a method for validating ASA PS classification levels. METHODS The NSQIP preoperative risk factors, including ASA PS, were recorded from a random sample of 5878 surgical patients on 6 services between October 1, 2001 and September 30, 2003 at the University of Kentucky Medical Center. Mortality, morbidity, costs, and length of stay were obtained and compared across ASA PS levels. The ability of 1) ASA PS alone, 2) the other NSQIP risk factors, and, 3) all factors combined to predict outcomes was analyzed. A model using the other NSQIP risk factors was developed to predict ASA PS. RESULTS ASA PS alone was a strong predictor of outcomes (P < 0.01). However, the other NSQIP risk factors were better predictors as a group. There was significant interdependence between the ASA PS and the other NSQIP risk factors. Predictions of ASA PS using the other factors showed strong agreement with the anesthesiologists' assignments. CONCLUSIONS The NSQIP risk factors other than ASA PS can and should be used to validate ASA PS classifications.
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Ben-Ami I, Vaknin Z, Schneider D, Halperin R. Perioperative morbidity and mortality of gynecological oncologic surgery in elderly women. Int J Gynecol Cancer 2006; 16:452-7. [PMID: 16445678 DOI: 10.1111/j.1525-1438.2006.00478.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The study compares the perioperative morbidity and mortality rates of elderly (> or =70 years) and younger (< 70 years) patients. The study cohort consisted of 171 women undergoing explorative laparotomy due to uterine or ovarian cancer. Clinical data included patients' age, comorbidities, chronic use of medications, body mass index (kg/m(2)), past and current surgical procedures, surgical FIGO stage, histologic type and number of dissected lymph nodes, optimal versus nonoptimal debulking, occurrence of perioperative complications, and postoperative hospital stay (days). Participants were divided to 108 (63.2%) patients with uterine cancer and 63 (36.8%) patients with ovarian cancer. Women having uterine cancer were further subdivided to those <70 years of age (72 women, 66.7%) and those > or =70 years of age (36 women, 33.3%). Women with ovarian cancer were subdivided to those <70 years of age (48 women, 76.2%) and those > or =70 years of age (15 women, 23.8%). Excluding the occurrence of postoperative ileus and poorly controlled hypertension in the elderly subgroup of women with uterine cancer, the rate of early postoperative complications was similar between the two subgroups. Chronological age by itself should not be a contraindication for the treatment of elderly women with gynecological malignancy since it is a poor predicting factor for perioperative morbidity.
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Affiliation(s)
- I Ben-Ami
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin 70300, Israel.
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Stepp KJ, Barber MD, Yoo EH, Whiteside JL, Paraiso MFR, Walters MD. Incidence of perioperative complications of urogynecologic surgery in elderly women. Am J Obstet Gynecol 2005; 192:1630-6. [PMID: 15902169 DOI: 10.1016/j.ajog.2004.11.026] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the incidence of and risk factors for perioperative complications in elderly women who undergo urogynecologic surgery. STUDY DESIGN A retrospective chart review of patients > or = 75 years old who underwent urogynecologic surgery between January 1999 and December 2003 was performed. Demographics, comorbidities, and significant perioperative complications were recorded. The Charlson Comorbidity Index and American Society of Anesthesiologists classification were calculated to summarize the patients' overall perioperative risk. Logistic regression was used to identify independent risk factors for perioperative complications. RESULTS Two hundred sixty-seven patients who were > or = 75 years old met the inclusion criteria; 25.8% of the patients had a significant perioperative complication. The most common perioperative complication was blood transfusion or significant blood loss, pulmonary edema, and postoperative congestive heart failure. Independent risk factors that were predictive of a patient having a perioperative complication were the length of surgery, coronary artery disease, and peripheral vascular disease. The Charlson Comorbidity Index and American Society of Anesthesiologists classification did not predict perioperative complications in this population. CONCLUSION Pre-existing cardiovascular disease increases the risk of a significant perioperative complication in elderly women who undergo urogynecologic surgery. However, the overall perioperative morbidity rate in elderly women who undergo urogynecologic surgery is low.
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Affiliation(s)
- Kevin J Stepp
- Department of Obstetrics and Gynecology, The Cleveland Clinic Foundation, Ohio 44116, USA.
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