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Xu L, Wang W, Xu Y. A new risk calculation model for complications of hepatectomy in adults over 75. Perioper Med (Lond) 2024; 13:10. [PMID: 38409071 PMCID: PMC10898145 DOI: 10.1186/s13741-024-00366-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/13/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Owing to poor organ function reserve, older adults have a high risk of postoperative complications. However, there is no well-established system for assessing the risk of complications after hepatectomy in older adults. METHODS This study aimed to design a risk assessment tool to predict the risk of complications after hepatectomy in adults older than 75 years. A total of 326 patients were identified. A logistic regression equation was used to create the Risk Assessment System of Hepatectomy in Adults (RASHA) for the prediction of complications (Clavien‒Dindo classification ≥ II). RESULTS Multivariate correlation analysis revealed that comorbidity (≥ 5 kinds of disease or < 5 kinds of disease, odds ratio [OR] = 5.552, P < 0.001), fatigue (yes or no, OR = 4.630, P = 0.009), Child‒Pugh (B or A, OR = 4.211, P = 0.004), number of liver segments to be removed (≥ 3 or ≤ 2, OR = 4.101, P = 0.001), and adjacent organ resection (yes or no, OR = 1.523, P = 0.010) were independent risk factors for postoperative complications after hepatectomy in older persons (aged ≥ 75 years). A binomial logistic regression model was established to evaluate the RASHA score (including the RASHA scale and RASHA formula). The area under the curve (AUC) for the RASHA scale was 0.916, and the cut-off value was 12.5. The AUC for the RASHA formula was 0.801, and the cut-off value was 0.2106. CONCLUSION RASHA can be used to effectively predict the postoperative complications of hepatectomy through perioperative variables in adults older than 75 years. TRIAL REGISTRATION The Research Registry: researchregistry8531. https://www.researchregistry.com/browse-the-registry#home/registrationdetails/63901824ae49230021a5a0cf/ .
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Affiliation(s)
- Lining Xu
- Department of General Surgery, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853, China
| | - Weiyu Wang
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology On Transplantation, Wuhan, 430071, China.
| | - Yingying Xu
- Department of Internal Medicine, Henan Cancer Hospital, Zhengzhou, 450003, China
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Xu L, Xu Y, Li G, Yang B. Study on anxiety and depression in elderly patients with malignant liver tumor undergoing hepatectomy. Eur J Med Res 2023; 28:87. [PMID: 36803425 PMCID: PMC9940320 DOI: 10.1186/s40001-023-01040-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 02/02/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Patients with malignant tumors are more likely to have psychological problems due to their worries about their life expectancy. To understand the psychological status of elderly patients with malignant liver tumor undergoing hepatectomy better, the study was designed to investigate the current situation of anxiety and depression in elderly patients with malignant liver tumor undergoing hepatectomy and to analyze its related factors. METHODS A total of 126 elderly patients with malignant liver tumor undergoing hepatectomy were selected as the research objects. The anxiety and depression of all subjects were evaluated by HADS (Hosptial Anxiety and Depression Scale). The correlation factors affecting the psychological state of elderly patients with malignant liver tumor undergoing hepatectomy were analyzed by linear regression method. RESULTS The HADS-A score of elderly patients with malignant liver tumor undergoing hepatectomy was 8.79 ± 2.56, among which 37 patients were asymptomatic, 60 patients with suspicious symptoms, and 29 patients with definite symptoms. The HADS-D score was 8.40 ± 2.97, among which 61 patients were asymptomatic, 39 patients with suspicious symptoms, and 26 patients with definite symptoms. Multivariate analysis using linear regression method showed that FRAIL score, residence, and complication were significantly associated with anxiety and depression of elderly patients with malignant liver tumor undergoing hepatectomy. CONCLUSIONS Anxiety and depression in elderly patients with malignant liver tumor undergoing hepatectomy were obvious. FRAIL score, regional differences, and the complication were the risk factors for anxiety and depression in elderly patients with malignant liver tumor undergoing hepatectomy. Improving frailty, reducing regional differences, and preventing complications is beneficial to alleviate the adverse mood of elderly patients with malignant liver tumor undergoing hepatectomy.
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Affiliation(s)
- Lining Xu
- grid.414252.40000 0004 1761 8894Department of General Surgery, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853 China
| | - Yingying Xu
- grid.414008.90000 0004 1799 4638Department of Internal Medicine, Henan Cancer Hospital, Zhengzhou, 450003 China
| | - Guiping Li
- Department of Radiology, Hubei Province Integrated Hospital of Chinese and Western Medicine, Wuhan, 430015 China
| | - Bo Yang
- Department of Radiology, Affiliated Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Cizginer S, Prohl EG, Monteiro JFG, Yildiz F, Jones RN, Schechter S, Patterson R, Klipfel A, Katlic MR, Daiello LA, Mujahid N, Neupane I, Cioffi WG, Ducharme M, Vrees MD, McNicoll L. Integrated postoperative care model for older colorectal surgery patients improves outcomes and reduces healthcare costs. J Am Geriatr Soc 2023; 71:1452-1461. [PMID: 36721263 DOI: 10.1111/jgs.18216] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/27/2022] [Accepted: 11/26/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Older surgical patients have an increased risk for postoperative complications, driving up healthcare costs. We determined if postoperative co-management of older surgery patients is associated with postoperative outcomes and hospital costs. METHODS Retrospective data were collected for patients ≥70 years old undergoing colorectal surgery at a community teaching hospital. Patient outcomes were compared between those receiving postoperative surgery co-management care through the Optimization of Senior Care and Recovery (OSCAR) program and controls who received standard of care. Main outcome measures were postoperative complications and hospital charges, 30-day readmission rate, length of stay (LOS), and transfer to intensive care during hospitalization. Multivariable linear regression was used to model total charge and multivariable logistic regression to model complications, adjusted for multiple variables (e.g., age, sex, race, body mass index, Charlson Comorbidity Index [CCI], American Society of Anesthesiologists score, surgery duration). RESULTS All 187 patients in the OSCAR and control groups had a similar mean CCI score of 2.7 (p = 0.95). Compared to the control group, OSCAR recipients experienced less postoperative delirium (17% vs. 8%; p = 0.05), cardiac arrhythmia (12% vs. 3%; p = 0.03), and clinical worsening requiring transfer to intensive care (20% vs. 6%; p < 0.005). OSCAR group patients had a shorter mean LOS among high-risk patients (CCI ≥3) (-1.8 days; p = 0.09) and those ≥80 years old (-2.3 days; p = 0.07) compared to the control group. Mean total hospital charge was $10,297 less per patient in the OSCAR group (p = 0.01), with $17,832 less per patient with CCI ≥3 (p = 0.01), than the control group. CONCLUSIONS A co-management care approach after colorectal surgery in older patients improves outcomes and decreases costs, with the most benefit going to the oldest patients and those with higher comorbidity scores.
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Affiliation(s)
- Sevdenur Cizginer
- Department of Surgery, The Miriam Hospital, Providence, Rhode Island, USA.,Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Eian G Prohl
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | | | - Ferhat Yildiz
- Department of Surgery, The Miriam Hospital, Providence, Rhode Island, USA
| | - Richard N Jones
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Steven Schechter
- Department of Surgery, The Miriam Hospital, Providence, Rhode Island, USA
| | - Robert Patterson
- Department of Surgery, The Miriam Hospital, Providence, Rhode Island, USA
| | - Adam Klipfel
- Department of Surgery, The Miriam Hospital, Providence, Rhode Island, USA
| | | | - Lori A Daiello
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.,Department of Neurology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Nadia Mujahid
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Iva Neupane
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - William G Cioffi
- Department of Surgery, The Miriam Hospital, Providence, Rhode Island, USA
| | - Maria Ducharme
- Department of Medicine, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Matthew D Vrees
- Department of Surgery, The Miriam Hospital, Providence, Rhode Island, USA
| | - Lynn McNicoll
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Xu L, Xu Y, Li G, Yang B. Perioperative factors related to the prognosis of elderly patients with hepatocellular carcinoma. Eur J Med Res 2022; 27:280. [PMID: 36494837 PMCID: PMC9733384 DOI: 10.1186/s40001-022-00896-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 11/10/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hepatic resection is a potentially curative treatment for patients with hepatocellular carcinoma (HCC). The treatment of elderly patients with HCC has always been difficult. With the development of geriatrics and geriatric surgery, the number of elderly patients with HCC undergoing hepatectomy has gradually increased. To further improve the long-term prognosis of elderly patients with hepatocellular carcinoma undergoing surgery, it is necessary to study the related perioperative factors. Our aim was to study the impact of preoperative and intraoperative factors on the long-term survival of elderly patients with HCC who underwent hepatectomy. METHODS A total of 151 elderly patients with HCC who underwent hepatectomy were retrospectively studied. Univariate and multivariate Cox regression analyses were performed for preoperative- and intraoperative-related prognostic factors. RESULTS The 1-, 3-, 5- and 10-year overall survival rates of elderly patients with HCC who underwent resection were 79.5%, 60.8%, 46.6%, and 25.4%, respectively. Multivariate analyses identified four independent predictors of long-term prognosis: Child-Pugh grade (B/C versus A: HR[hazard ratio] = 2.318, P = 0.019), alpha-fetoprotein value (> 20 ng/ml versus ≤ 20 ng/ml: HR = 1.972, P = 0.005), resection style (anatomical versus no anatomical: HR = 1.976, P = 0.006), and intraoperative blood loss (> 400 ml versus ≤ 400 ml: HR = 2.008, P = 0.003). CONCLUSIONS Poor survival of elderly patients with HCC who underwent hepatectomy was correlated with the preoperative and intraoperative factors of Child-Pugh grade, Alpha-fetoprotein value, resection style, and intraoperative blood loss.
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Affiliation(s)
- Lining Xu
- grid.414252.40000 0004 1761 8894Department of General Surgery, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853 China
| | - Yingying Xu
- grid.414008.90000 0004 1799 4638Department of Internal Medicine, Henan Cancer Hospital, Zhengzhou, 450003 China
| | - Guiping Li
- Department of Radiology, Hubei Province Integrated Hospital of Chinese and Western Medicine, Wuhan, 430015 China
| | - Bo Yang
- grid.33199.310000 0004 0368 7223Department of Radiology, Affiliated Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
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El-Shakankery KH, Mieiro L. A key role for comprehensive geriatric assessment in aortic valve replacement. BMJ Case Rep 2020; 13:13/12/e237031. [PMID: 33370976 PMCID: PMC7757492 DOI: 10.1136/bcr-2020-237031] [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: 12/24/2022] Open
Abstract
As our population ages, the demand for surgical services in older people is increasing exponentially. Shown to be indispensable in the care of medical patients, use of the comprehensive geriatric assessment (CGA) is also growing in the perioperative setting. We present the case of a previously independent 82-year-old man who underwent a standard preoperative assessment and surgical aortic valve replacement. In the 7 months that followed, prior to his death, he suffered a rapid functional decline contributed to by slow postoperative recovery, delirium and recurrent falls. Post-mortem revealed cardiac amyloid deposition and extensive small vessel disease in the brain. This case highlights the importance of the CGA in the perioperative management of older patients, especially in identification and optimisation of geriatric syndromes and consideration of less-invasive alternative treatments. We review the existing literature on CGA use in cardiothoracic and vascular surgical settings, drawing on experiences learnt from the above case.
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Affiliation(s)
| | - Luis Mieiro
- Department of Medicine for Elderly People, Whipps Cross Hospital, Barts Health NHS Trust, London, UK
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