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Pernik MN, Hicks WH, Akbik OS, Nguyen ML, Luu I, Traylor JI, Deme PR, Dosselman LJ, Hall K, Wingfield SA, Aoun SG, Bagley CA. Psoas Muscle Index as a Predictor of Perioperative Outcomes in Geriatric Patients Undergoing Spine Surgery. Global Spine J 2023; 13:2016-2024. [PMID: 35034500 PMCID: PMC10556882 DOI: 10.1177/21925682211072626] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
STUDY DESIGN Single-center retrospective study. OBJECTIVE The objective of this study was to evaluate the association of psoas muscle mass defined sarcopenia with perioperative outcomes in geriatric patients undergoing elective spine surgery. METHODS We included geriatric patients undergoing thoracolumbar spinal surgery. Total psoas surface area (TPA) was measured on preoperative axial computerized tomography or magnetic resonance imaging at the L3 vertebra and normalized to the L3 vertebral body area. Patients were divided into quartiles by normalized TPA, and the fourth quartile (Q4) was compared to quartiles 1-3 (Q1-3). Outcomes included perioperative transfusions, length of stay (LOS), delirium, pseudoarthrosis, readmission, discharge disposition, revision surgery, and mortality. RESULTS Of the patients who met inclusion criteria (n = 196), the average age was 73.4 y, with 48 patients in Q4 and 148 patients in Q1-3. Q4 normalized TPA cut-off was <1.05. Differences in Q4 preoperative characteristics included significantly lower body mass index, baseline creatinine, and a greater proportion of females (Table 1). Q4 patients received significantly more postoperative red blood cell and platelet transfusions and had longer ICU LOS (P < .05; Table 2). There was no difference in intraoperative transfusion volumes, delirium, initiation of walking, discharge disposition, readmission, pseudoarthrosis, or revision surgery (Tables 2 and 3). Mortality during follow-up was higher in Q4 but was not statistically significant (P = .075). CONCLUSION Preoperative TPA in geriatric patients undergoing elective spine surgery is associated with increased need for intensive care and postoperative blood transfusion. Preoperative normalized TPA is a convenient measurement and could be included in geriatric preoperative risk assessment algorithms.
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Affiliation(s)
- Mark N. Pernik
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - William H. Hicks
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Omar S. Akbik
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Madelina L. Nguyen
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Ivan Luu
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Jeffrey I. Traylor
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Palvasha R. Deme
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Luke J. Dosselman
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Kristen Hall
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Sarah A. Wingfield
- Department of Internal Medicine, Geriatrics Division, UT Southwestern Medical School, Dallas, TX, USA
| | - Salah G. Aoun
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
| | - Carlos A. Bagley
- Department of Neurological Surgery, UT Southwestern Medical School, Dallas, TX, USA
- Department of Orthopedic Surgery, UT Southwestern Medical School, Dallas, TX, USA
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Mikus E, Calvi S, Albertini A, Tripodi A, Zucchetta F, Brega C, Pin M, Cimaglia P, Ferrari R, Campo G, Serenelli M. Impact of comorbidities on older patients undergoing open heart surgery. J Cardiovasc Med (Hagerstown) 2022; 23:318-324. [PMID: 35013050 DOI: 10.2459/jcm.0000000000001296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The number of elderly patients undergoing cardiac surgery is increasing. Age greater than 80 years has been identified as a strong independent risk factor for shortand long-term survival. The current study is aimed to identify the impact of preoperative comorbidities on early and late outcomes in older patients undergoing cardiac surgery. METHODS Baseline characteristics, procedurals and postoperative complications of all patients undergoing cardiac surgery at our institution are collected. The current analysis is focused on patients aged at least 80 years at the time of intervention and treated from January 2010 to December 2019. RESULTS In-hospital mortality resulted as 6.3%. Redo intervention [odds ratio (OR) 2.49, 95% confidence interval (CI) 1.13-5.48], chronic obstructive pulmonary disease (COPD) (OR 2.99, 95% CI 1.75-5.12) and peripheral arterial disease (PAD) (OR 2.23, 95% CI 1.30-3.81) were independent baseline predictors of outcome in the multivariate analysis. Prolonged extracorporeal circulation time, need for transfusion and prolonged intubation time strongly and independently predicted in-hospital mortality. During a mean follow-up of 3.6 years 34.3% of patients died and unplanned admission (HR 1.33, 95% CI 1.05-1.67), NYHA class III-IV (HR 1.35, 95% CI 1.12-1.64), diabetes (HR 1.27, 95% CI 1.01-1.59), COPD (HR 1.60, 95% CI 1.25-2.04) and PAD (HR 1.32, 95% CI 1.03-1.71) resulted as independent predictors of all-cause death. CONCLUSION Cardiac surgery is feasible in octogenarians, with an acceptable risk of mortality. Chronological age itself should not be the main determinant of choice while referring patients for cardiac surgical intervention. Comorbidities such as COPD, PAD and diabetes need to be taken into account for risk stratification.
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Affiliation(s)
- Elisa Mikus
- Maria Cecilia Hospital, GVM Care & Research, Cotignola
| | - Simone Calvi
- Maria Cecilia Hospital, GVM Care & Research, Cotignola
| | | | | | | | | | - Maurizio Pin
- Maria Cecilia Hospital, GVM Care & Research, Cotignola
| | | | - Roberto Ferrari
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Matteo Serenelli
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
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Birkey T, Dixon J, Jacobsen R, Ginde S, Nugent M, Yan K, Simpson P, Kovach J. Cardiopulmonary Exercise Testing for Surgical Risk Stratification in Adults with Congenital Heart Disease. Pediatr Cardiol 2018; 39:1468-1475. [PMID: 29882186 DOI: 10.1007/s00246-018-1918-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 06/01/2018] [Indexed: 11/28/2022]
Abstract
Adult congenital heart disease (ACHD) patients often require repeat cardiothoracic surgery, which may result in significant morbidity and mortality. Currently, there are few pre-operative risk assessment tools available. In the general adult population, pre-operative cardiopulmonary exercise testing (CPET) has a predictive value for post-operative morbidity and mortality following major non-cardiac surgery. The utility of CPET for risk assessment in ACHD patients requiring cardiothoracic surgery has not been evaluated. Retrospective chart review was conducted on 75 ACHD patients who underwent CPET less than 12 months prior to major cardiothoracic surgery at Children's Hospital of Wisconsin. Minimally invasive procedures, cardiomyopathy, acquired heart disease, single ventricle physiology, and heart transplant patients were excluded. Demographic information, CPET results, and peri-operative surgical data were collected. The study population was 56% male with a median age of 25 years (17-58). Prolonged post-operative length of stay correlated with increased ventilatory efficiency slope (VE/[Formula: see text] slope) (P = 0.007). Prolonged intubation time correlated with decreased peak HR (P = 0.008), decreased exercise time (P = 0.002), decreased heart rate response (P = 0.008) and decreased relative peak oxygen consumption (P = 0.034). Post-operative complications were documented in 59% of patients. While trends were noted between post-operative complications and some measurements of exercise capacity, none met statistical significance. Future studies may further define the relationship between exercise capacity and post-operative morbidity in ACHD patients.
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Affiliation(s)
| | - Jennifer Dixon
- Department of Cardiology, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Roni Jacobsen
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Salil Ginde
- Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Ke Yan
- Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Joshua Kovach
- Medical College of Wisconsin, Milwaukee, WI, USA. .,, Milwaukee, USA.
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Wallen MP, Skinner TL, Pavey TG, Hall A, Macdonald GA, Coombes JS. Safety, adherence and efficacy of exercise training in solid-organ transplant candidates: A systematic review. Transplant Rev (Orlando) 2016; 30:218-26. [DOI: 10.1016/j.trre.2016.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 04/06/2016] [Accepted: 07/13/2016] [Indexed: 01/24/2023]
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Abstract
PURPOSE To assess whether atrial fibrillation (AF) in heart failure (HF) affects oxygen uptake at anaerobic threshold ((Equation is included in full-text article.)O2 AT) and heart rate (HR) kinetics. METHODS A total of 15 patients with HF and AF and 18 with HF and sinus rhythm (SR) performed a maximal incremental and 2 constant workload cycle ergometer cardiopulmonary exercise tests (below and above AT, at 25% and 75% of maximal workload, respectively). At constant workload tests, kinetics of (Equation is included in full-text article.)O2 and HR were assessed by calculating time constant (τ). RESULTS HF patients with AF showed a similar peak (Equation is included in full-text article.)O2 to those with SR (16.7 ± 4.5 mL/kg/min vs 16.6 ± 3.9 mL/kg/min). However, (Equation is included in full-text article.)O2 AT (11.3 ± 2.9 mL/kg/min vs 9.3 ± 2.8 mL/kg/min; P < .05), peak HR (149 ± 18.8 bpm vs 116.4 ± 20.4 bpm; P < .001), HR AT (125.3 ± 19.1 bpm vs 90.3 ± 15.5 bpm; P < .001), and HR increase during exercise were greater in HF patients with AF. Finally, τHR and τ(Equation is included in full-text article.)O2 below and above AT were not significantly different. CONCLUSIONS In HF patients with AF, despite a similar peak (Equation is included in full-text article.)O2 compared with patients with HF and SR, (Equation is included in full-text article.)O2 AT is higher because of a higher HR and a greater HR increase during exercise. One postulated mechanism would be a greater cardiac output increase at the beginning of exercise in HF patients with AF. The delayed AT generates uncertainty about the meaning of a (Equation is included in full-text article.)O2 value at AT in HF patients with AF, because a higher AT is usually associated with better performance and a better prognosis.
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Magrì D, Agostoni P, Corrà U, Passino C, Scrutinio D, Perrone-Filardi P, Correale M, Cattadori G, Metra M, Girola D, Piepoli MF, Iorio A, Emdin M, Raimondo R, Re F, Cicoira M, Belardinelli R, Guazzi M, Limongelli G, Clemenza F, Parati G, Frigerio M, Casenghi M, Scardovi AB, Ferraironi A, Di Lenarda A, Bussotti M, Apostolo A, Paolillo S, La Gioia R, Gargiulo P, Palermo P, Minà C, Farina S, Battaia E, Maruotti A, Pacileo G, Contini M, Oliva F, Ricci R, Sinagra G. Deceptive meaning of oxygen uptake measured at the anaerobic threshold in patients with systolic heart failure and atrial fibrillation. Eur J Prev Cardiol 2014; 22:1046-55. [DOI: 10.1177/2047487314551546] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 08/26/2014] [Indexed: 01/23/2023]
Affiliation(s)
- Damiano Magrì
- Department of Clinical and Molecular Medicine, “La Sapienza” University of Rome, Italy
- Centro Cardiologico Monzino, IRCCS, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Italy
- Department of Clinical Sciences and Community Health, University of Milano, Italy
| | - Ugo Corrà
- Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Italy
| | - Claudio Passino
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Italy
- Scuola Superiore S. Anna, Italy
| | - Domenico Scrutinio
- Division of Cardiology, “S. Maugeri” Foundation, IRCCS, Institute of Cassano Murge, Italy
| | | | | | | | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, Italy
| | - Davide Girola
- Dipartimento Cardiologico “A. De Gasperis”, Ospedale Cà Granda- A.O. Niguarda, Italy
| | | | - AnnaMaria Iorio
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Italy
| | - Michele Emdin
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Italy
| | - Rosa Raimondo
- Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Tradate, Italy
| | - Federica Re
- Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Italy
| | | | | | - Marco Guazzi
- Heart Failure Unit, IRCCS Policlinico San Donato, Italy
| | - Giuseppe Limongelli
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Italy
| | - Francesco Clemenza
- Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Italy
| | | | - Maria Frigerio
- Dipartimento Cardiologico “A. De Gasperis”, Ospedale Cà Granda- A.O. Niguarda, Italy
| | - Matteo Casenghi
- Department of Clinical and Molecular Medicine, “La Sapienza” University of Rome, Italy
| | | | | | | | - Maurizio Bussotti
- Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Institute of Milan, Italy
| | | | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, “Federico II” University, Italy
| | - Rocco La Gioia
- Division of Cardiology, “S. Maugeri” Foundation, IRCCS, Institute of Cassano Murge, Italy
| | - Paola Gargiulo
- SDN Foundation, Institute of Diagnostic and Nuclear Development, Napoli, Italy
| | | | - Chiara Minà
- Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Italy
| | | | - Elisa Battaia
- Section of Cardiology, Department of Medicine, University of Verona, Italy
| | - Antonello Maruotti
- Southampton Statistical Sciences Research Institute & School of Mathematics, University of Southampton, United Kingdom
- Department of Politic Sciences, Università “Roma Tre”, Italy
| | - Giuseppe Pacileo
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Italy
| | | | - Fabrizio Oliva
- Dipartimento Cardiologico “A. De Gasperis”, Ospedale Cà Granda- A.O. Niguarda, Italy
| | | | - Gianfranco Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Italy
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Hoyland K, Vasdev N, Adshead JM, Thorpe A. Cardiopulmonary exercise testing in patients undergoing radical cystectomy (open, laparoscopic and robotic). JOURNAL OF CLINICAL UROLOGY 2014. [DOI: 10.1177/2051415814537823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of cardiopulmonary exercise testing (CPET) is gaining popularity as a preoperative functional assessment tool and is a useful adjunct to risk stratification before radical cystectomy. It is important for urologists to understand the indications, contraindications, methodology and different parameters evaluated during CPET assessment and use this information acquired to tailor pre-, intra- and postoperative care in patients undergoing a radical cystectomy. We present a review on the increasing role of CPET in patients undergoing a radical cystectomy.
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Lemasle L, Gayat E. Nouveautés dans la prise en charge cardiovasculaire en période périopératoire. MEDECINE INTENSIVE REANIMATION 2014. [DOI: 10.1007/s13546-014-0862-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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