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Zhu W, Wu L, Xie W, Zhang G, Gu Y, Hou Y, He Y. Comparison of morbidity and mortality after radical cystectomy between individuals older and younger than 80 years: a systematic review and meta-analysis. Int Urol Nephrol 2024; 56:1525-1535. [PMID: 38095810 DOI: 10.1007/s11255-023-03897-3] [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: 09/22/2023] [Accepted: 11/23/2023] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To compare outcomes related to survival and post-operative complications in individuals older and younger than 80 years with bladder cancer undergoing radical cystectomy (RC). METHODS We conducted a systematic search using three large databases: PubMed, EMBASE, and Scopus. We included observational studies comparing outcomes between individuals older than 80 years and younger patients undergoing RC. The outcomes of interest included overall survival, disease-specific survival, progression-free survival, and risk of post-operative complications. We applied a random effects model for the analysis and reported pooled effect sizes as odds ratios (ORs) or hazards ratios (HRs) along with 95% confidence intervals. RESULTS We analyzed 21 studies. Our results show that individuals older than 80 years had higher risks of mortality at 30 days (OR 2.82; 95% CI 1.97, 4.04), 90 days (OR 3.34; 95% CI 2.61, 4.27), 12 months (HR 3.03; 95% CI 2.64, 3.49), and 24 months (HR 3.54; 95% CI 2.27, 5.50) of the post-operative follow-up than younger individuals. In addition, individuals older than 80 years also had poor 5-year survivals (HR 2.17; 95% CI 1.64, 2.88), an increased risk of 5-year cancer-specific mortality (HR 1.58; 95% CI 1.24, 2.03), poor 5-year recurrence free survivals (HR 1.49; 95% CI 1.07, 2.08), and high complications risks (OR 1.20; 95% CI 1.02, 1.42) when compared to younger patients. CONCLUSION Individuals older than 80 years undergoing RC are likely to have poor survival-related outcomes and increased complications risks. Pre-planned comprehensive geriatric assessments (CGAs) may be needed to offer better peri- and post-operative care to improve the outcomes in this patient population.
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Affiliation(s)
- Wei Zhu
- Department of Urology, The First Hospital of Jiaxing andThe Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing City, 314000, Zhejiang Province, China
| | - Lingfeng Wu
- Department of Urology, The First Hospital of Jiaxing andThe Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing City, 314000, Zhejiang Province, China
| | - Wenhua Xie
- Department of Urology, The First Hospital of Jiaxing andThe Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing City, 314000, Zhejiang Province, China
| | - Gaoyue Zhang
- Department of Urology, The First Hospital of Jiaxing andThe Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing City, 314000, Zhejiang Province, China
| | - Yanqin Gu
- Department of Urology, The First Hospital of Jiaxing andThe Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing City, 314000, Zhejiang Province, China
| | - Yansong Hou
- Department of Urology, The First Hospital of Jiaxing andThe Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing City, 314000, Zhejiang Province, China
| | - Yi He
- Department of Urology, The First Hospital of Jiaxing andThe Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing City, 314000, Zhejiang Province, China.
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Zhou Y, Zhang XL, Ni HX, Shao TJ, Wang P. Impact of frailty on short-term postoperative outcomes in patients undergoing colorectal cancer surgery: A systematic review and meta-analysis. World J Gastrointest Surg 2024; 16:893-906. [PMID: 38577090 PMCID: PMC10989331 DOI: 10.4240/wjgs.v16.i3.893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/28/2023] [Accepted: 02/05/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Colorectal cancer is a major global health challenge that predominantly affects older people. Surgical management, despite advancements, requires careful consideration of preoperative patient status for optimal outcomes. AIM To summarize existing evidence on the association of frailty with short-term postoperative outcomes in patients undergoing colorectal cancer surgery. METHODS A literature search was conducted using PubMed, EMBASE and Scopus databases for observational studies in adult patients aged ≥ 18 years undergoing planned or elective colorectal surgery for primary carcinoma and/or secondary metastasis. Only studies that conducted frailty assessment using recognized frailty assessment tools and had a comparator group, comprising nonfrail patients, were included. Pooled effect sizes were reported as weighted mean difference or relative risk (RR) with 95% confidence intervals (CIs). RESULTS A total of 24 studies were included. Compared with nonfrail patients, frailty was associated with an increased risk of mortality at 30 d (RR: 1.99, 95%CI: 1.47-2.69), at 90 d (RR: 4.76, 95%CI: 1.56-14.6) and at 1 year (RR: 5.73, 95%CI: 2.74-12.0) of follow up. Frail patients had an increased risk of any complications (RR: 1.81, 95%CI: 1.57-2.10) as well as major complications (Clavien-Dindo classification grade ≥ III) (RR: 2.87, 95%CI: 1.65-4.99) compared with the control group. The risk of reoperation (RR: 1.18, 95%CI: 1.07-1.31), readmission (RR: 1.70, 95%CI: 1.36-2.12), need for blood transfusion (RR: 1.67, 95%CI: 1.52-1.85), wound complications (RR: 1.49, 95%CI: 1.11-1.99), delirium (RR: 4.60, 95%CI: 2.31-9.16), risk of prolonged hospitalization (RR: 2.09, 95%CI: 1.22-3.60) and discharge to a skilled nursing facility or rehabilitation center (RR: 3.19, 95%CI: 2.0-5.08) was all higher in frail patients. CONCLUSION Frailty in colorectal cancer surgery patients was associated with more complications, longer hospital stays, higher reoperation risk, and increased mortality. Integrating frailty assessment appears crucial for tailored surgical management.
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Affiliation(s)
- Yao Zhou
- Department of Operating Room, Affiliated Tumor Hospital of Nantong University & Nantong Tumor Hospital, Nantong 226361, Jiangsu Province, China
| | - Xiao-Lei Zhang
- Department of Gastrointestinal Surgery, The Affiliated Tumor Hospital of Nantong University & Nantong Tumor Hospital, Nantong 226361, Jiangsu Province, China
| | - Hong-Xia Ni
- Department of Operating Room, Affiliated Tumor Hospital of Nantong University & Nantong Tumor Hospital, Nantong 226361, Jiangsu Province, China
| | - Tian-Jing Shao
- Department of Operating Room, Affiliated Tumor Hospital of Nantong University & Nantong Tumor Hospital, Nantong 226361, Jiangsu Province, China
| | - Ping Wang
- Department of Operating Room, Affiliated Tumor Hospital of Nantong University & Nantong Tumor Hospital, Nantong 226361, Jiangsu Province, China
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Mishra RK, Bara RO, Zulbaran-Rojas A, Park C, Fernando ME, Ross J, Lepow B, Najafi B. The Application of Digital Frailty Screening to Triage Nonhealing and Complex Wounds. J Diabetes Sci Technol 2024; 18:389-396. [PMID: 35856398 PMCID: PMC10973858 DOI: 10.1177/19322968221111194] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE We investigated the association between the complexity of diabetic foot ulcers (DFUs) and frailty. RESEARCH DESIGN AND METHODS Individuals (n = 38) with Grade 2 Wagner DFU were classified into 3 groups based on the Society for Vascular Surgery risk-stratification for major limb amputation as Stage 1 at very low risk (n = 19), Stage 2 at low risk (n = 9), and Stage 3 to 4 at moderate-to-high risk (n = 10) of major limb amputation. Frailty status was objectively assessed using a validated digital frailty meter (FM). The FM works by quantifying weakness, slowness, rigidity, and exhaustion over a 20-second repetitive elbow flexion-extension exercise using a wrist-worn sensor. FM generates a frailty index (FI) ranging from 0 to 1; higher values indicate progressively greater severity of frailty. Skin perfusion pressure (SPP), albumin, and tissue oxygenation level (SatO2) were also measured. One-way analysis of variance (ANOVA) was used to identify group effect for wound complexity. Pearson's correlation coefficient was used to assess the associations with frailty and clinical endpoints. RESULTS Frailty index was higher in Stage 3 and 4 as compared to Stage 1 (d = 1.4, P < .01) and Stage 2 (d = 1.2, P < .01). Among assessed frailty phenotypes, exhaustion was correlated with SPP (r = -0.63, P < .01) and albumin (r = -0.5, P < .01). CONCLUSION Digital biomarkers of frailty may predict complexity of DFU and thus triage individuals who can be treated more simply in their primary clinic versus higher risk patients who require prompt referral to multidisciplinary, more complex care.
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Affiliation(s)
- Ram Kinker Mishra
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Rasha O. Bara
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Alejandro Zulbaran-Rojas
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Catherine Park
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Big Data Scientist Training Enhancement Program, VA Office of Research and Development, Washington, DC, USA
| | - Malindu E. Fernando
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Ulcer and Wound Healing Consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia
| | - Jeffrey Ross
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Brian Lepow
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- School of Health Professions, Baylor College of Medicine, Houston, TX, USA
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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Moore ZEH, Aynge GE, Carr CG, Horton AJ, Jones HA, Murphy NS, Payne MR, McCarthy CH, Murdoch JM. A Clinical Support App for routine wound management: reducing practice variation, improving clinician confidence and increasing formulary compliance. Int Wound J 2022; 19:1263-1275. [PMID: 35793908 PMCID: PMC9284651 DOI: 10.1111/iwj.13868] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/18/2022] [Accepted: 05/29/2022] [Indexed: 11/27/2022] Open
Abstract
Wounds continue to be of a global concern. Therefore, a more focussed, evidence-based approach to wound assessment and management is required. The WOUND COMPASS™ Clinical Support App (CSA) is designed to support the health care professional with wound assessment and management at the point of care. This real-world pilot study aimed to determine the utility of the CSA during routine wound management, in multiple care settings. A non-interventional, real-world pilot programme of the CSA was conducted at four sites. Patients received routine wound management. The CSA was programmed to replicate the site's formulary for evidence-based wound management. Anonymised pre- and post-pilot clinician opinion surveys on useability and impact of the CSA were collected and reported. Wound Specialists (n = 7 [100%]) and Non-Wound Specialists (NWS) (n = 58 [82%]) indicated that competence and confidence in wound assessment were enhanced with use of the CSA (100%; 82%). Furthermore, practice variation was reduced because of a greater compliance to their local formulary (n = 7 [100%]; 79% [54%]). This real-world pilot shows the positive impact of the CSA, and the improvements that can be potentially realised via reduction in practice variation, improvement in NWSs confidence when managing wounds and increased formulary compliance.
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Affiliation(s)
- Zena E H Moore
- Skin Wounds and Trauma (SWaT) Research Centre, School of Nursing and Midwifery, RCSI University of Medicine and Health Services, Dublin, Ireland.,School of Nursing & Midwifery, Griffith University, Gold Coast, Queensland, Australia.,School of Health Sciences, Faculty of Life and Health Sciences, Ulster University, Ulster, UK.,School of Medicine, Cardiff University, Cardiff, UK.,Department of Nursing, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia.,Faculty of Medicine and Health Sciences, UGent, Ghent University, Ghent, Belgium.,School of Nursing and Health, Lida Institute, Shanghai, China
| | - Georgina E Aynge
- Tissue Viability, Medway NHS Foundation Trust, Medway Maritime Hospital, Gillingham, UK
| | - Caryn G Carr
- Tissue Viability, Southern Health NHS Foundation Trust, Long Term Conditions Centre, Lyndhurst, UK
| | - Aundrea J Horton
- Education, Home Health and Hospice HCA, Nashville, Tennessee, USA
| | - Hayley A Jones
- Tissue Viability, Medway NHS Foundation Trust, Medway Maritime Hospital, Gillingham, UK
| | - Nina S Murphy
- Interim Operational Lead for Long Term Condition, Northeast London Foundation Trust, Mayflower Community Hospital, Blunts, UK
| | - Matthew R Payne
- Tissue Viability, Southern Health NHS Foundation Trust, Long Term Conditions Centre, Lyndhurst, UK
| | - Catherine H McCarthy
- Global Clinical Strategy - Advanced Wound Management, Smith and Nephew, Watford, UK
| | - Julie M Murdoch
- Global Clinical Strategy - Advanced Wound Management, Smith and Nephew, Watford, UK
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[Convergent and discriminative validity of the Frail-VIG index with the Braden scale in people cared for in home care]. Rev Esp Geriatr Gerontol 2022; 57:71-78. [PMID: 35307198 DOI: 10.1016/j.regg.2021.12.003] [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: 11/11/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 11/24/2022]
Abstract
The Frail-VIG index and the Braden scale are validated instruments for assessing frailty and the risk of developing dependency-related skin lesions respectively. The Frail-VIG index is a multidimensional instrument that allows rapid and efficient assessment of the degree of frailty in the context of clinical practice. OBJECTIVE Our aim was to investigate the convergent and discriminative validity of the Frail-VIG index with regard to Braden scale value. METHODS We carried out a cross-sectional study in 2 primary health care centres of the Catalan Institute of Health, Barcelona (Spain). Participants in the study were all people included under a home care programme during the year 2018. No exclusion criteria were applied. We used the Frail-VIG index to measure frailty and the Braden scale to measure the risk of developing pressure ulcers. Trained nurses administered both instruments during face-to-face assessments in a participant's home during usual care. The relationships between both instruments were examined using Pearson's correlation coefficient. RESULTS Four hundred and twelve participants were included. Frail-VIG score and Braden scale value were negatively correlated (r=-0.597; P<.0001). Non-frail people had a lower risk of developing dependency-related skin lesions than moderate to severe frail people. The Braden scale value declined significantly as the Frail-VIG index score increased. CONCLUSIONS Frail-VIG index demonstrated a convergent validity with the Braden scale. Its discriminative validity was optimal, as their scores showed an excellent capacity to differentiate between people with a higher and lower risk of developing. These findings provide additional pieces of evidence for construct validity of the Frail-VIG index.
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Maltese G, Basile G, Meehan H, Fuller M, Cesari M, Fountoulakis N, Karalliedde J. Frailty Is Associated with Impaired Diabetic Foot Ulcer Healing and All-Cause Re-Hospitalization. J Nutr Health Aging 2022; 26:169-173. [PMID: 35166310 DOI: 10.1007/s12603-022-1726-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Diabetic Foot Ulcers (DFUs) are a common and feared complication of type 1 and type 2 diabetes. People with DFUs often present a significant clinical complexity due to multimorbidity, frailty, polypharmacy, and disabling conditions. Frailty, defined using the accumulation of health deficits model, has shown to predict worsening health status, hospitalizations, and death in older persons. There are no clinical studies, to date, that have examined the prevalence and effect of frailty on DFUs outcomes. The aim of our study was to explore the impact of frailty on DFUs healing and re-hospitalization in a cohort of patients hospitalized with DFUs. DESIGN prospective cohort study. SETTING AND PARTICIPANTS The frailty status of 76 consecutive hospitalized patients with DFUs was assessed by using the Frailty Index (FI). MEASUREMENTS The primary outcome was the non-healing of the DFU. Secondary outcome was re-hospitalization events (for any cause) within 6 months from hospital discharge. Frailty was defined as FI>0.25. RESULTS Out of 76 patients (median age 65 years, range 31-84), 56 (74%) were frail. At six months, 81.5% of frail patients had non-healing of the DFU compared to 55% in non-frail patients (p=0.02). The rate of of re-hospitalization was also higher in frail compared to non-frail (90.3% vs 54%, respectively; p=0.01) patients. In multivariable analyses, frailty was significantly associated with a more than fivefold increased risk of DFU non-healing [odds ratio 5.54 (95% confidence interval 1.28-23.91), p=0.02]. Similarly, re-hospitalization was also significantly higher in frail patients compared to the non-frail ones. CONCLUSIONS In hospitalized patients with DFUs, frailty was highly prevalent. Frailty emerged as an independent risk factor for DFU non-healing and re-hospitalization events. Patients with DFUs require a comprehensive assessment of their frailty status which would enable personalization of their management and interventions.
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Affiliation(s)
- G Maltese
- Dr Giuseppe Maltese, School of Cardiovascular Medicine and Sciences, Faculty of Life Sciences, King's College London, 150 Stamford Street, London SE1 9NH, UK, , Twitter: @docmaltese
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