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Sample records for elderly postoperative patients

  1. Postoperative Conversion Disorder in Elderly Oral Cancer Patient.

    PubMed

    Yakushiji, Takashi; Hayashi, Kamichika; Morikawa, Takamichi; Migita, Masashi; Ogane, Satoru; Muramatsu, Kyotaro; Kamio, Takashi; Shibahara, Takahiko; Takano, Nobuo

    2016-01-01

    Conversion disorder is a condition in which psychological stress in response to difficult situations manifests as physical symptoms. Here, we report a case of postoperative coma due to conversion disorder in an elderly oral cancer patient. An 82-year-old woman was referred to Tokyo Dental College Chiba Hospital with a mass lesion on the tongue. A biopsy revealed a well-differentiated squamous cell carcinoma. Surgical treatment was performed for the tongue carcinoma and tracheotomy for management of the airway. On postoperative day 5, the patient exhibited loss of consciousness (Glasgow Coma Scale: E1, VT, M1; Japan Coma Scale: III-300). The patient's vital signs were all normal, as were the results of a full blood count, brain-CT, MRI, and MRA. Only the arm dropping test was positive. Therefore, the cause of the coma was diagnosed as conversion disorder. Seven hours later, the patient showed a complete recovery.

  2. Postoperative mental status in elderly hip surgery patients.

    PubMed

    Jagmin, M G

    1998-01-01

    To determine if elderly patients undergoing hip surgery became delirious postoperatively and, if so, whether age and/or time of day were related to delirium. Repeated measures. A convenience sample of 70 hip surgery patients 60 years of age and older at a large Midwestern teaching hospital were studied. Patients were excluded who were unconscious, unable to hear, see, and/or verbally communicate in English. Patients were also excluded who had a known history of dementia, Alzheimer's dementia, addiction to alcohol and/or sedative hypnotics, functional psychosis, or any other psychiatric diagnosis. Of the 70 patients, 37 were female and 33 were male. Mean age of the patients was 72.9 years (S.D. = 8.13). Patients were placed into one of three groups: Group 1--age 60 to 69 years (n = 25); Group 2--age 70 to 79 years (n = 25); or Group 3--80 years and older (n = 20). The most common procedure for all groups was total hip replacement (n = 48). Data were collected primarily by both objective and subjective assessment of the patients. Both the Folstein's Mini Mental Status Exam (MMSE) and the NEECHAM Confusion Tool were used to collect data. Chart reviews provided additional data. Patients were assessed preoperatively to obtain baseline assessment and screen out patients with preexisting confusion. Assessments were then done once in the morning and once in the evening for 5 days following surgery. Delirium, sundowning, sundown syndrome. The MMSE and NEECHAM were found to be highly correlated: Morning NEECHAM vs morning MMSE (Correlation Coefficient = .6515; p = .000), evening NEECHAM vs evening MMSE (Correlation Coefficient = .8301; p = .000). A test of repeated measures was used to examine the data. The Within factor was time, the Between factor was age, and the interaction effect was age by time of day. Dependent variables were total NEECHAM scores and total MMSE scores, in addition to total scores of these tests' subsections. An alpha level of .05 was used for all

  3. Risk, diagnosis and treatment to postoperative delirium in elderly patients with gastrointestinal cancers.

    PubMed

    Ma, Li-Na; Zhang, Rui-Li

    2015-01-01

    In recent years, more elderly patients with gastrointestinal cancers have been undergoing surgery. As one of main postoperative complications, postoperative delirium (POD) is harmful and difficult to prevent and treat. Prevention, diagnosis and treatment to POD properly and ptomptly can promote the patient's overall recovery. However, health care providers still have many problems for POD to face in elderly,with gastrointestinal cancers during the clinical care. In this paper, Etiology, damages, prevention, diagnosis and treatment of POD in elderly with gastrointestinal cancer were reviewed, and the prospect of POD was also discussed.

  4. Recognition of Delirium in Postoperative Elderly Patients: A Multicenter Study.

    PubMed

    Numan, Tianne; van den Boogaard, Mark; Kamper, Adriaan M; Rood, Paul J T; Peelen, Linda M; Slooter, Arjen J C

    2017-09-01

    To evaluate to what extent delirium experts agree on the diagnosis of delirium when independently assessing exactly the same information and to evaluate the sensitivity of delirium screening tools in routine daily practice of clinical nurses. Prospective observational longitudinal study. Three medical centers in the Netherlands. Elderly postoperative adults (n = 167). A researcher examined participants daily (Postoperative Day 1-3) for delirium using a standardized cognitive assessment and interview including the Delirium Rating Scale Revised-98 as global impression without any cut-off values that was recorded on video. Two delirium experts independently evaluated the videos and clinical information from the last 24 hours in the participants' record and classified each assessment as delirious, possibly delirious, or not delirious. Interrater agreement between the delirium experts was determined using weighted Cohen's kappa. When there was no consensus, a third expert was consulted. Final classification was based on median score and compared with the results of the Confusion Assessment Method for Intensive Care Unit and Delirium Observation Scale that clinical nurses administered. Four hundred twenty-four postoperative assessments of 167 participants were included. The overall kappa was 0.61 (95% confidence interval = 0.53-0.68). There was no agreement between the experts for 89 (21.0%) assessments and a third delirium expert was needed for the final classification. Delirium screening that nurses performed detected 32% of the assessments that the experts diagnosed as (possibly) delirious. There was considerable disagreement in classification of delirium by experts who independently assessed exactly the same information, showing the difficulty of delirium diagnosis. Furthermore, the sensitivity of daily delirium screening by clinical nurses was poor. Future research should focus on development of objective instruments to diagnose delirium. © 2017, Copyright the

  5. Sarcopenia: a new predictor of postoperative complications for elderly gastric cancer patients who underwent radical gastrectomy.

    PubMed

    Zhou, Chong-Jun; Zhang, Feng-Min; Zhang, Fei-Yu; Yu, Zhen; Chen, Xiao-Lei; Shen, Xian; Zhuang, Cheng-Le; Chen, Xiao-Xi

    2017-05-01

    A geriatric assessment is needed to identify high-risk elderly patients with gastric cancer. However, the current geriatric assessment has been considered to be either time-consuming or subjective. The present study aimed to investigate the predictive effect of sarcopenia on the postoperative complications for elderly patients who underwent radical gastrectomy. We conducted a prospective study of patients who underwent radical gastrectomy from August 2014 to December 2015. Computed tomography-assessed lumbar skeletal muscle, handgrip strength, and gait speed were measured to define sarcopenia. Sarcopenia was present in 69 of 240 patients (28.8%) and was associated with lower body mass index, lower serum albumin, lower hemoglobin, and higher nutritional risk screening 2002 scores. Postoperative complications significantly increased in the sarcopenic patients (49.3% versus 24.6%, P < 0.001), compared with nonsarcopenic patients. The multivariate analysis demonstrated that sarcopenia (odds ratio: 2.959, 95% CI: 1.629-5.373, P < 0.001) and the Charlson comorbidity index ≥2 (odds ratio: 3.357, 95% CI: 1.144-9.848, P = 0.027) were independent risk factors for postoperative complications. Sarcopenia, presented as a new geriatric assessment factor, was a strong and independent risk factor for postoperative complications of elderly patients with gastric cancer. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Effectiveness of postoperative elemental diet (Elental®) in elderly patients after gastrectomy.

    PubMed

    Ohkura, Yu; Haruta, Shusuke; Tanaka, Tsuyoshi; Ueno, Masaki; Udagawa, Harushi

    2016-10-19

    We aimed to investigate the efficacy of postoperative early intervention with an elemental diet to reduce weight loss and enhance recovery after gastrectomy. Nutritional status and gastrointestinal immune function tend to worsen, and postoperative weight loss is inevitable in these patients; therefore, improvement in their postoperative condition is important, especially in gastric cancer patients aged ≥80 years. Clinical outcomes and postoperative nutritional status were compared between 21 and 22 consecutive elderly patients aged ≥80 years who underwent distal gastrectomy before and after the introduction of postoperative oral elemental diet (Elental®, 300 kcal/day), respectively, between October 2011 and June 2016. A significant reduction in postoperative complications was noted in the nutrition support group (N-group) as compared with the control group (C-group). In particular, the prevalence of systemic complications was significantly lower in the N-group (33.3 vs. 4.5 %, p = 0.015), whereas no significant difference was observed in the prevalence of locoregional complications. The percentage of weight loss and reduction in BMI from 1 month to 1 year after surgery was significantly lower in the N-group (p = 0.012 each). The nutrition status (albumin, total protein, hemoglobin, and C-reactive protein levels) at 1 month after surgery showed improvements (p = 0.005, p = 0.048), and hospital stay was decreased in the N-group as compared to the C-group (16.0 vs. 12.5 days, p = 0.041). Early intervention with an elemental diet after distal gastrectomy is valuable for reducing perioperative weight loss and improving nutritional management and may be associated with enhanced postoperative recovery in elderly patients.

  7. [Effect of anaesthesia on incidence of postoperative delirium after major abdominal surgery in elderly patients].

    PubMed

    Zabolotskikh, I B; Trembach, N V

    2013-01-01

    Delirium can be caused by haemodynamics abnormalities during anaesthesia. The main role in delirium appearance is given to decreasing of cerebral perfusion pressure. Especially it can happen in patients with underlying intracranial hypertension. Anaesthetics effects on intracranial pressure are different therefore cerebral hypoperfusion can happens in these patients even without systemic hypotension. Purpose of the study was to define an effect of cerebral perfusion pressure decreasing during different technics of anaesthesia on frequency of delirium in elderly patients after major abdominal surgery. The article deals with results of study of 182 patients (medium age 69 y.o.) underwent elective major abdominal surgery. Delirium frequency was 11%, continuing of delirium was 3 days. The frequency of delirium was higher in patients who had got anaesthesia based on sevoflurane. Additionally these patients had higher frequency of cerebral perfusion pressure decreasing. Conclusions; Anaesthesia based on sevoflurane is characterized by higher frequency of postoperative delirium in elderly patients after major abdominal surgery.

  8. Postoperative Pain and Intravenous Patient-Controlled Analgesia-Related Adverse Effects in Young and Elderly Patients

    PubMed Central

    Koh, Jae Chul; Lee, Jinae; Kim, So Yeon; Choi, Sumin; Han, Dong Woo

    2015-01-01

    Abstract In this retrospective analysis of 10,575 patients who used fentanyl-based intravenous patient-controlled analgesia (IV-PCA) after surgery, we evaluated difference between young and elderly patients on their characteristic of adverse effects. We reviewed the data collected from the patients who were provided IV-PCA for pain control following elective surgery under either general or spinal anesthesia between September 2010 and March 2014. Postoperative pain, incidence of PCA-related adverse effects, and risk factors for the need of rescue analgesics and antiemetics for postoperative 48 hours were analyzed. Pain intensity (numerical rating scale [NRS]) at postoperative 6 to 12 hours (4.68 vs 4.58, P < 0.01) and incidence of nausea or vomiting (23.8% vs 20.6%, P < 0.001) were higher in young patients, while incidence of PCA discontinuation (9.9% vs 11.5%, P < 0.01) and sedation (0.1% vs 0.7%, P < 0.001) was higher in elderly patients. Despite larger fentanyl dose used, a greater proportion of young patients required rescue analgesics (53.8% vs 47.9%, P < 0.001) while addition of ketorolac was effective in reducing postoperative pain. Despite lower incidence of postoperative nausea and vomiting (PONV), a larger proportion of elderly patients required rescue antiemetics (10.1% vs 12.2%, P < 0.001) while addition of ramosetron was effective in reducing PONV. In conclusion, when fentanyl-based IV-PCA is used for postoperative pain control, a larger proportion of young patients may require rescue analgesics while elderly patients may require more rescue antiemetics. The addition of ketorolac or ramosetron to the PCA of young and elderly patients can be effective to prevent rescue analgesics or antiemetics use. PMID:26559296

  9. Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Surgery in the Sugammadex Era: A Retrospective Study

    PubMed Central

    Oh, Chung-Sik; Rhee, Ka Young; Yoon, Tae-Gyoon; Woo, Nam-Sik; Hong, Seung Wan; Kim, Seong-Hyop

    2016-01-01

    Background. Residual neuromuscular block (NMB) after general anesthesia has been associated with pulmonary dysfunction and hypoxia, which are both associated with postoperative delirium (POD). We evaluated the effects of sugammadex on POD in elderly patients who underwent hip fracture surgery. Methods. Medical records of 174 consecutive patients who underwent hip fracture surgery with general anesthesia were reviewed retrospectively to compare the perioperative incidence of POD, pulmonary complications, time to extubation, incidence of hypoxia, and laboratory findings between patients treated with sugammadex and those treated with a conventional cholinesterase inhibitor. Results. The incidence of POD was not significantly different between the two groups (33.3% versus 36.5%, resp.; P = 0.750). Postoperative pulmonary complications and laboratory findings did not showed significant intergroup difference. However, time to extubation (6 ± 3 versus 8 ± 3 min; P < 0.001) and the frequency of postoperative hypoxia were significantly lower (23% versus 43%; P = 0.010) in the sugammadex group than in the conventional cholinesterase inhibitor group. Conclusion. Sugammadex did not reduce POD or pulmonary complications compared to conventional cholinesterase inhibitors, despite reducing time to extubation and postoperative hypoxia in elderly patients who underwent hip fracture surgery under general anesthesia. PMID:26998480

  10. Parecoxib prevents early postoperative cognitive dysfunction in elderly patients undergoing total knee arthroplasty

    PubMed Central

    Zhu, Yang-Zi; Yao, Rui; Zhang, Zhe; Xu, Hui; Wang, Li-Wei

    2016-01-01

    Abstract Background: Trial design neuroinflammation and postoperative pain after surgery are increasingly reported in association with postoperative cognitive dysfunction (POCD). Parecoxib, a selective cyclooxygenase (COX)-2 inhibitor, is used for postoperative analgesia for its potent anti-inflammatory and analgesic effects. This study aimed to evaluate parecoxib's effects on POCD in elderly patients undergoing total knee arthroplasty. Methods: Around 134 elderly patients undergoing total knee arthroplasty were randomly divided into parecoxib (group P) and control (group C) groups, and treated with parecoxib sodium and saline, respectively, shortly after induction of general anesthesia and 12-h postsurgery, respectively. Perioperative plasma IL-1β, IL-6, TNF-α, and C-reactive protein (CRP) 1evels were measured. Postoperative pain was assessed following surgery. Neuropsychological tests were performed before surgery, and 1 week and 3 months postoperation. Results: POCD incidence in group P was significantly lower compared with that of group C at 1 week after surgery (16.7% vs 33.9%; P < 0.05); no significant difference was found between groups C and P at 3-month follow-up (9.7% vs 6.7%). Compared with group C values, visual analog pain scale (VAS) scores at 3, 6, and 12 hours after surgery were significantly lower in group P(P < 0.05). Plasma IL-1β, IL-6, and TNF-α levels were lower in group P than in group C after the operation (P < 0.05). No significant difference in the plasma CRP level was found between groups P and C. Conclusions: Parecoxib sodium decreases POCD incidence after total knee arthroplasty in elderly patients and may explain how this drug suppresses inflammation and acute postoperative pain caused by surgical trauma. PMID:27428192

  11. Risk Factors and Outcomes for Postoperative Delirium after Major Surgery in Elderly Patients

    PubMed Central

    Raats, Jelle W.; van Eijsden, Wilbert A.; Crolla, Rogier M. P. H.; Steyerberg, Ewout W.; van der Laan, Lijckle

    2015-01-01

    Background Early identification of patients at risk for delirium is important, since adequate well timed interventions could prevent occurrence of delirium and related detrimental outcomes. The aim of this study is to evaluate prognostic factors for delirium, including factors describing frailty, in elderly patients undergoing major surgery. Methods We included patients of 65 years and older, who underwent elective surgery from March 2013 to November 2014. Patients had surgery for Abdominal Aortic Aneurysm (AAA) or colorectal cancer. Delirium was scored prospectively using the Delirium Observation Screening Scale. Pre- and peri-operative predictors of delirium were analyzed using regression analysis. Outcomes after delirium included adverse events, length of hospital stay, discharge destination and mortality. Results We included 232 patients. 51 (22%) underwent surgery for AAA and 181 (78%) for colorectal cancer. Postoperative delirium occurred in 35 patients (15%). Predictors of postoperative delirium included: delirium in medical history (Odds Ratio 12 [95% Confidence Interval 2.7–50]), advancing age (Odds Ratio 2.0 [95% Confidence Interval 1.1–3.8]) per 10 years, and ASA-score ≥3 (Odds Ratio 2.6 [95% Confidence Interval 1.1–5.9]). Occurrence of delirium was related to an increase in adverse events, length of hospital stay and mortality. Conclusion Postoperative delirium is a frequent complication after major surgery in elderly patients and is related to an increase in adverse events, length of hospital stay, and mortality. A delirium in the medical history, advanced age, and ASA-score may assist in defining patients at increased risk for delirium. Further attention to prevention of delirium is essential in elderly patients undergoing major surgery. PMID:26291459

  12. The impact of postoperative complications on the recovery of elderly surgical patients.

    PubMed

    Tahiri, Mehdi; Sikder, Tarifin; Maimon, Geva; Teasdale, Debby; Hamadani, Fadi; Sourial, Nadia; Feldman, Liane S; Guralnick, Jack; Fraser, Shanon A; Demyttenaere, Sebastian; Bergman, Simon

    2016-05-01

    While the negative impact of postoperative complications on hospital costs, survival, and cancer recurrence is well known, few studies have quantified the impact of postoperative complications on patient-centered outcomes such as functional status. The objective of this study was to estimate the impact of postoperative complications on recovery of functional status after elective abdominal surgery in elderly patients. Elderly patients (70 years and older) undergoing elective abdominal surgery, with a planned length of stay >1 day, were prospectively enrolled between July 2012 and December 2014. The primary outcome was time to recovery to the preoperative functional status measured by the short physical performance battery (SPPB) preoperatively and at 1 week, 1, 3, and 6 months after surgery. The comprehensive complication index was calculated to grade the severity and number of postoperative complications. A Weibull survival model with interval censoring was performed, controlling for age, sex, body mass index (BMI), comorbidities (Charlson comorbidity index-CCI), frailty, presence of cancer, nutritional status, wound class, preoperative functional status, and surgical approach. Hundred and forty-nine patients (79 men and 70 women) were included in the analysis. Mean age was 77.7 ± 4.9 years, mean BMI was 27.2 ± 5.5 kg/m(2), and the median CCI was 3 (IQR 2-6). The mean preoperative SPPB score was 9.62 ± 2.33. A total of 52 patients (34.9 %) experienced one or more postoperative complications, including four mortalities, and a total of 72 complications. The mean comprehensive complication index score for these patients was 25.7 ± 23.8. In the presence of all other variables included in the model, a higher comprehensive complication index score was found to significantly decrease the hazard of recovery (HR 0.96, CI 0.94-0.98, p value = 0.0004) and hence increase the time to recovery. Following elective abdominal surgery, elderly patients who

  13. Sarcopenia is associated with severe postoperative complications in elderly gastric cancer patients undergoing gastrectomy.

    PubMed

    Fukuda, Yasunari; Yamamoto, Kazuyoshi; Hirao, Motohiro; Nishikawa, Kazuhiro; Nagatsuma, Yukiko; Nakayama, Tamaki; Tanikawa, Sugano; Maeda, Sakae; Uemura, Mamoru; Miyake, Masakazu; Hama, Naoki; Miyamoto, Atsushi; Ikeda, Masataka; Nakamori, Shoji; Sekimoto, Mitsugu; Fujitani, Kazumasa; Tsujinaka, Toshimasa

    2016-07-01

    Malignancy is a secondary cause of sarcopenia, which is associated with impaired cancer treatment outcomes. The aim of this study was to investigate the prevalence of preoperative sarcopenia among elderly gastric cancer patients undergoing gastrectomy and the differences in preoperative dietary intake and postoperative complications between sarcopenic and non-sarcopenic patients. Ninety-nine patients over 65 years of age who underwent gastrectomy for gastric cancer were analyzed. All patients underwent gait and handgrip strength testing, and whole-body skeletal muscle mass was measured using a bioimpedance analysis technique based on the European Working Group on Sarcopenia in Older People (EWGSOP) algorithm for the evaluation of sarcopenia before surgery. Preoperative dietary intake was assessed using a food frequency questionnaire. Of these patients, 21 (21.2 %) were diagnosed with sarcopenia. Sarcopenic patients consumed fewer calories and less protein preoperatively (23.9 vs. 27.8 kcal/kg ideal weight/day and 0.86 vs. 1.04 g/kg ideal weight/day; P = 0.001 and 0.0005, respectively). Although the overall incidence of postoperative complications was similar in the two groups (57.1 % vs. 35.9 %; P = 0.08), the incidence of severe (Clavien-Dindo grade ≥ IIIa) complications was significantly higher in the sarcopenic group than in the non-sarcopenic group (28.6 % vs. 9.0 %; P = 0.029). In the multivariate analysis, sarcopenia alone was identified as a risk factor for severe postoperative complications (odds ratio, 4.76; 95 % confidence interval, 1.03-24.30; P = 0.046). Preoperative sarcopenia as defined by the EWGSOP algorithm is a risk factor for severe postoperative complications in elderly gastric cancer patients undergoing gastrectomy.

  14. [Low-dose ketamine combined with fentanyl for intravenous postoperative analgesia in elderly patients].

    PubMed

    Liang, Shi-wei; Chen, Ye-ming; Lin, Chun-shui

    2006-11-01

    To investigate the clinical efficacy of and complications arising from low-dose ketamine combined with fentanyl for intravenous postoperative analgesia in comparison with the exclusive use of fentanyl in elderly patients. Eighty elderly patients were randomized into two equal groups following thoracoabdominal surgery, and received intravenous analgesia with the combination of 0.5 mg/ml ketamine, 5.0 microg/ml fentanyl and 50 microg/ml midazolam (KF group) and with 7.5 microg/ml fentanyl plus 50 microg/ml midazolam (FT group), respectively. The drugs used were diluted in 200 ml normal saline. For analgesic administration, a loading dose (2-4 ml) was given followed by a background infusion (2.5-3.5 ml), with patient-controlled bolus doses of 2.0-3.0 ml with lock-out time of 20 min via PCA pump (Automedical, Korea). The static pain score (VAS), sedation score, and incidences of nausea, vomiting, pruritus and hallucinations were recorded during the initial 48 h after the surgery. The total analgesic dosage and PCA dosage in the two groups were similar (P>0.05). With similar VAS in the two groups (P>0.05), the sedative effect in KF group was much better than that in FT group (P<0.05) during the initial 48 h postoperatively. The incidences of nausea, vomiting and itching were lower in KF group than in FT group (P<0.05), and no illusion was reported in two groups during the initial 48 h. For producing comparable postoperative analgesic effect, low-dose ketamine combined with fentanyl can markedly reduce fentanyl requirement in the elderly patients and lowers the incidences of nausea, vomiting and itching in comparison with the exclusive use of fentanyl.

  15. Postoperative Treatment of Primary Glioblastoma Multiforme With Radiation and Concomitant Temozolomide in Elderly Patients

    SciTech Connect

    Combs, Stephanie E. Wagner, Johanna; Bischof, Marc; Welzel, Thomas; Wagner, Florian; Debus, Juergen; Schulz-Ertner, Daniela

    2008-03-15

    Purpose: To evaluate efficacy and toxicity in elderly patients with glioblastoma multiforme (GBM) treated with postoperative radiochemotherapy with temozolomide (TMZ). Patients and Methods: Forty-three patients aged 65 years or older were treated with postoperative with radiochemotherapy using TMZ for primary GBM. Median age at primary diagnosis was 67 years; 14 patients were female, 29 were male. A complete surgical resection was performed in 12 patients, subtotal resection in 17 patients, and biopsy only in 14 patients. Radiotherapy was applied with a median dose of 60 Gy, in a median fractionation of 5 x 2 Gy/wk. Thirty-five patients received concomitant TMZ at 50 mg/m{sup 2}, and in 8 patients 75 mg/m{sup 2} of TMZ was applied. Adjuvant cycles of TMZ were prescribed in 5 patients only. Results: Median overall survival was 11 months in all patients; the actuarial overall survival rate was 48% at 1 year and 8% at 2 years. Median overall survival was 18 months after complete resection, 16 months after subtotal resection, and 6 months after biopsy only. Median progression-free survival was 4 months; the actuarial progression-free survival rate was 41% at 6 months and 18% at 12 months. Radiochemotherapy was well tolerated in most patients and could be completed without interruption in 38 of 43 patients. Four patients developed hematologic side effects greater than Common Terminology Criteria Grade 2, which led to early discontinuation of TMZ in 1 patient. Conclusions: Radiochemotherapy is safe and effective in a subgroup of elderly patients with GBM and should be considered in patients without major comorbidities.

  16. Predictors of severe pain in the immediate postoperative period in elderly patients following hip fracture surgery.

    PubMed

    Radinovic, Kristina; Milan, Zoka; Markovic-Denic, Ljiljana; Dubljanin-Raspopovic, Emilija; Jovanovic, Bojan; Bumbasirevic, Vesna

    2014-08-01

    The aim of this study was to identify risk factors for severe postoperative pain immediately after hip-fracture surgery. Three hundred forty-four elderly patients with an acute hip fracture were admitted to the hospital during a 12-months period. All patients who entered the study answered a structured questionnaire to assess demographic characteristics, previous diseases, drug use, previous surgery, and level of education. Physical status was assessed through the American Society of Anesthesiologists' preoperative risk classification, cognitive status using the Short Portable Mental Status Questionnaire, and depression using the Geriatric Depression Scale. The presence of preoperative delirium using the Confusion Assessment Method was assessed during day and night shifts until surgery. Pain was measured using a numeric rating scale (NRS). An NRS ≥ 7 one hour after surgery indicated severe pain. Patients with elementary-level education (8 yr in school) presented a higher risk for immediate severe postoperative pain than university-educated patients (> 12 yr in school) (P < 0.05). Higher cognitive function was associated with higher postoperative pain (P < 0.01). Patients with symptoms of depression and patients with preoperative delirium presented a higher risk for severe pain (P < 0.05, P < 0.01, respectively). Multivariate analysis showed that depression and a low level of education were independent predictors of severe pain immediately after surgery. Depression and lower levels of education were independent predictors of immediate severe pain following hip-fracture surgery. These predictors could be clinically used to stratify analgesic risk in elderly patients for more aggressive pain treatment immediately after surgery. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. Preoperative cerebrospinal fluid cytokine levels and the risk of postoperative delirium in elderly hip fracture patients

    PubMed Central

    2013-01-01

    Background Aging and neurodegenerative disease predispose to delirium and are both associated with increased activity of the innate immune system resulting in an imbalance between pro- and anti-inflammatory mediators in the brain. We examined whether hip fracture patients who develop postoperative delirium have altered levels of inflammatory mediators in cerebrospinal fluid (CSF) prior to surgery. Methods Patients were 75 years and older and admitted for surgical repair of an acute hip fracture. CSF samples were collected preoperatively. In an exploratory study, we measured 42 cytokines and chemokines by multiplex analysis. We compared CSF levels between patients with and without postoperative delirium and examined the association between CSF cytokine levels and delirium severity. Delirium was diagnosed with the Confusion Assessment Method; severity of delirium was measured with the Delirium Rating Scale Revised-98. Mann–Whitney U tests or Student t-tests were used for between-group comparisons and the Spearman correlation coefficient was used for correlation analyses. Results Sixty-one patients were included, of whom 23 patients (37.7%) developed postsurgical delirium. Concentrations of Fms-like tyrosine kinase-3 (P=0.021), Interleukin-1 receptor antagonist (P=0.032) and Interleukin-6 (P=0.005) were significantly lower in patients who developed delirium postoperatively. Conclusions Our findings fit the hypothesis that delirium after surgery results from a dysfunctional neuroinflammatory response: stressing the role of reduced levels of anti-inflammatory mediators in this process. Trial registration The Effect of Taurine on Morbidity and Mortality in the Elderly Hip Fracture Patient. Registration number: NCT00497978. Local ethical protocol number: NL16222.094.07. PMID:24093540

  18. Haloperidol prophylaxis for preventing aggravation of postoperative delirium in elderly patients: a randomized, open-label prospective trial.

    PubMed

    Fukata, Shinji; Kawabata, Yasuji; Fujishiro, Ken; Kitagawa, Yuichi; Kuroiwa, Kojiro; Akiyama, Hirotoshi; Takemura, Marie; Ando, Masahiko; Hattori, Hideyuki

    2017-07-01

    The aim of this study was to evaluate the safety and efficacy of the early administration haloperidol in preventing the aggravation of postoperative delirium in elderly patients. A total of 201 patients (age ≥75 years) who underwent elective surgery were enrolled. The patients were divided into two groups: the intervention group (n = 101) received prophylactic haloperidol (5 mg); the control group (n = 100) did not. Haloperidol was administered daily during postoperative days 0-5 to the patients who presented with NEECHAM scores of 20-24 when measured at 18:00. The primary endpoint was the incidence of severe postoperative delirium. The incidence of severe postoperative delirium in all patients was 25.1%. The incidence of severe postoperative delirium in the intervention group (18.2%) was significantly lower than that in the control group (32.0%) (p = 0.02). The difference between the two groups was larger when the analysis was limited to the 70 patients who had NEECHAM scores of 20-24 for at least one day during postoperative days 0-5. No adverse effects of the haloperidol were observed. The prophylactic administration of haloperidol at the early stage of delirium significantly reduced the incidence of severe postoperative delirium in elderly patients. Clinical Trial Registration UMIN000007204.

  19. Use of a Comprehensive Geriatric Assessment to Predict Short-Term Postoperative Outcome in Elderly Patients With Colorectal Cancer

    PubMed Central

    Lee, Yoon Hyun; Oh, Heung-Kwon; Ihn, Myong Hoon; Kim, Jee Hyun; Son, Il Tae; Kang, Sung Il; Kim, Gwang Il; Ahn, Soyeon; Kang, Sung-Bum

    2016-01-01

    Purpose This study was conducted to identify the effectiveness of a preoperative comprehensive geriatric assessment (CGA) for predicting postoperative morbidity in elderly patients who underwent surgery for colorectal cancer. Methods Elderly patients (≥70 years old) who underwent surgery for colorectal cancer at a tertiary hospital in Korea were identified, and their cases were analyzed using data from a prospectively collected database to establish an association between major postsurgical complications and 'high-risk' patient as defined by the CGA. Results A total of 240 patients, with a mean age of 76.7 ± 5.2 years, were enrolled. Ninety-five patients (39.6%) were classified as "high-risk" and 99 patients (41.3%) as having postoperative complications. The univariate analysis indicated that risk factors for postoperative complications were age, American Society of Anesthesiologists physical status classification, serum hemoglobin, carcinoembryonic antigen, cancer stage, and "high-risk" status. The multivariable analyses indicated that "high-risk" status (odds ratio, 2.107; 95% confidence interval, 1.168–3.804; P = 0.013) and elevated preoperative carcinoembryonic antigen (odds ratio, 2.561; 95% confidence interval, 1.346–4.871, P = 0.004) were independently associated with postoperative complications. A multivariable analysis of the individual CGA domains indicated that high comorbidities and low activities of daily living were significantly related with postoperative complications. Conclusion A preoperative CGA indicating "high-risk" was associated with major postoperative complications in elderly patients who underwent surgery for colorectal cancer. Thus, using the CGA to identify elderly colorectal-cancer patients who should be given more care during postoperative management may be clinically beneficial. PMID:27847786

  20. Dysfunction of pre- and post-operative cardiac autonomic nervous system in elderly patients with diabetes mellitus.

    PubMed

    Zhang, Junlong; Tu, Weifeng; Dai, Jianqiang; Lv, Qing; Yang, Xiaoqi

    2011-01-01

    The pre- and post-operative cardiac autonomic nervous functions were compared in elderly, non-cardiac surgery patients with diabetes mellitus (DM) and without diabetes mellitus (NDM). A group of 30 unpremedicated elderly patients scheduled to undergo elective non-cardiac surgery were studied, including 15 DM patients and 15 NDM patients. Each component of heart rate variability (HRV) analysis in the frequency domain was monitored with Holter during the nights of the day before and on 1st and 2nd day after operation. After surgery, total power (TP), high frequency (HF), low frequency (LF) and very low frequency (VLF) significantly decreased as compared to the baseline values before operation in both groups (p<0.05). The LF/HF ratio was significantly changed in DM group but did not change in NDM group. On the 2nd postoperative day, TP, HF, LF and VLF in DM group were further decreased as compared to those on the 1st postoperative day and were significantly lower than those in NDM group (p<0.01 or 0.05), but these indices in NDM group did not show significant decreases. Surgery induced the cardiac autonomic nervous dysfunction in elderly patients not only with DM but also without diabetes. On the 2nd postoperative day, the disturbances of cardiac autonomic nervous activity were more sever in DM patients, compared to the 1st postoperative day, but was not significantly more sever than in the NDM patients.

  1. Effects of Dexmedetomidine on Serum Interleukin-6, Hemodynamic Stability, and Postoperative Pain Relief in Elderly Patients under Spinal Anesthesia.

    PubMed

    Yun, So Hui; Park, Jong Cook; Kim, Sang Rim; Choi, Yun Suk

    2016-01-01

    The beneficial effects of dexmedetomidine (DEX) have not been extensively investigated in elderly patients receiving spinal anesthesia. This study evaluated the effects of intravenous DEX infusion on stress and hemodynamic response, as well as on postoperative analgesia in elderly patients undergoing total knee arthroplasty (TKA). We randomly allocated 45 adult patients to 3 patient groups (n=15 each): uni-saline group patients underwent unilateral TKA with saline administration, uni-DEX group patients underwent unilateral TKA with DEX administration, and bilateral-DEX group patients underwent bilateral TKA with DEX administration. Serum interleukin-6 (IL-6) levels were significantly lower in the bilateral-DEX group than in the uni-saline group 6 and 24h postoperatively, and were negatively correlated with total DEX dosage 24h postoperatively. Bradycardia occurred more frequently in the uni-DEX and bilateral-DEX groups than in the uni-saline group. The total dose of required supplementary analgesics was significantly higher in the uni-saline group than in the uni-DEX and bilateral-DEX groups 6h postoperatively. The results indicate that perioperative intravenous DEX administration decreases postoperative serum IL-6 levels in patients undergoing bilateral TKA, and has a postoperative analgesic effect in patients undergoing unilateral or bilateral TKA.

  2. Do Elderly Patients Experience Increased Perioperative or Postoperative Morbidity or Mortality When Given Neoadjuvant Chemoradiation Before Esophagectomy?

    SciTech Connect

    Fogh, Shannon E.; Yu, Anthony; Kubicek, Gregory J.; Scott, Walter; Mitchell, Edith; Rosato, Ernest L.; Berger, Adam C.

    2011-08-01

    Background: The use of induction chemoradiotherapy followed by surgery has been widely used for the treatment of esophageal cancer. The presumed risk of increased postoperative morbidity and mortality with this regimen has led to reluctance to offer this therapy to elderly patients. We compared the perioperative morbidity and mortality of patients 70 years old and older with those of patients younger than 70 who received CRT followed by esophagectomy and sought to identify preoperative risk factors that may predict higher risk of postoperative death or complications. Methods and Materials: We identified 260 patients who underwent preoperative chemoradiotherapy followed by esophagectomy. The association of age with postoperative death and complications was evaluated. The Charlson index, prior cardiac history, and diabetes were identified as preoperative risk factors and were evaluated as potential confounders or effect modifiers. Results: Cardiac disease and the Charlson index were potential modifiers of the effect of age on length of hospital stay (p = 0.08 and p = 0.07, respectively) and postoperative complications (p = 0.1 and p = 0.2) but were not statistically significant. There was a slight nonsignificant decrease in the risk of death in elderly patients after adjustment for the Charlson index (p = 0.2). Conclusion: No significant differences were detected with respect to morbidity and mortality in elderly patients. The presence of cardiac disease, higher scores on the Charlson index, or diabetes did not significantly influence length of stay, postoperative complications, or postoperative death. Given the potential to improve outcomes, this regimen should not be discounted in elderly patients.

  3. Perception of barriers to postoperative pain management in elderly patients in Polish hospitals - a multicentre study.

    PubMed

    Wioletta, Mędrzycka-Dąbrowska; Sebastian, Dąbrowski; Andrzej, Basiński

    2016-11-01

    The purpose of the paper was to compare the prevalence of barriers to optimum postoperative pain management in elderly patients, observed by nurses in a clinical, provincial and municipal hospital in Poland. It is currently estimated that the lack of adequate pain management affects 80% of the global population and the phenomenon poses a serious problem in more than 150 countries. A questionnaire-based study of 1602 nurses working at clinical, provincial and municipal hospitals. In the clinical hospitals barriers more often related to a poorly organised systems of care and obstacles in discussing pain management within the team. In provincial and municipal hospitals lack of uninform pain measurement was more evident. Despite the availability of effective pain treatments in hospitals difficulties continue with communication, poorly organised care and limited access to clinical guidelines. Although there are possibilities of pain relief after surgery, they are still used insufficiently. Postoperative pain management in Poland needs considerable improvement. This study can contribute to the improvement of pain management quality by supporting and developing practical guidelines or management algorithms for nurses, facilitating the effective implementation of new pain management practices. © 2016 John Wiley & Sons Ltd.

  4. Postoperative delirium is an independent risk factor for posttraumatic stress disorder in the elderly patient: a prospective observational study.

    PubMed

    Drews, Tanja; Franck, Martin; Radtke, Finn M; Weiss, Björn; Krampe, Henning; Brockhaus, Wolf R; Winterer, Georg; Spies, Claudia D

    2015-03-01

    Posttraumatic stress disorder (PTSD) may appear after hospitalisation for surgery with general anaesthesia in elderly patients. Prevalence and risk factors in this setting are unknown. Postoperative delirium could be a risk factor. The purpose of this study was to identify the prevalence of, and risk factors for, PTSD 3 months after surgery with general anaesthesia in elderly patients. A prospective, clinical observational study. This study was carried out between March 2009 and May 2010 in a German university hospital in Berlin and was part of a larger study focusing on depth of anaesthesia. at least 60 years of age; noncardiac surgery with general anaesthesia. impaired preoperative cognitive function [mini-mental state examination (MMSE) score <24]; expected surgery time less than 1 h; nonproficiency in the German language. None. Screening for PTSD 3 months after surgery using the screening instrument Post-Traumatic Stress Syndrome 14-Questions Inventory Score (PTSS-14). The following risk factors for PTSD 3 months after surgery were tested: age; American Society of Anesthesiologists physical status; sex; duration of anaesthesia; postoperative delirium; PTSS-14 score 7 days after surgery; postoperative vomiting and nausea; postoperative pain; and preoperative depression. Univariate statistical analysis was performed with Fisher's exact test and Spearman correlation. A backward logistic regression was performed. A total of 559 out of 1277 patients were included. Sixty-six patients (12%) were identified with PTSD 3 months after surgery. Seventy-seven patients (14%) were identified with postoperative delirium. Independent associated factors in the backward logistic regression were postoperative delirium (risk factor) and preoperative depression (protective factor). The prevalence of PTSD 3 months after surgery in elderly patients was high using the screening instrument PTSS-14. Postoperative delirium is a risk factor for PTSD 3 months after surgery. ISRCTN

  5. Sedation Depth During Spinal Anesthesia and the Development of Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Repair

    PubMed Central

    Sieber, Frederick E.; Zakriya, Khwaji J.; Gottschalk, Allan; Blute, Mary-Rita; Lee, Hochang B.; Rosenberg, Paul B.; Mears, Simon C.

    2010-01-01

    OBJECTIVE: To determine whether limiting intraoperative sedation depth during spinal anesthesia for hip fracture repair in elderly patients can decrease the prevalence of postoperative delirium. PATIENTS AND METHODS: We performed a double-blind, randomized controlled trial at an academic medical center of elderly patients (≥65 years) without preoperative delirium or severe dementia who underwent hip fracture repair under spinal anesthesia with propofol sedation. Sedation depth was titrated using processed electroencephalography with the bispectral index (BIS), and patients were randomized to receive either deep (BIS, approximately 50) or light (BIS, ≥80) sedation. Postoperative delirium was assessed as defined by Diagnostic and Statistical Manual of Mental Disorders (Third Edition Revised) criteria using the Confusion Assessment Method beginning at any time from the second day after surgery. RESULTS: From April 2, 2005, through October 30, 2008, a total of 114 patients were randomized. The prevalence of postoperative delirium was significantly lower in the light sedation group (11/57 [19%] vs 23/57 [40%] in the deep sedation group; P=.02), indicating that 1 incident of delirium will be prevented for every 4.7 patients treated with light sedation. The mean ± SD number of days of delirium during hospitalization was lower in the light sedation group than in the deep sedation group (0.5±1.5 days vs 1.4±4.0 days; P=.01). CONCLUSION: The use of light propofol sedation decreased the prevalence of postoperative delirium by 50% compared with deep sedation. Limiting depth of sedation during spinal anesthesia is a simple, safe, and cost-effective intervention for preventing postoperative delirium in elderly patients that could be widely and readily adopted. Trial Registration: clinicaltrials.gov Identifier: NCT00590707 PMID:20042557

  6. Predicting postoperative complications of head and neck squamous cell carcinoma in elderly patients using random forest algorithm model.

    PubMed

    Chen, YiMing; Cao, Wei; Gao, XianChao; Ong, HuiShan; Ji, Tong

    2015-06-09

    Head and Neck Squamous Cell Carcinoma (HNSCC) has a high incidence in elderly patients. The postoperative complications present great challenges within treatment and they're hard for early warning. Data from 525 patients diagnosed with HNSCC including a training set (n = 513) and an external testing set (n = 12) in our institution between 2006 and 2011 was collected. Variables involved are general demographic characteristics, complications, disease and treatment given. Five data mining algorithms were firstly exploited to construct predictive models in the training set. Subsequently, cross-validation was used to compare the different performance of these models and the best data mining algorithm model was then selected to perform the prediction in an external testing set. Data from 513 patients (age > 60 y) with HNSCC in a training set was included while 44 variables were selected (P < 0.05). Five predictive models were constructed; the model with 44 variables based on the Random Forest algorithm demonstrated the best accuracy (89.084%) and the best AUC value (0.949). In an external testing set, the accuracy (83.333%) and the AUC value (0.781) were obtained by using the random forest algorithm model. Data mining should be a promising approach used for elderly patients with HNSCC to predict the probability of postoperative complications. Our results highlighted the potential of computational prediction of postoperative complications in elderly patients with HNSCC by using the random forest algorithm model.

  7. [Integrative management of operation, perioperative rehabilitation and postoperative adjuvant chemotherapy in elderly patients with colorectal carcinoma].

    PubMed

    Xu, Dong; Jiao, Yurong; Ding, Kefeng

    2016-05-01

    With the aging of the Chinese population, it seems obvious that the number of elderly patients with the disease of colorectal carcinoma grows significantly. Meanwhile, no evidence-based practical guideline for the treatment of colorectal carcinoma are available in this particular age group. Therefore, the concept of integrative management has been brought up by the Colorectal Cancer Center of the Second Affiliated Hospital of Zhejiang University, which combines the processes of surgery, perioperative rehabilitation and adjuvant chemotherapy together. In this way, the cooperation and complementarity between different clinical departments could cooperate and complete tasks together to integrate the treatment processes into a cohesive one. To achieve the goal of integrative management, the project is divided into horizontal and vertical aspects. The horizontal integration means the cooperation between different clinical departments, which is also known as multi-discipline treatment (MDT). The vertical integration reflects the completeness of the entire treatment under the goal of consistency, strictness and job separation, which could also be explained as the clinical pathway. Furthermore, this review stresses on the integrative strategy of both clinical and biochemical indexes rehabilitation, as well as the operation and postoperative adjuvant chemotherapy which has been put in execution several years by the Colorectal Cancer Center of the Second Affiliated Hospital of Zhejiang University.

  8. Effect of propofol, sevoflurane, and isoflurane on postoperative cognitive dysfunction following laparoscopic cholecystectomy in elderly patients: A randomized controlled trial.

    PubMed

    Geng, Ying-Jie; Wu, Qing-Hua; Zhang, Rui-Qin

    2017-05-01

    To compare the incidence of postoperative cognitive dysfunction (POCD) in elderly surgical patients (>60years) receiving different anesthetics (propofol, sevoflurane, or isoflurane) and to identify potential biomarkers of POCD in this patient population. Prospective, randomized, double-blind clinical trial. University-affiliated teaching hospital. One hundred and fifty elderly patients scheduled for laparoscopic cholecystectomy. Elderly patients undergoing laparoscopic cholecystectomy were randomly assigned to receive propofol, sevoflurane, or isoflurane anesthesia. Cognitive function was assessed using neuropsychological tests at baseline (1day before surgery [D0]), and on postoperative day 1 (D1) and day 3 (D3). Plasma S-100β and Aβ1-40 protein, IL-1β, IL-6 and TNF-α concentrations were assessed before induction of anesthesia (T0), after extubation (T1), and 1h (T2) and 24h (T3) postoperatively. The incidence of POCD was significantly lower in the propofol group compared to the isoflurane group and the sevoflurane group at D1 and D3 (propofol vs. isoflurane: D1 and D3, P<0.001; propofol vs. sevoflurane: D1, P=0.012; D3, P=0.013). The incidence of POCD was significantly lower in the sevoflurane group compared to the isoflurane group at D1 (P=0.041), but not at D3. Postoperatively, plasma S-100β and Aβ1-40 protein, IL-1β, IL-6, and TNF-α concentrations were significantly decreased in the propofol group compared to the isoflurane group. Propofol anesthesia may be an option for elderly surgical patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Low Serum Albumin Level, Male Sex, and Total Gastrectomy Are Risk Factors of Severe Postoperative Complications in Elderly Gastric Cancer Patients.

    PubMed

    Kang, Sung Chan; Kim, Hyun Il; Kim, Min Gyu

    2016-03-01

    It is well known that old age is a risk factor for postoperative complications. Therefore, this study aimed to explore the risk factors for poor postoperative surgical outcomes in elderly gastric cancer patients. Between January 2006 and December 2015, 247 elderly gastric cancer patients who underwent curative gastrectomy were reviewed. In this study, an elderly patient was defined as a patient aged ≥65 years. All possible variables were used to explore the risk factors for poor early surgical outcomes in elderly gastric cancer patients. Based on multivariate analyses of preoperative risk factors, preoperative low serum albumin level (<3.5 g/dl) and male sex showed statistical significance in predicting severe postoperative complications. Additionally, in an analysis of surgery-related risk factors, total gastrectomy was a risk factor for severe postoperative complications. Our study findings suggest that low serum albumin level, male sex, and total gastrectomy could be risk factors of severe postoperative complications in elderly gastric cancer patients. Therefore, surgeons should work carefully in cases of elderly gastric cancer patients with low preoperative serum albumin level and male sex. We believe that efforts should be made to avoid total gastrectomy in elderly gastric cancer patients.

  10. A Comparision of the Effect of Sugammadex on the Recovery Period and Postoperative Residual Block in Young Elderly and Middle-Aged Elderly Patients.

    PubMed

    Yazar, Emine; Yılmaz, Canan; Bilgin, Hülya; Karasu, Derya; Bayraktar, Selcan; Apaydın, Yılmaz; Sayan, Halil Erkan

    2016-03-01

    The importance of the characteristics of anesthesia and postoperative residual curarization (PORC) in the elderly population should be a growing concern in this century. To investigate the effect of sugammadex on the duration of the recovery from neuromuscular blocking agents and postoperative residual curarization in the young elderly and middle-aged elderly patients who underwent elective laparoscopic cholecystectomy, followed by a train of four (TOF) watch monitorization. Prospective clinical trial study. Sixty patients over the age of 65 with American Society of Anesthesiologists I-III were divided into two groups according to their age (65-74 years old and ≥75 years old). Patients received sugammadex (2.0 mg/kg iv) at the reappearance of the second twitch of the TOF as an agent for reversal of neuromuscular blockage at the end of surgery. Patients were extubated at the time of TOF ≥0.9. The patients' TOF responses were evaluated with regards to PORC in at the 5th minute and were followed up for one hour in the recovery room. Reintubation was applied for those patients who developed PORC and had peripheric oxygen saturation <90% despite being given 6 L oxygen per min with a face mask. The onset time of neuromuscular blocking agent and time from T2 to achieve TOF ratio 90% (the duration of sugammadex effect) or over were found to be longer in the middle-aged elderly group than in the young elderly group. A statistically significant relationship was found between age and the duration of TOF ratio to reach 0.9 in the same direction. The PORC incidence and rate of reintubation were found to be 1.7% in all patients. In our opinion, it is necessary to remember that the duration of sugammadex effect on the recovery period is prolonged for patients who are aged ≥75 years compared to patients aged between 65-74 years. (ClinicalTrials.gov Identifier: ACTRN12615000758505).

  11. The effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture

    PubMed Central

    Yang, Si-Dong; Ning, Sheng-Hua; Zhang, Li-Hong; Zhang, Ying-Ze; Ding, Wen-Yuan; Yang, Da-Long

    2016-01-01

    Abstract The purpose of this study was to explore the effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture after undergoing intramedullary nail fixation surgery. We collected medical records of elderly patients aged ≥ 60 years with femoral shaft fracture between 03/2010 and 03/2015 in Longyao County Hospital. Totally, 160 patients were identified and divided into the intervention group (n = 80) and the control group (n = 80). During the postoperative period, the intervention group received lower limb rehabilitation gymnastics treatment for 3 months, but the control group did not. All patients were routinely asked to return hospital for a check in the 1st postoperative week, as well as the 2nd week, the 1st month, and the 3rd month, after surgery. The clinical rehabilitation effect was evaluated by checking lower limb action ability, detecting the lower limb deep venous thrombosis (DVT), scoring muscle strength of quadriceps and visual analog scale (VAS) score, and performing satisfaction survey. At the 1st week and 2nd week after surgery, the clinical rehabilitation effect in the intervention group was better regarding lower limb action ability, lower limb DVT, muscle strength of quadriceps, VAS score, and patient satisfaction, as compared with the control group. However, there was no significant difference at the 1st month and the 3rd month after surgery when comparing the intervention group to the control group. In the early postoperative stage, lower limb rehabilitation gymnastics can effectively improve the recovery of lower limb function, beneficial to reducing postoperative complications such as lower limb DVT and muscle atrophy, and increasing patient satisfaction rate. PMID:27537579

  12. Preventive effects of low-dose dexmedetomidine on postoperative cognitive function and recovery quality in elderly oral cancer patients

    PubMed Central

    Guo, Yong; Sun, Lulu; Zhang, Junfeng; Li, Qifang; Jiang, Hong; Jiang, Wei

    2015-01-01

    This study analyzed the preventive effects of low-dose dexmedetomidine on postoperative cognitive function and recovery quality in elderly oral cancer patients by observing the perioperative kinetics of inflammatory cytokines, cortisol and melatonin.A total of 149 elderly oral cancer patients who had undergone tumor resection surgery were selected and randomly divided into 2 groups, Group D and Group S. After surgery, Group D was assigned to take intravenous dexmedetomidine at a dose of 0.2 μg/kg/h for 12 h, while Group S was administered physiological saline in the same manner. On the day of surgery and for the first three postoperative days, the patients were assessed with the Mini-Mental State Examination (MMSE) and a 40-item quality of recovery score questionnaire (QoR40) at 7:00 am every morning. Venous blood was harvested at the same time. Then, IL-6, CRP, cortisol and melatonin levels were measured. There were no significant between-group differences in the baseline characteristics. After surgery, the MMSE and QoR40 scores in Group D were better than those in Group S. No between-group differences were observed in the incidences of severe hypotension and bradycardia. Moreover, respiratory depression was not observed in the 2 groups. The peaks of IL-6, CRP and cortisol concentrations in Group D were lower than those in Group S. However, the melatonin levels did not differ between the 2 groups. In elderly patients, intravenous dexmedetomidine administered postoperatively for 12 h at a dose of 0.2 ug/kg/h could improve postoperative cognitive function and recovery quality by decreasing excessive inflammation and stress levels. PMID:26629132

  13. Production of inflammatory cytokines, cortisol, and Aβ1-40 in elderly oral cancer patients with postoperative delirium

    PubMed Central

    Sun, Lulu; Jia, Peiyu; Zhang, Junfeng; Zhang, Xin; Zhang, Yiwei; Jiang, Hong; Jiang, Wei; Guo, Yong

    2016-01-01

    Aim Pathophysiological disorders after surgery might be related to postoperative delirium (POD). This study was designed to elucidate the pathogenesis of POD in elderly oral cancer patients by determining the perioperative kinetics of inflammatory cytokines, cortisol, and amyloid β1-40 (Aβ1-40). Methods A total of 257 elderly oral cancer patients who underwent tumor resection surgery were selected. Venous blood was collected prior to surgery (T0), at the end of surgery (T1), and at 12 hours after surgery (T2). During the first three postoperative days, patients were examined using the confusion assessment method twice a day (8 am and 8 pm). Mini-Mental State Examination scores were recorded at T0 and on postoperative days 1, 3, and 7. Ultimately, 56 patients suffering from POD made up the POD group, and 56 patients randomly selected from a cohort of patients without POD were allocated to the no POD (NPOD) group. Subsequently, interleukin-6, C-reactive protein, procalcitonin, cortisol, and Aβ1-40 in plasma from the two groups were measured. Results The two groups displayed comparable basic characteristics. There were no differences in all tested biomarkers between the two groups at T0. However, after surgery, the biomarker levels displayed distinct patterns between the two groups. The peak levels of all biomarkers were higher in the POD group than in the NPOD group. Conversely, the Mini-Mental State Examination scores after surgery were lower in the POD group than in the no POD group. Conclusion The boost of inflammatory cytokines, cortisol, and Aβ1-40 after surgery might be involved in POD onset among elderly oral cancer patients. POD was accompanied by progressive cognitive deficiency. PMID:27822051

  14. Perioperative psychological and music interventions in elderly patients undergoing spinal anesthesia: effect on anxiety, heart rate variability, and postoperative pain.

    PubMed

    Wang, Yisha; Dong, Youjing; Li, Yang

    2014-07-01

    The aim of this study was to evaluate the effects of perioperative psychological and music interventions in elderly patients undergoing elective surgery on anxiety, post-operative pain, and changes in heart rate variability (HRV) to ascertain if perioperative psychological and music interventions can affect overall anxiety levels. Fourty elderly patients undergoing elective surgery were randomized to two groups; one group received psychological and music intervention, and the other was the control. The intervention group underwent psychological intervention and listening to music for 30 min before surgery. The mean change in HRV as determined by low frequency (LF) power measurements. After the intervention, the ratio of mean LF to high frequency (HF) power decreased significantly in the intervention group compared to before the intervention (p<0.05). In the control group, mean LF measurements and the ratio of LF:HF did not change significantly. In the intervention group, mean HF power was significantly higher after the procedure than before (p<0.01). Moreover, the mean self-rating anxiety score of the intervention group decreased after the procedure compared to before (p<0.05). The mean visual analogue score of the intervention group 6 hours after surgery was significantly lower than that of the control group (p<0.01). Perioperative psychological and music interventions can reduce anxiety and postoperative pain in elderly patients.

  15. [Effect of early postoperative use of ACEI/ARB or diuretics on the incidence of acute kidney injury after cardiac surgery in elderly patients].

    PubMed

    Hu, Peng-hua; Chen, Yuan-han; Liang, Xin-ling; Li, Rui-zhao; Li, Zhi-lian; Jiang, Fen; Shi, Wei

    2013-07-01

    To explore the influence of early postoperative use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) or diuretics on acute kidney injury (AKI) after cardiac surgery in elderly patients. Data from elderly patients (age≥60 years old) who underwent cardiac surgery with extracorporeal circulation in Guangdong General Hospital between January 2007 and December 2010 were analyzed in this retrospective research. The primary endpoint was AKI as diagnosed according to the serum creatinine criteria of RIFLE (risk, injury, failure, loss, end stage renal disease). The baseline serum creatinine was defined as the latest serum creatinine level before cardiac surgery. Multivariate analysis by logistic regression was used to obtain the independent risk factors for AKI. Among 618 elderly patients, 76 (12.3%) patients received ACEI/ARB during early postoperative period, 491 (79.4%) patients were given diuretics during early postoperative period, and postoperative AKI occurred in 394 (63.8%) patients. The incidence of AKI was 46.1% in patients who received early postoperative ACEI/ARB, and 66.2% in patients who did not (P<0.001). Patients who received diuretics postoperatively were less likely to suffer from AKI compared with patients who did not (57.0% vs. 89.8%, P<0.001). After adjustment of other potential factors of postoperative AKI, logistic regression analysis showed that early postoperative use of ACEI/ARB [odds ratio (OR)=0.131, 95% confidence interval (95%CI) 0.033-0.517, P=0.004], and early postoperative use of diuretics (OR=0.149, 95%CI 0.076-0.291, P<0.001) independently predicted the occurrence of AKI. Early postoperative use of ACEI/ARB or diuretics is associated with a lower incidence of AKI after cardiac surgery with extracorporeal circulation in elderly patients.

  16. Quantitative Analysis of Rest-Activity Patterns in Elderly Postoperative Patients with Delirium: Support for a Theory of Pathologic Wakefulness

    PubMed Central

    Jacobson, Sandra A.; Dwyer, Patrick C.; Machan, Jason T.; Carskadon, Mary A.

    2008-01-01

    Study Objectives: To investigate the feasibility of using wrist actigraphy in a postoperative cohort of elderly patients (delirious versus nondelirious), and to use actigraphy to help characterize diurnal rest-activity patterns in this population. Methods: This was a prospective postoperative study using wrist actigraphy and clinical scales (DRS-R-98 and Mini-Mental State Examination). Actigraphy was continuous for 24 to 72 hours, and scales were completed once daily. DSM-IV-TR criteria were used to diagnose delirium and to separate the sample into delirium and nondelirium groups. Groups were compared at inception (age, sex, time since surgery, number of medications, number of active medical conditions, and presurgical sleep quality). For actigraphy analysis, a 24-hour sample (taken when the DRS-R-98 score was highest) was used for each patient. Statistical analyses were performed on 6 rest-activity parameters to examine group differences. Results: Thirteen patients were studied: 6 with delirium and 7 without delirium. The groups did not differ significantly at inception. Significant group differences were found in diurnal rest-activity patterns: delirious patients showed fewer nighttime minutes resting, fewer minutes resting over 24 hours, greater mean activity at night, and a smaller amplitude of change in activity from day to night. Conclusions: This is the first study to document a significant disruption of the diurnal rest-activity cycle among delirious patients using objective methods and quantitative analysis of activity. Rest and activity consolidation were significantly reduced in delirious patients, as was the amplitude of day-night differences in rest and activity. These findings are consistent with a state of pathologic wakefulness in delirium. Citation: Jacobson SA; Dwyer PC; Machan JT; Carskadon MA. Quantitative analysis of rest-activity patterns in elderly postoperative patients with delirium: support for a theory of pathologic wakefulness. J Clin

  17. Prevention and Management of Postoperative Delirium in Elderly Patients Following Elective Spinal Surgery.

    PubMed

    Nazemi, Alireza K; Gowd, Anirudh K; Carmouche, Jonathan J; Kates, Stephen L; Albert, Todd J; Behrend, Caleb J

    2017-04-01

    This study is a systematic review. Propose an evidence-based algorithm for prevention, diagnosis, and management of postoperative delirium in geriatric patients undergoing elective spine surgery. Delirium is associated with longer stays after elective surgery, increased risk of readmission, and $6.9 billion annually in medical costs. Early diagnosis and treatment of delirium can reduce length of stay (LOS), in-hospital morbidity, and health care costs. After spinal surgery, postoperative delirium increases average LOS to >7 days and is diagnosed in 12.5%-24.3% of geriatric patients. Currently, studies for management of postoperative delirium after elective spinal procedures are not available. A literature review was performed for observational studies, randomized controlled trials, and systematic reviews between 1990 and 2015. Risk factors for delirium after elective spinal surgery include age, functional impairment, preexisting dementia, general anesthesia, surgical duration >3 hours, intraoperative hypercapnia and hypotension, greater blood loss, low hematocrit and albumin, preoperative affective dysfunction, and postoperative sleep disorders. Postoperatively, decreasing the use of methylprednisolone and promoting movement with an appropriate orthosis can reduce delirium incidence (P=0.0091). Polypharmacy is an independent risk factor for delirium (P=0.01) and decreasing use of delirium-inducing medications may reduce incidence. The delirium observation screening scale diagnoses and monitors delirium and is rated by nurses as easier to use than the NEECHAM Confusion Scale (P<0.003). Haloperidol is used widely to treat postoperative delirium. Randomized controlled trials show that adding quetiapine results in delirium resolution an average of 3.5 days faster than haloperidol alone (P=0.001) and decreases agitation and LOS (P=0.02; P=0.05). An evidence-based algorithm is proposed to prevent, diagnose, and manage postoperative delirium that can be used clinically

  18. Post-operative delirium is an independent predictor of 30-day hospital readmission after spine surgery in the elderly (≥65years old): A study of 453 consecutive elderly spine surgery patients.

    PubMed

    Elsamadicy, Aladine A; Wang, Timothy Y; Back, Adam G; Lydon, Emily; Reddy, Gireesh B; Karikari, Isaac O; Gottfried, Oren N

    2017-07-01

    In the last decade, costs of U.S. healthcare expenditures have been soaring, with billions of dollars spent on hospital readmissions. Identifying causes and risk factors can reduce soaring readmission rates and help lower healthcare costs. The aim of this is to determine if post-operative delirium in the elderly is an independent risk factor for 30-day hospital readmission after spine surgery. The medical records of 453 consecutive elderly (≥65years old) patients undergoing spine surgery at Duke University Medical Center from 2008 to 2010 were reviewed. We identified 17 (3.75%) patients who experienced post-operative delirium according to DSM-V criteria. Patient demographics, comorbidities, and post-operative complication rates were collected for each patient. Elderly patients experiencing post-operative delirium had an increased length of hospital stay (10.47days vs. 5.70days, p=0.009). Complication rates were similar between the cohorts with the post-operative delirium patients having increased UTI and superficial surgical site infections. In total, 12.14% of patients were re-admitted within 30-days of discharge, with post-operative delirium patients experiencing approximately a 4-fold increase in 30-day readmission rates (Delirium: 41.18% vs. No Delirium: 11.01%, p=0.002). In a multivariate logistic regression analysis, post-operative delirium is an independent predictor of 30-day readmission after spine surgery in the elderly (p=0.03). Elderly patients experiencing post-operative delirium after spine surgery is an independent risk factor for unplanned readmission within 30-days of discharge. Preventable measures and early awareness of post-operative delirium in the elderly may help reduce readmission rates. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. A Comparision of the Effect of Sugammadex on the Recovery Period and Postoperative Residual Block in Young Elderly and Middle-Aged Elderly Patients

    PubMed Central

    Yazar, Emine; Yılmaz, Canan; Bilgin, Hülya; Karasu, Derya; Bayraktar, Selcan; Apaydın, Yılmaz; Sayan, Halil Erkan

    2016-01-01

    Background: The importance of the characteristics of anesthesia and postoperative residual curarization (PORC) in the elderly population should be a growing concern in this century. Aims: To investigate the effect of sugammadex on the duration of the recovery from neuromuscular blocking agents and postoperative residual curarization in the young elderly and middle-aged elderly patients who underwent elective laparoscopic cholecystectomy, followed by a train of four (TOF) watch monitorization. Study Design: Prospective clinical trial study. Methods: Sixty patients over the age of 65 with American Society of Anesthesiologists I–III were divided into two groups according to their age (65–74 years old and ≥75 years old). Patients received sugammadex (2.0 mg/kg iv) at the reappearance of the second twitch of the TOF as an agent for reversal of neuromuscular blockage at the end of surgery. Patients were extubated at the time of TOF ≥0.9. The patients’ TOF responses were evaluated with regards to PORC in at the 5th minute and were followed up for one hour in the recovery room. Reintubation was applied for those patients who developed PORC and had peripheric oxygen saturation <90% despite being given 6 L oxygen per min with a face mask. Results: The onset time of neuromuscular blocking agent and time from T2 to achieve TOF ratio 90% (the duration of sugammadex effect) or over were found to be longer in the middle-aged elderly group than in the young elderly group. A statistically significant relationship was found between age and the duration of TOF ratio to reach 0.9 in the same direction. The PORC incidence and rate of reintubation were found to be 1.7% in all patients. Conclusion: In our opinion, it is necessary to remember that the duration of sugammadex effect on the recovery period is prolonged for patients who are aged ≥75 years compared to patients aged between 65–74 years. (ClinicalTrials.gov Identifier: ACTRN12615000758505) PMID:27403387

  20. Counseling, quality of life, and acute postoperative pain in elderly patients with hip fracture

    PubMed Central

    Gambatesa, Maria; D’Ambrosio, Alessandro; D’Antini, Davide; Mirabella, Lucia; De Capraris, Antonella; Iuso, Salvatore; Bellomo, Antonello; Macchiarola, Antonio; Dambrosio, Michele; Cinnella, Gilda

    2013-01-01

    Introduction Hip fractures represent one of the most important causes of morbidity and mortality in elderly people. Anxiety and depression affect their quality of life and increase pain severity, and have adverse effects on functional recovery. Recent World Health Organization guidelines emphasize that therapeutic regimes need to be individualized and combined with psychological support. This study was launched with the primary endpoint of assessing if and to what extent client-centered therapy affects the perception of pain, reduces anxiety and depression, and increases the quality of life of elderly patients with hip fracture. Materials and methods Forty patients were admitted to the Orthopedic and Trauma Surgery ward for hip fracture. Patients were randomly divided into two subgroups: (1) case (group C), had to receive patient-centered counseling throughout the hospitalization; and (2) control (group NC), receiving the analgesic treatment without receiving counseling. Short Form-36-item Health Survey Questionnaire, State–Trait Anxiety Inventory, and Hamilton Rating Scale for Depression scores were recorded before any treatment, at discharge, and after 30 days. Pain levels were evaluated by means of Visual Analog Scale every 12 hours during the hospitalization from the day of surgery until day 5. Results The hierarchical clustering analysis identified before any treatment were two clusters based on different physical functioning perceptions and role limitations, which were due to physical and emotional problems. Counseling did have a positive impact on quality of life on all patients, but in a more relevant way if patients were low functioning upon admittance to the ward. Anxiety and depression decreased in patients undergoing counseling, and their pain levels were lower than among patients not receiving it. Conclusion This study reveals that hip fracture patients can be clustered on the basis of Short Form-36 baseline scores. Counseling affects the evolution

  1. Postoperative pain management after total knee arthroplasty in elderly patients: treatment options.

    PubMed

    McCartney, Colin J L; Nelligan, Kathleen

    2014-02-01

    Total knee arthroplasty (TKA) is a common surgical procedure in the elderly and is associated with severe pain after surgery and a high incidence of chronic pain. Several factors are associated with severe acute pain after surgery, including psychological factors and severe preoperative pain. Good acute pain control can be provided with multimodal analgesia, including regional anesthesia techniques. Studies have demonstrated that poor acute pain control after TKA is strongly associated with development of chronic pain, and this emphasizes the importance of attention to good acute pain control after TKA. Pain after discharge from hospital after TKA is currently poorly managed, and this is an area where increased resources need to be focused to improve early pain control. This is particularly as patients are often discharged home within 4-5 days after surgery. Chronic pain after TKA in the elderly can be managed with both pharmacological and non-pharmacological techniques. After excluding treatable causes of pain, the simplest approach is with the use of acetaminophen combined with a short course of non-steroidal anti-inflammatory drugs (NSAIDs). Careful titration of opioid analgesics can also be helpful with other adjuvants such as the antidepressants or antiepileptic medications used especially for patients with neuropathic pain. Topical agents may provide benefit and are associated with fewer systemic side effects than oral administration. Complementary or psychological therapies may be beneficial for those patients who have failed other options or have depression associated with chronic pain.

  2. Prediction of Mortality and Postoperative Complications using the Hip-Multidimensional Frailty Score in Elderly Patients with Hip Fracture

    PubMed Central

    Choi, Jung-Yeon; Cho, Kwan-Jae; Kim, Sun-wook; Yoon, Sol-Ji; Kang, Min-gu; Kim, Kwang-il; Lee, Young-Kyun; Koo, Kyung-Hoi; Kim, Cheol-Ho

    2017-01-01

    High mortality and dependent living after hip fracture pose a significant public health concern. Retrospective study was conducted with 481 hip fracture patients (≥65 years of age) undergoing surgery from March 2009 to May 2014. The Hip-MFS was calculated by Comprehensive Geriatric Assessment (CGA). The primary outcome was the 6-month all-cause mortality rate. The secondary outcomes were 1-year all-cause mortality, postoperative complications and prolonged hospital stay, and institutionalization. Thirty-five patients (7.3%) died within 6 months after surgery (median [interquartile range], 2.9 [1.4–3.9] months). The fully adjusted hazard ratio per 1 point increase in Hip-MFS was 1.458 (95% confidence interval [CI]: 1.210–1.758) for 6-months mortality and odds ratio were 1.239 (95% CI: 1.115–1.377), 1.156 (95% CI: 1.031–1.296) for postoperative complications and prolonged total hospital stay, respectively. High-risk patients (Hip-MFS > 8) showed higher risk of 6-month mortality (hazard ratio: 3.545, 95% CI: 1.466–8.572) than low-risk patients after adjustment. Hip-MFS successfully predict 6-month mortality, postoperative complications and prolonged hospital stay in elderly hip fracture patients after surgery. Hip-MFS more precisely predict 6-month mortality than age or existing tools (P values of comparison of ROC curve: 0.002, 0.004, and 0.044 for the ASA classification, age and NHFS, respectively). PMID:28233870

  3. Factors associated with and consequences of unplanned post-operative intubation in elderly vascular and general surgery patients.

    PubMed

    Nafiu, Olubukola O; Ramachandran, Satya K; Ackwerh, Ray; Tremper, Kevin K; Campbell, Darrell A; Stanley, James C

    2011-03-01

    Unplanned post-operative intubation (UPI) may be associated with significant morbidity and/or mortality after surgery. The purpose of this investigation was to determine the incidence and predictors of UPI in elderly patients who underwent general and vascular surgical procedures. Data from the American College of Surgeons National Surgical Quality Improvement Program Participant Use Data File was used to calculate the incidence of UPI in all elderly vascular and general surgery patients undergoing operations from 2005 to 2008. UPI was defined as a requirement for the placement of an endotracheal tube and mechanical or assisted ventilation because of the onset of respiratory or cardiac failure manifested by severe respiratory distress, hypoxia, hypercarbia or respiratory acidosis within 30 days of the index operation. Univariate factors associated with UPI were identified. Multivariate stepwise logistic regression was used to calculate odds ratios (ORs) for UPI after controlling for known clinically relevant cofactors. Incidence of UPI as well as morbidity and mortality associated with UPI. Among 115 692 patients, 3.3% required UPI. Univariate predictors of UPI were older age group, chronic obstructive pulmonary disease, low pre-operative functional status as well as emergency operation. UPI was associated with an 18-fold increased risk of death as well as significantly increased hospital length of stay. Multivariate analysis identified several predictors of UPI with re-operation having the greatest odds for UPI (OR = 4.5; 95% confidence interval = 4.29-4.86, P < 0.001). Although the incidence of UPI in this elderly surgical cohort was low, it was associated with significant morbidity and mortality as well as prolonged hospital length of stay, underscoring the need for accurately identifying modifiable risk factors.

  4. Intraoperative Infusion of Dexmedetomidine for Prevention of Postoperative Delirium and Cognitive Dysfunction in Elderly Patients Undergoing Major Elective Noncardiac Surgery: A Randomized Clinical Trial.

    PubMed

    Deiner, Stacie; Luo, Xiaodong; Lin, Hung-Mo; Sessler, Daniel I; Saager, Leif; Sieber, Frederick E; Lee, Hochang B; Sano, Mary; Jankowski, Christopher; Bergese, Sergio D; Candiotti, Keith; Flaherty, Joseph H; Arora, Harendra; Shander, Aryeh; Rock, Peter

    2017-08-16

    Postoperative delirium occurs in 10% to 60% of elderly patients having major surgery and is associated with longer hospital stays, increased hospital costs, and 1-year mortality. Emerging literature suggests that dexmedetomidine sedation in critical care units is associated with reduced incidence of delirium. However, intraoperative use of dexmedetomidine for prevention of delirium has not been well studied. To evaluate whether an intraoperative infusion of dexmedetomidine reduces postoperative delirium. This study was a multicenter, double-blind, randomized, placebo-controlled trial that randomly assigned patients to dexmedetomidine or saline placebo infused during surgery and for 2 hours in the recovery room. Patients were assessed daily for postoperative delirium (primary outcome) and secondarily for postoperative cognitive decline. Participants were elderly (>68 years) patients undergoing major elective noncardiac surgery. The study dates were February 2008 to May 2014. Dexmedetomidine infusion (0.5 µg/kg/h) during surgery and up to 2 hours in the recovery room. The primary hypothesis tested was that intraoperative dexmedetomidine administration would reduce postoperative delirium. Secondarily, the study examined the correlation between dexmedetomidine use and postoperative cognitive change. In total, 404 patients were randomized; 390 completed in-hospital delirium assessments (median [interquartile range] age, 74.0 [71.0-78.0] years; 51.3% [200 of 390] female). There was no difference in postoperative delirium between the dexmedetomidine and placebo groups (12.2% [23 of 189] vs 11.4% [23 of 201], P = .94). After adjustment for age and educational level, there was no difference in the postoperative cognitive performance between treatment groups at 3 months and 6 months. Adverse events were comparably distributed in the treatment groups. Intraoperative dexmedetomidine does not prevent postoperative delirium. The reduction in delirium previously demonstrated

  5. Postoperative reading speed does not indicate implicit memory in elderly cardiac patients after propofol and remifentanyl anaesthesia.

    PubMed

    Münte, S; Münte, T F; Mitzlaff, B; Walz, R; Leuwer, M; Piepenbrock, S

    2001-07-01

    A recent study in young patients undergoing propofol-alfentanil-nitrous oxide anaesthesia demonstrated implicit memory for stories presented during operation using a postoperative reading speed task. In this study we investigated whether patients who tolerate only small amounts of anaesthetics are prone to develop implicit and explicit memories about intraoperative events. Thirty patients with poor physical status (ASA III-IV) undergoing cardioverter defibrillator implantation were included in the study. Patients were premedicated with intravenous midazolam and anaesthesia was maintained using propofol and remifentanil infusions. During surgery one of two audio-tapes containing two short stories was played to the patients. Reading speed for the stories played during surgery and two similar stories from the other tape was tested 4 h later. Explicit memory was tested at 4 h and 24 h after audiotape presentation using a structured interview and a forced-choice recognition test pertaining to the story content. Thirty additional awake subjects served as controls. Although half of the patients seemed to be awake one or more times during the operation, no explicit memories of intraoperative events were reported. The forced-choice recognition of the stories was at chance level. No effect on reading speed was found in either the patients or the control subjects. The possible reasons for reduced explicit and implicit memory performance in elderly patients are age and poor physical status of the patients and the modality change between study and test phases. A non-anaesthetised control group of the same age and physical status should therefore be included in all studies of implicit memory.

  6. [Localization Establishment of an Interdisciplinary Intervention Model to Prevent Post-Operative Delirium in Older Patients Based on 'Hospital Elder Life Program'].

    PubMed

    Wang, Yan-Yan; Liao, Yu-Lin; Gao, Lang-Li; Hu, Xiu-Ying; Yue, Ji-Rong

    2017-06-01

    Postoperative delirium is a significant complication in elderly patients. The occurrence of delirium may increase the related physical and psychological risks, delay the length of hospital stays, and even lead to death. According to the current evidence-based model, the application of interdisciplinary intervention may effectively prevent delirium, shorten the length of hospital stays, and save costs. To establish a culturally appropriate interdisciplinary intervention model for preventing postoperative delirium in older Chinese patients. The authors adapted the original version of the Hospital Elder Life Program (HELP©) from the Hebrew Senior Life Institute for Aging Research of Harvard University by localizing the content using additional medical resources and translating the modified instrument into Chinese. Furthermore, the final version of this interdisciplinary intervention model for postoperative delirium was developed in accordance with the "guideline of delirium: diagnosis, prevention and management produced by the National Institute for Health and Clinical Excellence in 2010" and the "clinical practice guideline for postoperative delirium in older adults" produced by American geriatrics society in 2014. Finally, the translated instrument was revised and improved using discussions, consultations, and pilot study. The abovementioned procedure generated an interdisciplinary intervention model for preventing postoperative delirium that is applicable to the Chinese medical environment. The content addresses personnel structure and assignment of responsibility; details of interdisciplinary intervention protocols and implementation procedures; and required personnel training. The revised model is expected to decrease the occurrence of post-operative delirium and other complications in elderly patients, to help them maintain and improve their function, to shorten the length of their hospital stays, and to facilitate recovery.

  7. Postoperative analgesia and recovery course after major colorectal surgery in elderly patients: a randomized comparison between intrathecal morphine and intravenous PCA morphine.

    PubMed

    Beaussier, Marc; Weickmans, Henri; Parc, Yann; Delpierre, Eric; Camus, Yvon; Funck-Brentano, Christian; Schiffer, Eduardo; Delva, Eric; Lienhart, André

    2006-01-01

    Intrathecal morphine is a widely used method for postoperative pain relief after major abdominal surgery. The aim of this randomized, double-blinded study was to compare intrathecal morphine and intravenous PCA morphine for postoperative analgesia and recovery course after major colorectal surgery in elderly patients. After written informed consent, patients >70 years of age were prospectively and randomly assigned to receive either preoperative intrathecal morphine (0.3 mg) and postoperative patient-controlled (PCA) intravenous morphine (IT morphine) or PCA alone (group control). Results are presented as mean +/- SD (95% confidence interval). Twenty-six patients successfully completed the study in each group. In the IT morphine group, rate of awakening was delayed. Pain intensity and daily intravenous morphine consumption were significantly reduced 1 and 2 days after surgery in the IT morphine group (P < .01). Mental function (assessed by Mini Mental State and Digit Symbol Substitution Test) was similar in both groups. Episodes of postoperative delirium/confusion occurred similarly in both groups. Time to ileus resolution and time to ambulation without assistance did not differ between the 2 groups. The duration of hospitalization was 8.4 +/- 1.7 (7-11) days and 7.9 +/- 2.0 (6-9.9) days for control and IT morphine, respectively (nonstatistical difference). Patients in the IT morphine group had longer time to awakening from anesthesia and experienced more sedation. Intrathecal morphine, as compared with intravenous PCA morphine alone, improves immediate postoperative pain and reduces parenteral morphine consumption but does not improve postoperative recovery in elderly patients after major colorectal surgery.

  8. Postoperative plasma 8-iso-prostaglandin F2α levels are associated with delirium and cognitive dysfunction in elderly patients after hip fracture surgery.

    PubMed

    Zheng, Yuan-Bo; Ruan, Guo-Mo; Fu, Jia-Xing; Su, Zhong-Liang; Cheng, Peng; Lu, Jian-Zuo

    2016-04-01

    Oxidative stress may be involved in occurrence of postoperative delirium (POD) and cognitive dysfunction (POCD). 8-iso-Prostaglandin F2α (8-iso-PGF2α), an isoprostane derived from arachidonic acid via lipid peroxidation, is considered a gold standard for measuring oxidative stress. The present study aimed to investigate the ability of postoperative plasma 8-iso-PGF2α levels to predict POD and POCD in elderly patients undergoing hip fracture surgery. Postoperative plasma 8-iso-PGF2α levels of 182 patients were measured by an enzyme-linked immunosorbent assay. We assessed the relationships between plasma 8-iso-PGF2α levels and the risk of POD and POCD using a multivariate analysis. Plasma 8-iso-PGF2α levels and age were identified as the independent predictors for POD and POCD. Based on areas under receiver operating characteristic curve, the predictive values of 8-iso-PGF2α were obviously higher than those of age for POD and POCD. In a combined logistic-regression model, 8-iso-PGF2α significantly enhanced the areas under curve of age for prediction of POD and POCD. Postoperative plasma 8-iso-PGF2α levels may have the potential to predict POD and POCD in elder patients undergoing hip fracture surgery. Copyright © 2016 Elsevier B.V. All rights reserved.

  9. The effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture: A retrospective case-control study.

    PubMed

    Yang, Si-Dong; Ning, Sheng-Hua; Zhang, Li-Hong; Zhang, Ying-Ze; Ding, Wen-Yuan; Yang, Da-Long

    2016-08-01

    The purpose of this study was to explore the effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture after undergoing intramedullary nail fixation surgery.We collected medical records of elderly patients aged ≥ 60 years with femoral shaft fracture between 03/2010 and 03/2015 in Longyao County Hospital. Totally, 160 patients were identified and divided into the intervention group (n = 80) and the control group (n = 80). During the postoperative period, the intervention group received lower limb rehabilitation gymnastics treatment for 3 months, but the control group did not. All patients were routinely asked to return hospital for a check in the 1st postoperative week, as well as the 2nd week, the 1st month, and the 3rd month, after surgery. The clinical rehabilitation effect was evaluated by checking lower limb action ability, detecting the lower limb deep venous thrombosis (DVT), scoring muscle strength of quadriceps and visual analog scale (VAS) score, and performing satisfaction survey.At the 1st week and 2nd week after surgery, the clinical rehabilitation effect in the intervention group was better regarding lower limb action ability, lower limb DVT, muscle strength of quadriceps, VAS score, and patient satisfaction, as compared with the control group. However, there was no significant difference at the 1st month and the 3rd month after surgery when comparing the intervention group to the control group.In the early postoperative stage, lower limb rehabilitation gymnastics can effectively improve the recovery of lower limb function, beneficial to reducing postoperative complications such as lower limb DVT and muscle atrophy, and increasing patient satisfaction rate.

  10. E-PASS score as a useful predictor of postoperative complications and mortality after colorectal surgery in elderly patients.

    PubMed

    Tominaga, Tetsuro; Takeshita, Hiroaki; Takagi, Katsunori; Kunizaki, Masaki; To, Kazuo; Abo, Takafumi; Hidaka, Shigekazu; Nanashima, Atsushi; Nagayasu, Takeshi; Sawai, Terumitsu

    2016-02-01

    The aim of this study was to clarify whether a surgical-specific risk scoring system estimating the physiologic ability and surgical stress (E-PASS) score was useful for prediction of postoperative morbidity and mortality. The E-PASS score consists of the preoperative risk score (PRS), surgical stress score (SSS), and the comprehensive risk score (CRS). Conventional scoring systems [colorectal physiologic and operative severity score for the enumeration of mortality (CR-POSSUM) and the prognostic nutritional index (PNI)] were also examined. We retrospectively compared these scores in patients with or without postoperative complications. We assessed the relationship between these scores, clinicopathological features and postoperative mortality. Postoperative complications developed in 78 patients (33%). American Society of Anesthesiologists score, performance status, PNI score, PRS, SSS, and CRS were significantly higher in patients with postoperative complications than in those without postoperative complications (p < 0.05). The area under the receiver operating characteristic curve (AUC) was highest for E-PASS [E-PASS (PRS, 0.74; SSS, 0.62; CRS, 0.78), PNI (0.62), CR-POSSUM (PS, 0.57; OSS, 0.52)]. Multivariate logistic analysis identified CRS ≥ 0.2 as a significant determinant of postoperative complications (p < 0.01; hazard ratio, 4.84). Overall survival was significantly better in the CRS < 0.2 group than in the CRS > 0.2 group (p < 0.01). The E-PASS score system was a useful predictor of postoperative complications and mortality, especially in patients with advanced age.

  11. Which frailty measure is a good predictor of early post-operative complications in elderly hip fracture patients?

    PubMed

    Kua, Joanne; Ramason, Rani; Rajamoney, Ganesan; Chong, Mei Sian

    2016-05-01

    Current pre-operative assessment using, e.g., American Society of Anaesthesiologists score does not accurately predict post-operative outcomes following hip fracture. The multidimensional aspect of frailty syndrome makes it a better predictor of post-operative outcomes in hip fracture patients. We aim to discover which frailty measure is more suitable for prediction of early post-operative outcomes in hip fracture patients. Hundred consecutive hip fracture patients seen by the orthogeriatric service were included. We collected baseline demographic, functional and comorbidity data. In addition to ASA, a single blinded rater measured frailty using two scales (i) modified fried criteria (MFC) and (ii) reported edmonton frail scale (REFS). The MFC adopted a surrogate gait speed measure with two questions: (i) Climbing one flight of stairs and (ii) Ability to walk 1 km in the last 2 weeks. Immediate post-operative complications during the inpatient stay were taken as the primary outcome measure. Subjects had mean age of 79.1 ± 9.6 years. Sixty six percent were female and 87 % of Chinese ethnicity. Eighty two percent had surgery, of which 37.8 % (n = 31) had post-operative complications. Frailty, measured by MFC (OR 4.46, p = 0.04) and REFS (OR 6.76, p = 0.01) were the only significant predictors of post-operative complications on univariate analyses. In the hierarchical logistic regression model, only REFS (OR 3.42, p = 0.04) predicted early post-operative complications. At 6 months follow-up, REFS significantly predicted [basic activities of daily living (BADL)] function on the multivariable logistic regression models. (BADL, OR 6.19, p = 0.01). Frailty, measured by the REFS is a good predictor of early post-operative outcomes in our pilot study of older adults undergoing hip surgery. It is also able to predict 6 months BADL function. We intend to review its role in longer-term post-operative outcomes and validate its potential role in pre

  12. Impact of Lifestyle Diseases on Postoperative Complications and Survival in Elderly Patients with Stage I Non-Small Cell Lung Cancer

    PubMed Central

    Jeong, Sang Seok; Choi, Pil Jo; Yi, Jung Hoon; Yoon, Sung Sil

    2017-01-01

    Background The influence of lifestyle diseases on postoperative complications and long-term survival in patients with non-small cell lung cancer (NSCLC) is unclear. The aim of this study was to determine whether lifestyle diseases were significant risk factors of perioperative and long-term surgical outcomes in elderly patients with stage I NSCLC. Methods Between December 1995 and November 2013, 110 patients aged 65 years or older who underwent surgical resection of stage I NSCLC at Dong-A University Hospital were retrospectively studied. We assessed the presence of the following lifestyle diseases as risk factors for postoperative complications and long-term mortality: diabetes, hypertension, chronic obstructive pulmonary disease, stroke, and ischemic heart disease. Results The mean age of the patients was 71 years (range, 65 to 82 years). Forty-six patients (41.8%) had hypertension, making it the most common lifestyle disease, followed by diabetes (n=23, 20.9%). The in-hospital mortality rate was 0.9% (n=1). The 3-year and 5-year survival rates were 78% and 64%, respectively. Postoperative complications developed in 32 patients (29.1%), including 7 (6.4%) with prolonged air leakage, 6 (5.5%) with atrial fibrillation, 5 (4.5%) with delirium and atelectasis, and 3 (2.7%) with acute kidney injury and pneumonia. Univariate and multivariate analyses showed that the presence of a lifestyle disease was the only independent risk factor for postoperative complications. In survival analysis, univariate analysis showed that age, smoking, body mass index, extent of resection, and pathologic stage were associated with impaired survival. Multivariate analysis revealed that resection type (hazard ratio [HR], 2.20; 95% confidence interval [CI], 1.08 to 4.49; p=0.030) and pathologic stage (HR, 1.89; 95% CI, 1.02 to 3.49; p=0.043) had independent adverse impacts on survival. Conclusion This study demonstrated that the presence of a lifestyle disease was a significant prognostic

  13. Risk factors for postoperative delirium following hip fracture repair in elderly patients: a systematic review and meta-analysis.

    PubMed

    Yang, Yanjiang; Zhao, Xin; Dong, Tianhua; Yang, Zongyou; Zhang, Qi; Zhang, Yingze

    2017-04-01

    No formal systematic review or meta-analysis was performed up to now to summarize the risk factors of delirium after hip surgery. The present study aimed to quantitatively and comprehensively conclude the risk factors of delirium after hip surgery in elderly patients. A search was applied to CNKI, Embase, Medline, and Cochrane central database (all up to August 2015). All studies assessing the risk factors of delirium after hip surgery in elderly patients without language restriction were reviewed, and qualities of included studies were assessed using the Newcastle-Ottawa Scale. Data were pooled and a meta-analysis was completed. A total of 24 studies were selected, which altogether included 5364 patients with hip fracture. One thousand and ninety of them were cases of delirium occurred after surgery, suggesting the accumulated incidence of 24.0 %. Results of meta-analyses showed that elderly patients with preoperative cognitive impairment [odds ratio (OR) 3.21, 95 % confidence interval (CI) 2.26-4.56), advanced age (standardized mean difference 0.50, 95 % CI 0.33-0.67), living in an institution (OR 2.94; 95 % CI 1.65-5.23), heart failure (OR 2.46; 95 % CI 1.72-3.53), total hip arthroplasty (OR 2.21; 95 % CI 1.16-4.22), multiple comorbidities (OR 1.37; 95 % CI 1.12-1.68) and morphine usage (OR 3.01; 95 % CI 1.30-6.94) were more likely to sustain delirium after hip surgery. Females were less likely to develop delirium after hip surgery (OR 0.83; 95 % CI 0.70-0.98). Related prophylaxis strategies should be implemented in elderly patients involved with above-mentioned risk factors to prevent delirium after hip surgery.

  14. Prevalence and impact of incompetence of internal jugular valve on postoperative cognitive dysfunction in elderly patients undergoing robot-assisted laparoscopic radical prostatectomy.

    PubMed

    Roh, Go Un; Kim, Won Oak; Rha, Koon Ho; Lee, Byung Ho; Jeong, Hae Won; Na, Sungwon

    2016-01-01

    Internal jugular vein (IJV) is the main pathway of cerebral venous drainage and its valves prevent regurgitation of blood to the brain. IJV valve incompetence (IJVVI) is known to be associated with cerebral dysfunctions. It occurs more often in male over 50 years old, conditions elevating intra-abdominal or intra-thoracic pressure. In robot-assisted laparoscopic radical prostatectomy (RALRP), elderly male undergoes surgery in Trendelenburg position with pneumoperitoneum applied. Therefore, we assessed the IJVVI during RALRP and its influence on postoperative cognitive function. 57 patients undergoing RALRP were enrolled. Neurocognitive tests including Mini-Mental State Examination (MMSE), Auditory Verbal Learning Test, Digit Symbol Substitution Test, Color Word Stroop Test, digit span test, and grooved pegboard test were performed the day before and 2 days after surgery. During surgery, IJVVI was assessed with ultrasonography in supine position with and without pneumoperitoneum, and Trendelenburg position with pneumoperitoneum. 50 patients underwent sonographic assessment and 41 patients completed neurocognitive examination. A total of 27 patients presented IJVVI, 19 patients in supine position without pneumoperitoneum, 7 patients in supine position with pneumoperitoneum and 1 patient in Trendelenburg position with pneumoperitoneum. In neurocognitive tests, patients with IJVVI showed statistically significant decline of score in MMSE postoperatively (p<0.05). IJVVI occurred in 38% in supine position but the incidence was increased to 54% after Trendelenburg position and pneumoperitoneum. Patients with IJVVI did not show significant differences in cognitive function tests except MMSE. Clinical and neurological significance of physiologic changes associated RALRP should be studied further.

  15. Postoperative mortality and need for transitional care following liver resection for metastatic disease in elderly patients: a population-level analysis of 4026 patients

    PubMed Central

    Orcutt, Sonia T; Artinyan, Avo; Li, Linda T; Silberfein, Eric J; Berger, David H; Albo, Daniel; Anaya, Daniel A

    2012-01-01

    Objectives The goal of this study was to characterize the association of age with postoperative mortality and need for transitional care following hepatectomy for liver metastases. Methods A retrospective cohort study using the Nationwide Inpatient Sample (2005–2008) was performed. Patients undergoing hepatectomy for liver metastases were categorized by age as: Young (aged <65 years); Old (aged 65–74 years), and Oldest (aged ≥75 years). Multivariate logistic regression analyses were performed to identify predictors of in-hospital mortality and need for transitional care (non-home discharge). Results A total of 4026 patients were identified; 36.6% (n = 1475) were elderly (aged ≥65 years). Rates of in-hospital mortality and non-home discharge increased with advancing age group [1.3% vs. 2.2% vs. 3.3% (P = 0.005) and 2.1% vs. 6.1% vs. 18.3% (P < 0.001), respectively]. Independent predictors of in-hospital mortality were age within the Oldest category [odds ratio (OR) 2.21, 95% confidence interval (CI) 1.19–4.12] and a Deyo Comorbidity Index score of ≥3 (OR 6.95, 95% CI 3.55–13.60). Independent predictors for need for transitional care were age within the Old group (OR 2.44, 95% CI 1.66–3.58), age within the Oldest group (OR 8.48, 95% CI 5.87–12.24), a Deyo score of 1 (OR 2.00, 95% CI 1.40–2.85), a Deyo score of 2 (OR 4.70, 95% CI 2.93–7.56), a Deyo score of ≥3 (OR 6.41, 95% CI 3.67–11.20), and female gender (OR 1.56, 95% CI 1.15–2.11). Conclusions Although increasing age was associated with higher risk for in-hospital mortality, the absolute risk was low and within accepted ranges, and comorbidity was the primary driver of mortality. Conversely, need for transitional care was significantly more common in elderly patients. Therefore, liver resection for metastases is safe in well-selected elderly patients, although consideration should be made for potential transitional care needs. PMID:23134189

  16. Is the Centers for Medicare and Medicaid Service's lack of reimbursement for postoperative urinary tract infections in elderly emergency surgery patients justified?

    PubMed

    Zielinski, Martin D; Thomsen, Kristine M; Polites, Stephanie F; Khasawneh, Mohammad A; Jenkins, Donald H; Habermann, Elizabeth B

    2014-10-01

    Urinary tract infections, a risk factor for readmission, have been deemed a potentially preventable problem and, therefore, not reimbursable by the Centers for Medicare and Medicaid Services since 2008. Defining the risk factors for development of urinary tract infection in the postoperative period will provide risk stratification for development of urinary tract infection in these challenging patients. Pre-, intra-, and postoperative characteristics were collected for patients ≥65 years who underwent an emergency abdominal operation from the 2005 to 2012 National Surgical Quality Improvement Program Participant User File, a database of 374 participating hospitals. In-hospital urinary tract infections occurring within 30 days of the operation were identified. Multivariable logistic regression analysis was conducted to identify risk factors of urinary tract infection. In total, 53,879 patients were included, 1,881 (3.5%) of whom were diagnosed with a postoperative urinary tract infection before discharge. In-hospital urinary tract infection was associated with a longer hospital stay (27 vs 13 days, P < .001) and greater 30-day mortality rates (18% vs 16%, P = .003). The rate of urinary tract infection decreased from 4.5% before the Centers for Medicare and Medicaid Services decree to 3.2% thereafter (P < .001). Multivariable logistic regression demonstrated advanced age, female sex, insulin-dependent diabetes mellitus, dependent functional status, open wound, hypoalbuminemia, increased American Society of Anesthesiologists class, operative approach, and prolonged operative time were independent risk factors for development of postoperative urinary tract infection. Although postoperative rates of urinary tract infection decreased after the Centers for Medicare and Medicaid Services decree, the lack of reimbursement is not justified, as few modifiable risk factors to further improve postoperative urinary tract infection rates in elderly emergency surgical

  17. Estimation of Physiologic Ability and Surgical Stress (E-PASS) versus modified E-PASS for prediction of postoperative complications in elderly patients who undergo gastrectomy for gastric cancer.

    PubMed

    Kitano, Yuki; Iwatsuki, Masaaki; Kurashige, Junji; Kuroda, Daisuke; Kosumi, Keisuke; Baba, Yoshifumi; Sakamoto, Yasuo; Miyamoto, Yuji; Yoshida, Naoya; Haga, Yoshio; Baba, Hideo

    2017-02-01

    Improvements in operative technique and perioperative management have resulted in increasing numbers of elderly patients undergoing gastrectomy for gastric cancer (GC). We evaluated the accuracy of Estimation of Physiologic Ability and Surgical Stress (E-PASS) and modified (m)E-PASS scores in predicting postoperative complications in elderly patients with GC. We retrospectively analyzed short-term outcomes in 413 patients who underwent gastrectomy for GC between 2005 and 2014. They were divided into two groups: Group N comprised 341 non-elderly patients <80 years of age and Group E comprised 72 elderly patients ≥80 years of age. We calculated the E-PASS and mE-PASS scores and evaluated the correlation between the comprehensive risk score (CRS) and occurrence of postoperative complications. Morbidity rates were 25.5 % in Group N and 31.9 % in Group E. In Group N, the CRS values of both the E-PASS (P < 0.0001) and mE-PASS (P < 0.0001) scores were significantly higher in patients with complications than in those without complications. In Group E, although the E-PASS CRS was significantly higher in patients with complications than in patients without complications (P = 0.01), the mE-PASS CRS fixed (CRSf) score was not significantly correlated with the occurrence of postoperative complications (P = 0.08). Both E-PASS and mE-PASS can be used to predict the occurrence of postoperative complications in GC patients undergoing gastrectomy. However, the E-PASS CRS is more accurate for elderly patients because variations in intraoperative parameters such as operation time, blood loss, and extent of skin incision have a strong influence on the occurrence of postoperative complications.

  18. Effect of early enteral nutrition on postoperative nutritional status and immune function in elderly patients with esophageal cancer or cardiac cancer.

    PubMed

    Yu, Guiping; Chen, Guoqiang; Huang, Bin; Shao, Wenlong; Zeng, Guangqiao

    2013-06-01

    To explore the effect of early enteral nutrition (EN) on postoperative nutritional status, intestinal permeability, and immune function in elderly patients with esophageal cancer or cardiac cancer. A total of 96 patients with esophageal cancer or cardiac cancer who underwent surgical treatment in our hospital from June 2007 to December 2010 were enrolled in this study. They were divided into EN group (n=50) and parenteral nutrition (PN) group (n=46) based on the nutrition support modes. The body weight, time to first flatus/defecation, average hospital stay, complications and mortality after the surgery as well as the liver function indicators were recorded and analyzed. Peripheral blood samples were collected on the days 1, 4 and 7 after surgery. The plasma diamine oxidase (DAO) activity and D-lactate level were determined to assess the intestinal permeability. The plasma endotoxin levels were determined using dynamic turbidimetric assay to assess the protective effect of EN on intestinal mucosal barrier. The postoperative blood levels of inflammatory cytokines and immunoglobulins were determined using enzyme-linked immunosorbent assay (ELISA). After the surgery, the time to first flatus/defecation, average hospital stay, and complications were significantly less in the EN group than those in the PN group (P<0.05), whereas the EN group had significantly higher albumin levels than the PN group (P<0.05). On the 7th postoperative day, the DAO activity, D-lactate level and endotoxin contents were significantly lower in the EN group than those in the PN group (all P<0.05). In addition, the EN group had significantly higher IgA, IgG, IgM, and CD4 levels than the PN group (P<0.05) but significantly lower IL-2, IL-6, and TNF-α levels (P<0.05). In elderly patients with esophageal cancer or cardiac cancer, early EN after surgery can effectively improve the nutritional status, protect intestinal mucosal barrier (by reducing plasma endoxins), and enhance the immune function.

  19. Associations Between Impaired Cerebral Blood Flow Autoregulation, Cerebral Oxygenation, and Biomarkers of Brain Injury and Postoperative Cognitive Dysfunction in Elderly Patients After Major Noncardiac Surgery.

    PubMed

    Goettel, Nicolai; Burkhart, Christoph S; Rossi, Ariane; Cabella, Brenno C T; Berres, Manfred; Monsch, Andreas U; Czosnyka, Marek; Steiner, Luzius A

    2017-03-01

    Increasing evidence links postoperative cognitive dysfunction (POCD) to surgery and anesthesia. POCD is recognized as an important neuropsychological adverse outcome in surgical patients, particularly the elderly. This prospective cohort study aimed to investigate whether POCD is associated with impaired intraoperative cerebral autoregulation and oxygenation, and increased levels of biomarkers of brain injury. Study subjects were patients ≥65 years of age scheduled for major noncardiac surgery. Cognitive function was assessed before and 1 week after surgery. POCD was diagnosed if a decline of >1 standard deviation of z-scores was present in ≥2 variables of the test battery. The incidence of POCD 1 week after surgery was modeled as a multivariable function of the index of autoregulation (MxA) and tissue oxygenation index (TOI), adjusting for baseline neuropsychological assessment battery (Consortium to Establish a Registry for Alzheimer's Disease-Neuropsychological Assessment Battery [CERAD-NAB]) total score and the maximum C-reactive protein (CRP) concentration. The biomarkers of brain injury neuron-specific enolase and S100β protein, age, and level of education were included in secondary multivariable logistic regression analyses. Of the 82 patients who completed the study, 38 (46%) presented with POCD 1 week after surgery. In the multivariable regression analysis, higher intraoperative MxA (odds ratio [OR; 95% confidence interval (CI)], 1.39 [1.01-1.90] for an increase of 0.1 units, P = .08 after Bonferroni adjustment), signifying less effective autoregulation, was not associated with higher odds of POCD. The univariable logistic regression model for MxA yielded an association with POCD (OR [95% CI], 1.44 [1.06-1.95], P = .020). Tissue oxygenation index (1.12 [0.41-3.01] for an increase of 10%, P = 1.0 after Bonferroni adjustment) and baseline CERAD-NAB total score (0.80 [0.45-1.42] for an increase of 10 points, P = .45) did not affect the odds of POCD. POCD

  20. Pharmacological and psychosomatic treatments for an elderly patient with severe nausea and vomiting in reaction to postoperative stress.

    PubMed

    Otera, Masako; Machida, Takatsugu; Machida, Tomomi; Abe, Mai; Ichie, Masayoshi; Fukudo, Shin

    2015-10-01

    Here we present a case of successful treatment employing a mixed approach including pharmacological and psychosomatic treatments for a 72-year-old woman who experienced severe nausea and vomiting in reaction to postoperative stress from gastric cancer surgery. This case demonstrates that appropriate provision of psychosomatic treatments, including a psychotherapeutic session and autogenic training, enhances the efficacy of pharmacotherapy.

  1. The impact of nutritional status and appetite on the hospital length of stay and postoperative complications in elderly patients with severe aortic stenosis before aortic valve replacement

    PubMed Central

    Jagielak, Dariusz; Wernio, Edyta; Bramlage, Peter; Gruchała-Niedoszytko, Marta; Rogowski, Jan; Małgorzewicz, Sylwia

    2016-01-01

    Introduction Severe aortic stenosis (AS) is associated with the reduction of physical activity and muscle mass and may be associated with decreased appetite. Aim To assess the nutritional status and the impact of nutritional status and appetite on the hospital length of stay and postoperative complications in elderly patients with severe AS before aortic valve replacement. Material and methods Ninety-nine patients (55 male, 44 female; 74.3 ±5.2 years old) with severe AS and an indication for aortic valve replacement (AVR) were included. The nutritional status was assessed by different questionnaires (7-point Subjective Global Assessment Score – 7-SGA, full-Mini Nutritional Assessment – full-MNA) and anthropometric measurements (body mass index (BMI) kg/m2). Body composition was estimated using multi-frequency bioelectrical impedance analysis. Appetite was assessed by the Simplified Nutrition Assessment Questionnaire (SNAQ). Results The average BMI of patients was 28.8 ±5.8 kg/m2. Results of the 7-SGA and f-MNA questionnaires revealed that 39 patients (39.4%) were at risk of malnutrition. The mean SNAQ score was 15.8 ±1.8. The average length of hospital stay was 10 ±5.8 days. There was a positive correlation of LOS with age (r = 0.26, p = 0.03) and a negative correlation with fat mass (kg) (r = –0.28, p = 0.04) and BMI (r = –0.22, p = 0.03). Postoperative complications were observed in 37 patients (37.4%). Patients who developed complications were older and had poorer nutritional status according to the results of the 7-SGA. Conclusions Despite many patients undergoing AVR being overweight and obese, a considerable proportion displayed clinical signs of malnutrition. The results suggest that an assessment of nutritional status and appetite in this group of patients should be conducted regularly and that the 7-SGA scale could represent a reliable tool to assess malnutrition. PMID:27516781

  2. Lung cancer in elderly patients

    PubMed Central

    Diso, Daniele; Onorati, Ilaria; Anile, Marco; Mantovani, Sara; Rendina, Erino A.

    2016-01-01

    There is a worldwide-accepted evidence of a population shift toward older ages. This shift favors an increased risk of developing lung cancer that is primarily a disease of older populations. Decision making is extremely difficult in elderly patients, since this group is under-represented in clinical trials with only 25% of them historically opening to patients older than 65 years. For all these reasons, a “customized” preoperative assessment to identify physiological or pathological frailty should be encouraged since standard tools may be less reliable. The work already done to improve patient selection for lung surgery in the elderly population clearly shows that surgical resection seems the treatment of choice for early stage lung cancer. Further studies are required to improve outcome by reducing postoperative morbidity and mortality. PMID:27942414

  3. Safety of Cosmetic Procedures in Elderly and Octogenarian Patients.

    PubMed

    Yeslev, Max; Gupta, Varun; Winocour, Julian; Shack, R Bruce; Grotting, James C; Higdon, K Kye

    2015-09-01

    The proportion of elderly patients in North America is increasing. This has resulted in an increased number of elderly patients undergoing cosmetic procedures. The purpose of this study was to determine the incidence of postoperative complications in elderly patients (age ≥65) undergoing elective aesthetic plastic surgical procedures compared with younger patients. A total of 183,914 cosmetic surgical procedures were reviewed using the prospectively enrolled cohort of patients in the CosmetAssure database. Comorbidities and postoperative complications in elderly and younger patient groups were recorded and compared. A separate analysis of postoperative complications was performed in the octogenarian subgroup (age ≥80). A total of 6786 elderly patients who underwent cosmetic procedures were included in the study. Mean ages (±standard deviation) in elderly and younger patients were 69.1 ± 4.1 and 39.2 ± 12.5 years, respectively. The elderly patient population had more men, a higher mean body mass index (BMI), a higher prevalence of diabetes mellitus (DM), and fewer smokers compared with the younger patients. The overall postoperative complication rate was not significantly different between elderly and younger patients. When stratified by type of cosmetic procedure, only abdominoplasty was associated with a higher postoperative complication rate in elderly compared with younger patients. The most common postoperative complications in elderly patients were hematoma and infection. The overall postoperative complication rate in octogenarians was 2.2%, which was not significantly different from the younger population. Cosmetic procedures in elderly patients, including octogenarians, remain safe with an acceptable complication rate compared to younger patients. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

  4. [Anesthesiological management of elderly trauma patients].

    PubMed

    Coburn, M; Röhl, A B; Knobe, M; Stevanovic, A; Stoppe, C; Rossaint, R

    2016-02-01

    The demographic change is accompanied by an increasing number of elderly trauma patients. Geriatric patients with trauma often show several comorbidities and as a result have a high perioperative risk to develop postoperative morbidity and mortality. The 30-day mortality is high. This article presents an overview of the perioperative management of elderly trauma patients in order to improve the perioperative outcome of these high risk patients. A literature search was carried out focusing on the latest developments in the field of elderly trauma patients in order to present guidance on preoperative, intraoperative and postoperative anesthesiological management. Elderly trauma patients should undergo operative interventions as soon as possible. Many of these patients have a high risk profile. This can be estimated using risk scores in order to allow a prognosis for the outcome of patients. The informed consent needs to be discussed accordingly. The perioperative management is ideally addressed in a multidisciplinary approach. An array of questions in perioperative management, such as the mode of anesthesia, the ideal individual transfusion trigger and fluid management have not yet been adequately addressed in studies. The level of evidence in the perioperative management of elderly trauma patients is poor; therefore, there is an urgent need for large prospective studies in order to define uniform standards and guidelines.

  5. Surgery in elderly patients with otosclerosis.

    PubMed

    Vartiainen, E

    1995-07-01

    Hearing results and complications of surgery were studied in 42 patients with otosclerosis (46 ears operated on) who were over the age of 60 years at the time of stapedectomy. The mean follow-up period was 8 years. The results were compared with those obtained in 275 patients (330 ears operated on) younger than 60 years of age undergoing stapes surgery during the same time period. Large fenestra stapedectomy with fascia seal to the oval window was used in all cases. Hearing results as judged by postoperative air-bone gaps were as good in the older age group as in the younger patients. In contrast to some earlier reports, complications of surgery such as postoperative sensorineural hearing loss occurred not more frequently among elderly patients than in younger patients. It is concluded that stapes surgery should be offered to elderly patients with the same indications as in younger patients with otosclerosis.

  6. [Treatment of hip fractures in elderly patients].

    PubMed

    Hack, Juliana; Bliemel, Christopher; Ruchholtz, Steffen; Bücking, Benjamin

    2015-04-01

    Hip fractures are among the most common fractures in elderly people. The annual number of femoral fractures is even expected to increase because of an aging society. Due to the high number of comorbidities, there are special challenges in treating geriatric hip fracture patients, which require a multidisciplinary management. This includes surgical treatment allowing full weight bearing in the immediate postoperative period, osteoporosis treatment and falls prevention as well as an early ortho-geriatric rehabilitation program.

  7. Review of Postoperative Delirium in Geriatric Patients Undergoing Hip Surgery.

    PubMed

    Rizk, Paul; Morris, William; Oladeji, Philip; Huo, Michael

    2016-06-01

    Postoperative delirium is a serious complication following hip surgery in elderly patients that can adversely affect outcomes in both hip fracture and arthroplasty surgery. Recently, the incidence of hip fracture in the Medicare population was estimated at approximately 500 000 patients per year, with the majority treated surgically. The annual volume of total hip arthroplasty is nearly 450 000 patients and is projected to increase over the next 15 to 20 years. Subsequently, the incidence of postoperative delirium will rise. The incidence of postoperative delirium after hip surgery in the elderly patients ranges between 4% and 53%, and it is identified as the most common surgical complication of older patients. The most common risk factors include advanced age, hip fracture surgery (vs elective hip surgery), and preoperative delirium/cognitive impairment. Exact pathophysiology has not been fully defined. It is hypothesized that imbalances in cortical neurotransmitters or inflammatory cytokine pathway mechanisms contribute to delirium. Development of postoperative delirium is associated with longer hospital stay, increased medical complications, and poorer short-term functional outcome. Patients who develop postoperative delirium are also at increased risk for cognitive decline beyond the acute phase. Following acute care, postoperative delirium is associated with the need for a higher level of care, an additional cost. Management of postoperative delirium centers on prevention and early recognition. Medical prophylaxis has been demonstrated to have limited utility. Utilization of delirium detection methods contributed to early recognition. The most effective means of prevention involved a multidisciplinary team focused on adequate hydration, optimization of analgesia, reduction in polypharmacy, aggressive physiotherapy, and early recognition of the delirium symptoms.

  8. Review of Postoperative Delirium in Geriatric Patients Undergoing Hip Surgery

    PubMed Central

    Morris, William; Oladeji, Philip; Huo, Michael

    2016-01-01

    Postoperative delirium is a serious complication following hip surgery in elderly patients that can adversely affect outcomes in both hip fracture and arthroplasty surgery. Recently, the incidence of hip fracture in the Medicare population was estimated at approximately 500 000 patients per year, with the majority treated surgically. The annual volume of total hip arthroplasty is nearly 450 000 patients and is projected to increase over the next 15 to 20 years. Subsequently, the incidence of postoperative delirium will rise. The incidence of postoperative delirium after hip surgery in the elderly patients ranges between 4% and 53%, and it is identified as the most common surgical complication of older patients. The most common risk factors include advanced age, hip fracture surgery (vs elective hip surgery), and preoperative delirium/cognitive impairment. Exact pathophysiology has not been fully defined. It is hypothesized that imbalances in cortical neurotransmitters or inflammatory cytokine pathway mechanisms contribute to delirium. Development of postoperative delirium is associated with longer hospital stay, increased medical complications, and poorer short-term functional outcome. Patients who develop postoperative delirium are also at increased risk for cognitive decline beyond the acute phase. Following acute care, postoperative delirium is associated with the need for a higher level of care, an additional cost. Management of postoperative delirium centers on prevention and early recognition. Medical prophylaxis has been demonstrated to have limited utility. Utilization of delirium detection methods contributed to early recognition. The most effective means of prevention involved a multidisciplinary team focused on adequate hydration, optimization of analgesia, reduction in polypharmacy, aggressive physiotherapy, and early recognition of the delirium symptoms. PMID:27239384

  9. Leptospirosis in elderly patients.

    PubMed

    Gancheva, Galya Ivanova

    2013-01-01

    Leptospirosis is a re-emerging zoonosis with broad clinical spectrum and high mortality in severe forms. The aim of this study was to analyze clinical manifestations, laboratory findings, epidemiological data, and management in elderly patients with leptospirosis. Toward that end, we performed a descriptive analysis of 15 leptospirosis elderly cases (age 60-78 years) treated at the Clinic of Infectious Diseases of University Hospital - Pleven (1976-2012). Patients were serologically confirmed by microscopic agglutination test. Twelve cases (80%) presented with the severe form of leptospirosis. Co-morbidity (hypertonic diseases, chronic pulmonary diseases, chronic alcohol abuse, and diabetes) was registered in 13 cases. All cases had fever, oliguria, conjunctival suffusions, hepatosplenomegaly. Jaundice (14/93%), hemorrhagic diathesis (13/87%), vomiting (11/73%), abdominal pain (10/67%), myalgia (7/47%) and hypotension (7/47%) also were observed. Renal dysfunction was expressed by increased blood urea nitrogen (mean 38.1±24.1mmol/L) and serum creatinine (mean 347.6±179.8μmol/L). Hepatic dysfunction was expressed by increased total serum bilirubin level (mean 274.6±210.7μmol/L) and slightly elevated aminotransferases (ASAT mean 125.8±61.6IU/L; ALAT mean 131.3±126.5IU/L). Five cases (33%) had a lethal outcome. In conclusion, leptospirosis in elderly patients is associated with severe course and higher risk for death, and requires prompt intensive treatment. Copyright © 2013 Elsevier Editora Ltda. All rights reserved.

  10. Mastocytosis among elderly patients

    PubMed Central

    Rouet, Audrey; Aouba, Achille; Damaj, Gandhi; Soucié, Erinn; Hanssens, Katia; Chandesris, Marie-Olivia; Livideanu, Cristina Bulai; Dutertre, Marine; Durieu, Isabelle; Grandpeix-Guyodo, Catherine; Barète, Stéphane; Bachmeyer, Claude; Soria, Angèle; Frenzel, Laurent; Fain, Olivier; Grosbois, Bernard; de Gennes, Christian; Hamidou, Mohamed; Arlet, Jean-Benoit; Launay, David; Lavigne, Christian; Arock, Michel; Lortholary, Olivier; Dubreuil, Patrice; Hermine, Olivier; Georgin-Lavialle, Sophie

    2016-01-01

    Abstract Mastocytosis is a heterogeneous group of diseases with a young median age at diagnosis. Usually indolent and self-limited in childhood, the disease can exhibit aggressive progression in mid-adulthood. Our objectives were to describe the characteristics of the disease when diagnosed among elderly patients, for which rare data are available. The French Reference Center conducted a retrospective multicenter study on 53 patients with mastocytosis >69 years of age, to describe their clinical, biological, and genetic features. The median age of our cohort of patients was 75 years. Mastocytosis variants included were cutaneous (n = 1), indolent systemic (n = 5), aggressive systemic (n = 11), associated with a hematological non-mast cell disease (n = 34), and mast cell leukemia (n = 2). Clinical manifestations were predominantly mast cell activation symptoms (75.5%), poor performance status (50.9%), hepatosplenomegaly (50.9%), skin involvement (49.1%), osteoporosis (47.2%), and portal hypertension and ascites (26.4%). The main biological features were anemia (79.2%), thrombocytopenia (50.9%), leucopenia (20.8%), and liver enzyme abnormalities (32.1%). Of the 40 patients tested, 34 (85%), 2 (5%), and 4 (10%) exhibited the KIT D816V mutant, other KIT mutations and the wild-type form of the KIT gene, respectively. Additional sequencing detected significant genetic defects in 17 of 26 (65.3%) of the patients with associated hematological non-mast cell disease, including TET2, SRSF2, IDH2, and ASLX1 mutations. Death occurred in 19 (35.8%) patients, within a median delay of 9 months, despite the different treatment options available. Mastocytosis among elderly patients has a challenging early detection, rare skin involvement, and/or limited skin disease; it is heterogeneous and has often an aggressive presentation with nonfortuitous associated myeloid lineage malignant clones, and thus a poor overall prognosis. PMID:27310990

  11. Physical therapy in the postoperative of proximal femur fracture in elderly. Literature review

    PubMed Central

    Carneiro, Mariana Barquet; Alves, Débora Pinheiro Lédio; Mercadante, Marcelo Tomanik

    2013-01-01

    The proximal femoral fracture in the elderly is a serious public health problem. Surgical treatment of this fracture is used to reduce morbidity, together with postoperative physical therapy. The objective was to conduct a systematic review of physical therapy protocols in postoperative for fractures of the proximal femur in elderly. We selected randomized controlled trials in elderly in the past 10 years, in Portuguese and English. There were 14 articles in the literature. Physical therapy has an important role in functional recovery of the elderly. Level of Evidence I, Systematic Review RCTs (Study results were homogenous). PMID:24453665

  12. Postoperative Delirium in the Geriatric Patient

    PubMed Central

    Schenning, Katie J.; Deiner, Stacie G.

    2015-01-01

    SYNOPSIS Postoperative delirium, a common complication in older surgical patients, is independently associated with increased morbidity and mortality. Patients over the age of 65 years receive greater than 1/3 of the over 40 million anesthetics delivered yearly in the United States. This number is expected to increase with the aging of the population. Thus, it is increasingly important that perioperative clinicians who care for geriatric patients have an understanding of the complex syndrome of postoperative delirium. PMID:26315635

  13. Surgery in elderly people: preoperative, operative and postoperative care to assist healing.

    PubMed

    Hughes, Sarah; Leary, Antonella; Zweizig, Susan; Cain, Joanna

    2013-10-01

    Surgery for elderly women is likely to increase steadily as the population of elderly people increases globally. Although increasing age increases perioperative morbidity and mortality, the functional age and physiologic reserve rather than chronological age is more important in preventing complications. Preparation for surgery, with special attention to functional capacity and activity, mental status, and existing comorbid conditions, can improve outcomes. Perioperative management must be tailored to physiologic changes of ageing, which affect respiratory, cardiac and renal function, as well as guidelines for preventing infection and thrombotic events. Of particular note is the enhanced effect of narcotic medications in elderly people, which affects intraoperative and postoperative management of pain. Prevention of postoperative delirium is accomplished through preoperative and postoperative planning. Discharge planning, particularly for frail elderly people, must start before surgery. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. Neuromuscular blockade in the elderly patient.

    PubMed

    Lee, Luis A; Athanassoglou, Vassilis; Pandit, Jaideep J

    2016-01-01

    Neuromuscular blockade is a desirable or even essential component of general anesthesia for major surgical operations. As the population continues to age, and more operations are conducted in the elderly, due consideration must be given to neuromuscular blockade in these patients to avoid possible complications. This review considers the pharmacokinetics and pharmacodynamics of neuromuscular blockade that may be altered in the elderly. Compartment distribution, metabolism, and excretion of drugs may vary due to age-related changes in physiology, altering the duration of action with a need for reduced dosage (eg, aminosteroids). Other drugs (atracurium, cisatracurium) have more reliable duration of action and should perhaps be considered for use in the elderly. The range of interpatient variability that neuromuscular blocking drugs may exhibit is then considered and drugs with a narrower range, such as cisatracurium, may produce more predictable, and inherently safer, outcomes. Ultimately, appropriate neuromuscular monitoring should be used to guide the administration of muscle relaxants so that the risk of residual neuromuscular blockade postoperatively can be minimized. The reliability of various monitoring is considered. This paper concludes with a review of the various reversal agents, namely, anticholinesterase drugs and sugammadex, and the alterations in dosing of these that should be considered for the elderly patient.

  15. Impact of a multifaceted program to prevent postoperative delirium in the elderly: the CONFUCIUS stepped wedge protocol

    PubMed Central

    2011-01-01

    Background Postoperative delirium is common in the elderly and is associated with a significant increase in mortality, complications, length of hospital stay and admission in long care facility. Although several interventions have proved their effectiveness to prevent it, the Cochrane advises an assessment of multifaceted intervention using rigorous methodology based on randomized study design. Our purpose is to present the methodology and expected results of the CONFUCIUS trial, which aims to measure the impact of a multifaceted program on the prevention of postoperative delirium in elderly. Method/Design Study design is a stepped wedge cluster randomized trial within 3 surgical wards of three French university hospitals. All patients aged 75 and older, and admitted for scheduled surgery will be included. The multifaceted program will be conducted by mobile geriatric team, including geriatric preoperative consultation, training of the surgical staff and implementation of the Hospital Elder Life Program, and morbidity and mortality conference related to delirium cases. The primary outcome is based on postoperative delirium rate within 7 days after surgery. This program is planned to be implemented along four successive time periods within all the surgical wards. Each one will be affected successively to the control arm and to the intervention arm of the trial and the order of program introduction within each surgical ward will be randomly assigned. Based on a 20% reduction of postoperative delirium rate (ICC = 0.25, α = 0.05, β = 0.1), three hundred sixty patients will be included i.e. thirty patients per service and per time period. Endpoints comparison between intervention and control arms of the trial will be performed by considering the cluster and time effects. Discussion Better prevention of delirium is expected from the multifaceted program, including a decrease of postoperative delirium, and its consequences (mortality, morbidity, postoperative

  16. Assessment of age-specific safety of laparoscopic surgery in elderly patients with ovarian tumors.

    PubMed

    Otake, Akiko; Sasase, Aya; Suzuki, Atsuko; Takahashi, Kayo; Sasamoto, Naoko; Miyoshi, Yukari; Shioji, Mitsunori; Yamamoto, Yoshimitsu; Adachi, Kazushige

    2016-03-01

    We assessed the age-specific safety of laparoscopic surgery in elderly patients with ovarian tumors. We performed a retrospective analysis of 55 elderly patients treated by laparoscopic salpingo-oophorectomy under the diagnosis of an ovarian tumor between January 2009 and December 2014. We divided patients into three groups: "young-elderly" (aged 65-74), "old-elderly" (aged 75-84), and "super-elderly" (aged 85-105) and assessed clinical characteristics, surgical results and postoperative course. Statistical significance of categorical variables was examined by the Student's t-test, Mann-Whitney U test, or Fisher's exact test. Multiple regression analysis was used for multivariate analysis. Of a total of 55 patients who underwent laparoscopic surgery, there were 36 patients in the young-elderly group, 17 in the old-elderly group, and two in the super-elderly group. Statistical analysis was performed between the young-elderly and the old-elderly groups because of the small number in the super-elderly group. More frequent comorbidities were found in the patients in the old-elderly than in the young-elderly group (Fisher's exact test, P = 0.007). There were no significant differences in operative time, estimated blood loss and postoperative hospital stay between the young-elderly and old-elderly groups. Intraoperative complications only occurred in the young-elderly group. Postoperative complications occurred in all groups. Although patients in the old-elderly group had a significantly higher risk for surgery, they had equivalent surgical results to the young-elderly group for laparoscopic salpingo-oophorectomy. © 2015 Japan Society of Obstetrics and Gynecology.

  17. [Deglutition disorders in elderly patients].

    PubMed

    Menasria, Feriel; Lakroun, Samia; David, Jean-Philippe

    2013-01-01

    Deglutition disorders are frequent in elderly patients and can lead to serious consequences in terms of morbidity and mortality. Despite an easy screening test with the water, they are ignored or underestimated. Moreover, early detection and treatment focused essentially on the adaptation of textures, postures as well as the provision of information and training to all the people involved in feeding the elderly person require few resources and provide a real benefit.

  18. [Nutritional anemias in elderly patients].

    PubMed

    Serraj, Khalid; Federici, Laure; Kaltenbach, Georges; Andrès, Emmanuel

    2008-09-01

    Nutritional deficiencies cause one third of the cases of anemia in the elderly. The urgency of anemia management in elderly patients depends on tolerance and repercussions, rather than only on the hemoglobin level. Iron, vitamin B12 and folate are the most common deficiencies, and their levels should be tested. Chronic gastrointestinal bleeding is the principal cause of iron-deficiency anemia. Management is based on supplementation combined with effective etiological treatment.

  19. Outcome after pancreaticoduodenectomy for cancer in elderly patients.

    PubMed

    Scurtu, Radu; Bachellier, Philippe; Oussoultzoglou, Elie; Rosso, Edoardo; Maroni, Rodrigo; Jaeck, Daniel

    2006-06-01

    During the last decade, the outcome after pancreaticoduodenectomy (PD) for cancer showed a continuous improvement. Therefore, an increasing number of patients, especially elderly patients, have been considered for this procedure. However, the debate on the possible deleterious influence of patients' advanced age on their postoperative outcome after pancreaticoduodenectomy still continues. From June 1995 to October 2003, 70 elderly patients (range, 70-84 years) underwent pancreaticoduodenectomy with pancreato-gastrostomy for cancer. Among them, 38 patients were 70-75 years old and 32 were > or =75 years. Patients were identified from a prospective database of a single institution, and their records were reviewed retrospectively. Patient and tumor characteristics, postoperative morbidity and mortality, length of hospital stay, readmission rate, and overall survival were compared between the two groups. There were no statistical differences regarding the postoperative mortality (P = 0.205), overall morbidity (P = 0.267), mean length of hospital stay (P = 0.345), and readmission rate (P = 1) between both groups. Only delayed gastric emptying was significantly more frequent in patients > or =75 years (P = 0.039). The median overall survival was 20 months. Survival was significantly influenced by the pathological type of the tumor, with worse results for patients with ductal pancreatic adenocarcinoma. In elderly patients, age does not seem to influence the postoperative outcome after pancreaticoduodenectomy with pancreato-gastrostomy.

  20. [Laparoscopic cholecystectomy in elderly and old patients].

    PubMed

    Galashev, V I; Zotikov, S D; Gliantsev, S P

    2001-01-01

    The results of cholecystectomy from mini-approach (CEMA) in 111 elderly and old patients with acute and chronic cholecystitis living in European North of Russia were analyzed, and also 84 patients were operated by traditional approach (TCE). Duration of CEMA was less than TCE (75 +/- 3.2 and 95.2 +/- 4.6 min respectively; p < 0.05). Sutures after CEMA were removed on day 8.4 +/- 1.2 (after TCE--on day 13.8 +/- 2.4, p < 0.05). Postoperative period after CEMA was 11.4 +/- 2.1 days vs. 18.8 +/- 3.5 days after TCE (p < 0.05). Complications after CEMA were seen in 1.8% patients, after TCE--in 5.0%. Lethality was 0.9% after CEMA and 3.5% after TCE. The main advantages of CEMA are: reduction of surgery time, early activation of patients, decrease of postoperative complications number and reduction of postoperative treatment time (11.4 +/- 2.1 days after CEMA and 18.8 +/- 3.5 days after TCE, p < 0.05).

  1. Postoperative Pain Trajectories in Cardiac Surgery Patients

    PubMed Central

    Chapman, C. Richard; Zaslansky, Ruth; Donaldson, Gary W.; Shinfeld, Amihay

    2012-01-01

    Poorly controlled postoperative pain is a longstanding and costly problem in medicine. The purposes of this study were to characterize the acute pain trajectories over the first four postoperative days in 83 cardiac surgery patients with a mixed effects model of linear growth to determine whether statistically significant individual differences exist in these pain trajectories, and to compare the quality of measurement by trajectory with conventional pain measurement practices. The data conformed to a linear model that provided slope (rate of change) as a basis for comparing patients. Slopes varied significantly across patients, indicating that the direction and rate of change in pain during the first four days of recovery from surgery differed systematically across individuals. Of the 83 patients, 24 had decreasing pain after surgery, 24 had increasing pain, and the remaining 35 had approximately constant levels of pain over the four postoperative days. PMID:22448322

  2. Postoperative Delirium in the Geriatric Patient.

    PubMed

    Schenning, Katie J; Deiner, Stacie G

    2015-09-01

    Postoperative delirium, a common complication in older surgical patients, is independently associated with increased morbidity and mortality. Patients older than 65 years receive greater than one-third of the more than 40 million anesthetics delivered yearly in the United States. This number is expected to increase with the aging of the population. Thus, it is increasingly important that perioperative clinicians who care for geriatric patients have an understanding of the complex syndrome of postoperative delirium. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Perioperative care in elderly cardiac surgery patients

    PubMed Central

    Kiecak, Katarzyna; Urbańska, Ewa; Maciejewski, Tomasz; Kaliś, Robert; Pakosiewicz, Waldemar; Kołodziej, Tadeusz; Knapik, Piotr; Przybylski, Roman; Zembala, Marian

    2016-01-01

    Introduction Surgery is an extreme physiological stress for the elderly. Aging is inevitably associated with irreversible and progressive cellular degeneration. Patients above 75 years of age are characterized by impaired responses to operative stress and a very narrow safety margin. Aim To evaluate perioperative complications in patients aged ≥ 75 years who underwent cardiac surgery in comparison to outcomes in younger patients. Material and methods The study was conducted at the Silesian Centre for Heart Diseases in Zabrze in 2009–2014 after a standard of perioperative care in seniors was implemented to reduce complications, in particular to decrease the duration of mechanical ventilation and reduce postoperative delirium. The study group included 1446 patients. Results The mean duration of mechanical ventilation was 13.8 h in patients aged ≥ 75 years and did not differ significantly compared to younger patients. In-hospital mortality among seniors was 3.8%, a value significantly higher than that observed among patients younger than 75 years of age. Patients aged ≥ 75 years undergoing cardiac surgery have significantly more concomitant conditions involving other organs, which affects treatment outcomes (duration of hospital stay, mortality). Conclusions The implementation of a standard of perioperative care in this age group reduced the duration of mechanical ventilation and lowered the rate of postoperative delirium. PMID:28096832

  4. Frailty and elderly in urology: Is there an impact on post-operative complications?

    PubMed Central

    Morlacco, Alessandro; Motterle, Giovanni; Barbieri, Lisa; Zattoni, Filiberto

    2017-01-01

    Introduction Frailty used as predictive tool is still not carried out in daily practice, although many studies confirm the great clinical importance of the frailty syndrome in surgical outcomes. There is no standardized method of measuring the physiological reserves of older surgical patients. The aim of this study was to analyze a cohort of older urological patients according to various frailty indices, in order to evaluate whether they are predictors of post-operative complications after urological procedures. Material and methods This is a prospective observational study on 78 consecutive older (≥70 years) patients, subjected to major urological (both endoscopic and ’open surgical’) procedures. Frailty was defined according to the Edmonton Frail Scale. Several risk models and biochemical parameters were evaluated. Post-operative outcomes were surgical and medical complications, mortality and rehospitalisation within 3 months. Results An overall prevalence of frailty of 21.8% was found. Patients with complications were frailer than those without complications (univariate analysis), considering both total patients (p = 0.002) and endoscopic (p = 0.04) and ’open surgical’ patients (p = 0.013). However, in multivariate analysis, a significant correlation was not found between all frailty indices tested and the risk of major complications. Limitation of the study: the small sample size (lack of statistical power), although this is a prospective study focused on older urological patients. Conclusions New urology-tailored pre-operative assessment tools may prove beneficial when calculating the risks/benefits of urological procedures, so that objective data can guide surgical decision- making and patient counselling. Further large clinical studies specifically focusing on elderly in urology will be needed. PMID:28721290

  5. Safety of microvascular decompression for elderly patients with trigeminal neuralgia.

    PubMed

    Amagasaki, Kenichi; Watanabe, Saiko; Naemura, Kazuaki; Shono, Naoyuki; Nakaguchi, Hiroshi

    2016-02-01

    The present study compared the safety and efficacy of microvascular decompression (MVD) in groups of elderly patients and non-elderly patients with medically refractory trigeminal neuralgia (TN) and collected detailed perioperative data. Retrospective analysis of clinical data was performed in 99 patients who underwent MVD from May 2012 to June 2015. The outcome data from 27 MVD operations for 27 patients aged 70-80 years (mean 74.6 years) were compared with 72 MVD operations with 72 patients aged 25-69 years (mean 55.7 years). Preoperative comorbidities were recorded and postoperative worsening comorbidities and non-neurological complications were evaluated at discharge. Efficacy of the surgery and neurological complications were evaluated in July 2015. No decrease in activity of daily living was found in any patient. Complete pain relief without medication was achieved in 77.8% and partial pain relief in 14.8% in the elderly group, and 83.3% and 9.7%, respectively, in the non-elderly group (p=0.750). Permanent neurological complication was not observed in the elderly group, whereas Vth nerve and VIIIth nerve complications were observed in the non-elderly group. Rates of preoperative multiple comorbidities and of cardiovascular comorbidity were significantly higher in the elderly group (p<0.01). Worsening comorbidity and new pathology at discharge were mainly hypertension in both groups, but glaucoma attack and asthma attack were observed in the elderly group. All pathologies were successfully managed. MVD for elderly patients with TN can be achieved safely with careful perioperative management. Information of comorbidity should be shared with all staff involved in the treatment, who should work as a team to avoid worsening comorbidity. The possibility of unpredictable events in the elderly patients should always be considered. Copyright © 2015 Elsevier B.V. All rights reserved.

  6. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study.

    PubMed

    Roche, J J W; Wenn, R T; Sahota, O; Moran, C G

    2005-12-10

    To evaluate postoperative medical complications and the association between these complications and mortality at 30 days and one year after surgery for hip fracture and to examine the association between preoperative comorbidity and the risk of postoperative complications and mortality. Prospective observational cohort study. University teaching hospital. 2448 consecutive patients admitted with an acute hip fracture over a four year period. We excluded 358 patients: all those aged < 60; those with periprosthetic fractures, pathological fractures, and fractures treated without surgery; and patients who died before surgery. Routine care for hip fractures. Postoperative complications and mortality at 30 days and one year. Mortality was 9.6% at 30 days and 33% at one year. The most common postoperative complications were chest infection (9%) and heart failure (5%). In patients who developed postoperative heart failure mortality was 65% at 30 days (hazard ratio 16.1, 95% confidence interval 12.2 to 21.3). Of these patients, 92% were dead by one year (11.3, 9.1 to 14.0). In patients who developed a postoperative chest infection mortality at 30 days was 43% (8.5, 6.6 to 11.1). Significant preoperative variables for increased mortality at 30 days included the presence of three or more comorbidities (2.5, 1.6 to 3.9), respiratory disease (1.8, 1.3 to 2.5), and malignancy (1.5, 1.01 to 2.3). In elderly people with hip fracture, the presence of three or more comorbidities is the strongest preoperative risk factor. Chest infection and heart failure are the most common postoperative complications and lead to increased mortality. These groups offer a clear target for specialist medical assessment.

  7. Scurvy in hospitalized elderly patients.

    PubMed

    Raynaud-Simon, A; Cohen-Bittan, J; Gouronnec, A; Pautas, E; Senet, P; Verny, M; Boddaert, J

    2010-06-01

    The aim of this study was to systematically screen hospitalized elderly patients for clinical symptoms of scurvy and to confirm the diagnosis with biological measures. Geriatric acute care ward. Scurvy symptoms (one or more among perifollicular hyperkeratosis, petechiae or bruises, haemorrhagic features caused by venous puncture, severe gingivitis). We compared associated diseases, nutritional status, need for assistance for feeding, serum albumin, transthyretin, B9 and B12 vitamins, iron status and Serum Ascorbic Acid Level (SAAL) and outcome (in-hospital mortality) between scurvy and scurvy free patients. 18 patients with clinical symptoms of scurvy (scurvy group) were identified out of 145 consecutive patients (12%). They were compared to 23 consecutive control patients with no clinical symptoms of scurvy (scurvy-free group). SAAL was significantly lower (1.09 +/- 1.06 vs 4.87 +/- 4.2 mg x L-1, p < .001) and vitamin C deficiency more frequent (94 vs 30 %, p < .001) in the scurvy group. Moreover, in scurvy group, coronary heart disease (39 vs 9 %, p=.028), need for assistance for feeding (56 vs 13 %, p=.006) and in-hospital deaths (44 vs 9 %, p=.012) were more frequent. Ninety-four percent of patients with clinical symptoms of scurvy had vitamin C deficiency. Our results suggest that in hospitalized elderly patients, clinical symptoms allow scurvy diagnosis. Scurvy could be a frequent disease in elderly patients admitted to acute geriatric ward.

  8. Laparoscopic Cholecystectomy for Acute Cholecystitis in Elderly Patients

    PubMed Central

    Filho, Euler de Medeiros Ázaro; Galvão, Thales Delmondes; Ettinger, João Eduardo Marques de Menezes; Silva Reis, Jadson Murilo; Lima, Marcos; Fahel, Edvaldo

    2006-01-01

    Background: Acute cholecystitis is the major complication of biliary lithiasis, for which laparoscopic treatment has been established as the standard therapy. With longer life expectancy, acute cholecystitis has often been seen in elderly patients (>65 years old) and is often accompanied by comorbity and severe complications. We sought to compare the outcome of laparoscopic treatment for acute cholecystitis with special focus on comparison between elderly and nonelderly patients. Method: This study was a prospective analysis of 190 patients who underwent laparoscopic cholecystectomy due to acute cholecystitis or chronic acute cholecystitis, comparing elderly and nonelderly patients. Results: Of 190 patients, 39 (21%) were elderly (>65 years old) and 151 (79%) were not elderly (≤65 years), with conversion rates of 10.3% and 6.6% (P=0.49), respectively. The incidence of postoperative complications in elderly and nonelderly patients were the following, respectively: atelectasis 5.1% and 2.0% (P=0.27); respiratory infection 5.1% and 2.7% (P=0.6); bile leakage 5.1% and 2.0% (P=0.27), and intraabdominal abscess 1 case (0.7%) and no incidence (P=1). Conclusion: According to our data, laparoscopic cholecystectomy is a safe and efficient procedure for the treatment of acute cholecystitis in patients older than 65 years of age. PMID:17575761

  9. Paradoxical emboli in elderly patients.

    PubMed

    Vella, M; McNabb, R; Lewis, R; Sulke, N; Poston, R; Lugon, M

    1992-01-01

    We report two elderly patients who each had a patent foramen ovale (PFO) and were considered to have had paradoxical emboli. In one patient the PFO was detected by contrast two-dimensional echocardiography, whereas in the other it was demonstrated at post-mortem examination. This is an unusual but treatable condition, particularly difficult to diagnose in older people and probably occurring more frequently than is generally suspected.

  10. Effect of Oral Taurine on Morbidity and Mortality in Elderly Hip Fracture Patients: A Randomized Trial

    PubMed Central

    Van Stijn, Mireille F. M.; Bruins, Arnoud A.; Vermeulen, Mechteld A. R.; Witlox, Joost; Teerlink, Tom; Schoorl, Margreet G.; De Bandt, Jean Pascal; Twisk, Jos W. R.; Van Leeuwen, Paul A. M.; Houdijk, Alexander P. J.

    2015-01-01

    Hip fracture patients represent a large part of the elderly surgical population and face severe postoperative morbidity and excessive mortality compared to adult surgical hip fracture patients. Low antioxidant status and taurine deficiency is common in the elderly, and may negatively affect postoperative outcome. We hypothesized that taurine, an antioxidant, could improve clinical outcome in the elderly hip fracture patient. A double blind randomized, placebo controlled, clinical trial was conducted on elderly hip fracture patients. Supplementation started after admission and before surgery up to the sixth postoperative day. Markers of oxidative status were measured during hospitalization, and postoperative outcome was monitored for one year after surgery. Taurine supplementation did not improve in-hospital morbidity, medical comorbidities during the first year, or mortality during the first year. Taurine supplementation lowered postoperative oxidative stress, as shown by lower urinary 8-hydroxy-2-deoxyguanosine levels (Generalized estimating equations (GEE) analysis average difference over time; regression coefficient (Beta): −0.54; 95% CI: −1.08–−0.01; p = 0.04), blunted plasma malondialdehyde response (Beta: 1.58; 95% CI: 0.00–3.15; p = 0.05) and a trend towards lower lactate to pyruvate ratio (Beta: −1.10; 95% CI: −2.33–0.12; p = 0.08). We concluded that peri-operative taurine supplementation attenuated postoperative oxidative stress in elderly hip fracture patients, but did not improve postoperative morbidity and mortality. PMID:26035756

  11. Effect of oral taurine on morbidity and mortality in elderly hip fracture patients: a randomized trial.

    PubMed

    Van Stijn, Mireille F M; Bruins, Arnoud A; Vermeulen, Mechteld A R; Witlox, Joost; Teerlink, Tom; Schoorl, Margreet G; De Bandt, Jean Pascal; Twisk, Jos W R; Van Leeuwen, Paul A M; Houdijk, Alexander P J

    2015-05-29

    Hip fracture patients represent a large part of the elderly surgical population and face severe postoperative morbidity and excessive mortality compared to adult surgical hip fracture patients. Low antioxidant status and taurine deficiency is common in the elderly, and may negatively affect postoperative outcome. We hypothesized that taurine, an antioxidant, could improve clinical outcome in the elderly hip fracture patient. A double blind randomized, placebo controlled, clinical trial was conducted on elderly hip fracture patients. Supplementation started after admission and before surgery up to the sixth postoperative day. Markers of oxidative status were measured during hospitalization, and postoperative outcome was monitored for one year after surgery. Taurine supplementation did not improve in-hospital morbidity, medical comorbidities during the first year, or mortality during the first year. Taurine supplementation lowered postoperative oxidative stress, as shown by lower urinary 8-hydroxy-2-deoxyguanosine levels (Generalized estimating equations (GEE) analysis average difference over time; regression coefficient (Beta): -0.54; 95% CI: -1.08--0.01; p = 0.04), blunted plasma malondialdehyde response (Beta: 1.58; 95% CI: 0.00-3.15; p = 0.05) and a trend towards lower lactate to pyruvate ratio (Beta: -1.10; 95% CI: -2.33-0.12; p = 0.08). We concluded that peri-operative taurine supplementation attenuated postoperative oxidative stress in elderly hip fracture patients, but did not improve postoperative morbidity and mortality.

  12. Toxic epidermal necrolysis (TEN) in elderly patients.

    PubMed

    Honari, S; Gibran, N S; Heimbach, D M; Gibbons, J; Pharmd; Cain, V; Engrav, L H

    2001-01-01

    Toxic epidermal necrolysis (TEN) is a severe exfoliative disease of the skin and mucous membranes that results in high mortality. As the elderly population increases, the number of elderly patients with TEN can also be expected to increase. Elderly patients with comparably sized burn wounds usually have a poor prognosis. Our purpose was to determine whether elderly TEN patients exhibit similarly high mortality. A retrospective review was conducted of 52 patients treated for TEN from October 1991 through September 1998. Eleven patients were older than 65 years. All patients were treated according to our TEN protocol. Eight of 11 patients recovered, and 3 died. The mean total body surface area (TBSA) involvement for the patients who recovered was 24%, compared with 66% for the nonsurvivors. The survival rate for elderly patients (73%) compares well with that for those younger than 65 years (89%). Therefore, we propose that we should be aggressive in treating elderly patients with TEN.

  13. Radiotherapy issues in elderly breast cancer patients.

    PubMed

    Kunkler, Ian

    2012-12-01

    Breast cancer in the elderly is a rising health care challenge. Under-treatment is common. While the proportion of older patients receiving adjuvant radiotherapy (RT) is rising, the proportion undergoing breast-conserving surgery without irradiation has also risen. The evidence base for loco-regional treatment is limited, reflecting the historical exclusion of older patients from randomised trials. The 2011 Oxford overview shows that the risk of first recurrence is halved in all age groups by adjuvant RT after breast-conserving surgery, although the absolute benefit in older 'low-risk' patients is small. There is level 1 evidence that a breast boost after breast-conserving surgery and whole-breast irradiation reduces local recurrence in older as in younger women, although in the former the absolute reduction is modest. Partial breast irradiation (external beam or intraoperative or postoperative brachytherapy) is potentially an attractive option for older patients, but the evidence base is insufficient to recommend it routinely. Similarly, shortened (hypofractionated) dose fraction schedules may be more convenient for older patients and are supported by level 1 evidence. There remains uncertainty about whether there is a subgroup of older low-risk patients in whom postoperative RT can be omitted after breast-conserving surgery. Biomarkers of 'low risk' are needed to refine the selection of patients for the omission of adjuvant RT. The role of postmastectomy irradiation is well established for 'high-risk' patients but uncertain in the intermediate-risk category of patients with 1-3 involved axillary nodes or node-negative patients with other risk factors where its role is investigational.

  14. [Chronic subdural haematomas in very elderly patients].

    PubMed

    Castro-Rodríguez, Cristina; Román-Pena, Paula; Arán-Echabe, Eduardo; Gelabert-González, Miguel

    Chronic subdural haematoma (CSDH) is one of the most common neurosurgical conditions and is especially prevalent among elderly individuals. The objective of this study was to analyse the demographic, clinical and radiological findings, and surgical outcomes in a series of chronic subdural haematoma in patients older than 85 years. A review was carried out on all patients over 85 years with CSDH treated in our neurosurgical service from April 1986 to November 2015. A record was made of the baseline patient characteristics (age, sex, comorbidities, known risk factors, imaging characteristics, and number of burr-holes) and surgical outcomes (complications, especially recurrences and mortality). An analysis was carried out on the special characteristics of these patients, as well as the relationships between gender, clinical grade, anti-platelet or anticoagulant therapy, internal architecture of the haematoma, and midline shift, with mortality and recurrence of the haematoma. A total of 200 patients were included, with a mean age of 88.5 (range 85-104) years, and the male: female sex ratio was 1:1.1. History of injury was reported in 114 (57%) cases. Anti-platelet or anticoagulant therapy was being used by 71 (35.5%) patients. On admission, 114 patients (57%) were in satisfactory condition (Markwalder grades 0-2). The main symptom was behavioural disturbance in 82 (41%) cases. CSDH was left-sided in 89 (44.5%) patients, right-sided in 78 (39%) cases (39%), and bilateral in the remaining 33 (16.5%) cases). Postoperative complications were observed in 59 cases (29 recurrences). Preoperative Markwalder grade correlated significantly with recurrence rate and mortality (P<.0001). CSDH was a very common disease in very elderly patients. Behavioural disturbance and neurological deficits are the most common first symptom. Preoperative neurological status at admission is the most important factor in recurrences and mortality. Copyright © 2016 SEGG. Publicado por Elsevier Espa

  15. Perioperative outcomes and survival in elderly patients undergoing laparoscopic distal pancreatectomy.

    PubMed

    Sahakyan, Mushegh A; Edwin, Bjørn; Kazaryan, Airazat M; Barkhatov, Leonid; Buanes, Trond; Ignjatovic, Dejan; Labori, Knut Jørgen; Røsok, Bård Ingvald

    2017-01-01

    The outcomes following laparoscopic distal pancreatectomy (LDP) in elderly patients have not been widely reported to date. This study aimed to analyze perioperative and oncologic outcomes in patients aged ≥70 years (elderly group) and compare with those <70 years (non-elderly group). From April 1997 to September 2015, 402 consecutive patients with lesions in the body and tail of the pancreas underwent LDP at Rikshospitalet, Oslo University Hospital. Of these, 118 (29.4%) were elderly, whereas 284 (70.6%) were non-elderly. Despite higher rate of comorbidities and American Society of Anesthesiologists score (P = 0.001 and 0.001, respectively), elderly patients had lower postoperative morbidity, pancreatic fistula (PF) and readmission rates, compared with non-elderly (P = 0.032, 0.001 and 0.025, respectively). Spleen-preserving LDP (SPLDP) resulted in similar postoperative outcomes in the two groups. Elderly patients with pancreatic ductal adenocarcinoma (PDAC) were comparable to non-elderly in terms of median and 3-year survival (20.2 vs. 19 months (P = 0.94, log-rank) and 26.7% vs. 34.3%, respectively). Both LDP and SPLDP are safe in patients aged ≥70 years, providing outcomes similar to those in younger group. Elderly patients with PDAC can benefit from LDP, since age itself is not associated with decreased survival after surgery. © 2016 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  16. Surgical treatment of secondary hyperparathyroidism in elderly patients: an institutional experience.

    PubMed

    Polistena, Andrea; Sanguinetti, Alessandro; Lucchini, Roberta; Galasse, Segio; Avenia, Stefano; Monacelli, Massimo; Johnson, Louis Banka; Jeppsson, Bengt; Avenia, Nicola

    2017-02-01

    Secondary hyperparathyroidism in elderly fragile patients presents clinical difficulties due to severity of symptoms and related comorbidity. The optimal surgical approach for this group of patients is still debated. The aim of the study was to define the optimal technique of parathyroidectomy in elderly patients with secondary hyperparathyroidism. Retrospective analysis in a series of 253 patients including 35 elderly individuals at a single institution was carried out. Postoperative parathyroid hormone decrease, surgical complications and symptoms control were analyzed for all patients in relation to the types of parathyroidectomy performed. In elderly patients, total parathyroidectomy was the most used approach. Subtotal parathyroidectomy was mostly reserved for younger patients suitable for kidney transplantation. No elderly patients treated with total parathyroidectomy were autotransplanted. No significant difference in surgical complications was observed between younger and elderly patients and considering the different procedures. Adequate symptom control after surgery was achieved in almost 90% of patients. A limited rate of recurrence requiring repeat surgery was observed only after subtotal parathyroidectomy. Considering the features of all types of parathyroidectomy, very low recurrence rate, contained postoperative hypocalcemia and limited complications following total parathyroidectomy, might represent specific advantages for elderly patients. Total parathyroidectomy without parathyroid transplantation is safe for elderly patients with secondary hyperparathyroidism and a good alternative to the well-established total parathyroidectomy with autografting.

  17. Elderly patients also have rights

    PubMed Central

    Pérez‐Cárceles, M D; Lorenzo, M D; Luna, A; Osuna, E

    2007-01-01

    Background Sharing information with relatives of elderly patients in primary care and in hospital has to fit into the complex set of obligations, justifications and pressures concerning the provision of information, and the results of some studies point to the need for further empirical studies exploring issues of patient autonomy, privacy and informed consent in the day‐to‐day care of older people. Objectives To know the frequency with which “capable” patients over 65 years of age receive information when admitted to hospital, the information offered to the families concerned, the person who gives consent for medical intervention, and the degree of satisfaction with the information received and the healthcare provided. Method A descriptive questionnaire given to 200 patients and 200 relatives during the patients' stay in hospital. Results Only 5% of patients confirmed that they had been asked whether information could be given to their relatives. A significantly higher proportion of relatives received information on the successive stages of the care offered than did patients themselves. As the age of the patients increased, so the number who were given information, understood the information and were asked for their consent for complementary tests decreased. The degree of satisfaction with the information offered was high for both patients and relatives (86.5% and 84%, respectively), despite the irregularities observed. Conclusions The capacity of elderly patients to participate in the decision‐making process is frequently doubted simply because they have reached a certain age and it is thought that relatives should act as their representatives. In Spain, the opinion of the family and doctors appears to play a larger role in making decisions than does the concept of patient autonomy. PMID:18055902

  18. [Injuries in the elderly patients].

    PubMed

    Hładki, Waldemar; Brongel, Leszek; Lorkowski, Jacek

    2006-01-01

    More and more higher development of civilisation causes constant lengthening of life in humans. Changes, which occur during growing old of organism predispose to increased risk of trauma. Financial cost of medical treatment of injuries in elderly are higher and higher. Degenerative disease of joints, osteoporosis, earlier body injuries and co-existing other diseases are important risk factors of trauma. Deficiencies of eyesight, hearing and prolonged time reaction are other strengthening risk of trauma. Falls and motor-vehicle accidents are the most frequent causes of trauma in elderly. Distal radius fracture, fracture of the proximal femur bone and compressive vertebral fracture of spine are typical fractures in the skeletal system. Head injuries are the most frequent cause of death in this group of patients. Limited functional reserves, especially in the respiratory and circulatory system brings difficulties in the treatment of even not dangerous injuries of chest and increases risks of infectious complications in respiratory system and finally may lead to organ failure. Elderly patients need more precise physical examination and diagnostics because essential information from the patient's history are often difficult to obtain. Indications to hospitalisation should be often widened even at not dangerous injuries, because the patients may demand intensive analgesic treatment and nursing. Necessity of care provided by other persons, poor care in household conditions, and inadequate social circumstances extend also indications to hospitalisation. There is a need to creation of nursing care departments for considerable group of injured persons who finished proper hospital-treatment, but because of the above-mentioned reasons cannot exist at home.

  19. Hospitalizations in elderly glioblastoma patients.

    PubMed

    Moroney, Claire; Perry, James R; Tsang, Derek S; Bilodeau, Denise; Mueller, Chris; Soliman, Hany; Myrehaug, Sten; Sahgal, Arjun; Tseng, Chia-Lin; Tsao, May N

    2017-08-11

    Elderly glioblastoma (GB) patients are at risk of hospitalizations due to the morbidity of the disease and possible treatment toxicity. In this observational cohort study, 255 newly diagnosed GB patients age 65 years and older were included. Survival, emergency room visits and admissions to an acute care hospital were determined. Mean and median total health care costs were calculated. Risk factors for Emergency room visits and acute care hospital admissions were determined. Median overall survival was 6 months. The majority of patients (68%) had at least one visit to the emergency department and 77% had at least one admission to acute care. The mean and median total costs (hospital, ambulatory, physician billing, other health care costs) per patient were $162,479.78 (CAN) and $125,511.00 (CAN), respectively. Treatment with radiation or treatment with radio-chemotherapy was associated with a relative risk (RR) of 2.31 (95% CI: 1.44-3.7; P=0.0005) and 2.19 (95% CI: 1.28-3.74; P=0.004), respectively for emergency department visits as compared to patients who were managed with comfort measures only. Patients with a baseline ECOG 0 had a RR of 1.71 (95% CI: 1.06-2.77; P=0.0289) and patients with baseline ECOG 1 had a RR of 1.49 (0.98-2.26; P=0.0623) for hospital admission as compared to patients with ECOG 4. A large proportion of elderly GB patients (particularly those with good baseline performance status who underwent active treatment) presented to the emergency department and had at least one admission to acute care.

  20. Postoperative Patient Satisfaction After Laparoscopic Supracervical Hysterectomy

    PubMed Central

    Gardanis, Konstantinos; Bojahr, Bernd; de Wilde, Rudy Leon

    2013-01-01

    Background and Objectives: The aim of this study was to evaluate postoperative patient satisfaction in women after laparoscopic supracervical hysterectomy (LASH). Methods: A retrospective study by a mailed questionnaire among 2334 women who underwent hysterectomy via LASH at the MIC-Klinik, Berlin, between 1998 and 2004 was conducted. Indications for LASH were uterus myomatosus, adenomyosis uteri, disorders of bleeding, and genital descensus. The LASH operation technique was standardized and remained consistent throughout the observation period. Pearson's test for metric variables, Spearman's rank correlation test for ordinal data, Mann-Whitney U test, and Kruskal-Wallis test were used. Results: Of the 2334 questionnaires mailed, 1553 were returned and 1431 (61.3%) of those could be analyzed. Almost 94% (93.9%) of the women were highly satisfied with the outcome, 5.6% reported medium satisfaction, and 0.5% were not satisfied. There was no significant difference in patient satisfaction with regard to the different indication for LASH. Conclusion: This study demonstrates high postoperative patient satisfaction after LASH. The rate of highly satisfied women might be increased by carefully choosing the right indications for LASH and improving operation techniques. This is important for widening acceptance of this innovative new operation standard. PMID:23743380

  1. Postoperative rehabilitation for chronic subdural hematoma in the elderly. An observational study focusing on balance, ambulation and discharge destination.

    PubMed

    Carlisi, Ettore; Feltroni, Lucia; Tinelli, Carmine; Verlotta, Mariarosaria; Gaetani, Paolo; Dalla Toffola, Elena

    2017-02-01

    Chronic subdural hematoma (CSDH) can have a negative impact on autonomy of the elderly. Ambulatory and functional status may remain limited despite successful surgical evacuation. To evaluate the outcome of a postoperative assisted rehabilitation program. Single-institution short-term observational study. Inpatient (Neurosurgery Unit of a University Hospital). Thirty-five patients, aged 65 or older, who underwent burr-hole drainage for chronic subdural hematoma. Postoperatively all participants underwent a rehabilitation program, described in details, aimed at recovering standing position and gait as soon as possible. The program involved daily 30-minute individual sessions assisted by a physiotherapist, until discharge from hospital. The Markwalder's Grading Scale was used to assess the neurological status preoperatively and at discharge. The Trunk Control Test, the Standing Balance by Bohannon Scale and the Modified Rankin Scale were used to evaluate balance and general function (primary outcome) in the immediate postoperative and at discharge. We also recorded the rate of pre-CSDH walking patients who maintained ambulation at discharge and the discharge destination (secondary outcome). Total scores of Markwalder's Grading Scale, Trunk Control Test, Standing Balance by Bohannon Scale and Modified Rankin Scale improved (P<0.05), indicating a global favorable outcome, especially for balance. Excluding the patients who were dependent pre-CSDH, the others maintained gait function in 74.2% of cases. Only 45.7% of the patients were discharged home, the others being divided between inpatient medical settings and rehabilitation. The rehabilitation program was well tolerated by the patients. Our study showed a clear improvement in trunk control and standing balance and an overall favorable outcome for neurological and ambulatory status at discharge. Despite an assisted postoperative rehabilitation program, the residual impairment in general function was the main factor

  2. [Robotic surgery for colorectal cancer in elderly patients].

    PubMed

    Xu, Pingping; Wei, Ye; Xu, Jianmin

    2016-05-01

    The outstanding advantages of robotic surgery include the stable and three-dimension image and the convenience of surgery manipulation. The disadvantages include the lack of factile feedback, high cost and prolonged surgery time. It was reported that robotic surgery was associated with less trauma stress and faster recovery in elderly patients(≥75 years old) when compared with open surgery. Elderly people have a higher incidence of carcinogenesis and also have more comorbidities and reduced functional reserve. Clinical data of patients over 75 years old treated by robotic surgery in Zhongshan Hospital affiliated to Fudan University from March 2011 to October 2014 were analyzed retrospectively. A total of 24 consecutive patients were included with a median age of 77.8 years old. There were 18 male and 6 female patients. Among them, 14 patients were diagnosed with descending and sigmoid colon cancers while 10 with rectal cancers; 19 had tumor size larger than 5 cm; 16 were diagnosed with ulcerative adenocarcinoma. Fourteen patients were complicated with hypertension, 6 with cardiopulmonary diseases, 4 with diabetes mellitus and 3 with cerebrovascular diseases. Twenty-two patients underwent low anterior resection and 2 abdominoperineal resection. The estimated blood loss was 85 ml; the median operation time was (123.1±45.2) min; the median number of retrieved lymph node was 12.4. Postoperative pathologic results showed that 3 patients were stage I, 10 stage II, and 11 stage III. Postoperative complication was observed in 3 patients: urinary infection in 1 case, intraperitoneal infection in 1 case and atria fibrillation in 1 case, respectively. Median time to first postoperative flatus was 2.8 days. Our results indicated that robotic surgery is safe and feasible in the elderly patients. The next generation of robotic system may make up for these deficiencies through new technologies. With the advantage of more advanced surgical simulator, robotic surgery will play a

  3. Therapeutic experience of 289 elderly patients with biliary diseases

    PubMed Central

    Zhang, Zong-Ming; Liu, Zhuo; Liu, Li-Min; Zhang, Chong; Yu, Hong-Wei; Wan, Bai-Jiang; Deng, Hai; Zhu, Ming-Wen; Liu, Zi-Xu; Wei, Wen-Ping; Song, Meng-Meng; Zhao, Yue

    2017-01-01

    AIM To present clinical characteristics, diagnosis and treatment strategies in elderly patients with biliary diseases. METHODS A total of 289 elderly patients with biliary diseases were enrolled in this study. The clinical data relating to these patients were collected in our hospital from June 2013 to May 2016. Patient age, disease type, coexisting diseases, laboratory examinations, surgical methods, postoperative complications and therapeutic outcomes were analyzed. RESULTS The average age of the 289 patients with biliary diseases was 73.9 ± 8.5 years (range, 60-102 years). One hundred and thirty-one patients (45.3%) had one of 10 different biliary diseases, such as gallbladder stones, common bile duct stones, and cholangiocarcinoma. The remaining patients (54.7%) had two types of biliary diseases. One hundred and seventy-nine patients underwent 9 different surgical treatments, including pancreaticoduodenectomy, radical resection of hilar cholangiocarcinoma and laparoscopic cholecystectomy. Ten postoperative complications occurred with an incidence of 39.3% (68/173), and hypopotassemia showed the highest incidence (33.8%, 23/68). One hundred and sixteen patients underwent non-surgical treatments, including anti-infection, symptomatic and supportive treatments. The cure rate was 97.1% (168/173) in the surgical group and 87.1% (101/116) in the non-surgical group. The difference between these two groups was statistically significant (χ2 = 17.227, P < 0.05). CONCLUSION Active treatment of coexisting diseases, management of indications and surgical opportunities, appropriate selection of surgical procedures, improvements in perioperative therapy, and timely management of postoperative complications are key factors in enhancing therapeutic efficacy in elderly patients with biliary diseases. PMID:28428722

  4. [Results of dental implantation in elderly patients].

    PubMed

    Botabaev, B K

    2010-01-01

    In absence of contraindications, with competent planning and complex oral mouth treatment and adequate use of surgical and orthopedic protocols, the dental implantation could be successfully implemented for esthetical and functional rehabilitation of elderly patients with different forms of adentia. Dental implantation can significantly increase the quality of life of elderly patients.

  5. [Postoperative period in previously irradiated lung cancer patients].

    PubMed

    Bronskaia, K L; Zaikina, L V; Grigor'eva, S P

    1978-01-01

    The postoperative period in 62 patients with lung cancer was studied in a comparative aspect. Preoperative use of radiotherapy influences but insignificantly the postoperative course. As a whole, the incidence of postoperative complications and mortality does not differ considerably from that in patients not irradiated with a Betatron. The state of blood coagulation was studied before and prior to surgery in 34 patients previously irradiated with a Betatron. Following the irradiation some changes indicative of hypocoagulation were revealed. In the early postoperative period (2d--10th day postoperatively) a marked increase in the fibrinogen "A" content is observed.

  6. Critical care nursing in acute postoperative neurosurgical patients.

    PubMed

    Brooks, Christin

    2015-03-01

    The nursing discipline is vital throughout patients' hospital progression. One of the most critical moments in the hospital stay is the postoperative period. Neurosurgical patients require a high level of nursing care and vigilance and additional postoperative monitoring in intensive care units designed specifically for this demographic. In the postoperative setting, patient care must be transferred from anesthesia to nursing in a manner that is continuous and safe. This article focuses on neurosurgical patients in the postoperative period, the assessment of these patients, and critical care nursing, with emphasis on common issues and interventions for this dynamic patient population.

  7. Postoperative conversion disorder in a pediatric patient.

    PubMed

    Judge, Amy; Spielman, Fred

    2010-11-01

    According to the Diagnostic and Statistical Manual IV (DSM IV), conversion disorder is classified as a somatoform illness and defined as an alteration or loss of physical function because of the expression of an underlying psychological ailment. This condition, previously known as hysteria, hysterical neurosis, or conversion hysteria occurs rarely, with an incidence of 11-300 cases per 100,000 people (American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th edn. Washington, DC: American Psychiatric Association, 1994). Presentation after an anesthetic is exceptional. After thorough review of the literature, fewer than 20 cases have been documented, with only two instances in patients younger than 18 years of age after general anesthesia; both were mild in nature. We present a severe case of postoperative conversion disorder that developed upon emergence from anesthesia in a previously healthy 16-year-old girl following direct laryngoscopy with vocal fold injection.

  8. [Postoperative venous thrombosis in general surgery patients and perioperative prophylaxis].

    PubMed

    Horie, Hisanaga; Endo, Noriyuki; Sata, Naohiro; Yasuda, Yoshikazu; Nagai, Hideo

    2005-03-01

    In a population of general surgery patients in Western countries, there was a 19% incidence of deep vein thrombosis (DVT) and a 1.6% incidence of pulmonary embolism (PE), with 0.9% of patients experiencing fatal PE. In Japan, there was a 15.8% incidence of DVT and a 0.34% incidence of PE, with 0.08% of patients experiencing fatal PE in a population of abdominal surgery patients. The incidences of PE and fatal PE in our department were 0.11% and 0.03%, respectively. We started to use intermittent pneumatic compression (IPC) for the prophylaxis of postoperative PE in 1999 and then added elastic stockings in 2002 and low-dose unfractionated heparin (LDUH) in 2003 for prophylaxis. The incidence of PE has dropped and that of fatal PE has become 0% with the use of such prophylactic measures. When the risk of venous thromboembolism of the 15 patients who experienced PE in our department were assessed using the Japanese Guidelines for Prevention of Venous Thromboembolism, 13 patients were assessed as high risk and 2 as low risk. The mean age and mean body mass index of the 15 patients were 54 yeas old and 24.8, respectively, and PE was not limited to obese or elderly patients. Such findings appear to indicate the difficulty of risk assessment for PE. Therefore we started to use IPC, elastic stockings, and LDUH for the prophylaxis of PE and DVT for all general surgery patients from April 2004. These prophylactic measures are recommended for the highest-risk patients in the Japanese Guidelines for Prevention of Venous Thromboembolism. There have so far been no serious bleeding complications with the administration of LDUH. We will continue to observe the effects of prophylaxis and the risk of bleeding.

  9. Optimizing radiotherapy schedules for elderly glioblastoma multiforme patients.

    PubMed

    Clarke, James W; Chang, Eric L; Levin, Victor A; Mayr, Nina A; Hong, Eugene; Cavaliere, Robert; Lo, Simon S

    2008-05-01

    Glioblastoma is the most common malignant primary brain tumor. Despite recent advances, the overall prognosis remains poor with median survivals of approximately 1 year and 5-year survivals of less than 5%. Efforts at risk stratification have identified age and performance status as the most important prognostic features. It is well established that patients treated with postoperative radiation therapy have improved survival and functional capacity compared with unirradiated patients. Recent evidence suggests that the benefit of postoperative radiation persists even within the cohort aged 70 years or over. Some investigators have questioned whether the standard treatment schedule of 60 Gy delivered over a 6-week period is necessary for older patients with limited functional status. Alternative treatment schedules have been devised to reduce the inconvenience and morbidity of standard therapy. This review aims to evaluate the current state of knowledge on alternative radiotherapy schedules for elderly and poor-prognosis patients with glioblastoma.

  10. Intestinal intussusception in elderly patients.

    PubMed

    Israelit, S H; Brook, O R; Abbou, B; Molner, R; Duek, S D; Krausz, M M

    2009-02-20

    Intussusception is the most common cause of bowel obstruction in children, but it is a very rare cause of bowel obstruction in the elderly. Diagnosis is based on a high index of suspicion, complete anamnestic recall, physical examination, and imaging modalities. We find abdominal CT scans to be highly sensitive and accurate for making the diagnosis. Treatment of intussusception in adults is always surgical. Segmental bowel resection must be performed. The extent of resection should include any nonviable bowel as well as the leading point of the intussusception. We present a case of an 82-year-old patient with ileo-cecal intussusception, followed by a discussion of the diagnostic and therapeutic options.

  11. Ankle fractures in elderly patients.

    PubMed

    Giannini, Sandro; Chiarello, Eugenio; Persiani, Valentina; Luciani, Deianira; Cadossi, Matteo; Tedesco, Giuseppe

    2013-10-01

    The incidence of ankle fractures (AFs) in the elderly is rising due to the increase in life expectancy. Rather than directly related to osteoporosis, AFs are a predictor of osteoporotic fractures in other sites. In women AFs are associated with weight and BMI. AFs are difficult to categorize; therapeutic options are non-operative treatment with plaster casts or surgical treatment with Kirschner's wires, plates and screws. The choice of treatment should be based not only on the fracture type but also on the local and general comorbidity of the patient. Considering the new evidence that postmenopausal women with AFs have disrupted microarchitecture and decreased stiffness of the bone compared with women with no fracture history, in our opinion low-trauma AFs should be considered in a similar way to the other classical osteoporotic fractures.

  12. The medical evaluation of the elderly preoperative patient.

    PubMed

    Daly, M P

    1989-06-01

    Improvements in anesthesia and surgical techniques have greatly reduced the perioperative mortality and morbidity of elderly patients. Mortality is more closely correlated with pathology, type of surgery, and duration of anesthesia rather than with age. Particular attention should be directed toward cardiac and pulmonary status, because operative mortality and morbidity is related, for the most part, to cardiovascular and pulmonary complications. Postoperatively, the occurrence of pulmonary emboli and painless myocardial infarctions is more common in this age group. Elderly patients are more often confused postoperatively owing to the residual effect of anesthetics, analgesics, fever, and electrolyte disturbances. The stress of surgery and unfamiliar surroundings are also frequent precipitating causes. Orthostatic blood pressure and pulse readings should be checked before ambulating elderly patients who have been at bed rest for more than 2 to 3 days because of the frequent occurrence of orthostatic hypotension. Pressure sores, incontinence, and aspiration pneumonia may also occur owing to immobility. The elderly patient's functional status and mental status may be enhanced by simple encouragement, early mobilization, and by social interaction. It is not possible to precisely define the risks of proposed procedure, nor can the physician eliminate all risks from a surgical procedure. The risks a particular patient is subjected to depend on the complex interplay of the preoperative medical condition of the patient, the type of surgery proposed, and the skill and expertise of the anesthesiologist and surgeon. We must strive to achieve the goal of bringing our patient to the operating room in the best possible condition in the time available.

  13. Posterior vaginal sling experience in elderly patients yields poor results.

    PubMed

    Mattox, T Fleming; Moore, Susan; Stanford, Edward J; Mills, Benjie B

    2006-05-01

    The objective of the study was to evaluate our experience with the posterior vaginal sling in an elderly population. Elderly patients with significant vaginal prolapse underwent a posterior vaginal sling using the IVS Tunneller device (Tyco Healthcare, United States Surgical, Norwalk, CT). Primary failure was defined as a postoperative pelvic organ prolapse quantitative point C (the apex of the vagina) within 2 cm of the preoperative value. Secondary failure was defined as any portion of the anterior or posterior vaginal walls protruding to or beyond the hymeneal ring (pelvic organ prolapse quantitative points Aa or Ap equal to or greater than 0). Twenty-one patients underwent the procedure; 19 were seen for follow up. The average age was 70 years (range 60-78). Twelve patients had primary or secondary failures (12 of 19, 63%). There were 5 primary failures (5 of 19, 26%) and 7 secondary failures (7 of 19, 37%). The mean time to failure was 7 weeks (range 1-18). In our elderly population, the posterior vaginal sling has a high failure rate, occurring early in the postoperative period.

  14. Prediction of Postoperative Pain using Path Analysis in Older Patients

    PubMed Central

    Kinjo, Sakura; Sands, Laura P.; Lim, Eunjung; Paul, Sudeshna; Leung, Jacqueline M.

    2013-01-01

    Purpose Effective postoperative pain management is important for older surgical patients since pain affects perioperative outcomes. A prospective cohort study was conducted to describe the direct and indirect effects of patient risk factors and pain treatment in explaining levels of postoperative pain in older surgical patients. Methods We studied patients who were 65 years of age or older and were scheduled for major non-cardiac surgery with a postoperative hospital stay of at least 2 days. The numeric rating scale (0 = no pain, 10 = worst possible pain) was used to measure pain levels before surgery and once daily for 2 days after surgery. Path analysis was performed to examine the association between predictive variables and postoperative pain levels. Results Three hundred fifty patients were studied. The results reveal that preoperative pain level, use of preoperative opioids, female gender, higher ASA physical status, and postoperative pain control methods were the strongest predictors of postoperative pain as measured the first day after surgery. Younger age, greater preoperative symptoms of depression and lower cognitive function also contributed to higher postoperative pain levels. Pain levels on the second day after surgery were strongly predicted by preoperative pain level, use of preoperative opioids, surgical risk, and pain and opioid dose on postoperative day 1. However, younger age, female gender, higher ASA physical status, greater preoperative symptoms of depression, lower cognitive function and postoperative pain control methods indirectly contributed to pain levels on the second day after surgery. Conclusion Although preoperative pain and use of preoperative opioids have the strongest effects on postoperative pain, clinicians should be aware that other factors such as age, gender, surgical risk, preoperative cognitive impairment and depression also contribute to reported postoperative pain. Based on significant statistical correlations, these

  15. Prognostic factors for gastrectomy in elderly patients with gastric cancer.

    PubMed

    Ueno, Daisuke; Matsumoto, Hideo; Kubota, Hisako; Higashida, Masaharu; Akiyama, Takashi; Shiotani, Akiko; Hirai, Toshihiro

    2017-03-11

    The aim of the present study was to investigate the age-specific prognostic factors in patients who underwent gastrectomy for gastric cancer. The medical records of 366 patients with gastric cancer who underwent surgical resection at our hospital between January 2007 and December 2014 were retrospectively reviewed. Of the 366 patients, 117 were aged 75 years or older and 249 were aged 74 years or younger. All factors that were identified as significant using univariate analysis were included in the multivariate analysis. The median follow-up duration was 52.9 months (range, 1.0-117.5 months). We found that in patients aged 75 years or older, postoperative complications and the extent of cancer were independent prognostic factors of overall survival and disease-free survival. In contrast, in patients aged 74 years or younger, only the lymph node status and postoperative chemotherapy were independent prognostic factors for overall survival and disease-free survival, respectively. Pathological outcomes and postoperative complications are important prognostic factors for survival in patients aged 75 years or older with gastric cancer, whereas pathological outcomes and postoperative chemotherapy are important prognostic factors for survival in patients aged 74 years or younger. Because the prevention of postoperative complications may contribute to improvements in the prognosis of elderly patients with gastric cancer, we suggest that it is necessary to consider limited surgery instead of radical surgery, depending on the patient's general condition and co-morbidities.

  16. Bariatric surgery in elderly patients: a systematic review.

    PubMed

    Giordano, Salvatore; Victorzon, Mikael

    2015-01-01

    Controversy exists regarding the effectiveness and safety of bariatric/metabolic surgery in elderly patients. We performed a systematic review on this issue in patients aged 60 years or older. MEDLINE, Cochrane Library, Embase, Scopus, and Google Scholar were searched until August 2015 for studies on outcomes of bariatric surgery in elderly patients. The results were expressed as pooled proportions (%) with 95% confidence intervals. Heterogeneity across the studies was evaluated by the I (2) test, and a random-effects model was used. Twenty-six articles encompassing 8,149 patients were pertinent with this issue and included data on bariatric surgery outcomes in elderly population. Fourteen patients died during the 30-day postoperative period, with a pooled mortality of 0.01%. Pooled overall complication rate was 14.7%. At 1-year follow-up, pooled mean excess weight loss was 53.77%, pooled diabetes resolution was 54.5%, and pooled hypertension resolution was 42.5%, while pooled lipid disorder resolution was 41.2%. Outcomes and complication rates of bariatric surgery in patients older than 60 years are comparable to those in a younger population, independent of the type of procedure performed. Patients should not be denied bariatric surgery because of their age alone.

  17. Aspiration prevention protocol: decreasing postoperative pneumonia in heart surgery patients.

    PubMed

    Starks, Bobbie; Harbert, Christy

    2011-10-01

    BACKGROUND Postoperative pneumonia contributes to morbidity and mortality in patients who have open heart surgery. OBJECTIVES To determine if measures to reduce aspiration in patients after cardiothoracic surgery would decrease the occurrence of postoperative pneumonia. METHODS All patients undergoing cardiothoracic surgery from April 2008 through October 2008 were prospectively enrolled in the study. An aspiration prevention protocol was developed and implemented in a 24-bed intensive care unit. The protocol incorporated a bedside swallowing evaluation by a speech therapist and progressive oral intake. RESULTS In the 6 months before development and implementation of the protocol, postoperative pneumonia developed in 11% of patients. After implementation of the protocol, no patients had postoperative pneumonia (P < .01). CONCLUSIONS Implementing an aspiration prevention protocol was effective in reducing the occurrence of postoperative pneumonia in patients who had cardiothoracic surgery.

  18. Promoting safety of postoperative orthopaedic patients with obstructive sleep apnea.

    PubMed

    Veney, Amy J

    2013-01-01

    Orthopaedic patients with obstructive sleep apnea are at risk for postoperative complications related to administration of pain medications, anxiolytics, and antiemetics. They are more likely to experience respiratory and cardiac complications, be transferred to an intensive care unit, or have an increased length of stay in the hospital. This informational article is for nurses who care for postoperative orthopaedic patients with obstructive sleep apnea. The focus is on promoting patient safety through communication, vigilant postoperative sedation assessment, and nursing interventions that include appropriate patient positioning, patient education, and involving patients and their families in care.

  19. Fast track for elderly patients: is it feasible for colorectal surgery?

    PubMed

    Compagna, Rita; Aprea, Giovanni; De Rosa, Davide; Gentile, Maurizio; Cestaro, Giovanni; Vigliotti, Gabriele; Bianco, Tommaso; Massa, Guido; Amato, Maurizio; Massa, Salvatore; Amato, Bruno

    2014-01-01

    Fast-track program has been applied in several surgical fields. However, currently many surgical patients are elderly over 70 years of age, and discussion about the application of such protocols for elderly patients is inadequate. The present study was designed to consider the safety and feasibility of application of a fast-track program after colorectal surgery in elderly patients. A total of 76 elderly patients with colorectal cancer who underwent laparoscopic colorectal resection were randomly assigned to receive either the fast-track care program (n = 40) or the conventional perioperative care protocol (control group, n = 36). The fast track protocol included no preoperative mechanical bowel irrigation, immediate oral alimentation and earlier postoperative ambulation exercise. The length of postoperative hospital stay, the length of time to regain bowel function and the rate of postoperative complications were compared between the two groups. The length of time to regain bowel function, including the passage of flatus [32 (24-40) h vs 42 (32-52) h], and to start a liquid diet (13 [10-16] h v/s 43 [36-50] h) were significantly shorter in patients receiving the fast track care protocol compared with those receiving the conventional care protocol. A shorter duration of postoperative hospital stay was recorded in patients receiving the fast-track program than in those receiving conventional care [6 (5-7) days v/s 9.5 (7-12) days]. A reduced percentage of patients who developed general complications was also observed in the fast-track group (5.0% v/s 18%). Fast-track after laparoscopic colorectal surgery can be safely applied in carefully selected elderly patients older than age 70 years. The fast-track recovery program resulted in a more rapid postoperative recovery, earlier discharge from hospital and fewer general complications compared with a conventional postoperative protocol. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights

  20. [Full attention to several key issues in surgical treatment for the elderly patients with gastrointestinal cancer].

    PubMed

    Zhu, Zhenggang

    2016-05-01

    With the development of population aging in our country, the incidence of gastrointestinal cancer is increasing. The risk of developing gastrointestinal cancer in elderly over 75 years was 5-6 times and the risk of death of gastrointestinal cancer was 7-8 times of the general population. As compared to non-elderly, the incidence of gastric cancer was not decreased obviously but the total incidence of colorectal cancer was increased more quickly. Therefore, screening of gastrointestinal cancer should be performed in the elderly for early discovery, diagnosis and treatment. Because of the insidious onset of the illness in elderly patients, gastrointestinal cancers are mostly diagnosed at advanced or late stage (stage III or IV). Well differentiated cancer is more common, such as papillary or tubular adenocarcinoma. Lauren type, Borrmann II or III are more common in gastric cancer, which are relatively favorable. Compared with non-elderly patients, many elderly patients also suffer from comorbid diseases with higher operation risk and postoperative complication rates. Therefore, we must pay great attention to the perioperative management and the surgical operation for the elderly patients. In this paper, several key issues involved the development trend of incidence and mortality of gastrointestinal cancer, the clinicopathological characteristics, the comorbidity and surgical treatment in the elderly patients with gastrointestinal cancer will be elaborated, aiming at promoting further attention to the clinical therapeutic strategies, management measures and prognostic factors for the elderly patients with gastrointestinal cancer.

  1. Effectiveness of the Laminoplasty in the Elderly Patients with Cervical Spondylotic Myelopathy

    PubMed Central

    Son, Doo Kyung; Song, Geun Sung; Lee, Sang Weon

    2014-01-01

    Objective The purpose of this study is to evaluate clinical and radiological outcomes analysis of the laminoplasty in the elderly patients, and to compare with the non-elderly patients. Methods A retrospective study of the short term result in patients who had treated with the laminoplasty for cervical spondylotic myelopathy (CSM) was performed. From January 2008 to December 2012, total 62 patients were operated with single open-door technique because of CSM; 28 patients were the elderly and 34 patients were the non-elderly. We evaluated some factors including sex, symptom duration, estimated blood loss during operation, operation time, hospitalization day, complications, pre- and postoperative modified Japanese Orthopedic Association (mJOA) score, recovery rate of mJOA score, achieved mJOA score, mean cervical canal width and expansion ratio of antero-posterior diameter in order to identify difference between the two group. Clinical outcomes were calculated with the recovery rate of mJOA score at the time of one year after operation. Results Mean age were 71.9 in the elderly group and 52.9 in the non-elderly group. Although postoperative mJOA score in the elderly group was lower than that of the non-elderly group, achieved mJOA score was statistically same between the two groups. Other clinical and radiological outcomes were also statistically same. Conclusion We conclude that the laminoplasty also assures good clinical outcomes in the elderly patients with CSM, same as in the non-elderly group. PMID:25110481

  2. Elderly patients and inflammatory bowel disease

    PubMed Central

    Nimmons, Danielle; Limdi, Jimmy K

    2016-01-01

    The incidence and prevalence of inflammatory bowel disease (IBD) is increasing globally. Coupled with an ageing population, the number of older patients with IBD is set to increase. The clinical features and therapeutic options in young and elderly patients are comparable but there are some significant differences. The wide differential diagnosis of IBD in elderly patients may result in a delay in diagnosis. The relative dearth of data specific to elderly IBD patients often resulting from their exclusion from pivotal clinical trials and the lack of consensus guidelines have made clinical decisions somewhat challenging. In addition, age specific concerns such as co-morbidity; loco-motor and cognitive function, poly-pharmacy and its consequences need to be taken into account. In applying modern treatment paradigms to the elderly, the clinician must consider the potential for more pronounced adverse effects in this vulnerable group and set appropriate boundaries maximising benefit and minimising harm. Meanwhile, clinicians need to make personalised decisions but as evidence based as possible in the holistic, considered and optimal management of IBD in elderly patients. In this review we will cover the clinical features and therapeutic options of IBD in the elderly; as well as addressing common questions and challenges posed by its management. PMID:26855812

  3. Gliomatosis cerebri treatment in 11 elderly patients.

    PubMed

    Piccirilli, M; Landi, A; Salvati, M

    2006-06-01

    The Authors report their experience in the treatment of eleven patients over 70 years old (range from 70 to 83, average age 74.8, 7 males and 4 females), with histologically proven diagnosis of glioblastoma multiforme. The GC golden standard treatment is still debated, particularly in elderly patients. All the patients underwent a first line treament with chemotherapy (Temozolomide), followed by Whole Brain Radiotherapy (WBRT) and PCV schedule without Vincristine in case of progression of the disease. The median survival was 16.3 months, ranging from 13 to 22 months. According to our experience, elderly patients should undergo the same treatment of younger patients, provided they are in good health conditions.

  4. Analysis of surgeries for Degenerative lumbarstenosis in elderly patients

    PubMed Central

    Bai, Bin; Li, Yuxin

    2016-01-01

    Objective: To analyze the effect of decompression alone and combined decompression, fusion and internal fixation procedure for degenerative lumbar stenosis in elderly patients. Methods: We reviewed 168 lumbar stenosis patients treated using decompression alone or with combined procedures in the department of orthopaedics of Tianjin 4th Centre Hospital from October 2010 to January 2014. The clinical data including age, gender, procedure type, operation time, follow-up period, blood loss, preoperative and postoperative JOA and ODI scores were recorded. The patients were divided into decompression alone group and combined surgeries group according to the procedure type. Results: The combined surgeries group presented with larger blood loss (p<0.05) and more operation time (p<0.05), compared with the group of decompression alone. The preoperative and postoperative JOA scores were significantly higher (p<0.05), and the ODI scores significantly lower in the decompression alone group (P<0.05), but at the final follow-up, there were no significant difference between the two groups (p>0.05). The complication rate was lower in the group of decompression alone, but there was no significant difference between the two groups (p>0.05). Conclusion: Both the decompression alone and combined surgeries can result in a satisfactory effects in elderly patients with degenerative lumbar spinal stenosis, but the combined surgeries presented with a relatively higher complication rate. PMID:27022361

  5. Inflammatory markers as predictors of postoperative adverse outcome in octogenarian surgical patients: an observational prospective study.

    PubMed

    González-Martínez, Sergio; Olona Tabueña, Noemí; Martín Baranera, Montserrat; Martí-Saurí, Isidro; Moll, Josep Lluís; Morales García, Miguel Ángel; Borrell Grau, Nuria; Pueyo Zurdo, José María

    2015-03-01

    The value of inflammatory proteins, interleukin-6 and alpha-1-acid glycoprotein as prognostic factors in elderly people undergoing surgery has not been determined yet. To know whether preoperatively determined inflammatory markers may predict the postoperative outcome of elderly patients undergoing surgery. A scoring system for predicting postoperative morbidity was assessed. Hospital-based observational prospective study, with geriatric surgical patients. Preoperative determination of following data: age, gender, scheduled or urgent operation, comorbid diseases, malignancy, physical, mental and nutritional profile. Biochemical markers of inflammation, C Reactive Protein, interleukin-6, and alpha-1-acid glycoprotein were also studied. Preoperative data and postoperative complications were recorded. Binary logistic regression analysis was used to obtain a morbidity risk prediction model. A total of 225 patients were included. Fifty-five patients (24.4%) had postoperative complications, with a mortality rate of 5.3%. Binary logistic regression analysis showed an independent relation between morbidity and the variables malignancy, alpha-1-acid glycoprotein and interleukin-6. The risk (R) of postoperative morbidity adjusted by age was calculated. The model showed a 22.2% sensitivity, 94.8% specificity, and a percentage of correct classification of 78.3%. The area under the ROC curve was 0.781 (95% CI: 0.703-0.858). An age-adjusted equation for predicting 30-day morbidity that included malignancy, serum IL-6 and alpha 1-acid glycoprotein levels may be useful for risk assessment in octogenarian surgical patients. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Follicular Lymphoma: The Management of Elderly Patient

    PubMed Central

    Castellino, Alessia; Santambrogio, Elisa; Nicolosi, Maura; Botto, Barbara; Boccomini, Carola; Vitolo, Umberto

    2017-01-01

    Follicular lymphoma (FL) is the most common indolent non-Hodgkin lymphoma, which typically affects mature adults and elderly, whose median age at diagnosis is 65 years. The natural history of FL appears to have been favorably impacted by the introduction of Rituximab. Randomized clinical trials demonstrated that the addition of rituximab to standard chemotherapy induction has improved the overall survival and new strategies of chemo-immunotherapy, such as Bendamustine combined with Rituximab, showed optimal results on response and reduced hematological toxicity, becoming one of the standard treatments, particularly in elderly patients. Moreover, maintenance therapy with Rituximab demonstrated improvement of progression-free survival. Despite these exciting results, FL is still an incurable disease. It remains a critical unmet clinical need finding new prognostic factors to identify poor outcome patients better, to reduce the risk of transformation and to explore new treatment strategies, especially for patients not candidate to intensive chemotherapy regimens, such as elderly patients. Some progress were already reached with novel agents, but larger and more validated studies are needed. Elderly patients are the largest portion of patients with FL and represent a subgroup with higher treatment difficulties, because of comorbidities and smaller spectrum for treatment choice. Further studies, focused on elderly follicular lymphoma patients, with their peculiar characteristics, are needed to define the best-tailored treatment at diagnosis and at the time of relapse in this setting. PMID:28105297

  7. The evolution of cardiovascular surgery in elderly patient: a review of current options and outcomes.

    PubMed

    Nicolini, Francesco; Agostinelli, Andrea; Vezzani, Antonella; Manca, Tullio; Benassi, Filippo; Molardi, Alberto; Gherli, Tiziano

    2014-01-01

    Due to the increase in average life expectancy and the higher incidence of cardiovascular disease with advancing age, more elderly patients present for cardiac surgery nowadays. Advances in pre- and postoperative care have led to the possibility that an increasing number of elderly patients can be operated on safely and with a satisfactory outcome. Currently, coronary artery bypass surgery, aortic and mitral valve surgery, and major surgery of the aorta are performed in elderly patients. The data available show that most cardiac surgical procedures can be performed in elderly patients with a satisfactory outcome. Nevertheless, the risk for these patients is only acceptable in the absence of comorbidities. In particular, renal dysfunction, cerebrovascular disease, and poor clinical state are associated with a worse outcome in elderly patients. Careful patient selection, flawless surgery, meticulous hemostasis, perfect anesthesia, and adequate myocardial protection are basic requirements for the success of cardiac surgery in elderly patients. The care of elderly cardiac surgical patients can be improved only through the strict collaboration of geriatricians, anesthesiologists, cardiologists, and cardiac surgeons, in order to obtain a tailored treatment for each individual patient.

  8. The Evolution of Cardiovascular Surgery in Elderly Patient: A Review of Current Options and Outcomes

    PubMed Central

    Agostinelli, Andrea; Manca, Tullio; Gherli, Tiziano

    2014-01-01

    Due to the increase in average life expectancy and the higher incidence of cardiovascular disease with advancing age, more elderly patients present for cardiac surgery nowadays. Advances in pre- and postoperative care have led to the possibility that an increasing number of elderly patients can be operated on safely and with a satisfactory outcome. Currently, coronary artery bypass surgery, aortic and mitral valve surgery, and major surgery of the aorta are performed in elderly patients. The data available show that most cardiac surgical procedures can be performed in elderly patients with a satisfactory outcome. Nevertheless, the risk for these patients is only acceptable in the absence of comorbidities. In particular, renal dysfunction, cerebrovascular disease, and poor clinical state are associated with a worse outcome in elderly patients. Careful patient selection, flawless surgery, meticulous hemostasis, perfect anesthesia, and adequate myocardial protection are basic requirements for the success of cardiac surgery in elderly patients. The care of elderly cardiac surgical patients can be improved only through the strict collaboration of geriatricians, anesthesiologists, cardiologists, and cardiac surgeons, in order to obtain a tailored treatment for each individual patient. PMID:24812629

  9. [Post-operative pain therapy of a chronic pain patient].

    PubMed

    Pawlik, Michael T; Ittner, Karl Peter

    2006-11-01

    Post-operative pain therapy of chronic pain patients poses a challenge. Here we report the perioperative management of a 39-year-old male under chronic therapy with oxycodon, gabapentin and tolperison. Particular the pharmacointeractions regarding premedication and postoperative dose finding of opioids with intravenous PCIA are discussed.

  10. Tuberculous spondylitis in elderly Japanese patients.

    PubMed

    Maeda, Yuki; Izawa, Kazutaka; Nabeshima, Takaharu; Yonenobu, Kazuo

    2008-01-01

    Although the number of patients with tuberculous spondylitis in Japan is increasing slowly, the proportion of the elderly among these patients is increasing more quickly. The purpose of this study was to describe the clinical features and diagnostic imaging findings in elderly tuberculous spondylitis patients in order to enhance diagnosis of the condition in the elderly population. We conducted a retrospective review of 23 patients over 70 years of age previously diagnosed with tuberculous spondylitis. Clinical signs and symptoms, including local pain, fever, and neurological deficits, were analyzed. Routine laboratory tests, including the erythrocyte sedimentation rate, the white blood cell count, and the C-reactive protein level were also reviewed. The results of plain X-rays and magnetic resonance imaging were studied. Patients' signs and symptoms were as follows: local pain in 19 patients (83%); fever in 7 patients (30%) and no fever in 16 patients (70%); and neurological deficits in 13 patients (57%). C-Reactive protein was less than 1.0 mg/dl in 6 patients (26%). Radiography revealed several changes in the affected vertebrae; 3 patients had atypical changes involving only a single vertebra. It is difficult to diagnose tuberculous spondylitis in the elderly because there are atypical symptoms, a scarcity of inflammatory changes, and degenerative changes normally seen in the elderly may mask the radiographic changes due to tuberculous spondylitis. Tuberculous spondylitis should be considered a possibility in the differential diagnosis of back pain in the elderly, especially in countries with a significant history of tuberculosis in the population.

  11. [Nutritional status of elderly surgical patients].

    PubMed

    Damuleviciene, Gyte; Lesauskaite, Vita; Macijauskiene, Jūrate

    2008-01-01

    The aim of this study was to assess nutritional status of aged surgical patients, to determine the prevalence of malnutrition and factors associated with it. A total of 156 patients aged 45 years and more, treated at the Departments of Surgery and Urology of Kaunas 2nd Clinical Hospital, were enrolled in the study. Elderly group (aged 65 years and more) consisted of 99 patients, and middle-aged group (45 to 64 years old) of 57 patients. The following anthropometric measurements were performed: weight, height, mid-arm circumference; hemoglobin, serum albumin level, and total lymphocyte count were determined. Standard assessment scales included Instrumental Activities of Daily Living, Geriatric Depression Scale, and Mini Mental State Exam. Statistical analysis was performed with the help of SPSS 12.0. Malnutrition was diagnosed in 53.5% of older patients and in 15.8% of middle-aged patients (P<0.05). Obesity was diagnosed in 32.3% of elderly patients and in 40.4% of middle-aged patients (P<0.05). Among men, obese patients made up 20%, among women - 54.4% (P<0.05). Malnutrition was more prevalent among elderly patients who underwent urgent operations than in patients who underwent planned operations (69.6% and 34.1%, respectively; P<0.05) and among elderly patients with impaired cognitive functions than among those without impaired cognitive functions (in 100% of patients with medium impaired cognitive function, in 59.3% of patients with mild impaired cognitive function, and in 44.4% of patients with unimpaired cognitive function, P<0.05). Malnourished elderly patients had lower functional level than the remaining (IADL score of 3.97 and 4.75 for men, 5.38 and 6.89 for women, respectively; P<0.05). The prevalence of malnutrition did not differ significantly in the groups of older patients with depression, probable depression and not depressed patients - 75.0%, 57.7%, and 46.7%, respectively (P>0.05). Malnutrition was diagnosed more frequently in elderly surgical

  12. [Nursing approaches toward postoperative pain in patients: patients' opinions].

    PubMed

    Yılmaz, Meryem; Gürler, Hesna

    2011-04-01

    We aimed in this defining study to determine patients' opinions about nursing practices with respect to their postoperative pain and their satisfaction with these practices. Data were collected by two questionnaires that were prepared by the researchers. The collected data were evaluated with chi-square and number, frequency tests. Of the 360 patients participating in this study, 61.4% were women, 83% were over 40 years old and 88% had low educational level. 60.4% had no previous surgery experience. It was determined that 30.6% of patients had undergone heart-lung (cardiovascular system, CVS) and 25.5% gastrointestinal system (GIS) surgery. It was found that 96.4% of patients experienced pain while coughing and 81.9% while getting out of bed. 96.4% of patients reported difficulty in coughing, 78.3% difficulty in mobilization and 46.7% difficulty in breathing because of postoperative pain. It was determined that patients who underwent CVS, TAH+BSO and GIS operations experienced more pain while coughing and trying to get out of bed, while patients who underwent discectomy experienced more pain while walking. There was a significant difference between types of operation and pain (p<0.05) and between activities in which patients experienced difficulty and types of operation (p<0.05). The patients stated that nurses did not use a pain scale, provide information about how pain could be relieved, demonstrate what they needed to do during the activities that caused pain, assist the patients to reposition to relieve the pain, or use any non-pharmacological interventions. Nevertheless, all of the patients were satisfied with the analgesics that were administered by nurses for pain relief.

  13. Principles of post-operative patient care.

    PubMed

    Hughes, Elaine

    Surgery causes physiological stress on the body and carries inherent risks such as shock and haemorrhage. This article discusses cardiogenic and hypovolaemic shock and outlines the principles of safe and effective post-operative care, including recognising hypovolaemia, maintaining fluid balance and administering pain control.

  14. Risk factors of post-operative delirium after elective vascular surgery in the elderly: A systematic review.

    PubMed

    Raats, J W; Steunenberg, S L; de Lange, D C; van der Laan, L

    2016-11-01

    Postoperative delirium is a common and serious adverse event in the elderly patient and is associated with significant morbidity and mortality. It is of great importance to identify patients at risk for delirium, in order to focus preventive strategies. The aim of this article is to systematically review current available literature on pre-operative risk factors for delirium after vascular surgery. A systematic literature search was conducted using PubMed and EMBASE, using the MeSH terms and key words "delirium", "surgery" and "risk factor". Studies were retained for review after meeting strict inclusion criteria that included only prospective studies evaluating risk factors for delirium in patients who had elective vascular surgery. Diagnosis of delirium needed to be confirmed using the Diagnostic and Statistical Manual of Mental Disorders (DSM) or ICD-10. Fifteen articles were selected for inclusion, incidence of delirium across the studies ranged from 5% to 39%. Many factors have been associated with increased risk of delirium, including age, cognitive impairment, comorbidity, depression, smoking, alcohol, visual and hearing impairment, ASA-score, biochemical abnormalities, operative strategies and blood loss. Delirium is a common complication after elective vascular surgery in elderly. The highest delirium incidence was observed after open aortic surgery as well as after surgery for critical limb ischemia. A picture starts to form of which predisposing factors lead to increased risk of delirium. The leading risk factors consistently identified in this systematic review were advanced age and cognitive impairment. Multi-disciplinary specialist-led interventions in the preoperative phase could decrease incidence and severity of delirium and should be focused on identified high-risk patients. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  15. Postoperative red blood cell transfusion strategy in frail anemic elderly with hip fracture. A randomized controlled trial.

    PubMed

    Gregersen, Merete

    2016-04-01

    Hip fracture in the elderly is associated with poor recovery from physical disability and mortality. Perioperative blood loss is common, and anemia might be fatal in the frail elderly. Red blood cell transfusions might increase the risk of infection. In an observational study, a liberal transfusion strategy with hemoglobin (Hb) target of 7 mmol/l (11.3 g/dl) seemed to improve survival in nursing home residents with hip fracture compared to the recommended restrictive strategy with a Hb target of 6 mmol/l (9.7 g/dl) according to the Danish Health Authority. Our aim was to compare these two strategies in the frail elderly in a randomized controlled trial on the outcomes: recovery from physical disabilities, mortality, infection, infection biomarkers, and overall Quality of Life (OQoL). We included 284 elderly admitted to hospital for surgical hip fracture repair from nursing homes or sheltered housing facilities. The anemic patients were assigned postoperatively to the liberal or the restrictive transfusion strategy. Randomization divided each transfusion group into two equal blocks with regard to type of the residence. Hb was measured daily during the first three postoperative days, at least once during the following 4-6 days, then at least once a week during the subsequent three weeks. The transfusions were administered according to group assignments, but no later than 24 hours after the Hb determination, one unit at a time, and no more than two units per day. The intervention lasted for 30 days after surgery. Outcome measurements were performed on days 10, 30, 90, and 365. Blinded assessors evaluated physical performance and OQoL. The liberal transfusion strategy did not improve recovery from physical disabilities, mortality, infection rate, or OQoL compared to the restrictive strategy. However, in nursing home residents, 90-day mortality rate (20%) following the liberal strategy was statistically significantly lower than that (36%) after the restrictive strategy

  16. Thyroid Surgery for Elderly Patients: Are They at Increased Operative Risks?

    PubMed Central

    Ng, Sze-How; Wong, Kai-Pun; Lang, Brian Hung-Hin

    2012-01-01

    An increasing elderly population, a rising incidence of differentiated thyroid carcinoma (DTC), and a rising incidence of benign nodular disease with age are all contributing to a rise in thyroid operations for the elderly. Literature review on the outcome and safety of thyroid surgery in elderly patients has been filled with conflicting results and this subject remains controversial. Although most single-institution studies conducted by high-volume surgeons did not find significant differences of complication rates in elderly when compared with younger cohorts, they often lacked the power necessary to identify subtle differences and suffered from various selection and referral biases. Recent evidence from large population-based studies concluded that thyroid surgery in the elderly was associated with higher complication rates. One of the major contributing factors for the increased complication rate was because most elderly patients suffered from many preexisting comorbidities. Therefore, elderly patients who have abnormal thyroid findings should complete a thorough preoperative workup and better postoperative care after undergoing any thyroid surgery. Furthermore, these high-risk patients would benefit if they could be referred to high-volume, specialized surgical units early. In this systemic review, we aimed to evaluate different issues and controversies in thyroidectomy for elderly patients. PMID:22970410

  17. [Lifestyle of elderly patients with diabetes mellitus].

    PubMed

    Fukuoka, Yuki; Yamada, Yuichiro

    2013-11-01

    In elderly people, glucose tolerance is deteriorated and the incidence of diabetes mellitus is increased, due to decreased muscle mass and physical activity, declining pancreatic beta cell function, and other factors. Diabetes mellitus is an important risk factor for arteriosclerosis development in the elderly. Precise diagnosis and adequate treatment are necessary to prevent cerebrovascular and ischemic heart diseases. Elderly patients with diabetes mellitus are characteristically afflicted with more complications, impaired activities of daily living, cognitive function decline, and family environment problems, as compared with young and middle-aged diabetics. Therefore, tailor-made rather than uniform therapy becomes important. Lifestyle modification is the basis of diabetes treatment. Herein, we describe "prevention and management" of diabetes mellitus, focusing on the lifestyles of elderly diabetics.

  18. Pancreatic cancer: Surgery is a feasible therapeutic option for elderly patients

    PubMed Central

    2011-01-01

    Background Compromised physiological reserve, comorbidities, and the natural history of pancreatic cancer may deny pancreatic resection from elderly patients. We evaluated outcomes of elderly patients amenable to pancreatic surgery. Methods The medical records of all patients who underwent pancreatic resection at our institution (1995-2007) were retrospectively reviewed. Patient, tumor, and outcomes characteristics in elderly patients aged ≥ 70 years were compared to a younger cohort (<70y). Results Of 460 patients who had surgery for pancreatic neoplasm, 166 (36%) aged ≥ 70y. Compared to patients < 70y (n = 294), elderly patients had more associated comorbidities; 72% vs. 43% (p = 0.01) and a higher rate of malignant pathologies; 73% vs. 59% (p = 0.002). Operative time and blood products consumption were comparable; however, elderly patients had more post-operative complications (41% vs. 29%; p = 0.01), longer hospital stay (26.2 vs. 19.7 days; p < 0.0001), and a higher incidence of peri-operative mortality (5.4% vs. 1.4%; p = 0.01). Multivariable analysis identified age ≥ 70y as an independent predictor of shorter disease-specific survival (DSS) among patients who had surgery for pancreatic adenocarcinoma (n = 224). Median DSS for patients aged ≥ 70y vs. < 70y were 15 months (SE: 1.6) vs. 20 months (SE: 3.4), respectively (p = 0.05). One, two, and 5-Y DSS rates for the cohort of elderly patients were 58%, 36% and 23%, respectively. Conclusions Properly selected elderly patients can undergo pancreatic resection with acceptable post-operative morbidity and mortality rates. Long term survival is achievable even in the presence of adenocarcinoma and therefore surgery should be seriously considered in these patients. PMID:21272335

  19. Experiences with microsurgical tissue transfers in elderly patients.

    PubMed

    Ozkan, Omer; Ozgentas, H Ege; Islamoglu, Kemal; Boztug, Neval; Bigat, Zekiye; Dikici, M Bahadir

    2005-01-01

    The combination of advances in microsurgery and the improvement of anesthetic management with increased understanding of the physiology of preoperative and postoperative care has significantly raised the upper age limit for free-flap transfer in elderly patients. Despite pessimistic opinions regarding elderly patients who have poor recovery potential and decreased physiological reserves, the unique feature of free-tissue transfer is that it allows the transfer of well-vascularized tissue to defects in a single-stage procedure, and leads to improved quality of life. In this report, a retrospective analysis of 55 patients aged 50 and older who underwent microsurgical tissue transfer is presented. Hospital and our own records were used to review various parameters. The preoperative medical status of each patient was assessed using the American Society of Anesthesiologists (ASA) Classification of Physical Status. Each patient's preoperative medical records, age, sex, transferred tissue type, and length of operation were outlined. Postoperative recorded parameters were the fate of flaps and the short-term postoperative outcome, including surgical complications, medical morbidity, and death within 30 days of surgery. Fifty-eight microvascular tissue transfers were performed in 55 consecutive patients. The study comprised 38 male and 17 female patients, with a mean age of 64.8 years. ASA classification status was class 1 for 15 patients, class 2 for 26 patients, and class 3 for 14 patients. Twenty-five flaps were used for lower extremity reconstruction, 32 flaps were used for head and neck reconstruction, and 1 was used for breast reconstruction. The average operative time was 5.7 h, ranging between 2-13 h. There were 14 major medical complications, resulting in an overall medical complication rate of 25%. There were 3 deaths within 30 days postoperatively. Thus, the overall surgical mortality rate was 5.4%. The longer operation times were associated with the development

  20. Outcome of Gastric Cancer Surgery in Elderly Patients

    PubMed Central

    Kim, Min Sung

    2016-01-01

    Purpose Owing to increased life expectancy, the number of elderly patients with gastric cancer has increased. This study aimed to identify the outcomes of gastric cancer patients aged 80 years or older through comparison of their clinicopathological characteristics, surgical outcomes, and oncologic outcomes. Materials and Methods Between January 2006 and December 2013, the records of 478 patients who underwent surgery for gastric cancer were retrospectively evaluated. Patients were divided into two groups: patients <80 years old (n=446) and patients ≥80 years old (n=32). Results There were no significant differences in sex, body mass index, length of hospital stay, duration of surgery, depth of invasion, nodal metastasis, histologic type, or tumor size between the two groups. However, significant differences were found for the American Society of Anesthesiologist score and the serum albumin level between the two groups. Postoperative morbidity, mortality, disease-free survival, and recurrence rate did not differ between curatively resected patients in the two groups. Conclusions In elderly patients with gastric cancer, active treatment including radical gastrectomy is necessary. PMID:28053812

  1. Laparoscopic Transcystic Common Bile Duct Exploration in the Elderly is as Effective and Safe as in Younger Patients.

    PubMed

    Zhu, Jie-Gao; Guo, Wei; Han, Wei; Zhang, Zhong-Tao

    2017-01-01

    Choledocholithiasis represents a greater proportion of gallstone in the elderly. Elderly patients have more comorbidity, which could increase the operative risk and postoperative complications. However, no study has focused on the effect and safety of laparoscopic transcystic common bile duct exploration (LTCBDE) in elderly patients. The aim of this study was to investigate whether LTCBDE can be performed effectively and safely in elderly patients. This is a retrospective study of patients who underwent LTCBDE for choledocholithiasis performed from January 2010 to December 2012. Patients of age 70 or older were included in the elderly group. The rest integrated the younger group. Demographic data and perioperative parameters were compared between groups. From January 2010 to December 2012, 171 patients admitted for choledocholithiasis and gallstone attempted a single-step treatment combining LTCBDE and laparoscopic cholecystectomy. There were 104 women (60.8%) and 67 men (39.2%) with a median age of 57 (range 24-87) years. Elderly patients had significantly more preoperative risk factors. However, there was no significant difference in the success rate of LTCBDE (96.9% versus 92.7%, P = .142) for the two groups. The operative time was a little longer in elderly group than in younger group: median 80 (60-110) minutes versus 70 (50-95) minutes, respectively (P < .001). Postoperative recovery was slower in elderly group than in younger group, as reflected by a longer median postoperative hospital stay (2 days versus 1 day, P < .001) and a higher rate of abdominal drain placed (17.1% versus 8.5%, P = .202). The rates of postoperative complications at discharge were similar between groups (3.0% versus 4.9%, P = .952). LTCBDE in the elderly patients is as effective and safe as in younger patients.

  2. Predictors of morbidity and mortality after hepatectomy in elderly patients: analysis of 7621 NSQIP patients

    PubMed Central

    Tzeng, Ching-Wei D; Cooper, Amanda B; Vauthey, Jean-Nicolas; Curley, Steven A; Aloia, Thomas A

    2014-01-01

    Objectives Increasingly, surgeons are performing hepatectomies in older patients. This study was designed to analyse the incidences of and risk factors for post-hepatectomy morbidity and mortality in elderly patients. Methods All elective hepatectomies for the period 2005–2010 recorded in the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database were evaluated. Factors associated with 30-day rates of morbidity and mortality were compared between patients aged ≥75 years and those aged <75 years. Results Elderly patients accounted for 894 of 7621 (11.7%) hepatectomies. These patients more frequently had comorbidities (diabetes, cardiovascular or lung disease, lower albumin, elevated creatinine, anaesthesia risk; all P < 0.05) and were more likely to undergo partial or left rather than right or extended hepatectomies (P = 0.013). Despite the lesser surgical magnitude of these procedures, elderly patients experienced higher rates of severe complications (23.9% versus 18.4%; P < 0.001) and overall postoperative mortality (4.8% versus 2.0%; P < 0.001). The occurrence of any severe complication was associated with a mortality rate of 20.1% in elderly patients and 10.8% in non-elderly patients (P < 0.001). This disparity in mortality was more pronounced in patients with two or more (31.7% versus 20.2%; P < 0.001) and three or more (46.3% versus 31.1%; P < 0.001) severe complications. Independent risk factors for severe complications and/or mortality included an albumin level of < 4 g/dl, lung disease, intraoperative transfusion, a concurrent intra-abdominal operation, and an operative time of >240 min (all P < 0.05). Conclusions Given their lower physiologic reserve, elderly patients are at much greater risk for mortality after severe complications. To improve outcomes, surgeons should balance age and preoperative comorbidities with magnitude of hepatectomy. PMID:24033514

  3. Perspectives of Swedish patients on postoperative pain management.

    PubMed

    Idvall, Ewa; Bergqvist, Anna; Silverhjelm, Jenny; Unosson, Mitra

    2008-06-01

    This study aimed to describe the perspectives of surgical patients towards postoperative pain management during their hospital stay. Thirty strategically chosen postoperative inpatients from different surgical wards in a university hospital in Sweden participated. A qualitative, descriptive approach using individual interviews was chosen. These were tape-recorded, transcribed verbatim, and analyzed according to a qualitative content analysis. The patients' descriptions of postoperative pain management indicated that pain was a symptom that was always in focus, either because it was constantly present or because pain could appear abruptly during different activities and movements. Although the focus was on pain and an awareness that it should be relieved or avoided, the solutions were often routine, short-term, and involved the regular intake of drugs, plus additional medication if needed for an acute pain episode. From the patients' descriptions of their experience with postoperative pain management, we distinguished three categories: "patients' pain knowledge", "patients' pain management approaches", and "patients' views of health-care professionals". The findings from this study highlight important aspects of nursing care that should receive greater attention in postoperative pain management. The patients' narratives could be a valuable asset in the quality improvement of postoperative pain management as these narratives highlight episodes difficult to elicit in other ways.

  4. Management of depression in elderly stroke patients

    PubMed Central

    Lökk, Johan; Delbari, Ahmad

    2010-01-01

    Poststroke depression (PSD) in elderly patients has been considered the most common neuropsychiatric consequence of stroke up to 6–24 months after stroke onset. When depression appears within days after stroke onset, it is likely to remit, whereas depression at 3 months is likely to be sustained for 1 year. One of the major problems posed by elderly stroke patients is how to identify and optimally manage PSD. This review provides insight to identification and management of depression in elderly stroke patients. Depression following stroke is less likely to include dysphoria and more likely characterized by vegetative signs and symptoms compared with other forms of late-life depression, and clinicians should rely more on nonsomatic symptoms rather than somatic symptoms. Evaluation and diagnosis of depression among elderly stroke patients are more complex due to vague symptoms of depression, overlapping signs and symptoms of stroke and depression, lack of properly trained health care personnel, and insufficient assessment tools for proper diagnosis. Major goals of treatment are to reduce depressive symptoms, improve mood and quality of life, and reduce the risk of medical complications including relapse. Antidepressants (ADs) are generally not indicated in mild forms because the balance of benefit and risk is not satisfactory in elderly stroke patients. Selective serotonin reuptake inhibitors are the first choice of PSD treatment in elderly patients due to their lower potential for drug interaction and side effects, which are more common with tricyclic ADs. Recently, stimulant medications have emerged as promising new therapeutic interventions for PSD and are now the subject of rigorous clinical trials. Cognitive behavioral therapy can also be useful, and electroconvulsive therapy is available for patients with severe refractory PSD. PMID:20856917

  5. Acute suppurative parotitis: a dreadful complication in elderly surgical patients.

    PubMed

    Lampropoulos, Pavlos; Rizos, Spyros; Marinis, Athanasios

    2012-08-01

    Acute suppurative parotitis (ASP) is a severe infection seen particularly in elderly surgical patients. Factors that increase the risk of ASP include post-operative dehydration, debilitating conditions, and immunosuppressed states. Case report and literature review. An 82-year-old female patient was admitted because of paralytic ileus, dehydration, and poor oral hygiene, and was in distress. After two days of hospitalization, the patient developed a progressive painful swelling of her right parotid gland and fever up to 39.0°C. Computed tomography scanning showed an abscess in the parotid gland. Because of her progressive clinical deterioration, the patient underwent operative drainage of the abscess and removal of the necrotic material. Unfortunately, she suffered multiple organ dysfunction syndrome and died. Acute suppurative parotitis requires prompt aggressive treatment that nevertheless may fail.

  6. Safety of pancreatic resection in the elderly: a retrospective analysis of 556 patients

    PubMed Central

    Ansari, Daniel; Aronsson, Linus; Fredriksson, Joakim; Andersson, Bodil; Andersson, Roland

    2016-01-01

    Background The safety of pancreatic resection for elderly patients is still controversial. We examined the postoperative morbidity and mortality in patients aged 75 years or more undergoing pancreatic resection. Methods Patients undergoing pancreatic resection were studied retrospectively and the outcomes were compared between patients aged <75 and ≥75 years. Results Of the 556 patients enrolled, 78 (14%) were ≥75 years old. Elderly patients had significantly more co-morbidities, especially cardiovascular pathology (P=0.005). Also, elderly patients had significantly lower body mass index prior to surgery (P=0.005). There were no significant differences in terms of surgical procedures and tumor types between age groups. The incidence of postoperative pancreatic fistula grade A was significantly lower in the elderly group (P=0.022), but no significant differences were noted in the overall morbidity or the incidence of postpancreatectomy hemorrhage, delayed gastric emptying, bile leakage, cardiac complications, pulmonary complications or septic complications. The 30-day mortality rate was similar between groups (0.8% vs. 1.3%; P=0.532). Conclusion Pancreatic resection is a safe option for selected elderly patients. Our study confirms that age alone should not preclude potentially curative surgical therapy. PMID:27065736

  7. [Management of intertrochanteric fractures with lazcano hemiarthroplasty in elderly patients].

    PubMed

    McNaught-Salguero, C; Campos-Hernández, C J; Rosas-Barrientos, V; Matías-Barrón, P

    2011-01-01

    To determine if elderly osteopenic patients sustaining an intertrochanteric fracture recover sooner when treated with Lazcano hemiarthroplasty compared with those treated with internal fixation, and whether they can return to their prefracture physical activity level. A case-control study was conducted at 1o de Octubre ISSSTE Hospital. Patients over age 70 with intertrochanteric hip fracture and advanced osteopenia were enrolled. The cases were treated with Lazcano hemiarthroplasty and the controls (20 patients) with standard internal fixation (angled plate, DHS system, gamma nail). The comorbid conditions and the prefracture activity level were assessed in both groups. The relation between comorbid conditions and complications was studied and the postoperative activity level of both groups was compared. Thirty patients with these characteristics were included. Ten were cases and 20 were controls. No relation was found between the comorbid conditions and the patients' ability to resume gait postoperatively. Patients treated with hemiarthroplasty walk sooner than those treated with standard internal fixation and have a lower complication rate. The Lazcano hemiarthroplasty is an excellent choice in the treatment of intertrochanteric fractures in osteopenic patients. Long-term studies with more patients are required to assess the presence of complications.

  8. Evaluation of preoperative geriatric assessment of elderly patients with colorectal carcinoma. A retrospective study.

    PubMed

    Indrakusuma, R; Dunker, M S; Peetoom, J J; Schreurs, W H

    2015-01-01

    Elderly patients with colorectal carcinoma are screened with the Identification of Seniors at Risk (ISAR) questionnaire to identify frail patients. These patients are more at risk for mortality and morbidity and are referred to the geriatric specialist for assessment (Dutch acronym: DOG). The DOG assessment aims to preoperatively optimize the patient in order to improve postoperative outcomes. This study evaluates if the DOG assessment influences postoperative outcome after colorectal surgery. Retrospective cohort and match-control study. Elderly patients who underwent elective resection between 01-01-2008 and 01-08-2013 in the Medical Centre Alkmaar were included. Patients with a positive ISAR score were referred to the geriatric specialists for DOG assessment (DOG patients). DOG assessment encompassed comprehensive geriatric assessment and interventions. Mortality, delirium and length of hospital stay. postoperative complications. Cohort ISAR- (2008-2010, no ISAR questionnaire) is compared with cohort ISAR+ (2011-2013, ISAR questionnaire). Match-control comparison: DOG patients are compared with matched controls from cohort ISAR-. Compared to their matched controls, DOG patients were older and had a higher prevalence of certain risk factors for postoperative delirium. In both comparisons, no statistical significant differences were found between the groups in mortality and postoperative delirium. Length of stay was significantly shorter in cohort ISAR+. While the DOG patients were significantly more at risk for postoperative complications, the DOG patients had comparable postoperative outcomes as their matched controls. We therefore conclude that the DOG assessment has a positive influence on the postoperative outcomes after colorectal surgery. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. Role of patient education in postoperative pain management.

    PubMed

    Ingadóttir, Brynja; Zoëga, Sigridur

    2017-09-06

    Postoperative pain continues to be a significant issue in healthcare, with a considerable proportion of patients experiencing severe pain after surgery and finding pain management at home challenging. There are several barriers to effective pain management, involving both patients and healthcare professionals. Patient education may be a useful way to overcome many of these barriers. This article outlines the four stages of the education process, which can be used to provide patient education: assessing the patient's educational needs and potential barriers to learning; setting educational objectives; teaching; and evaluating the patient's learning. This article discusses the issue of postoperative pain and how structured patient education, from admission to discharge, provided by skilled healthcare professionals, may improve postoperative recovery.

  10. Clinicopathological factors predictive of postoperative seizures in patients with gliomas.

    PubMed

    Yang, Pei; Liang, Tingyu; Zhang, Chuanbao; Cai, Jinquan; Zhang, Wei; Chen, Baoshi; Qiu, Xiaoguang; Yao, Kun; Li, Guilin; Wang, Haoyuan; Jiang, Chuanlu; You, Gan; Jiang, Tao

    2016-02-01

    Epilepsy is one of the most common manifestations in gliomas and has a severe effect on the life expectancy and quality of life of patients. The aim of our study was to assess the potential connections between clinicopathological factors and postoperative seizure. We retrospectively investigated a group of 147 Chinese high-grade glioma (HGG) patients with preoperative seizure to examine the correlation between postoperative seizure and clinicopathological factors and prognosis. Univariate analyses and multivariate logistic regression analyses were performed to identify factors associated with postoperative seizures. Survival function curves were calculated using the Kaplan-Meier method. 53 patients (36%) were completely seizure-free (Engel class I), and 94 (64%) experienced a postoperative seizure (Engel classes II, III, and IV). A Chi-squared analysis showed that anaplastic oligodendroglioma/anaplastic oligoastrocytoma (AO/AOA) (P=0.05), epidermal growth factor receptor (EGFR) expression (P=0.0004), O(6)-methylguanine DNA methyltransferase (MGMT) expression (P=0.011), and phosphatase and tensin homolog (PTEN) expression (P=0.045) were all significantly different. A logistic regression analysis showed that MGMT expression (P=0.05), EGFR expression (P=0.001), and AO/AOA (P=0.038) are independent factors of postoperative seizure. Patients with lower MGMT and EGFR expression and AO/AOA showed more frequent instances of postoperative seizure. Postoperative seizure showed no statistical significance on overall survival (OS) and progression-free survival (PFS). Our study identified clinicopathological factors related to postoperative seizure in HGGs and found two predictive biomarkers of postoperative seizure: MGMT and EGFR. These findings provided insight treatment strategies aimed at prolonging survival and improving quality of life. Copyright © 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  11. Treating Psychotic Symptoms in Elderly Patients

    PubMed Central

    Targum, Steven D.

    2001-01-01

    Research has shown that elderly patients are especially at risk for the development of psychotic symptoms. A combination of factors contributes to the increased risk for psychosis in this patient population. Various DSM-IV diagnostic categories including delirium, schizophrenia, delusional disorder, mood disorders, dementia, substance abuse, and medical-neurologic conditions can be associated with psychotic symptoms. In general, medications are prescribed for specific target symptoms, started at low doses, and titrated gradually. Although buspirone, trazodone, valproic acid, and carbamazepine have been used with some success, antipsychotic medications have been the primary treatment of psychosis in the elderly. Because the atypical antipsychotics offer effective management of psychotic symptoms combined with low liability of extrapyramidal symptoms, these agents may be the current treatment of choice for psychotic symptoms in the elderly when used cautiously. PMID:15014599

  12. A qualitative report of patient problems and postoperative instructions.

    PubMed

    Atchison, Kathryn A; Black, Edward E; Leathers, Richard; Belin, Thomas R; Abrego, Mirna; Gironda, Melanie W; Wong, Daniel; Shetty, Vivek; DerMartirosian, Claudia

    2005-04-01

    While surgery related stress may interfere with the patient's ability to concentrate on instructions, language difficulty or low health literacy may also impede appropriate doctor/patient communication. The purpose of this study is to understand from a sample of minority patients the types of problems encountered during healing and the level of information regarding elements of postoperative instructions they recalled receiving at an inner-city safety net hospital. We initiated a qualitative study to understand the care sequence process and provision of informed consent and postoperative instruction. African American or Latino patients, 18 years of age or older, who had third molars removed under general anesthesia or received treatment for a mandibular fracture were recruited to participate in a focus group to discuss their treatment. Patients described their problem and any informed consent given about treatment risks and benefits and postoperative information they recalled. A total of 137 former patients were approached, 57 agreed to participate (42%) and 34 of those (60%) completed the interview. Subjects included 14 females and 20 males. Five categories of patient problems were reported: physical, eating, treatment-related, psychosocial, and other problems. People reported 5 categories of coping strategies: medication use, physical treatments, dietary solutions, rest, and clinical assistance. Twenty people recalled being given informed consent, and 5 participants recalled no elements of informed consent. Overall, 14 participants recalled elements of postoperative instruction. Gaps in patient understanding of postoperative care suggest room for improvement in postoperative instructions. Additional research is necessary to design and test high-quality postoperative instructions for surgical treatment and recovery in populations with limited health related literacy.

  13. Clinical characteristics of hepatocellular carcinoma in elderly patients

    PubMed Central

    Honda, Takuya; Miyaaki, Hisamitsu; Ichikawa, Tatsuki; Taura, Naota; Miuma, Satoshi; Shibata, Hidetaka; Isomoto, Hajime; Takeshima, Fuminao; Nakao, Kazuhiko

    2011-01-01

    The incidence of hepatocellular carcinoma (HCC) in elderly patients in Japan has been on the increase. The aim of the present study was to evaluate the impact of aging on the clinicopathological findings and the survival of HCC patients. A total of 624 patients with HCC were examined in this study. The patients were classified according to their age at the time of diagnosis: one group comprised younger patients (<75 years; n=544) and the second comprised elderly patients [(≥75 years; n=80, (12%)]. Results showed that there were significantly more female patients (younger:elderly, 22:36; p=0.005), normal livers (younger:elderly, 0.3:6%; p=0.0002), non-viral HCC (younger:elderly, 11:31%; p<0.001) and solitary tumors (younger:elderly, 53:76%; p=0.0008) in the elderly group. Five out of seven (71%) non-B non-C (NBNC) HCC patients who developed HCC in the normal liver were elderly patients. Survival between the younger and elderly HCC groups was not significantly different (younger:elderly, 4.38:3.45 years; p=0.665). Additionally, elderly HCC patients had fewer tumors, more mild underlying liver damage, and more frequent NBNC HCC. Their prognosis was not necessarily poorer than that of the younger HCC patients. Additionally, it appears that elderly patients develop HCC even without fibrosis. Therefore, aging may be a factor affecting hepatocarcinogenesis. PMID:22866139

  14. Performing colonoscopy in elderly and very elderly patients: Risks, costs and benefits

    PubMed Central

    Lin, Otto S

    2014-01-01

    Many diagnostic and screening colonoscopies are performed on very elderly patients. Although colonoscopic yield increases with age, the potential benefits in such patients decrease because of shorter life expectancy and more frequent comorbidities. Colonoscopy in very elderly patients carries a greater risk of complications and morbidity than in younger patients, and is associated with lower completion rates and higher likelihood of poor bowel preparation. Thus, screening colonoscopy in very elderly patients should be performed only after careful consideration of potential benefits, risks and patient preferences. On the other hand, diagnostic and therapeutic colonoscopy are more likely to benefit even very elderly patients, and in most cases should be performed if indicated. PMID:24932373

  15. Performing colonoscopy in elderly and very elderly patients: Risks, costs and benefits.

    PubMed

    Lin, Otto S

    2014-06-16

    Many diagnostic and screening colonoscopies are performed on very elderly patients. Although colonoscopic yield increases with age, the potential benefits in such patients decrease because of shorter life expectancy and more frequent comorbidities. Colonoscopy in very elderly patients carries a greater risk of complications and morbidity than in younger patients, and is associated with lower completion rates and higher likelihood of poor bowel preparation. Thus, screening colonoscopy in very elderly patients should be performed only after careful consideration of potential benefits, risks and patient preferences. On the other hand, diagnostic and therapeutic colonoscopy are more likely to benefit even very elderly patients, and in most cases should be performed if indicated.

  16. Postoperative Acute Respiratory Failure In Patients Treated Surgically For Goiters.

    PubMed

    Buła, Grzegorz; Mucha, Ryszard; Paliga, Michał; Truchanowski, Witold; Gawrychowski, Jacek

    2015-07-01

    The aim of the study was to present a clinical picture, treatment and prognosis regarding patients who developed acute respiratory failure (ARF) while treated surgically for a goiter. A total of 3810 patients were treated for goiters between 2008 to 2013. Symptoms of postoperative ARF were recognized in 39 (1%) patients. Symptoms of postoperative ARF were a postoperative hemorrhage in 31 (79.4%), lymphorrhagia in 1 (2.6%), bilateral paralysis of recurrent laryngeal nerves in 6 (15.4%) and acute circulatory - respiratory failure in 1 (2.6%). Postoperative hemorrhage appeared in 19 patients operated for nodular goiter, 4 with a retrosternal nodular goiter, 1x nontoxic recurrent retrosternal nodular goiter, 1x toxic recurrent retrosternal goiter nodular goiter, 2x Graves'goiter and 4x with malignant goiter. The cause of hemorrhage was parenchymal bleeding from the stumps and / or short neck muscles (29x), arterial bleeding (1x) and bleeding into the subcutaneous tissue (1x). Massive lymphorrhagia appeared as a result of damage to the thoracic duct after total thyroidectomy due to papillary thyroid carcinoma with cervical lymph node dissection on the left side. All patients who were diagnosed with bilateral paralysis of RLN, tracheostomy was performed. Of all 39 patients who underwent surgery two died - one in 6 days after surgery due to myocardial infarction, and another as a result of micropulmonary embolism and acute circulatory - respiratory failure in 18 hours after surgery. 1. The most frequent causes of acute respiratory failure in postoperative period are a hemorrhage from the operation site and bilateral paralysis of recurrent laryngeal nerves. 2. Acute postoperative respiratory failure is an indication for postoperative wound revision.

  17. Association between Serum IGF-I levels and Postoperative Delirium in Elderly Subjects Undergoing Elective Knee Arthroplasty.

    PubMed

    Yen, Timothy E; Allen, John C; Rivelli, Sarah K; Patterson, Stephanie C; Metcalf, Meredith R; Flink, Benjamin J; Mirrakhimov, Aibek E; Lagoo, Sandhya A; Vail, Thomas P; Young, Christopher C; Moon, Richard E; Trzepacz, Paula T; Kwatra, Madan M

    2016-02-05

    Evidence is mixed for an association between serum insulin-like growth factor-I (IGF-I) levels and postoperative delirium (POD). The current study assessed preoperative serum IGF-I levels as a predictor of incident delirium in non-demented elderly elective knee arthroplasty patients. Preoperative serum levels of total IGF-I were measured using a commercially available Human IGF-I ELISA kit. POD incidence and severity were determined using DSM-IV criteria and the Delirium Rating Scale-Revised-98 (DRS-R98), respectively. Median IGF-I levels in delirious (62.6 ng/ml) and non-delirious groups (65.9 ng/ml) were not significantly different (p = 0.141). The ratio (95% CI) of geometric means, D/ND, was 0.86 (0.70, 1.06). The Hodges-Lehmann median difference estimate was 7.23 ng/mL with 95% confidence interval (-2.32, 19.9). In multivariate logistic regression analysis IGF-I level was not a significant predictor of incident POD after correcting for medical comorbidities. IGF-I levels did not correlate with DRS-R98 scores for delirium severity. In conclusion, we report no evidence of association between serum IGF-I levels and incidence of POD, although the sample size was inadequate for a conclusive study. Further efforts to investigate IGF-I as a delirium risk factor in elderly should address comorbidities and confounders that influence IGF-I levels.

  18. Management of Elderly Patients with Glioblastoma.

    PubMed

    Roth, Patrick; Gramatzki, Dorothee; Weller, Michael

    2017-04-01

    Glioblastoma represents one of the major challenges in neurooncology and approximately half of the patients are 60 years or older. We summarize the particular situation of elderly glioblastoma patients with a focus on therapeutic considerations. Favorable molecular markers such as mutations in the isocitrate dehydrogenase (IDH) 1 or 2 genes are virtually absent in glioblastomas in elderly patients. Treatment options are similar to the situation in young patients and comprise surgical resection, radiation therapy, and alkylating chemotherapy. The performance status as well as comorbidities may have a stronger impact on the individual treatment decision than in young patients. The MGMT promoter methylation status allows for a stratification of treatment beyond the surgical intervention. In patients with MGMT promoter methylated tumors, monotherapy with temozolomide is superior to radiotherapy alone. Similarly, the benefit conferred by combined temozolomide-based chemoradiotherapy compared to radiotherapy alone is largely restricted to patients with MGMT promoter-methylated tumors. At recurrence, no standard treatment has been established. The prognosis for elderly patients with glioblastoma remains poor. The MGMT promoter methylation status helps guiding treatment decisions and withholding inactive, but potentially harmful treatments.

  19. A Preoperative Personalized Risk Assessment Calculator for Elderly Ovarian Cancer Patients undergoing Primary Cytoreductive Surgery

    PubMed Central

    Barber, Emma L; Rutstein, Sarah; Miller, William C; Gehrig, Paola A

    2015-01-01

    Objective Cytoreductive surgery for ovarian cancer has higher rates of postoperative complication than neoadjuvant chemotherapy followed by surgery. If patients at high risk of postoperative complication were identified preoperatively, primary therapy could be tailored. Our objective was to develop a predictive model to estimate the risk of major postoperative complication after primary cytoreductive surgery among elderly ovarian cancer patients. Methods Patients who underwent primary surgery for ovarian cancer between 2005-2013 were identified from the National Surgical Quality Improvement Project. Patients were selected using primary procedure CPT codes. Major complications were defined as grade 3 or higher complications on the validated Claviden-Dindo scale. Using logistic regression, we identified demographic and clinical characteristics predictive of postoperative complication. Results We identified 2,101 ovarian cancer patients of whom 35.9% were older than 65. Among women older than 65, the rate of major postoperative complication was 16.4%. Complications were directly associated with preoperative laboratory values (serum creatinine, platelets, white blood cell count, hematocrit), ascites, white race, and smoking status, and indirectly associated with albumin. Our predictive model had an area under receiver operating characteristic curve of 0.725. In order to not deny patients necessary surgery, we chose a 50% population rate of postoperative complication which produced model sensitivity of 9.8% and specificity of 98%. Discussion Our predictive model uses easily and routinely obtained objective preoperative factors to estimate the risk of postoperative complication among elderly ovarian cancer patients. This information can be used to assess risk, manage postoperative expectations, and make decisions regarding initial treatment. PMID:26432038

  20. Presentation and surgery outcomes in elderly with pheocromocytoma: a comparative analysis with young patients

    PubMed Central

    Srougi, Victor; Chambo, Jose L.; Tanno, Fabio Y.; Soares, Iracy S.; Almeida, Madson Q.; Pereira, Maria A. A.; Srougi, Miguel; Fragoso, Maria C.

    2016-01-01

    ABSTRACT Purpose: To evaluate the presentation and early surgical outcomes of elderly patients undergoing adrenalectomy for phaeochromocytoma. Patients and Methods: A retrospective search was performed of our adrenal disorders database for patients who underwent surgery for phaeochromocytoma or paraganglioma between 2009 and 2014. Patients >60 years old were classified as elderly. The clinical manifestations, intraoperative course, and early postoperative outcomes of elderly patients were compared to those of younger individuals (<60 years old). Results: The mean (±standard deviation) age in the older (n=10) and younger (n=36) groups was 69.6±5.3 years and 34.0±12.9 years. Germ-line mutations were more common in younger patients (50.0% versus 0%; p=0.004), whereas incidental lesions were more common in the elderly (40.0% versus 5.3%; p=0.003). In both groups, surgery was most commonly performed by videolaparoscopy (90% in the elderly and 82% in the younger group), with similar intraoperative anesthetic and surgical outcomes. Postoperatively, the older group more commonly received vasoactive drugs (60.0% versus 10.5%; p<0.001) and had a longer intensive care unit stay (3.1±2.8 versus 1.4±1.0 days; p=0.014), more clinical complications (60% versus 18.9%; p=0.01), and longer hospital stay (10.2±8.4 versus 5.7±4.9 days; p=0.028). Conclusions: Although all patients received the same preoperative preparation, the elderly group exhibited a slower and more complicated recovery after adrenalectomy. Meticulous perioperative care should be used in the elderly when treating phaeochromocytoma; nevertheless, adrenalectomy is a relatively safe procedure in this patient population. PMID:27564276

  1. Dementia and delirium, the outcomes in elderly hip fracture patients.

    PubMed

    Mosk, Christina A; Mus, Marnix; Vroemen, Jos Pam; van der Ploeg, Tjeerd; Vos, Dagmar I; Elmans, Leon Hgj; van der Laan, Lijckle

    2017-01-01

    Delirium in hip fractured patients is a frequent complication. Dementia is an important risk factor for delirium and is common in frail elderly. This study aimed to extend the previous knowledge on risk factors for delirium and the consequences. Special attention was given to patients with dementia and delirium. This is a retrospective cohort study performed in the Amphia Hospital, Breda, the Netherlands. A full electronic patient file system (Hyperspace Version IU4: Epic, Inc., Verona, WI, USA) was used to assess data between January 2014 and September 2015. All patients presented were aged ≥70 years with a hip fracture, who underwent surgery with osteosynthesis or arthroplasty. Patients were excluded in case of a pathological or a periprosthetic hip fracture, multiple traumatic injuries, and high-energy trauma. Patient and surgical characteristics were documented. Postoperative outcomes were noted. Delirium was screened using Delirium Observation Screening Scale and dementia was assessed from medical notes. Of a total of 566 included patients, 75% were females. The median age was 84 years (interquartile range: 9). Delirium was observed in 35%. Significant risk factors for delirium were a high American Society of Anesthesiology score, delirium in medical history, functional dependency, preoperative institutionalization, low hemoglobin level, and high amount of blood transfusion. Delirium was correlated with a longer hospital stay (P=0.001), increased association with complications (P<0.001), institutionalization (P<0.001), and 6-month mortality (P<0.001). Patients with dementia (N=168) had a higher delirium rate (57.7%, P<0.001) but a shorter hospital stay (P<0.001). There was no significant difference in the 6-month mortality between delirious patients with (34.0%) and without dementia (26.3%). Elderly patients with a hip fracture are vulnerable for delirium, especially when the patient has dementia. Patients who underwent an episode of delirium were at

  2. Dementia and delirium, the outcomes in elderly hip fracture patients

    PubMed Central

    Mosk, Christina A; Mus, Marnix; Vroemen, Jos PAM; van der Ploeg, Tjeerd; Vos, Dagmar I; Elmans, Leon HGJ; van der Laan, Lijckle

    2017-01-01

    Background Delirium in hip fractured patients is a frequent complication. Dementia is an important risk factor for delirium and is common in frail elderly. This study aimed to extend the previous knowledge on risk factors for delirium and the consequences. Special attention was given to patients with dementia and delirium. Methods This is a retrospective cohort study performed in the Amphia Hospital, Breda, the Netherlands. A full electronic patient file system (Hyperspace Version IU4: Epic, Inc., Verona, WI, USA) was used to assess data between January 2014 and September 2015. All patients presented were aged ≥70 years with a hip fracture, who underwent surgery with osteosynthesis or arthroplasty. Patients were excluded in case of a pathological or a periprosthetic hip fracture, multiple traumatic injuries, and high-energy trauma. Patient and surgical characteristics were documented. Postoperative outcomes were noted. Delirium was screened using Delirium Observation Screening Scale and dementia was assessed from medical notes. Results Of a total of 566 included patients, 75% were females. The median age was 84 years (interquartile range: 9). Delirium was observed in 35%. Significant risk factors for delirium were a high American Society of Anesthesiology score, delirium in medical history, functional dependency, preoperative institutionalization, low hemoglobin level, and high amount of blood transfusion. Delirium was correlated with a longer hospital stay (P=0.001), increased association with complications (P<0.001), institutionalization (P<0.001), and 6-month mortality (P<0.001). Patients with dementia (N=168) had a higher delirium rate (57.7%, P<0.001) but a shorter hospital stay (P<0.001). There was no significant difference in the 6-month mortality between delirious patients with (34.0%) and without dementia (26.3%). Conclusion Elderly patients with a hip fracture are vulnerable for delirium, especially when the patient has dementia. Patients who underwent

  3. [Oropharyngeal candidiasis in elderly patients].

    PubMed

    Laurent, Marie; Gogly, Bruno; Tahmasebi, Farzad; Paillaud, Elena

    2011-03-01

    Oropharyngeal candidiasis is a common opportunistic infection of the oral cavity caused by an overgrowth of candida species, the commonest being Candida albicans. The prevalence in the hospital or institution varies from 13 to 47% of elderly persons. The main clinical types are denture stomatitis, acute atrophic glossitis, thrush and angular cheilitis. Diagnosis is usually made on clinical ground. Culture and sensitivity testing should be undertaken if initial therapy is unsuccessful. Predisposing factors of oral candidiasis could be local and/or systemic. Local factors include wearing dentures, impaired salivary gland function and poor oral health. Systemic factors include antibiotics and some other drugs, malnutrition, diabetes, immunosuppression and malignancies. Management involves an appropriate antifungal treatment and oral hygiene. Predisposing factors should be treated or eliminated where feasible. Oral hygiene involves cleaning the teeth and dentures. Dentures should be disinfected daily and left out overnight.

  4. [Cardiac rehabilitation in the elderly patient].

    PubMed

    de Pablo Zarzosa, C

    1995-01-01

    The number of people over 65 is progressively increasing. In this group, the incidence of ischemic cardiopathy is very high and nowadays revascularization procedures are being used more and more. Cardiac rehabilitation programmes have proved to be an efficacious therapy in ischemic cardiopathy. These programmes initially excluded high-risk patients and elderly patients. In the last years, it has been confirmed that the benefit obtained in people over 65 is at least similar to the benefit observed in younger patients, with no greater number of complications. The aims of a cardiac rehabilitation programme are to improve the prognosis and quality of life. In elderly patients, the aims are similar, but special stress is laid on improving their quality of life and obtaining the maximum survival rate free of incapacitation.

  5. Presentation and surgery outcomes in elderly with pheocromocytoma: a comparative analysis with Young patients.

    PubMed

    Srougi, Victor; Chambo, Jose L; Tanno, Fabio Y; Soares, Iracy S; Almeida, Madson Q; Pereira, Maria A A; Srougi, Miguel; Fragoso, Maria C

    2016-01-01

    To evaluate the presentation and early surgical outcomes of elderly patients undergoing adrenalectomy for phaeochromocytoma. A retrospective search was performed of our adrenal disorders database for patients who underwent surgery for phaeochromocytoma or paraganglioma between 2009 and 2014. Patients >60 years old were classified as elderly. The clinical manifestations, intraoperative course, and early postoperative outcomes of elderly patients were compared to those of younger individuals (<60 years old). The mean (±standard deviation) age in the older (n=10) and younger (n=36) groups was 69.6±5.3 years and 34.0±12.9 years. Germ-line mutations were more common in younger patients (50.0% versus 0%; p=0.004), whereas incidental lesions were more common in the elderly (40.0% versus 5.3%; p=0.003). In both groups, surgery was most commonly performed by videolaparoscopy (90% in the elderly and 82% in the younger group), with similar intraoperative anesthetic and surgical outcomes. Postoperatively, the older group more commonly received vasoactive drugs (60.0% versus 10.5%; p<0.001) and had a longer intensive care unit stay (3.1±2.8 versus 1.4±1.0 days; p=0.014), more clinical complications (60% versus 18.9%; p=0.01), and longer hospital stay (10.2±8.4 versus 5.7±4.9 days; p=0.028). Although all patients received the same preoperative preparation, the elderly group exhibited a slower and more complicated recovery after adrenalectomy. Meticulous perioperative care should be used in the elderly when treating phaeochromocytoma; nevertheless, adrenalectomy is a relatively safe procedure in this patient population. Copyright© by the International Brazilian Journal of Urology.

  6. [Nutritional status and postoperative complications in patients with digestive cancer].

    PubMed

    Pañella, Loreto; Jara, Marlene; Cornejo, Morelia; Lastra, Ximena; Contreras, María Gladys; Alfaro, Kattia; De La Maza, María Pía

    2014-11-01

    Risk of malnutrition is elevated among oncologic patients, and this increases postoperative morbidity and mortality. To study the association between nutritional status and postoperative outcomes in a group of patients with gastrointestinal cancers. We studied 129 patients with diagnosis of digestive cancer, previous to potentially curative surgery. Nutritional status was evaluated through anthropometric measures, Subjective Global Assessment (SGA), dietary intake recalls and routine biochemical parameters. Functional performance was assessed by the Karnofsky index (KI). Cancer stage was classified according to TNM4. During the postoperative period, complications, length of stay at the critical care ward and duration of hospitalization were registered. Thirty days after discharge, patients were contacted, and the appearance of new complications was listed. According to SGA 14.7% of patients were classified as well nourished (A), 57.3% as moderately undernourished or at risk of malnutrition (B) and 27.9% as severely malnourished (C). The incidence of total complications was 25.5%. Nutritional status was not associated with cancer stage. The frequency of complications among patients classified as A, B and C were 5.5, 25.3 and 37.1% respectively (p = 0.03). We detected a high frequency of malnutrition in this group of patients. Overall the frequency of postoperative complications was low, however malnourished patients exhibited a higher rate of surgical complications.

  7. Postoperative colonic motility and tone in patients after colorectal surgery.

    PubMed

    Huge, A; Kreis, M E; Zittel, T T; Becker, H D; Starlinger, M J; Jehle, E C

    2000-07-01

    Colonic motility is crucial for the resolution of postoperative ileus. However, few data are available on postoperative colonic motility and no data on postoperative colonic tone. We aimed to characterize postoperative colonic tone and motility in patients. Nineteen patients were investigated with combined barostat and manometry recordings after left colonic surgery. During surgery a combined recording catheter was placed in the colon with two barostat bags and four manometry channels cephalad to the anastomosis. Recordings were performed twice daily from Day 1 to Day 3 after surgery. Manometry showed an increasing colonic motility index, which was a mean (+/- standard error of the mean) of 37 +/- 5 mmHg/minute on Day 1, 87 +/- 19 mmHg/minute on Day 2, and 102 +/- 13 mmHg/minute on Day 3 (P < 0.05 for Day 1 vs. Day 2 and Day 2 vs. Day 3). Low barostat bag volumes indicating a high colonic tone were observed on Day 1 after surgery and increased subsequently (barostat bag I was 19 +/- 4, 32 +/- 6, and 32 +/- 6 ml; barostat bag II was 13 +/- 1, 19 +/- 3, and 22 +/- 5 ml on Days 1, 2, and 3, respectively; for both barostat bags P < 0.05 for Day 1 vs. Day 2 but not Day 2 vs. Day 3). Colonic motility increased during the postoperative course. The low barostat bag volumes indicated a high colonic tone postoperatively which would correspond to a contracted rather than to a distended colon. High colonic tone postoperatively may be relevant for pharmacologic treatment of postoperative ileus.

  8. Liver resection for metastases from colorectal cancer in very elderly patients: New surgical horizons.

    PubMed

    Nardo, Bruno; Serafini, Simone; Ruggiero, Michele; Grande, Raffaele; Fugetto, Francesco; Zullo, Alessandra; Novello, Matteo; Rizzuto, Antonia; Bonaiuto, Elisabetta; Vaccarisi, Sebastiano; Cavallari, Giuseppe; Serra, Raffaele; Cannistrà, Marco; Sacco, Rosario

    2016-09-01

    Patients with colorectal cancer (CRC) may develop liver metastases. Surgical resection remains the best treatment of choice for colorectal liver metastases (CRLM) according to resectability criteria, with a long-term survival of 25% up to 41% after 5 years. Advanced age is associated with a higher incidence and co-morbidity, particularly cardiovascular disease, as well as deteriorating physiological reserves. The aim of this study was to analyse the overall and disease-free survival for patients with CRLM according to their chronological age. Patients with CRLM were enrolled in the study. Data on gender, age, co-morbidity, metastasis characteristics (number, size and total metastatic volume (TMV)), use of perioperative chemotherapy and operative and post-operative complications were collected. Then, according to recent World Health Organization (WHO) guidelines, the patients were grouped by age. Statistical analysis was performed using the software R (ver. 2.14.1). Hepatic resection was performed in 149 patients (21 patients in the very elderly group, 79 in the elderly group and 49 in the younger group). The three groups were comparable in terms of operative duration, transfusion rate, length of high-dependency unit (HDU) stay and post-operative hospital stay. The very elderly group showed a non-significant increase in post-operative morbidity. The 30-day and 60-day/inpatient mortality rates increased with age without any significant statistically difference between the three groups (very elderly group 4.8% and 4.8%; elderly group: 2.5% and 3.8%; and younger group 0% and 2%). At 5 years, the overall survival was 28.6% for very elderly patients (≥75 years), 33.3% for elderly patients (≥65 to <75 years) and 43.5% for younger patients (≤65 years). The 1-, 3- and 5-year disease-free survival was similar across the groups. Liver resection for CRLM in carefully selected patients above the age of 75 can be performed with acceptable morbidity and mortality rates

  9. [Early postoperative hyperlactatemia in patients after surgery under extracorporeal circulation].

    PubMed

    Bakanov, A Iu; Naĭmushin, A V; Mikhaĭlov, A P; Khudonogova, S V; Kadyshkina, E B; Malaia, E Ia; Bel'ianinova, I V; Polianitsa, A V; Shatalkin, I V

    2009-01-01

    Metabolic disturbances, such as changes in blood acid-base balance and electrolytic composition; hyperglycemia and hyperlactatemia, are frequent factors that complicate the early postoperative period in patients after cardiac surgery under extracorporeal circulation. The purpose of the study was to estimate the incidence of hyperlactatemia in the early postoperative period and to reveal the predictors of its occurrence. This prospective study was conducted in our center from November 14, 2006, to September 1, 2007. The study covered 270 patients above 15 years of age, who had been operated on for coronary heart disease, acquired heart diseases, and combined lesions of valves and coronary arteries. Hyperlactatemia was observed in a substantial proportion of patients who had been operated on under extracorporeal circulation. Correlation analysis indicated a significant association between the duration of extracorporeal circulation and the magnitude of hyperlactatemia developing in the early postoperative period. Hyperglycemia with a glucose level of > 9 mmol/l is a predictor of the development of hyperglycemia.

  10. Questionable prescribing for elderly patients in Quebec.

    PubMed Central

    Tamblyn, R M; McLeod, P J; Abrahamowicz, M; Monette, J; Gayton, D C; Berkson, L; Dauphinee, W D; Grad, R M; Huang, A R; Isaac, L M

    1994-01-01

    OBJECTIVE: To estimate the prevalence of questionable and rational high-risk prescribing among elderly people of the three drug groups most commonly implicated in drug-related illness: cardiovascular drugs, psychotropic drugs and nonsteroidal anti-inflammatory drugs (NSAIDs). DESIGN: Retrospective prevalence study; all prescription and billing records for the period Jan. 1 to Dec. 31, 1990, for the study sample were retrieved from the relevant provincial databases of the Régie de l'assurance-maladie du Québec. SETTING: Quebec. PARTICIPANTS: Regionally stratified random sample of 63,268 elderly medicare registrants who made at least one visit to physician in 1990 and were not living in a health care institution for the entire year. MAIN OUTCOME MEASURE: Prescription information was examined for three types of high-risk prescribing: rational and questionable drug combinations, excessive treatment duration and drugs relatively contraindicated for use in elderly people. RESULTS: Overall, 52.6% of the patients experienced one or more events of high-risk prescribing, and 45.6% experienced at least one that was questionable. High-risk prescribing was most prevalent for psychotropic drugs, and questionable prescribing was more frequent than rational prescribing in this drug group. An estimated 30.8% of the total elderly population in Quebec received benzodiazepines for more than 30 consecutive days, 12.9% received a long-acting benzodiazepine, and 13.0% received a questionable high-risk psychotropic drug combination. The prevalence of high-risk prescribing was higher among the women than among the men and increased with age until 75 to 84 years. There were significant unexplained differences between regions in the regional prevalence of high-risk prescribing, particularly of psychotropic drugs. CONCLUSION: The prevalence of questionable high-risk prescribing, especially of psychotropic drugs, is substantial among elderly people. This may be a potentially important and

  11. Keeping record of the postoperative nursing care of patients.

    PubMed

    Roets, L; Aucamp, M C; de Beer, H; Niemand, M

    2002-11-01

    The aim of this research project was to evaluate the record-keeping of postoperative nursing care. A total of 186 randomly selected patient records were evaluated in terms of a checklist that included the most important parameters for postoperative nursing care. All the patients underwent operations under general anaesthetic in one month in a Level 3 hospital and were transferred to general wards after the operations. The data collected was analysed by means of frequencies. One finding was that the neurological status of most patients was assessed but that little attention was paid in the patient records to emotional status and physical comfort. The respiratory and circulatory status of the patients and their fluid balance were inadequately recorded. The patients were well monitored for signs of external haemorrhage, but in most cases haemorrhage was checked only once, on return from the theatre. Although the patients' pain experience were well-monitored, follow-up actions after the administration of pharmacological agents was poor. The surgical intervention was fully described and, generally speaking, the records were complete and legible, but the signatures and ranks of the nurses were illegible. Allergies were indicated in the most important records. The researchers recommend that a comprehensive and easily usable documentation form be used in postoperative nursing care. Such a form would serve as a checklist and could ensure to a large degree that attention is given to the most important postoperative parameters. Errors and negligence could also be reduced by this means.

  12. Determining the risk of falling in elderly patients undergoing hip fracture surgery.

    PubMed

    Seyhan, E; Cavdar, I

    2014-01-01

    PURPOSE OF THE STUDY This study examines the risk of falling in elderly patients who underwent hip fracture surgery in the orthopaedic clinic during the postoperative period. MATERIALS AND METHODS This study was a cross-sectional study. The study sample consisted of 71 elderly patients aged more than 65 years undergoing hip fracture surgery. A questionnaire, the Tinetti balance test and the mini-mental state examination (MMSE) were used. RESULTS The analyses included 71 elderly patients with a mean age of 78.45 years. All patients had been hospitalized for hip fracture due to falling, and 29.6% had a history of falling in the one year prior to hospitalization. The mean MMSE score was 18.37 ± 6.54 and the mean Tinetti score was 11.10 ± 6.66. CONCLUSION We found that as the mean age of the elderly patients increased, the risk of falling also increased and the MMSE scores deteriorate and that the elderly patients living alone were at a greater risk of falling and had worse cognitive function, that those with a history of falling before hospitalization were at a greater risk of falling again and that the risk of falling increased as cognitive function declined. Key words:elderly, falling, hip fracture, risk of falling.

  13. Hepatic resection for hepatocellular carcinoma in super-elderly patients aged 80 years and older in the first decade of the 21st century.

    PubMed

    Nozawa, Akinori; Kubo, Shoji; Takemura, Shigekazu; Sakata, Chikaharu; Urata, Yorihisa; Nishioka, Takayoshi; Kinoshita, Masahiko; Hamano, Genya; Uenishi, Takahiro; Suehiro, Shigefumi

    2015-07-01

    We evaluated the preoperative and postoperative characteristics and prognosis of super-elderly patients with hepatocellular carcinoma (HCC). Four hundred and thirty-one patients who underwent hepatic resection for HCC were classified into three groups according to their age at the time of surgery: super-elderly (≥80 years; n = 20), elderly (70-80 years; n = 172) and younger (<70 years; n = 239). We compared the clinical characteristics, preoperative and postoperative factors and prognosis among the groups to evaluate whether liver resection is appropriate for super-elderly patients. The liver function was not significantly different among the groups. The proportion of patients with preoperative cardiovascular and respiratory disease and hypertension was higher in the super-elderly group compared to the other groups. The super-elderly group had shorter operations and reduced hemorrhage rates compared to the other groups. Postoperative cardiovascular complications and delirium were more frequently observed in the super-elderly group. The overall and tumor-free survival rates were not significantly different among the groups. Super-elderly patients had a lower rate of liver or HCC-related death and a higher rate of death due to other causes than the other groups. Super-elderly HCC patients who are appropriately evaluated and selected might have a favorable prognosis after undergoing hepatic resection.

  14. Surgical Management in Elderly Patients with Tuberculous Spondylodiscitis: Ten Year Mortality Audit Study

    PubMed Central

    Kothari, Manish Kundanmal; Tikoo, Agnivesh; Nene, Abhay Madhusudan

    2016-01-01

    Study Design Retrospective study. Purpose To evaluate the factors affecting immediate postoperative mortality in elderly patients with tuberculous spondylodiscitis. Overview of Literature Treatment of spinal tuberculosis in the elderly involves consideration of age and co-morbidities, and often leads to an extended conservative management. Surgical intervention in these patients becomes a complex decision. There are no studies on risk factors of mortality in surgically treated elderly with tuberculous spondylodiscitis. Methods Two hundred and seventy-six patients with spondylodiscitis were operated between 2005 and 2015. 20 consecutive patients over 70 years of age with and proven tuberculosis who met the inclusion/exclusion criteria were included. Demographic, clinical and radiological profile data with operative details of instrumentation, blood loss, surgical duration, and mortality were noted. There were 20 patients (6 males, 14 females) with a mean age of 73.5 years. The patients were divided into those with mortality (M) and those who survived (non-mortality, NM). Various variables were statistically tested for immediate postoperative medical complications and mortality. Results There were four mortalities (20%). Age, sex, number of medical co-morbidities, American Society of Anaesthesiologists grade, Frankel grade C or worse, number of vertebrae involved, number of levels fused, blood loss and operative time did not have statistically significant impact on immediate postoperative mortality. Only preoperative immobility duration was statistically higher in the M group (p=0.016) than in the NM group. Conclusions Preoperative immobility is associated with immediate postoperative mortality in elderly patients with spinal tuberculosis undergoing surgery. The findings identify preoperative immobility as a risk factor for mortality, which could contribute to a more detailed prognostic discussion between surgeon and patient before surgery. PMID:27790320

  15. Spinal Anesthesia in Elderly Patients Undergoing Lumbar Spine Surgery.

    PubMed

    Lessing, Noah L; Edwards, Charles C; Brown, Charles H; Ledford, Emily C; Dean, Clayton L; Lin, Charles; Edwards, Charles C

    2017-03-01

    Spinal anesthesia is increasingly viewed as a reasonable alternative to general anesthesia for lumbar spine surgery. However, the results of spinal anesthesia in elderly patients undergoing lumbar spine decompression and combined decompression and fusion procedures are limited in the literature. The aim of this study was to report a single institution's experience using spinal anesthesia in elderly patients undergoing lumbar spine surgery. A retrospective review was conducted using a prospectively collected database of consecutive lumbar spine surgeries performed under spinal anesthesia in patients 70 years or older at a single center between December 2013 and October 2015. A total of 56 patients were included in the study; 27 patients (48%) underwent lumbar decompression and 29 patients (52%) underwent combined decompression and fusion procedures. Mean operative time was 101 minutes (range, 30-210 minutes), and mean operative blood loss was 187 mL (range, 20-700 mL). Mean maximum inpatient postoperative visual analog scale score was 6.2 (range, 1-10). Nausea occurred in 21% (12 of 56) of the patients. Mean length of stay was 2.4 days (range, 1-6 days). No mortality, stroke, permanent loss of function, or pulmonary embolism occurred. None of the cases required conversion to general anesthesia. All of the patients were ambulatory on either the day of the surgery or the next morning. These results demonstrate that spinal anesthesia is a viable method of anesthesia for patients 70 years and older undergoing lumbar spine surgery. They also demonstrate the safety of this method for patients older than 84 years and for surgeries lasting up to 3½ hours. [Orthopedics. 2017; 40(2):e317-e322.].

  16. Bowel Preparation Is Associated with Reduced Morbidity in Elderly Patients Undergoing Elective Colectomy.

    PubMed

    Dolejs, Scott C; Guzman, Michael J; Fajardo, Alyssa D; Robb, Bruce W; Holcomb, Bryan K; Zarzaur, Ben L; Waters, Joshua A

    2017-02-01

    Bowel preparation in elderly patients is associated with physiologic derangements that may result in postoperative complications. The aim of this study is to determine the impact of bowel preparation on postoperative outcomes in elderly patients. Patients age 75 years and older who underwent elective colectomy were identified from the 2012-2014 American College of National Surgical Quality Improvement Program (ACS-NSQIP database). Patients were grouped into no bowel preparation, mechanical bowel preparation (MBP), oral antibiotic preparation (OABP), or combined MBP + OABP. Logistic regression modeling was conducted to calculate risk-adjusted 30-day outcomes. There were 4829 patients included in the analysis. Morbidity was 34.3% in no bowel prep, 32.4% in MBP, 24.8% in OABP, and 24.6% in MBP + OABP groups (p < 0.001). The MBP + OABP group compared with no bowel prep was associated with reduced rates of anastomotic leak, ileus, superficial surgical site infection (SSI), organ space SSI, respiratory compromise, and reduced length of stay. There was no difference in the rate of acute kidney injury between the groups. MBP + OABP was associated with reduced morbidity compared with no bowel preparation in elderly patients undergoing elective colorectal resection. MBP alone was not associated with differences in outcomes compared with no bowel preparation. The use of MBP + OABP is safe and effective in elderly patients undergoing elective colectomy.

  17. Patients' perceptions of their postoperative recovery for one month.

    PubMed

    Forsberg, Angelica; Vikman, Irene; Wälivaara, Britt-Marie; Engström, Åsa

    2015-07-01

    To explore orthopaedic and general surgery patients' perceptions of their postoperative recovery for one month. In general, nursing research in the postoperative context has been directed towards a single symptom or area, which is valuable. However, there is a lack of studies of orthopaedic and general surgery patients' perceptions of postoperative recovery from a short-term perspective. A quantitative approach with a longitudinal design was used. A total of 180 patients participated in the study. Data were collected using a standardised questionnaire, the Postoperative Recovery Profile, for self-assessment of recovery. Descriptive statistics reported as proportions were used for the categorical variables. Analytic statistics were used to identify statistically significant differences. Mean values and t-tests were used for quantity variables, and Mann-Whitney U-tests and Chi-squared tests were used for nonparametric variables. Overall, the orthopaedic patients were substantially less recovered than the general surgery patients. Two-thirds of the orthopaedic patients and half of the general surgery patients perceived severe or moderate pain in the acute recovery phase. Within the general surgery group, there were significant differences in the recovery between the Gastric Bypass patients and colon/ileum surgery patients. The gastric bypass patients were overall more recovered than the other groups of patients. The Gastric Bypass patients reported that they had improved after one month compared to their own status prior to surgery. Nursing support for orthopaedic patients must be improved, especially after they are discharged from the hospital. To structure and monitor individual recovery, a top-five priority profile of the most important problems should be used during follow-up calls after the patient is discharged from the hospital. Postoperative pain continues to represent a clinical problem that requires attention. Heterogeneity in the perceptions of recovery

  18. The role of cystectomy in elderly patients - a multicentre analysis.

    PubMed

    Izquierdo, Laura; Peri, Lluis; Leon, Priscila; Ramírez-Backhaus, Miguel; Manning, Thomas; Alcaraz, Antonio; Roupret, Morgan; Solsona, Eduardo; Rubio, Jose; Sengupta, Shomik; Chan, Yee; Liodakis, Peter; Gyomber, Dennis; Bolton, Damien; Lawrentschuk, Nathan

    2015-10-01

    Life expectancy in developed countries is continuously increasing. Hence elderly patients are becoming more common in our clinical practice. Currently, one of the greatest challenges of medicine is balancing the life expectancy of elderly patients against aggressive treatments that carry significant risks. To outline the complications and survival in surgical patients 80 years and over undergoing radical cystectomy for bladder cancer. A review of a radical cystectomy in elderly recorded in four different institutional prospective databases during the period between 1991 and 2014. Clinical and pathologic features, complications and survival were evaluated. A total of 111 patients were available. Median (range) age 82.2 (80-89) years. Seventeen women and 94 men. Regarding the ASA score, 6 patients were ASA I, 47 patients were ASA II, 49 patients ASA III and 9 ASA IV. Prior to surgery, 48 patients had hydronephrosis. The median (range) creatinine series was 1.1 (0.71-11.1) ng/dL. In 88 cases an ileal conduit was performed, 17 a cutaneous ureterostomy diversion, 5 neobladders and 1 ureterosigmoidostomy case. The median (range) operative time was 230 (120-420) min and a total of 97 patients required blood transfusion. The median (range) hospital stay was 14 (7-126) days. The early and late complication rates were 50.4% and 32%, respectively. A total of 14 patients (12.6%) required surgical reintervention. Eight patients (7.2%) died in the immediate postoperative period. The readmission rate of the series was 27.2%. The mean follow-up of the series was 18 (0.27-134.73) months. During this period 66 patients died, 52 of them due to the tumor. Twelve month tumour progression free survival was 83.9% for ≤pT1, 70.2% for pT2 and 36% for ≥pT3, respectively. Twelve month cancer specific survival was 85.6% for ≤pT1, 75.1% for pT2 and 42.5% for ≥pT3, respectively. Radical cystectomy in elderly population is an aggressive surgical treatment with a significant

  19. Intraoperative Dexmedetomidine Promotes Postoperative Analgesia in Patients After Abdominal Colectomy

    PubMed Central

    Ge, Dong-Jian; Qi, Bin; Tang, Gang; Li, Jin-Yu

    2015-01-01

    Abstract Surgery-induced acute postoperative pain may lead to prolonged convalescence. The present study was designed to investigate the effects of intraoperative dexmedetomidine on postoperative analgesia following abdominal colectomy surgeries. Eighty patients scheduled for abdominal colectomy surgery under general anesthesia were divided into 2 groups, which were maintained using propofol/remifentanil/dexmedetomidine (PRD) or propofol/remifentanil/saline (PRS). During surgery, patients in the PRD group had a lower bispectral index (BIS) value, which indicated a deeper anesthetic state, and a higher sedation score right after extubation than patients in the PRS group. During the first 24 hours post surgery, PRD patients consumed less morphine in patient-controlled analgesia (PCA) and had a lower score in the visual analog scale (VAS) testing than their controls from the PRS group. Intraoperative administration of dexmedetomidine appears to promote the analgesic property of morphine-based PCA in patients after abdominal colectomy. PMID:26376397

  20. [Postoperative complications in patients with cervicothoracic injuries].

    PubMed

    Tatarinova, E V; Pogodina, A N; Korovkina, E N

    2014-01-01

    The results of the diagnosis and treatment of 117 patients with cervicothoracic injuries were analyzed. Different complications were observed in 51 (43.6%) cases. The main reasons contributing to the development of complications included late diagnosis of lesions of trachea and esophagus, acute blood loss, inadequate hemostasis during surgery.

  1. Analysis of hyponatraemia associated post-operative mortality in 3897 hip fracture patients.

    PubMed

    Tinning, Craig G; Cochrane, Lynda A; Singer, Brian R

    2015-07-01

    Hyponatraemia is common in hospitalised patients. In recent years the relationship between hyponatraemia and bone metabolism, falls and fractures has become more established. This study evaluates the prevalence of hyponatraemia (plasma sodium<135mmol/l) in 3897 patients undergoing operative treatment for hip fracture and the relationship between hyponatraemia and mortality in these patients. Hyponatraemia was an independent risk factor for increased post-operative mortality on multivariate analysis. Median age at admission was 83 years. Hyponatraemia was present in 19.1% of patients with hip fracture on admission, 29.5% of patients in the first 24h post-operatively and 20% of patients at discharge. There was a significant association between hyponatraemia and time from admission to surgery indicating that patients admitted with hyponatraemia waited longer. The median follow-up time was 863 (range 0-4352) days. There were 2460 deaths (63.1% of the original 3897 patients) prior to the censor date. A total of 1144 patients (29.4% of the original 3897 patients) died within 12 months of discharge. Median time to death for patients with and without hyponatraemia on admission was 34 months (SE 1.7 months) and 41 months (SE 2.5 months) respectively (p=0.003). Median time to death for patients with and without hyponatraemia within 24h post-operatively was 35 months (SE 2.5 months) and 42 months (SE 1.7 months) respectively (p=0.004). Following elimination of other independent variables associated with increased mortality, hyponatraemia on admission was associated with an increased risk of death (adjusted HR 1.15, p=0.005). Post-operative hyponatraemia was also associated with an increased risk of death (adjusted HR 1.15, p=0.006). Trends suggested that hyponatraemia within 48h of discharge was associated with an increased risk of death (adjusted HR 1.15, p=0.636). Hyponatraemia is common in elderly patients with hip fractures both at initial presentation and during

  2. [Treatment of breast cancer in elderly patients].

    PubMed

    Greiner, Maria

    2008-01-01

    Invasive therapeutic procedures in elderly patients with advanced breast cancer are usually contraindicated as improvement of the quality of life in this situation is considered more important than increasing life span. In the present case, however, surgical removal of the tumour has led to a significant improvement of the quality of life and could have been even more beneficial if carried out at an earlier stage.

  3. Optimising postoperative pain management in the ambulatory patient.

    PubMed

    Shang, Allan B; Gan, Tong J

    2003-01-01

    Over 60% of surgery is now performed in an ambulatory setting. Despite improved analgesics and sophisticated drug delivery systems, surveys indicate that over 80% of patients experience moderate to severe pain postoperatively. Inadequate postoperative pain relief can prolong recovery, precipitate or increase the duration of hospital stay, increase healthcare costs, and reduce patient satisfaction. Effective postoperative pain management involves a multimodal approach and the use of various drugs with different mechanisms of action. Local anaesthetics are widely administered in the ambulatory setting using techniques such as local injection, field block, regional nerve block or neuraxial block. Continuous wound infusion pumps may have great potential in an ambulatory setting. Regional anaesthesia (involving anaesthetising regional areas of the body, including single extremities, multiple extremities, the torso, and the face or jaw) allows surgery to be performed in a specific location, usually an extremity, without the use of general anaesthesia, and potentially with little or no sedation. Opioids remain an important component of any analgesic regimen in treating moderate to severe acute postoperative pain. However, the incorporation of non-opioids, local anaesthetics and regional techniques will enhance current postoperative analgesic regimens. The development of new modalities of treatment, such as patient controlled analgesia, and newer drugs, such as cyclo-oxygenase-2 inhibitors, provide additional choices for the practitioner. While there are different routes of administration for analgesics (e.g. oral, parenteral, intramuscular, transmucosal, transdermal and sublingual), oral delivery of medications has remained the mainstay for postoperative pain control. The oral route is effective, the simplest to use and typically the least expensive. The intravenous route has the advantages of a rapid onset of action and easier titratibility, and so is recommended for the

  4. Postoperative sepsis prediction in patients undergoing major cancer surgery.

    PubMed

    Sood, Akshay; Abdollah, Firas; Sammon, Jesse D; Arora, Nivedita; Weeks, Matthew; Peabody, James O; Menon, Mani; Trinh, Quoc-Dien

    2017-03-01

    Cancer patients are at increased risk for postoperative sepsis. However, studies addressing the issue are lacking. We sought to identify preoperative and intraoperative predictors of 30-d sepsis after major cancer surgery (MCS) and derive a postoperative sepsis risk stratification tool. Patients undergoing one of nine MCSs (gastrointestinal, urological, gynecologic, or pulmonary) were identified within the American College of Surgeons National Surgical Quality Improvement Program (2005-2011, n = 69,169). Multivariable adjusted analyses (MVA) were performed to identify the predictors of postoperative sepsis. A composite sepsis risk score (CSRS) was constructed using the regression coefficients of predictors significant on MVA. The score was stratified into low, intermediate, and high risk, and its predictive accuracy for sepsis, septic shock, and mortality was assessed using the area under the curve analysis. Overall, 4.3% (n = 2954) of patients developed postoperative sepsis. In MVA, Black race (odds ratio [OR] = 1.30, P = 0.002), preoperative hematocrit <30 (OR = 1.40, P = 0.022), cardiopulmonary and cerebrovascular comorbidities (P < 0.010), American Society of Anesthesiologists score >3 (P < 0.05), operative time (OR = 1.002, P < 0.001), surgical approach (OR = 1.81, P < 0.001), and procedure type (P < 0.001) were significant predictors of postoperative sepsis. CSRS demonstrated favorable accuracy in predicting postoperative sepsis, septic shock, and mortality (area under the curve 0.72, 0.75, and 0.74, respectively). Furthermore, CSRS risk stratification demonstrated high concordance with sepsis rates, 1.3% in low-risk patients versus 9.7% in high-risk patients. Similarly, 30-d mortality rate varied from 0.5% to 5.5% (10-fold difference) in low-risk patients versus high-risk patients. Our study identifies the major risk factors for 30-d sepsis after MCS. These risk factors have been converted into a simple, accurate bedside sepsis risk

  5. Head and neck cancer in elderly patients: is microsurgical free-tissue transfer a safe procedure?

    PubMed

    Tarsitano, A; Pizzigallo, A; Sgarzani, R; Oranges, C M; Cipriani, R; Marchetti, C

    2012-12-01

    The safety and success of microvascular transfer have been well documented in the general population, but the good results achieved with the use of free flaps in elderly patients have received little attention. This study sought to identify differences in complications, morbidity and functional outcomes between elderly (≥ 75 years) and younger (< 75 years) patients treated surgically for advanced head and neck cancer using the Head and Neck 35 module of the European Organisation for Research and Treatment of Cancer quality of life questionnaire. Patient treatment consisted of composite resection, including excision of the primary tumour with ipsilateral or bilateral neck dissection and microvascular reconstruction. Eighty-five microvascular tissue transfers were performed to reconstruct major surgical defects. Postoperative radiation therapy was performed when indicated. Total flap loss occurred in three cases in elderly patients and two cases in younger patients. The rates of major surgical complication were 9% in young patients and 11% in elderly patients. No significant difference was observed between the two groups in the rates of major and minor flap complications, morbidity or long-term functional outcome. The results of the present analysis indicate that free-flap microvascular reconstruction can be considered a safe procedure in elderly patients with head and neck cancer.

  6. Psychomotor Retardation in Elderly Untreated Depressed Patients

    PubMed Central

    Beheydt, Lieve Lia; Schrijvers, Didier; Docx, Lise; Bouckaert, Filip; Hulstijn, Wouter; Sabbe, Bernard

    2015-01-01

    Background: Psychomotor retardation (PR) is one of the core features in depression according to DSM V (1), but also aging in itself causes cognitive and psychomotor slowing. This is the first study investigating PR in relation to cognitive functioning and to the concomitant effect of depression and aging in a geriatric population ruling out contending effects of psychotropic medication. Methods: A group of 28 non-demented depressed elderly is compared to a matched control group of 20 healthy elderly. All participants underwent a test battery containing clinical depression measures, cognitive measures of processing speed, executive function and memory, clinical ratings of PR, and objective computerized fine motor skill-tests. Statistical analysis consisted of a General Linear Method multivariate analysis of variance to compare the clinical, cognitive, and psychomotor outcomes of the two groups. Results: Patients performed worse on all clinical, cognitive, and PR measures. Both groups showed an effect of cognitive load on fine motor function but the influence was significantly larger for patients than for healthy elderly except for the initiation time. Limitations: Due to the restrictive inclusion criteria, only a relatively limited sample size could be obtained. Conclusion: With a medication free sample, an additive effect of depression and aging on cognition and PR in geriatric patients was found. As this effect was independent of demand of effort (by varying the cognitive load), it was apparently not a motivational slowing effect of depression. PMID:25674065

  7. Early result of hemiarthroplasty in elderly patients with fracture neck of femur

    PubMed Central

    Daniel, Mue; Mohammed, Salihu; Francis, Awonusi; William, Yongu; Joseph, Kortor; Cornilius, Elachi

    2015-01-01

    Background: Fractured neck of femur is a frequent and severe injury in elderly patients with consequent high morbidity and mortality. Hemiarthroplasty is an established treatment modality for displaced intracapsular femoral neck fractures in elderly patients above 60 years. This study analysed the early functional outcome and complications of Austin Moore endoprosthesis in elderly patients above 60 years with fractured neck of femur. Materials and Methods: Retrospective data were obtained over a 5 year period from January 2007 to December 2012. Thirty-five elderly patients of 60 years and above with displaced intracapsular fracture neck of femur treated with hemiarthroplasty using Austin Moore endoprosthesis were included. Data were analysed using SPSS version 21. Results: A total of 35 patients were involved. The age-range was 60-90 years with mean age of 69.7 ± 7 years. The predominant mechanism of injury was trivial falls in 18 (66.7%) patients. The commonest complication was pressure sore in 2 (5.7%) patients, followed by surgical site infection in 1 (2.9%) patient and periprosthetic fracture in 1 (2.9%) patients. Early post-operative mortality was 2.9%. Post-operative hip functional status according to Postel and Merle d Aubigne revealed that majority (66.6%) of patients had satisfactory hip function. Conclusion: Functional outcome of Austin Moore in elderly patients above 60 years with fracture neck of femur was satisfactory in most of the cases with minimal morbidity. Careful patient selection for hemiarthroplasty is vital and may decrease the incidence of complications and ameliorate the outcomes in the treatment of intracapsular femoral neck fractures. PMID:25657497

  8. Can reduction mammoplasty patients be promised a particular size postoperatively?

    PubMed

    Dal Cin, Arianna; Jeans, Elizabeth Rose

    2005-01-01

    This retrospective study used self-reported bra sizes, heights and weights pre- and postoperatively in patients who underwent reduction mammoplasty by one surgeon between 2001 and 2003. Preoperative data were collected on 91 patients. Postoperative data were collected from 69 respondents by telephone survey. Bra sizes were standardized according to cup size. In bra-making, the cup is the same size for decreasing cup letter size as the band size increases. The most common standardized cup size was seven, representing bra sizes 34 F, 36 E, 38 D, 40 C, etc. The range of preoperative cup sizes was five (34 D) to 17 (42 L). The mass of tissue removed from each breast was averaged for each patient and ranged from 147 g to 2453 g (mean 522 g). The average body mass index was 29.6 kg/m(2) preoperatively and 29.3 kg/m(2) postoperatively, with six patients reporting weight gain, 13 reporting weight loss and 50 reporting no change at all. Postoperative standardized cup sizes ranged from five (34 D) to 14 (44 H). The difference between pre- and postoperative cup size ranged from zero to eight as follows: for no cup size change (n=17), mean tissue removed per breast was 577.1 g; decrease by one cup size (n=23), 489.2 g; decrease by two cup sizes (n=25), 425.8 g. These data indicate that when self-reported data from patients are used, a plastic surgeon may find that as many as 25% report no change in bra size after reduction mammoplasty, even when more than 500 g of tissue is removed from each breast, which may adversely affect patients' satisfaction with the surgical results. Future studies will determine the cause of the apparent discrepancy between operative and self-reported results.

  9. Noninvasive mechanical ventilation in immediate postoperative cardiac surgery patients.

    PubMed

    Mazullo Filho, João Batista Raposo; Bonfim, Vânia Jandira Gomes; Aquim, Esperidião Elias

    2010-12-01

    Noninvasive ventilation is routine in acute respiratory failure patients; nevertheless, the literature is controversial for its use in cardiac surgery postoperative period. To evaluate the effectiveness of preventive noninvasive ventilation in the immediate postoperative period of cardiac surgery, monitoring its impact until the sixth day of hospitalization. This was a controlled study, where patients in immediate postoperative period of cardiac surgery were randomized into two groups: control (G1) and investigational (G2) which received noninvasive ventilation set on pressure support mode and positive end expiratory pressure, for 2 hours following extubation. Were evaluated ventilatory, hemodynamical and oxygenation variables both immediately after extubation and after noninvasive ventilation in G2. Thirty-two patients completed the study, 18 in G1 and 14 in G2. The mean age was 61±16.23 years for G1 and for G2 61.5 ± 9.4 years. Of the initial twenty-seven patients in G1, nine patients (33.3%) were excluded due to invasive ventilation requirements, and three patients (11.11%) had to go back to invasive mechanical ventilation. None of the 14 G2 patients was reintubated. Patients undergoing early ventilatory support showed better results in the assessments throughout the hospitalization time. Noninvasive post-cardiac surgery ventilation was proven effective, as demonstrated by increased vital capacity, decreased respiratory rate, prevention of post-extubation acute respiratory failure and reduced reintubation rates.

  10. Swallowing and pharyngeal function in postoperative pharyngeal cancer patients.

    PubMed

    Martini, D V; Har-El, G; Lucente, F E; Slavit, D H

    1997-07-01

    This study examines the pharyngeal phase of swallowing after the resection of pharyngeal cancer, and focuses on the pharynx as a functional organ. The purpose of the study was to obtain information on both reconstruction and rehabilitation in cases of surgically treated pharyngeal cancer. The records of 21 consecutive patients who underwent surgical treatment of oropharyngeal and hypopharyngeal squamous cell carcinoma between 1990 and 1993 were reviewed. Functional results following surgery were graded on a numerical scale in three categories: pharyngeal swallow, laryngeal and lower airway protection, and oral alimentation. Three treatment groups were observed: group 1 = transoral excision with primary closure (six patients); group 2 = composite resection with primary closure (nine patients); and group 3 = composite resection with deltopectoral or pectoralis major flap closure (six patients). Comparison of pharyngeal swallow and laryngeal protection functions showed no significant difference between the three groups. However, oral alimentation performance in group 1 was significantly better than in group 3, and groups 1 and 2 achieved a similar level. In patients with T3 and T4 tumors postoperative function was poor and no difference in postoperative function was demonstrated between patients undergoing reconstruction with primary closure and patients undergoing reconstruction with deltopectoral or pectoralis major flaps. Patients with T3 and T4 tumors experienced impaired postoperative function regardless of the method of reconstruction used. This is not a condemnation of the surgical treatment of advanced pharyngeal tumors, but rather a suggestion that other reconstruction techniques be considered.

  11. Pancreaticoduodenectomy for adenocarcinoma of the pancreatic head is justified in elderly patients: A Retrospective Cohort Study.

    PubMed

    Renz, Bernhard W; Khalil, Philippe N; Mikhailov, Michael; Graf, Sandra; Schiergens, Tobias S; Niess, Hanno; Boeck, Stefan; Heinemann, Volker; Hartwig, Werner; Werner, Jens; Bruns, Christiane J; Kleespies, Axel

    2016-04-01

    The increasing elderly population is an inevitable trend worldwide in developed countries. Therefore, we aimed to assess the experience of a tertiary pancreatic center with a very homogenous population comprising only patients diagnosed with PDAC of the pancreatic head in patients older than 75 years of age compared to their younger counterparts regarding the benefit in life expectancy and tumor biological aggressiveness. 300 patients underwent partial pancreaticoduodenectomy (PD) or pylorus preserving pancreaticoduodenectomy (PPPD) for PDAC of the pancreatic head between 2002 and 2012 and were evaluated with regard to their co-morbidities, clinicopathological and perioperative variables, postoperative morbidity, mortality and long term survival. Therefore, two groups according to the age at the procedure (A: <75 years, n = 241, B: ≥75 years, n = 59) were designed. There were no differences between groups with regard to gender, performed procedure (PPPD or PD), operation time, blood loss, tumor invasiveness and grade of tumor differentiation, R-status, lymph node ratio, 30-day mortality, length of stay and adjuvant chemotherapy. Extended resections including total pancreatectomy were slightly more often performed in younger patients (p = 0.071) and trended toward a higher rate of surgical complications in patients <75 years of age (p = 0.183). A higher rate of preoperative co-morbidities in elderly patients (group B), was associated with more postoperative non-surgical complications (p = 0.002) in this group of patients. However, the median overall survival (19.2 vs. 18.4 months) did not differ significantly between groups. Major pancreatic surgery for ductal adenocarcinoma of the pancreatic head is justified in elderly patients. With careful patients' selection and prudent perioperative management, elderly patients will have a similar long term outcome despite the higher rate of postoperative morbidity based on non-surgical complications. Copyright

  12. Can reduction mammoplasty patients be promised a particular size postoperatively?

    PubMed Central

    Dal Cin, Arianna; Jeans, Elizabeth Rose

    2005-01-01

    This retrospective study used self-reported bra sizes, heights and weights pre- and postoperatively in patients who underwent reduction mammoplasty by one surgeon between 2001 and 2003. Preoperative data were collected on 91 patients. Postoperative data were collected from 69 respondents by telephone survey. Bra sizes were standardized according to cup size. In bra-making, the cup is the same size for decreasing cup letter size as the band size increases. The most common standardized cup size was seven, representing bra sizes 34 F, 36 E, 38 D, 40 C, etc. The range of preoperative cup sizes was five (34 D) to 17 (42 L). The mass of tissue removed from each breast was averaged for each patient and ranged from 147 g to 2453 g (mean 522 g). The average body mass index was 29.6 kg/m2 preoperatively and 29.3 kg/m2 postoperatively, with six patients reporting weight gain, 13 reporting weight loss and 50 reporting no change at all. Postoperative standardized cup sizes ranged from five (34 D) to 14 (44 H). The difference between pre- and postoperative cup size ranged from zero to eight as follows: for no cup size change (n=17), mean tissue removed per breast was 577.1 g; decrease by one cup size (n=23), 489.2 g; decrease by two cup sizes (n=25), 425.8 g. These data indicate that when self-reported data from patients are used, a plastic surgeon may find that as many as 25% report no change in bra size after reduction mammoplasty, even when more than 500 g of tissue is removed from each breast, which may adversely affect patients’ satisfaction with the surgical results. Future studies will determine the cause of the apparent discrepancy between operative and self-reported results. PMID:24222995

  13. Postoperative patients' perspectives on rating pain: A qualitative study.

    PubMed

    van Dijk, Jacqueline F M; Vervoort, Sigrid C J M; van Wijck, Albert J M; Kalkman, Cor J; Schuurmans, Marieke J

    2016-01-01

    In postoperative pain treatment patients are asked to rate their pain experience on a single uni-dimensional pain scale. Such pain scores are also used as indicator to assess the quality of pain treatment. However, patients may differ in how they interpret the Numeric Rating Scale (NRS) score. This study examines how patients assign a number to their currently experienced postoperative pain and which considerations influence this process. A qualitative approach according to grounded theory was used. Twenty-seven patients were interviewed one day after surgery. Three main themes emerged that influenced the Numeric Rating Scale scores (0-10) that patients actually reported to professionals: score-related factors, intrapersonal factors, and the anticipated consequences of a given pain score. Anticipated consequences were analgesic administration-which could be desired or undesired-and possible judgements by professionals. We also propose a conceptual model for the relationship between factors that influence the pain rating process. Based on patients' score-related and intrapersonal factors, a preliminary pain score was "internally" set. Before reporting the pain score to the healthcare professional, patients considered the anticipated consequences (i.e., expected judgements by professionals and anticipation of analgesic administration) of current Numeric Rating Scale scores. This study provides insight into the process of how patients translate their current postoperative pain into a numeric rating score. The proposed model may help professionals to understand the factors that influence a given Numeric Rating Scale score and suggest the most appropriate questions for clarification. In this way, patients and professionals may arrive at a shared understanding of the pain score, resulting in a tailored decision regarding the most appropriate treatment of current postoperative pain, particularly the dosing and timing of opioid administration. Copyright © 2015 Elsevier

  14. Coma blisters in two postoperative patients.

    PubMed

    Chacon, Anna H; Farooq, Uzma; Choudhary, Sonal; Yin, Natalie; Nolan, Bridgit; Shiman, Michael; Milikowski, Clara; Izakovic, Jan; Elgart, George W

    2013-05-01

    Coma blisters are self-limited cutaneous bullae that occur in the setting of loss of consciousness because of a drug, illness, or accident, with the most common settings being barbiturate overdose and neurological disorders. The etiology behind coma blisters is poorly understood and is not related to underlying infections or autoimmune conditions. The clinical presentation consists of bullae, erosions, and violaceous plaques usually involving sites of pressure. The skin lesions usually occur within 48-72 hours of the start of a coma and resolve within 2-4 weeks. We present one case of a 5-month-old infant with severe valvular disease who required surgical repair. He was placed on extra corporeal membrane oxygenation and developed multiple tense coma blisters during the course of therapy. Skin biopsy revealed a noninflammatory subepidermal blister with necrosis of the overlying epidermis and necrosis of the eccrine ducts. We also present a second case of an 18-year-old female patient who underwent surgical resection of a benign mandibular tumor. She subsequently developed bullae on both arms 4 days after surgery. The skin biopsy showed a necrotic epidermis, a subepidermal blister, and diffuse necrosis of the eccrine coils.

  15. Disposition of elderly patients after head and neck reconstruction.

    PubMed

    Hatcher, Jeanne L; Bell, Elizabeth Bradford; Browne, J Dale; Waltonen, Joshua D

    2013-11-01

    A patient's needs at discharge, particularly the need for nursing facility placement, may affect hospital length of stay and health care costs. The association between age and disposition after microvascular reconstruction of the head and neck has yet to be reported in the literature. To determine whether elderly patients are more likely to be discharged to a nursing or other care facility as opposed to returning home after microvascular reconstruction of the head and neck. From January 1, 2001, through December 31, 2010, patients undergoing microvascular reconstruction at an academic medical center were identified and their medical records systematically reviewed. During the study period, 457 patients were identified by Current Procedural Terminology codes for microvascular free tissue transfer for a head and neck defect regardless of cause. Seven patients were excluded for inadequate data on the postoperative disposition or American Society of Anesthesiologists (ASA) score. A total of 450 were included for analysis. Demographic and surgical data were collected, including the patient age, ASA score, and postoperative length of stay. These variables were then compared between groups of patients discharged to different posthospitalization care facilities. The mean age of participants was 59.1 years. Most patients (n = 386 [85.8%]) were discharged home with or without home health services. The mean age of those discharged home was 57.5 years; discharge to home was the reference for comparison and odds ratio (OR) calculation. For those discharged to a skilled nursing facility, mean age was 67.1 years (OR, 1.055; P < .001). Mean age of those discharged to a long-term acute care facility was 71.5 years (OR, 1.092; P = .002). Length of stay also affected the disposition to a skilled nursing facility (OR, 1.098), as did the ASA score (OR, 2.988). Elderly patients are less likely to be discharged home after free flap reconstruction. Age, ASA score, and length of stay are

  16. Impulse control disorders in elderly patients.

    PubMed

    Tamam, Lut; Bican, Mehtap; Keskin, Necla

    2014-05-01

    There is no epidemiological study on the prevalence of impulse control disorders (ICDs) in the elderly population. The studies on ICDs in elderly patients are limited and some of them are case reports about pathological gambling and kleptomania. The comorbidity of other psychiatric disorders makes diagnosis difficult and has negative effects on both treatment and the prognosis of ICDs. The aim of this study was to determine the prevalence of ICDs among elderly patients and to evaluate the related sociodemographic and clinical features. A total of 76 patients aged 60 and over who have been referred to our outpatient clinics in a one-year period were included in the study. A demographic data form was completed. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) was used to determine axis I psychiatric disorders. The prevalence of ICDs was investigated by using the modified version of the Minnesota Impulse Disorders Interview (MIDI). Impulsivity was measured with the Barratt Impulsiveness Scale Version 11 (BIS-11). The Mini-Mental State Examination (MMSE) test was performed to evaluate the cognitive status of patients and to exclude the diagnosis of dementia. In addition, all patients completed Symptom Check List-90 (SCL-90). The prevalence rate of at least one comorbid ICD in our sample was 17%. When patients with a diagnosis of ICDs not otherwise specified (ICD-NOS) were included, the prevalence rate increased to 22.4%. The most common ICD was intermittent explosive disorder (15.8%), followed by pathological gambling (9.2%). The majority of the sample was men (54%), married (80%), had a high school education (51%), and mid-level socioeconomic status (79%). The only statistically significant difference between the sociodemographic characteristics of patients with or without ICDs was gender. The lifetime prevalence of ICDs was 34.1% in men and 8.6% in women. The prevalence of childhood conduct disorder

  17. [Nutrition for elderly acute stroke patients].

    PubMed

    Ha, Lisa; Iversen, Per Ole; Hauge, Truls

    2008-09-11

    Elderly people have an increased risk of malnutrition due to biological and physiological changes and underlying disease. Almost 90% of the stroke patients are older than 65 years, and the consequences of acute stroke may lead to additional nutritional problems. This paper reviews nutritional therapy for stroke patients. PubMed was searched (non-systematically) for prospective cohort studies of occurrence, diagnostics and consequences of undernutrition in stroke patients. Randomized trials were examined to identify clinical effects of oral protein and energy supplements or tube feeding on nutritional status and intake, functional status, infections, length of stay, quality of life and mortality. 8-35% of stroke patients are undernourished. Body weight is one of the most important parameters for assessment of nutritional status. Dysphagia occurs in up to 80% of patients with acute stroke and increases the risk of undernutrition, which again leads to prolonged length of stay, reduced functional status and poorer survival. Early nasogastric tube feeding does not increase the risk of pneumonia and may improve survival after six months. Oral supplements lead to a significantly improved nutritional intake in undernourished stroke patients, as well as improved nutritional status and survival in undernourished elderly. Nutritional treatment can improve the clinical outcome after an acute stroke, provided that there are good procedures for follow-up and monitoring of the treatment.

  18. [Chronic kidney disease in the elderly patient].

    PubMed

    Mora-Gutiérrez, José María; Slon Roblero, María Fernanda; Castaño Bilbao, Itziar; Izquierdo Bautista, Diana; Arteaga Coloma, Jesús; Martínez Velilla, Nicolás

    2016-05-06

    Chronic kidney disease (CKD) is widely prevalent worldwide, with a special impact on elderly population. Around half of people aged over 75 meet diagnostic criteria for CKD according to the recent 'Kidney disease improving global outcomes' (KDIGO) 2012 clinical practice guideline on the evaluation and management of CKD. However, geriatric patients have characteristics that may not be addressed by general guidelines. Therefore, it is important to know the natural history of the disease, symptoms, and 'red-flags' that could help in the management of these patients. In this review, a complete approach is presented on the pathophysiology, diagnosis, and treatment of CKD in the geriatric population.

  19. Delirium in elderly vascular surgery patients.

    PubMed

    Cudennec, Tristan; Goëau-Brissonnière, Olivier; Coscas, Raphaël; Capdevila, Clément; Moulias, Sophi; Coggia, Marc; Teillet, Laurent

    2014-04-01

    The elderly represent a large percentage of patients seen in departments of vascular surgery. Delirium is a frequent perioperative complication in this population and contributes to increased morbidity and mortality. Prevention of problems associated with mental confusion rests in identifying comorbidities, their severity, and the risk factors associated with delirium syndrome. The aging of our population implies management of increasing numbers of older patients who often have concomitant pathologies and, consequently, polypharmacy. Optimization of their management rests on collaboration between surgeons, anesthetists, and geriatrists.

  20. [Isolated chest trauma in elderly patients].

    PubMed

    Yersin, Bertrand; Carron, Pierre-Nicolas; Pasquier, Mathieu; Zingg, Tobias

    2015-08-12

    In elderly patients, a blunt trauma of the chest is associated with a significant risk of complications and mortality. The number of ribs fractures (≥ 4), the presence of bilateral rib fractures, of a pulmonary contusion, of existent comorbidities or acute extra-thoracic traumatic lesions, and lastly the severity of thoracic pain, are indeed important risk factors of complications and mortality. Their presence may require hospitalization of the patient. When complications do occur, they are represented by alveolar hypoventilation, pulmonary atelectasia and broncho-pulmonary infections. When hospitalization is required, it may allow for the specific treatment of thoracic pain, including locoregional anesthesia techniques.

  1. [Application thymogen for preoperative preparation of elderly patients with tumor processes in abdominal cavity].

    PubMed

    Smirnov, V S; Petlenko, S V; El'tsin, S S

    2011-01-01

    A double-blind, randomized, placebo-controlled study of the efficacy of Thymogen preparation for elderly patients for surgery on the solid tumors in abdominal cavity and retroperitoneal space was carried out. The drug has been administered by intranasal instillation of 100 mg once a day for 7 days before surgery. The isotonic sodium chloride solution for the placebo group in the same scheme was used. The preoperative use of Thymogen proved to be useful to restore the structural and functional parameters of cellular immunity. Immunomodulatory therapy resulted in the significant decrease in the number and range of post-operative complications and the shorting of the postoperative period.

  2. Differences in vital signs between elderly and non-elderly patients prior to ward cardiac arrest

    PubMed Central

    Churpek, Matthew M; Yuen, Trevor C; Winslow, Christopher; Hall, Jesse; Edelson, Dana P

    2014-01-01

    Objective Vital signs and composite scores, such as the Modified Early Warning Score (MEWS), are used to identify high-risk ward patients and trigger rapid response teams. Although age-related vital sign changes are known to occur, little is known about the differences in vital signs between elderly and non-elderly patients prior to ward cardiac arrest (CA). We aimed to compare the accuracy of vital signs for detecting CA between elderly and non-elderly patients. Design Observational cohort study. Setting Five hospitals in the United States. Patients A total of 269,956 patient admissions to the wards with documented age, including 422 index ward CAs. Interventions None. Measurements and Main Results Patient characteristics and vital signs prior to CA were compared between elderly (age 65 years or older) and non-elderly (age less than 65 years) patients. The area under the receiver operating characteristic curve (AUC) for vital signs and the MEWS were also compared. Elderly patients had a higher CA rate (2.2 vs. 1.0 per 1000 ward admissions; P<0.001) and in-hospital mortality (2.9% vs. 0.7%; P<0.001) than non-elderly patients. Within four hours of CA, elderly patients had significantly lower mean heart rate (88 vs. 99 beats per minute; P<0.001), diastolic blood pressure (60 vs. 66 mm Hg; P=0.007), shock index (0.82 vs. 0.93; P<0.001), and MEWS (2.6 vs. 3.3; P<0.001), and higher pulse pressure index (0.45 vs. 0.41; P<0.001) and temperature (36.4 vs. 36.3 °C; P=0.047). The AUCs for all vital signs and the MEWS were higher for non-elderly patients than elderly patients (MEWS AUC 0.85 (95% CI 0.82-0.88) vs. 0.71 (95% CI 0.68-0.75); P<0.001). Conclusions Vital signs more accurately detect CA in non-elderly patients compared to elderly patients, which has important implications for how they are used for identifying critically ill patients. More accurate methods for risk stratification of elderly patients are necessary to decrease the occurrence of this devastating event

  3. [Postoperative nutrition in patients with head and neck cancer].

    PubMed

    Martín Villares, C; Fernández Pello, M E; San Román Carbajo, J; Tapia Risueño, M; Domínguez Calvo, J

    2003-01-01

    Patients who underwent surgery for head and neck malignant neoplasms are problematic because dysphagia, pain and postoperative secuelaes. Nutritional support is necessary in more than 90% of all patients with head and neck cancer. The purpose of this study is to determine nutritional support in these patients and problems related to nutrition. Fifty-four patients with oral and pharyngolaryngeal carcinomas underwent surgery were studied prospectively. We studied nutritional support (oral nutrition, enteral nutrition or parenteral nutrition) and problems related to nutrition: aspiration neumoniae and pharyngostoma. The 7% of the patients underwent oral feeding after surgery, 87% enteral nutrition with nasogastric tube and 6% parenteral nutrition. We identified neumoniae in 6% of patients and faringocutaneous fistula in 19%. When patients leaved the hospital, 98% of the patients underwent oral feeding and one patient had nasopharyngeal tube for enteral nutrition. 1. Artificial nutrition was necessary in 93% patients with oropharyngolaryngealcancer; 2. Enteral nutrition was the most useful modality of alimentation (87%); 3.25% of patients had postoperative complications: (18% pharyngostoma, 6% neumoniae); 4. Oral feeding was possible in 98% of patients out of hospital.

  4. Cutaneous surgery under local anesthesia in very elderly patients 90 years of age and older is as safe as in elderly patients ranging in age from 75 to 80 years old.

    PubMed

    Imamura, Taichi; Nakamura, Yasuhiro; Tanaka, Ryota; Teramoto, Yukiko; Asami, Yuri; Maruyama, Hiroshi; Fujisawa, Yasuhiro; Fujimoto, Manabu; Yamamoto, Akifumi

    2017-06-01

    The number of very elderly patients who require surgery for cutaneous tumors is increasing. However, there is limited information on the safety of cutaneous surgery in such patients. To evaluate the safety of cutaneous surgery in patients 90 years of age and older, we retrospectively reviewed the elderly patients who underwent surgery for cutaneous tumors under local anesthesia. Consecutive patients 90 years of age and older and 75-80 years old were included in the elderly group and the control group. The elderly and control groups included 104 and 106 patients, respectively. The mean age of the patients was 93.4 years (range, 90-101 years) in the elderly group and 77.4 years (range, 75-80 years) in the control group. The preoperative performance status was significantly worse in the elderly group than in the control group (P < 0.001). The surgical time was not significantly different between the two groups (P = 0.09). The occurrences of intraoperative and postoperative complications were not significantly different between the two groups (P = 0.19 and P = 0.07, respectively). The result of the present study indicates that cutaneous surgery for very elderly patients 90 years of age and older is as safe as for patients ranging in age from 75-80 years old. © 2017 The International Society of Dermatology.

  5. Postoperative urinary retention in patients undergoing elective spinal surgery.

    PubMed

    Altschul, David; Kobets, Andrew; Nakhla, Jonathan; Jada, Ajit; Nasser, Rani; Kinon, Merritt D; Yassari, Reza; Houten, John

    2017-02-01

    OBJECTIVE Postoperative urinary retention (POUR) is a common problem leading to morbidity and an increased hospital stay. There are limited data regarding its baseline incidence in patients undergoing spinal surgery and the risk factors with which it may be associated. The purpose of this study was to evaluate the incidence of POUR in elective spine surgery patients and determine the factors associated with its occurrence. METHODS The authors retrospectively reviewed the records of patients who had undergone elective spine surgery and had been prospectively monitored for POUR during an 18-month period. Collected data included operative positioning, surgery duration, volume of intraoperative fluid, length of hospital stay, and patient characteristics such as age, sex, and medical comorbidities. Dialysis patients or those with complete urinary retention preoperatively were excluded from analysis. RESULTS Of the 397 patients meeting the study inclusion criteria, 35 (8.8%) developed POUR. An increased incidence of POUR was noted in those who underwent posterior lumbar surgery, those with benign prostatic hypertrophy (BPH), those with chronic constipation or prior urinary retention, and those using a patient-controlled analgesia pump postoperatively. An increased incidence of POUR was seen with a longer operative time but not with intraoperative intravenous fluid administration. A significant relationship between the female sex and POUR was noted after controlling for BPH, yet there was no association between POUR and diabetes or intraoperative instrumentation. Postoperative retention significantly prolonged the hospital stay. Three patients developed epidural hematomas necessitating operative reexploration, and while they experienced POUR, they also developed the full constellation of cauda equina syndrome. CONCLUSIONS Awareness of the risk factors for POUR may be useful in perioperative Foley catheter management and in identifying patients who need particular

  6. Neopterin: a potential biomarker for delirium in elderly patients.

    PubMed

    Egberts, Angelique; Wijnbeld, Eline H A; Fekkes, Durk; van der Ploeg, Milly A; Ziere, Gijsbertus; Hooijkaas, Herbert; van der Cammen, Tischa J M; Mattace-Raso, Francesco U S

    2015-01-01

    The diagnosis of delirium is not supported by specific biomarkers. In a previous study, high neopterin levels were found in patients with a postoperative delirium. In the present study, we investigated levels of neopterin, interleukin-6 (IL-6) and insulin-like growth factor-1 (IGF-1) in acutely ill admitted elderly patients with and without a delirium. Plasma/serum levels of neopterin, IL-6 and IGF-1 were determined in patients aged ≥65 years admitted to the wards of Internal Medicine and Geriatrics. Differences in biomarker levels between patients with and without a delirium were investigated by the analysis of variance in models adjusted for age, gender, comorbidities and eGFR (when appropriate). Eighty-six patients were included; 23 of them with a delirium. In adjusted models, higher mean levels of neopterin (70.5 vs. 45.9 nmol/l, p = 0.009) and IL-6 (43.1 vs. 18.5 pg/ml, p = 0.034) and lower mean levels of IGF-1 (6.3 vs. 9.3 nmol/l, p = 0.007) were found in patients with a delirium compared to those without. The findings of this study suggest that neopterin might be a potential biomarker for delirium which, through oxidative stress and activation of the immune system, may play a role in the pathophysiology of delirium. © 2014 S. Karger AG, Basel.

  7. Which deep breathing device should the postoperative patient use?

    PubMed

    Lederer, D H; Van de Water, J M; Indech, R B

    1980-05-01

    A study was undertaken to compare the use of three types of deep-breathing devices in patients undergoing upper-abdominal operations. Seventy-nine patients were divided into three groups, each receiving preoperative bedside testing of pulmonary function and instruction in the use of one of three randomly assigned deep-breathing devices thought to be representative of those currently available (Triflo II, Bartlett-Edwards Incentive Spirometer, or Spirocare). Repeat testing and instruction were provided daily during each of the first five postoperative days. There were few statistically significant differences in pulmonary function, vital signs and white blood cell count, and no difference in length of postoperative stay. No device was uniformly acceptable to patients, and none was used as frequently as recommended. When left at the bedside and only one daily reinforcement of instructions, the three devices showed no clinically important differences.

  8. Quality of life in elderly cancer patients.

    PubMed

    Repetto, L; Ausili-Cefaro, G; Gallo, C; Rossi, A; Manzione, L

    2001-01-01

    Increasing age is a major risk factor for developing cancer and the number of older people is rapidly expanding. Therefore, cancer in the geriatric population is becoming an emerging problem. Older patients are extremely heterogeneous. Instruments collecting information related to comorbidity and disability, (which have both been demonstrated to affect the survival of elderly patients) may help treatment decision. The G.I.O.Ger (Gruppo Italiano di Oncologia Geriatrica) has validated a Comprehensive Geriatric Assessment (CGA) scale for geriatric cancer patients, and we recommend its use in clinical practice. Our findings suggest that cancer adversely affects physical performance and psychological status less than other comorbidities. Many aspects of physical limitations are not totally recognised by performance status, in particular those aspects of daily life that require instrumental activities and that may affect adherence to diagnostic or therapeutic protocols. Quality of life as a main objective in the management of elderly cancer patients is now recognized by many clinicians. In clinical practice. quality of life means maintenance of function and symptom control, and quality-of-life instruments rated by the patient rather than by clinicians should be preferred. Whether it is preferable to use cancer-specific or generic instruments is an ongoing debate.

  9. Non-invasive ventilation in postoperative patients: a systematic review.

    PubMed

    Chiumello, D; Chevallard, G; Gregoretti, C

    2011-06-01

    Postoperative pulmonary complications, generally defined as any pulmonary abnormality occurring in the postoperative period, are still a significant issue in clinical practice increasing hospital length of stay, morbidity and mortality. Non-invasive ventilation (NIV), primarily applied in cardiogenic pulmonary edema, decompensated COPD and hypoxemic pulmonary failure, is nowadays also used in perioperative settings. Investigate the application and results of preventive and therapeutic NIV in postsurgical patients. A systematic review. Medical literature databases were searched for articles about "clinical trials," "randomized controlled trials" and "meta-analyses." The keywords "cardiac surgery," "thoracic surgery," "lung surgery," "abdominal surgery," "solid organ transplantation," "thoraco-abdominal surgery" and "bariatric surgery" were combined with any of these: "non-invasive positive pressure ventilation," "continuous positive airway pressure," "bilevel ventilation," "postoperative complications," "postoperative care," "respiratory care," "acute respiratory failure," "acute lung injury" and "acute respiratory distress syndrome." Twenty-nine articles (N=2,279 patients) met the inclusion criteria. Nine studies evaluated NIV in post-abdominal surgery, three in thoracic surgery, eight in cardiac surgery, three in thoraco-abdominal surgery, four in bariatric surgery and two in post solid organ transplantation used both for prophylactic and therapeutic purposes. NIV improved arterial blood gases in 15 of the 22 prophylactic and in 4 of the 7 therapeutic studies, respectively. NIV reduced the intubation rate in 11 of the 29 studies and improved outcome in only 1. Despite these limited data and the necessity of new randomized trials, NIV could be considered as a prophylactic and therapeutic tool to improve gas exchange in postoperative patients. © Copyright jointly held by Springer and ESICM 2011

  10. [Postoperative period pecularities in patients of 70 years and older with ischemic heart disease after myocardial revasculization].

    PubMed

    Ziuliaeva, T P; Babaev, M A; Eremenko, A A; Zhbanov, I V; Molochkov, A V

    2013-01-01

    A comparative analysis of preoperative risk factors and postoperative period flow in patients older than 70 years (58 people) in comparison with control group aged 40-63 years (62 patients), undergoing myocardial revasculization was conducted. . Significantly higher rates of rhythm disturbances, arterial hypertension, lung diseases, chronic renal insufficiency, atherosclerotic carotid artery disease, lower limb atherosclerotic disease were found in patients older than 70 years preoperatively. It leads to postoperative complications and requires special preoperative correction. Complications incidence after CABG was higher by 1.7 times in patients older than 70 versus control group. The most frequent complications were: rhythm disturbances (in 5 times more often, than control group), respiratory failure (which in 70% of cases was caused by COPD), cerebral complications (in 2,5 times more often, than in control group). Myocardial revasculization surgery in elderly patients is effective treatment method and can be performed with good immediate results.

  11. Supportive therapy of elderly cancer patients.

    PubMed

    De Cicco, Marcello; Bortolussi, Roberto; Fantin, Dario; Matovic, Mira; Fracasso, Augusto; Fabiani, Fabio; Santantonio, Cristina

    2002-05-01

    Elderly cancer patients often require supportive care due to the physiologic decline of organs and apparatus linked with the aging process per se, and for the effects of tumor or of anticancer treatments. Pain and nutritional deficits are some clinical aspects requiring supportive care. Lack of studies on these latter topics does not allow an in depth analysis of the problem. The present review deals with literature concerning pain and nutritional problems in the general cancer population with emphasis on aspects typical for elderly cancer subjects. Physiologic and cancer-related changes in body composition, physical function and cognitive capacity of the elderly are presented and, when appropriate, linked with pathogenetic factors of pain and malnutrition, as well as their treatment. Pain demographic data, pain intensity evaluation and currently available techniques to provide pain relief such as etiologic treatment, analgesic pharmacotherapy and invasive analgesic procedures, are extensively discussed. Causes and assessment of malnutrition as well as available nutritional approaches such as oral, enteral and parenteral nutrition are also debated.

  12. [Prescription drug abuse in elderly psychiatric patients].

    PubMed

    Wetterling, Tilman; Schneider, Barbara

    2012-08-01

    Due to demographic changes there will be a fraction of elderly patients with substance use disorders. However, only a few data have been published about elderly abusers of prescription drugs. Since substance abuse is frequently comorbid with psychiatric disorders, treatment in a psychiatric hospital is often needed. In this explorative study elderly people with prescription drug abuse who required psychiatric inpatient treatment should be characterized. This study was part of the gerontopsychiatry study Berlin (Gepsy-B), an investigation of the data of all older inpatients (≥ 65 years) admitted to a psychiatric hospital within a period of 3 years. Among 1266 documented admissions in 110 cases (8.7 %) (mean age: 75.7 ± 7.1 years) prescription drug abuse, mostly of benzodiazepines was diagnosed. Females showed benzodiazepine abuse more often than males. In only a small proportion of the cases the reason for admission was withdrawal of prescribed drugs. 85.5 % suffered from psychiatric comorbidity, mostly depression. As risk factors for abuse depressive symptoms (OR: 3.32) as well as concurrent nicotine (OR: 2.69) or alcohol abuse (OR: 2.14) were calculated. Psychiatric inpatient treatment was primarily not necessary because of prescription drug abuse but because of other psychopathological symptoms. © Georg Thieme Verlag KG Stuttgart · New York.

  13. Microvascular decompression for elderly patients with trigeminal neuralgia.

    PubMed

    Phan, Kevin; Rao, Prashanth J; Dexter, Mark

    2016-07-01

    Microvascular decompression (MVD) has been demonstrated to be an excellent surgical treatment approach in younger patients with trigeminal neuralgia (TN). However, it is not clear whether there are additional morbidity and mortality risks for MVD in the elderly population. We performed a systematic literature review using six electronic databases for studies that compared outcomes for MVD for TN in elderly (cut-off ⩾60, 65, 70years) versus younger populations. Outcomes examined included success rate, deaths, strokes, thromboembolism, meningitis, cranial nerve deficits and cerebrospinal fluid leaks. There were 1524 patients in the elderly cohort and 3488 patients in the younger cohort. There was no significant difference in success rates in elderly versus younger patients (87.5% versus 84.8%; P=0.47). However, recurrence rates were lower in the elderly (11.9% versus 15.6%; P=0.03). The number of deaths in the elderly cohort was higher (0.9% versus 0.1%; P=0.003). Rates of stroke (2.5% versus 1%) and thromboembolism (1.1% versus 0%) were also higher for elderly TN patients. No differences were found for rates of meningitis, cranial nerve deficits or cerebrospinal fluid leak. MVD remains an effective and reasonable strategy in the elderly population. There is evidence to suggest that rates of complications such as death, stroke, and thromboembolism may be significantly higher in the elderly population. The presented results may be useful in the decision-making process for MVD in elderly patients with TN.

  14. [Radical cystectomy as a muscle-invasive bladder cancer treatment in elderly patients].

    PubMed

    March Villalba, J A; Martínez Jabaloyas, J M; Pastor Hernández, F; Günthner Stefan, F J; Rodríguez Navarro, R; Chuan Nuez, P

    2008-01-01

    Radical cystectomy in elderly is a controversial issue that increases importance overtime because average life span is growing. The purpose of our work was to analize the differences about perioperative and later outcomes between ages of patients with muscle-invasive bladder neoplasm treated with radical cystectomy. We retrospectively reviewed the records of patients who underwent radical cystectomy for muscle-invasive bladder cancer. Two age groups were compared: < 70-years-old at time of cystectomy (n = 55) and > or = 70 years (n = 57). There was no difference between both age groups about: time of surgery, intraoperative complications (< 70 = 21,8%, > or = 70 = 31,6%), postoperative mortality (< 70 = 3,6%, > or = 70 = 8,8%), minor (< 70 = 18,2%, > or = 70 = 26,3%) and major medical postoperative complications (< 70 = 7,3%, > or = 70 = 8,8%), late outcomes as cancer-specific morby-mortality and actuarial overall survival stratified by patient age. The rate of major postoperative complications (< 70 = 23,6%, > or = 70 = 43,9%) as well as the mean length of hospital stay (< 70 = 10,2, > or = 70 = 15,2 days) differed significantly between the two age groups. Age and cardiovascular risk factors were independient predictive factors of mayor postoperative complications. Radical cystectomy could be performed in carefully selected elderly patients.

  15. How patients fare after anaesthesia for elective surgery: a survey of postoperative nausea and vomiting, pain and confusion

    PubMed Central

    Lee, Yun Zhi; Lee, Ruth Qianyi; Thinn, Kyu Kyu; Poon, Keah How; Liu, Eugene Hern Choon

    2015-01-01

    INTRODUCTION Postoperative nausea and vomiting (PONV), and postoperative pain are common during the early postoperative period. In addition to these problems, elderly patients risk developing postoperative confusion. This study aimed to identify the risk factors associated with these problems, and the extent of these problems, in a Singapore inpatient surgical population. METHODS Over a period of six weeks, we surveyed 707 elective surgical inpatients aged ≥ 18 years who received general anaesthesia and/or regional anaesthesia. RESULTS The incidence of PONV was 31.8%(95% confidence interval [CI] 34.8–41.9). The incidence increased with increasing Apfel score (p < 0.001) and were higher in female patients (odds ratio [OR] 1.74, 95% CI 1.28–2.36), non-smokers (OR 1.72, 95% CI 1.04–2.88), patients with a history of PONV and/or motion sickness (OR 3.45, 95% CI 2.38–5.24), patients who received opioids (OR 1.39, 95% CI 1.03–1.88), and patients who received general anaesthesia (OR 1.76, 95% CI 1.11–2.79). Moderate to severe pain at rest and with movement were reported in 19.9% and 52.5% of patients, respectively. Among the patients who were predicted to experience mild pain, 29.5% reported moderate pain and 8.1% reported severe pain. The prevalence of postoperative confusion was 3.9% in the geriatric population. CONCLUSION Higher Apfel scores were associated with a higher risk of PONV and multimodal treatment for postoperative pain management was found to be insufficient. The incidence of postoperative confusion was low in this study. PMID:25640098

  16. How patients fare after anaesthesia for elective surgery: a survey of postoperative nausea and vomiting, pain and confusion.

    PubMed

    Lee, Yun Zhi; Lee, Ruth Qianyi; Thinn, Kyu Kyu; Poon, Keah How; Liu, Eugene Hern

    2015-01-01

    Postoperative nausea and vomiting (PONV), and postoperative pain are common during the early postoperative period. In addition to these problems, elderly patients risk developing postoperative confusion. This study aimed to identify the risk factors associated with these problems, and the extent of these problems, in a Singapore inpatient surgical population. Over a period of six weeks, we surveyed 707 elective surgical inpatients aged ≥ 18 years who received general anaesthesia and/or regional anaesthesia. The incidence of PONV was 31.8% (95% confidence interval [CI] 34.8-41.9). The incidence increased with increasing Apfel score (p < 0.001) and were higher in female patients (odds ratio [OR] 1.74, 95% CI 1.28-2.36), non-smokers (OR 1.72, 95% CI 1.04-2.88), patients with a history of PONV and/or motion sickness (OR 3.45, 95% CI 2.38-5.24), patients who received opioids (OR 1.39, 95% CI 1.03-1.88), and patients who received general anaesthesia (OR 1.76, 95% CI 1.11-2.79). Moderate to severe pain at rest and with movement were reported in 19.9% and 52.5% of patients, respectively. Among the patients who were predicted to experience mild pain, 29.5% reported moderate pain and 8.1% reported severe pain. The prevalence of postoperative confusion was 3.9% in the geriatric population. Higher Apfel scores were associated with a higher risk of PONV and multimodal treatment for postoperative pain management was found to be insufficient. The incidence of postoperative confusion was low in this study.

  17. Levetiracetam clinical pharmacokinetics in elderly and very elderly patients with epilepsy.

    PubMed

    Contin, M; Mohamed, S; Albani, F; Riva, R; Baruzzi, A

    2012-02-01

    We aimed to compare apparent steady-state oral clearance (CL/F) of the antiepileptic drug levetiracetam (LEV) in elderly (66-80 years, n=105) and very elderly (81-96 years, n=70) vs nonelderly (30-65 years, n=97) patients with epilepsy. Median weight-normalized CL/F (mLmin(-1)kg(-1)) decreased from 1.23 (nonelderly) to 0.83 (elderly) and 0.59 (very elderly) (p<0.001). LEV CL/F significantly declines with aging, elderly and very elderly patients requiring an about 30% and 50% lower dose, respectively, compared to nonelderly adults to achieve a given LEV plasma concentration. Copyright © 2011 Elsevier B.V. All rights reserved.

  18. Hepatocellular carcinoma in elderly patients: challenges and solutions

    PubMed Central

    Brunot, Angélique; Le Sourd, Samuel; Pracht, Marc; Edeline, Julien

    2016-01-01

    Hepatocellular carcinoma (HCC) is the second most common cause of death by cancer in the world. Due to the delayed HCC development in hepatitis C carriers and nonalcoholic fatty liver disease, the incidence of HCC in the elderly is increasing and is becoming a global health issue. Elderly patients with HCC should be assessed through proper oncologic approach, namely, screening tools for frailty (Geriatric-8 or Vulnerable Elders Survey-13) and comprehensive geriatric assessment. This review of the literature supports the same treatment options for elderly patients as for younger patients, in elderly patients selected as fit following proper oncogeriatric assessment. Unfit patients should be managed through a multidisciplinary team involving both oncological and geriatrician professionals. Specific studies and recommendations for HCC in the elderly should be encouraged. PMID:27574587

  19. Hepatocellular carcinoma in elderly patients: challenges and solutions.

    PubMed

    Brunot, Angélique; Le Sourd, Samuel; Pracht, Marc; Edeline, Julien

    2016-01-01

    Hepatocellular carcinoma (HCC) is the second most common cause of death by cancer in the world. Due to the delayed HCC development in hepatitis C carriers and nonalcoholic fatty liver disease, the incidence of HCC in the elderly is increasing and is becoming a global health issue. Elderly patients with HCC should be assessed through proper oncologic approach, namely, screening tools for frailty (Geriatric-8 or Vulnerable Elders Survey-13) and comprehensive geriatric assessment. This review of the literature supports the same treatment options for elderly patients as for younger patients, in elderly patients selected as fit following proper oncogeriatric assessment. Unfit patients should be managed through a multidisciplinary team involving both oncological and geriatrician professionals. Specific studies and recommendations for HCC in the elderly should be encouraged.

  20. Long Term Outcomes of a Geriatric Liaison Intervention in Frail Elderly Cancer Patients

    PubMed Central

    Hempenius, Liesbeth; Slaets, Joris P. J.; van Asselt, Dieneke; de Bock, Truuske H.; Wiggers, Theo; van Leeuwen, Barbara L.

    2016-01-01

    Background The aim of this study was to evaluate the long term effects after discharge of a hospital-based geriatric liaison intervention to prevent postoperative delirium in frail elderly cancer patients treated with an elective surgical procedure for a solid tumour. In addition, the effect of a postoperative delirium on long term outcomes was examined. Methods A three month follow-up was performed in participants of the Liaison Intervention in Frail Elderly study, a multicentre, prospective, randomized, controlled trial. Patients were randomized to standard treatment or a geriatric liaison intervention. The intervention consisted of a preoperative geriatric consultation, an individual treatment plan targeted at risk factors for delirium and daily visits by a geriatric nurse during the hospital stay. The long term outcomes included: mortality, rehospitalisation, Activities of Daily Living (ADL) functioning, return to the independent pre-operative living situation, use of supportive care, cognitive functioning and health related quality of life. Results Data of 260 patients (intervention n = 127, Control n = 133) were analysed. There were no differences between the intervention group and usual-care group for any of the outcomes three months after discharge. The presence of postoperative delirium was associated with: an increased risk of decline in ADL functioning (OR: 2.65, 95% CI: 1.02–6.88), an increased use of supportive assistance (OR: 2.45, 95% CI: 1.02–5.87) and a decreased chance to return to the independent preoperative living situation (OR: 0.18, 95% CI: 0.07–0.49). Conclusions A hospital-based geriatric liaison intervention for the prevention of postoperative delirium in frail elderly cancer patients undergoing elective surgery for a solid tumour did not improve outcomes 3 months after discharge from hospital. The negative effect of a postoperative delirium on late outcome was confirmed. Trial Registration Nederlands Trial Register, Trial ID NTR 823

  1. [Prevalence of metabolic syndrome in elderly patients].

    PubMed

    Castro Vilela, María Elena; Quílez Pina, Raquel María; Bonafonte Marteles, José Luis; Morlanes Navarro, Teresa; Calvo Gracia, Fernando

    2014-01-01

    To determine the prevalence of metabolic syndrome (MS) according to the definitions of the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) and the International Diabetes Federation (IDF) and its relation to cardiovascular disease (CVD) in hospitalized elderly patients. This descriptive and prospective study (February-March 2011) included 200 consecutive patients hospitalized in a Geriatric Department. Sociodemographic, clinical and biochemical data was collected. The prevalence of MS was 65% (NCEP-ATP III) and 67.5% (IDF) and was greater in women (NCEP-ATP III=72.8%, IDF=73.6%) than in men (NCEP-ATP III=50.7%; IDF=56.3%). The mean age of patients diagnosed with MS by both diagnostic criteria were similar: 84.7 years. MS was not associated with an increased prevalence of CVD. MS is highly prevalent in elderly hospitalized patients, being higher in women, with both diagnostic criteria (NCEP- ATP III and IDF). In our population the MS was not associated with an increased prevalence of CVD. Copyright © 2013 SEGG. Published by Elsevier Espana. All rights reserved.

  2. Protein depletion and metabolic stress in elderly patients who have a fracture of the hip.

    PubMed

    Patterson, B M; Cornell, C N; Carbone, B; Levine, B; Chapman, D

    1992-02-01

    A prospective study was performed to determine the effect of protein depletion and postoperative nutritional status on the outcome in sixty-three elderly patients who had been admitted to the hospital because of a fracture of the hip. The parameters that were used to determine the degree of protein depletion included levels of albumin, of prealbumin, and of transferrin; total lymphocyte count; and nitrogen-balance studies. The outcomes that were examined were the development of complications, the length of the stay in the hospital, the ability to return to the pre-fracture level of function, and over-all survivorship. The hypothesis was that the acute fracture and the subsequent operation are severe stresses in these elderly, often compromised patients. The results supported the hypothesis. Thirty-seven patients (58 per cent) in the study group were in a protein-depleted state during the period of hospitalization. The patients who were protein-depleted had a higher prevalence of complications, were less likely to return to their pre-fracture environment, and tended to stay in the hospital longer, as compared with the nonprotein-depleted patients. Survivorship analysis showed that protein-depleted patients had a significantly lower probability of survival one year after the fracture of the hip (p = 0.02). Elderly patients who sustain the trauma of a fracture of the hip should be managed appropriately with regard to intake of nutrients in the postoperative period.

  3. [Cancer treatment in elderly patients: evidence and clinical research].

    PubMed

    Repetto, Lazzaro; Luciani, Andrea

    2015-01-01

    In 2020 the percentage of patients with a diagnosis of cancer in people with more than 65 years will exceed 70% and 28% in ethnic minorities. The treatment of cancer in these populations is challenging for the oncologists due to socio-economic issues such as poverty, reduced access to the hospital care, level of education. The clinical pathway "diagnosis-treatment-cure", typical of the care of young patients has to be integrated in elderly patients with a more individualized treatment by means of comprehensive geriatric assessment (CGA). IADL (Instrumental Activities of Daily Living) have the best predictive role in oncological setting and their impairment significantly correlate with overall survival, chemotherapy toxicities and thirty days postoperative morbidities. The CGA is universally accepted as the most appropriate instrument to analitically evaluate the age related problems of elderly patients. The role of CGA is crucial to identify geriatric issues not easily diagnosed, to predict treatment toxicities, functional or cognitive decline, post operative complications and to estimate life expectancy. The CGA items are predictive of severe toxicity, however it is not clearly established which are the best performers and the best cut-offs points. Today CGA is integrated with physical performance tests (the most widely used is the "time up and go" test) and laboratory assay of Interleukin 6 and D-Dimer that correlate with mortality and physical decline. There are few prospective studies that evaluated the role of CGA in treatment choice. The first is a phase II study in solid tumors, the second is a haematological trial on non Hodgkin lymphoma. The largest trial is a 571 patients observational series that confirmed the role of CGA in decision making. The administration of CGA is time consuming and consequently some screening tools were developed. VES-13 is a 13 items tool that explores prevalently the functional status and the self reported health status. VES-13

  4. Treatment of complex postoperative lumbosacral wounds in nonparalyzed patients.

    PubMed

    Wendt, J R; Gardner, V O; White, J I

    1998-04-01

    Postoperative infections after back operations can produce complex wounds with myonecrosis, deep dead space, and exposed orthopedic hardware, bone, and dura. Three ambulatory patients with complex postoperative back wounds that resulted from infections were treated successfully with antibiotics, debridement, irrigation, and closure of deep dead space with a superior gluteal muscle flap. Several surgical maneuvers can be performed to increase the length of the superior gluteal muscle flap. The inferior portion of the gluteus maximus was left intact to preserve gluteus maximus function. All three patients obtained healed wounds. The exposed A.O. plating system was not removed. There has not been any recurrence of infections. The superior gluteal muscle flap is a reasonable flap to fill deep dead space in the low back and has some advantages over free flaps.

  5. Predictive model for postoperative delirium in cardiac surgical patients.

    PubMed

    Afonso, Anoushka; Scurlock, Corey; Reich, David; Raikhelkar, Jayashree; Hossain, Sabera; Bodian, Carol; Krol, Marina; Flynn, Brigid

    2010-09-01

    Delirium is a common complication following cardiac surgery, and the predictors of delirium remain unclear. The authors performed a prospective observational analysis to develop a predictive model for postoperative delirium using demographic and procedural parameters. A total of 112 adult postoperative cardiac surgical patients were evaluated twice daily for delirium using the Richmond Agitation-Sedation Scale (RASS) and Confusion Assessment Model for the ICU (CAM-ICU). The incidence of delirium was 34% (n = 38). Increased age (odds ratio [OR] = 2.5; 95% confidence interval [CI] = 1.6-3.9; P < .0001, per 10 years) and increased duration of surgery (OR = 1.3; 95% CI = 1.1-1.5; P = .0002, per 30 minutes) were independently associated with postoperative delirium. Gender, BMI, diabetes mellitus, preoperative ejection fraction, surgery type, length of cardiopulmonary bypass, intraoperative blood component administration, Acute Physiology and Chronic Health Evaluation II score, Sequential Organ Failure Assessment score, and Charlson Comorbidity Index, were not independently associated with postoperative delirium.

  6. Descending necrotizing mediastinitis in the elderly patients

    PubMed Central

    Mazzella, Antonio; Santagata, Mario; Cecere, Atirge; La Mart, Ettore; Fiorelli, Alfonso; Tartaro, Gianpaolo; Tafuri, Domenico; Testa, Domenico; Grella, Edoardo; Perrotta, Fabio; Mazzarella, Gennaro; Santini, Mario

    2016-01-01

    Abstract Descending Necrotizing Mediastinitis (DNM) is a polymicrobic, dangerous and often fatal process, arising from head or neck infections and spreading along the deep fascial cervical planes, descending into the mediastinum. It can rapidly progress to sepsis and can frequently lead to death. It has a high mortality rate, up to 40% in the different series, as described in the literature. Surgical and therapeutic management has been discussed for long time especially in an elderly patient population. The literature has been reviewed in order to evaluate different pathogenesis and evolution and to recognise a correct therapeutic management. PMID:28352835

  7. Pharmacotherapy for nocturia in the elderly patient.

    PubMed

    Asplund, Ragnar

    2007-01-01

    Nocturia may be attributable to nocturnal polyuria (nocturnal urine overproduction), a diminished nocturnal bladder capacity or a combination of the two conditions.A disorder of the vasopressin (antidiuretic hormone) system with very low or undetectable levels of vasopressin at night, affecting some elderly people, may cause an increase in the nocturnal urine output, which in the most extreme cases accounts for 85% of the 24-hour diuresis. The increased urine output can be treated with desmopressin orally at bedtime, generally using low doses. Self-imposed fluid restrictions before bedtime are not effective in reducing the nocturnal urine output in this condition. Nocturia is also more prevalent in association with a reduced bladder capacity. Antimuscarinic drugs are used in attempts to depress involuntary bladder contractions. Decreased nocturnal voided volumes in men and consequent increased nocturia may suggest difficulty in emptying the bladder or detrusor overactivity. alpha(1)-Adrenoceptor antagonists and 5alpha-reductase inhibitors are often used in men with symptoms indicative of benign prostatic hyperplasia, and one of their effects is reduction of nocturia. In women, estrogen deficiency, a common consequence of the menopausal transition, causes atrophic changes within the urogenital tract. Consequently, such women are more disposed to having urogenital symptoms, among them nocturia. This review emphasises the importance of correctly diagnosing and treating nocturia in elderly patients. This will improve patients' sleep and, in turn, reduce their risk of fall injuries and the associated detrimental consequences, thereby improving patients' health and quality of life.

  8. [Modified Latarjet procedure for recurrent shoulder dislocation in elderly patients].

    PubMed

    Hart, R; Sváb, P; Krejzla, J

    2010-04-01

    The aim of this prospective study was to report on an open approach to a bony defect of the glenoid associated with anterior shoulder instability, using a modified Latarjet procedure, in elderly patients. From 2003 to 2005, 11 patients older than 50 years underwent an open Latarjet procedure performed by two senior surgeons. The mean age of the patients was 65 years (range, 51 to 79 years). All of them were available for follow-up examination. There were seven women and four men. The study inclusion criteria were a bony defect of the anterior glenoid confirmed by a CT scan, age over 50 years, and three or more previous dislocations.The mean pre-operative forward elevation was 121.2 degrees+/-16.6 degrees (range, 40 degrees-180 degrees) and external rotation was 43.3 degrees+/-13.1 degrees (range, 5 degrees-80 degrees). The mean number of dis- locations before surgery was 4.8 (range, 3-8). The Latarjet operation makes use of a large coracoid bone graft to extend the glenoid articular surface by means of a lengthened bone platform, and a sling effect of the conjoined tendon passing through the subscapularis muscle. The Constant-Murley score was used to evaluate the results. Shoulder stability and function were restored in all 11 patients at a minimum follow-up of 4 years (range, 49-69 months). There was no recurrence of instability. The range of motion was minimally reduced; the mean loss of elevation was 18.8 degrees and the mean loss of external rotation was 4.0 degrees. The mean Constant-Murley score increased from 56.4+/-13.3 points preoperatively to 81.8+/-11.3 points post-operatively (p<0.05). No significant post-operative complications were observed. It is necessary to differentiate between the Latarjet procedure and its modification popularised by Helfet as the Bristow or the Bristow-Latarjet operation. The Bristow procedure transfers only the tip of the coracoid, along with the attached con- joined tendon, to the anterior side of the neck. This procedure

  9. Surgical outcomes of elderly patients with cervical spondylotic myelopathy: a meta-analysis of studies reporting on 2868 patients.

    PubMed

    Madhavan, Karthik; Chieng, Lee Onn; Foong, Hanyao; Wang, Michael Y

    2016-06-01

    group had lower Japanese Orthopaedic Association (JOA) scores (MD -1.36, 95% CI -1.62 to -1.09; p < 0.00001) to begin with compared with the nonelderly group. The nonelderly group also had a higher postoperative JOA score (MD -1.11, 95% CI -1.44 to -0.79; p < 0.00001), therefore demonstrating a higher recovery rate from surgeries (MD -11.98, 95% CI -16.16 to -7.79; p < 0.00001). The length of stay (MD 4.14, 95% CI 3.54-4.73; p < 0.00001) was slightly longer in the elderly group. In terms of radiological outcomes, the elderly group had a smaller postoperative Cobb angle but a greater increase in spinal canal diameter compared with the nonelderly group. The complication rates were not significant. CONCLUSIONS Cervical myelopathy is a disease of the elderly, and age is an independent factor for recovery from surgery. Postoperative and long-term outcomes have been remarkable in terms of improvement in mobility and independence requiring reduced nursing care. There is definitely a higher potential risk while operating on the elderly population, but no significant difference in the incidence of postoperative complications was noted. Withholding surgery from the elderly population can lead to increased morbidity due to rapid progression of symptoms in addition to deconditioning from lack of mobility and independence. Reduction in operative time under anesthesia, lower blood loss, and perioperative fluid management have been shown to minimize the complication rate. The authors request that neurosurgeons weigh the potential benefit against the risks for every patient before withholding surgery from elderly patients.

  10. Sternal wrapping for the prevention of sternal morbidity in elderly osteoporotic patients undergoing median sternotomy.

    PubMed

    Kirbas, Ahmet; Celik, Sezai; Gurer, Onur; Yildiz, Yahya; Isik, Omer

    2011-01-01

    Osteoporosis, a major risk factor for sternum-related morbidity after median sternotomy, is quite prevalent among the elderly. In this prospective study, we investigated the potential of sternal protection by use of the "sternal wrapping method" in elderly osteoporotic patients who were undergoing median sternotomy.For this study, we chose 100 elderly osteoporotic patients who were scheduled to undergo median sternotomy. During surgery, we wrapped the sternal edges with polyvinyl chloride tubing in 50 patients (group 1) and omitted the sternal wrapping in the remaining 50 patients (group 2). We then compared the groups with regard to postoperative pain, bleeding, early and late sternum-related morbidity, sternal fractures, and duration of hospitalization.Sternal wrapping was associated with fewer sternal fractures, less chest pain, and shorter hospital stays. Overall sternal morbidity was significantly less common among patients with sternal wrapping (4% vs. 20%, P = 0.03); however, the difference in individual rates for early and late dehiscence or deep sternal infection did not reach statistical significance.Sternal wrapping using polyvinyl chloride tubes provides mechanical protection and, apparently, less postoperative chest pain and shorter hospitalizations. Probably, it reduces sternum-related complications, particularly in high-risk patients. Its benefits, however, should be confirmed in larger studies.

  11. Predicting postoperative visual outcomes in cataract patients with maculopathy

    PubMed Central

    Macky, Tamer A; Mohamed, Abdel Moniem Hasaballah; Emarah, Ahmed M; Osman, Amr Abdellatif; Gado, Ahmed S

    2015-01-01

    Purpose: To assess the accuracy of the potential acuity meter (PAM) in predicting postcataract surgery visual acuity outcome in patients with healed inactive maculopathies. Study Design: Prospective interventional clinical trial. Patients and Methods: Patients scheduled for phacoemulsification had preoperative and 1 month postoperative best-corrected visual acuity (BCVA), PAM test, fluorescein angiography, and macular optical coherence tomography. Patients were grouped to following preoperative BCVA: PRE1: 0.29 and better, PRE2: 0.25–0.13, and PRE3: 0.1 or worse; age: G1 <60, G2 = 60–70, and G3 >70 years. PAM accuracy was divided into: Grade 1: Postoperative BCVA ≤1 or less line error of the PAM score, Grade 2: Between 1 and 2 lines error, and Grade 3: ≥3 lines or more error. Results: This study enrolled 57 patients with a mean age of 71.05 ± 6.78 years where 34 were females. There were 21 (36.84%) patients with diabetic maculopathy and 36 (63.16%) with age-related macular degeneration. The mean preoperative BCVA was 0.198 ± 0.12 (0.1–0.5). The mean PAM score was 0.442 ± 0.24 (0.1–1.3). The mean postoperative BCVA was 0.4352 ± 0.19 (0.17–1.00). The PAM score was in Grade 1, 2, and 3 in 46 (80.7%), 54 (94.7%), and 56 (98.2), respectively. There was a highly significant correlation between the PAM score and the postoperative BCVA (P < 0.001, Chi-square test). There was no correlation between the PAM test accuracy and age, gender, diagnosis, and preoperative BCVA (P = 0.661, 0.667, 0. 0.991, 0.833, Chi-square test; respectively). Conclusion: The PAM is an accurate method of predicting postoperative visual acuity for eyes with nuclear cataracts Grade I and II and inactive maculopathies. PMID:26655002

  12. Model for risk adjustment of postoperative mortality in patients with colorectal cancer.

    PubMed

    Walker, K; Finan, P J; van der Meulen, J H

    2015-02-01

    A model was developed for risk adjustment of postoperative mortality in patients with colorectal cancer in order to make fair comparisons between healthcare providers. Previous models were derived in relatively small studies with the use of suboptimal modelling techniques. Data from adults included in a national study of major surgery for colorectal cancer were used to develop and validate a logistic regression model for 90-day mortality. The main risk factors were identified from a review of the literature. The association with age was modelled as a curved continuous relationship. Bootstrap resampling was used to select interactions between risk factors. A model based on data from 62 314 adults was developed that was well calibrated (absolute differences between observed and predicted mortality always smaller than 0·75 per cent in deciles of predicted risk). It discriminated well between low- and high-risk patients (C-index 0·800, 95 per cent c.i. 0·793 to 0·807). An interaction between age and metastatic disease was included as metastatic disease was found to increase postoperative risk in young patients aged 50 years (odds ratio 3·53, 95 per cent c.i. 2·66 to 4·67) far more than in elderly patients aged 80 years (odds ratio 1·48, 1·32 to 1·66). Use of this model, estimated in the largest number of patients with colorectal cancer to date, is recommended when comparing postoperative mortality of major colorectal cancer surgery between hospitals, clinical teams or individual surgeons. © 2014 BJS Society Ltd. Published by John Wiley & Sons, Ltd.

  13. Postoperative seizure control in patients with tumor-associated epilepsy.

    PubMed

    Neal, Andrew; Morokoff, Andrew; O'Brien, Terence John; Kwan, Patrick

    2016-11-01

    The patterns of postoperative seizure control and response to antiepileptic drugs (AEDs) in tumor-associated epilepsy (TAE) are poorly understood. We aim to document these characteristics in patients with supratentorial gliomas. This was a retrospective analysis of 186 patients with supratentorial gliomas. Seizure patterns were classified into four groups: A, no postoperative seizure; B, early postoperative seizure control within 6 months; C, fluctuating seizure control; and D, never seizure-free. Rates and duration of seizure freedom, subsequent seizure relapse, and response to AED were analyzed. Among patients included, 49 (26.3%) had grade II, 28 (15.1%) had grade III, and 109 (58.6%) had grade IV glioma. Outcome pattern A was observed in 95 (51.1%), B in 22 (11.8%), C in 45 (24.2%), and D in 24 (12.9%). One hundred nineteen patients had at least one seizure and were classified as having TAE. Compared to pattern A, pattern B was predicted by histologic progression; pattern C by tumor grade, preoperative seizure, and histologic progression, and pattern D by preoperative seizure and gross total resection. Among patients with TAE, 57.5% of grade II, 68.2% of grade III, and 26.3% of grade IV experienced a period of 12-month seizure freedom. After first 12-month seizure remission, 39.1%, 60.0%, and 13.3% of grade II, III, and IV gliomas, respectively, experienced subsequent seizure; 22.6% of those with TAE reached terminal seizure freedom of at least 12 months on their first postoperative AED regimen, 6.5% on their second regimen, and 5.4% on subsequent regimens. Distinct patterns of postoperative seizure control exist in gliomas; they have specific risk factor profiles, and we hypothesize these correspond to unique pathogenic mechanisms. Twelve-month seizure freedom with subsequent relapse is frequent in grade II-III gliomas. Response to AEDs is markedly poorer than with non-TAE, highlighting the complex epileptogenicity of gliomas. Wiley Periodicals, Inc. © 2016

  14. Warming infusion improves perioperative outcomes of elderly patients who underwent bilateral hip replacement

    PubMed Central

    Ma, He; Lai, Bingjie; Dong, Shanshan; Li, Xinyu; Cui, Yunfeng; Sun, Qianchuang; Liu, Wenhua; Jiang, Wei; Xu, Feng; Lv, Hui; Han, Hongyu; Pan, Zhenxiang

    2017-01-01

    Abstract Background: This prospective, randomized, and controlled study was performed to determine the benefits of prewarmed infusion in elderly patients who underwent bilateral hip replacement. Methods: Between September 2015 and April 2016, elderly patients who underwent bilateral hips replacement that met the inclusion and exclusion criteria were included in this study. After inclusion, patients were randomized into one of the study groups: in the control group, patients received an infusion of fluid kept at room temperature (22–23°C); in the warming infusion group, patients received an infusion of fluid warmed using an infusion fluid heating apparatus (35°C). Postoperative outcomes, including recovery time, length of hospital stay, visual analogue scale (VAS) score, and postoperative complications rate of patients from both groups, were compared. Results: A total of 64 patients were included in our study (71.2 ± 7.6 years, 53.1% males), with 32 patients in the control group and 32 patients in warming infusion group. No significant difference was found in terms of demographic data and intraoperative blood transfusion rate between 2 groups (P > 0.05). Patients receiving a prewarmed infusion had a significantly shorter time to spontaneous breath, eye opening, consciousness recovery, and extubation than the control group (P < 0.05). In addition, significant differences were found in Steward score and VAS score between 2 groups (P < 0.05). Moreover, warming infusion group also showed an obviously decreased incidence of shivering and postoperative cognitive dysfunction (P < 0.05). Conclusion: A prewarmed infusion could reduce the incidence of perioperative hypothermia and improve outcomes in the elderly during bilateral hip replacement. PMID:28353593

  15. Communication in dental medicine: importance in motivating elderly dental patients.

    PubMed

    Scutariu, Mihaela Monica; Forna, Norina

    2013-01-01

    Dental services for elderly patients are characterized by a series of particularities related to the vulnerability of this age group, which is affected by various co morbidities, and the diminished physical, cognitive and financial capacities. Finding ways to keep elderly patients coming to a dental office is possible by improving the dentist-patient relationship and implicitly the quality of care by increasing the self-esteem of the elderly and their place in society, by increasing the role of oral health in the quality of life, and here we refer to the pleasure of eating, the pleasant physical aspect and normal diction. The present paper presents the psychological aspects that interfere in the communication process between the dentist and the elderly patient and the changes motivation undergoes when people are in pain. These data can sometimes change the reticent attitude of the dentist towards the elderly patient which is often considered to be a risk patient.

  16. Comparative analysis of survival between elderly and non-elderly severe sepsis and septic shock resuscitated patients

    PubMed Central

    Palomba, Henrique; Corrêa, Thiago Domingos; Silva, Eliézer; Pardini, Andreia; de Assuncao, Murillo Santucci Cesar

    2015-01-01

    Objective To compare outcomes between elderly (≥65 years old) and non-elderly (<65 years old) resuscitated severe sepsis and septic shock patients and determine predictors of death among elderly patients. Methods Retrospective cohort study including 848 severe sepsis and septic shock patients admitted to the intensive care unit between January 2006 and March 2012. Results Elderly patients accounted for 62.6% (531/848) and non-elderly patients for 37.4% (317/848). Elderly patients had a higher APACHE II score [22 (18-28) versus 19 (15-24); p<0.001], compared to non-elderly patients, although the number of organ dysfunctions did not differ between the groups. No significant differences were found in 28-day and in-hospital mortality rates between elderly and non-elderly patients. The length of hospital stay was higher in elderly compared to non-elderly patients admitted with severe sepsis and septic shock [18 (10-41) versus 14 (8-29) days, respectively; p=0.0001]. Predictors of death among elderly patients included age, site of diagnosis, APACHE II score, need for mechanical ventilation and vasopressors. Conclusion In this study population early resuscitation of elderly patients was not associated with increased in-hospital mortality. Prospective studies addressing the long-term impact on functional status and quality of life are necessary. PMID:26313436

  17. Bu ji (hozai) for treatment of postoperative gastric cancer patients.

    PubMed

    Horie, Y; Kato, K; Kameoka, S; Hamano, K

    1994-01-01

    We proposed that postgastrectomy cancer patients with organ deficit were xu zheng, or of deficient constitution, and administered bu ji or supplementary regimen to them. With alleviation of the symptoms, our diagnosis seemed correct from the traditional medicine perspective. Interleukin 2 reactivity, natural killer activity, nutritional index and bone mineral indices also improved. Such results suggest that our diagnosis was also correct according to Western medical theory. In addition, nutrition seemed to have positive relationship with NK activity and bone mineral content. Therefore, administration of bu ji seemed useful to improve the quality of life of postoperative cancer patients.

  18. Postoperative Lower Extremity Edema in Patients with Primary Endometrial Cancer.

    PubMed

    Bae, Hyo Sook; Lim, Myong Cheol; Lee, Jeong Seon; Lee, Yumi; Nam, Byung Ho; Seo, Sang-Soo; Kang, Sokbom; Chung, Seung Hyun; Kim, Joo-Young; Park, Sang-Yoon

    2016-01-01

    The goal of this study was to investigate clinical manifestations of lower extremity edema (LEE) after lymph node dissection in patients with primary endometrial cancer. Women with primary endometrial cancer who underwent staging surgery between November 2001 and March 2011 were included in the study. Medical records and/or responses to the Gynecologic Cancer Lymphedema Questionnaire (GCLQ) were used for LEE evaluation. All 154 patients underwent pelvic lymph node dissection, and 126 patients (81.8 %) underwent paraaortic LN dissection. The median age of the patients was 52 years, the majority had stage I cancer (78.6 %), and most had endometrioid histology (90.9 %). The most frequent GCLQ responses were "experienced swelling" (35.7 %), "experienced numbness" (30.5 %), "experienced heaviness" (29.9 %), and "experienced aching" (29.9 %). Sixty-four patients (41.6 %) had previous (9/64, 14.1 %) and/or current (55/64, 85.9 %) patient-reported LEE. Most patients developed LEE within 12 months after surgery (39/56, 69.6 %), and LEE lasted for more than 12 months in most patients (45/56, 80.4 %). Three patients reported recurrent LEE after recovery. Multivariate logistic regression identified the number of dissected pelvic lymph node (≥21) as a risk factor for LEE [odds ratio (OR) 3.28; 95 % confidence interval (CI) 1.058-10.136] and postoperative radiotherapy (OR 3.81, 95 % CI 1.67-8.69). LEE developed in more than one-third of patients with endometrial cancer after surgery, and LEE lasted for more than 12 months in most patients. A high number of dissected pelvic lymph nodes and postoperative radiotherapy is associated with LEE.

  19. Effects of preoperative and postoperative enteral nutrition on postoperative nutritional status and immune function of gastric cancer patients.

    PubMed

    Ding, Dayong; Feng, Ye; Song, Bin; Gao, Shuohui; Zhao, Jisheng

    2015-03-01

    Effects of preoperative one week enteral nutrition (EN) support on the postoperative nutritional status, immune function and inflammatory response of gastric cancer patients were investigated. 106 cases of gastric cancer patients were randomly divided into preoperative one week EN group (trial group) and early postoperative EN group (control group), which were continuously treated with EN support until the postoperative 9th day according to different treatment protocols. All the patients were checked for their body weight, skinfold thickness, upper arm circumference, white blood cell count (WBC), albumin (ALB), prealbumin (PA), C-reactive protein (CRP), humoral immunity (IgA, IgG), T cell subsets (CD4, CD8 and CD4/CD8), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), etc. on the preoperative and the postoperative 1st and 10th day, respectively. PA and IgG levels of the experimental group were higher than those of the control group on the postoperative 10th day, whereas IL-6 level of the experimental group was lower than that of the control group. EN support for preoperative gastric cancer patients will improve the postoperative nutritional status and immune function, alleviate inflammatory response, and facilitate the recovery of patients.

  20. Sarcopenia is a predictor of outcomes in very elderly patients undergoing emergency surgery.

    PubMed

    Du, Yang; Karvellas, Constantine J; Baracos, Vickie; Williams, David C; Khadaroo, Rachel G

    2014-09-01

    With the increasing aging population, the number of very elderly patients (age ≥80 years) undergoing emergency operations is increasing. Evaluating patient-specific risk factors for postoperative morbidity and mortality in the acute care surgery setting is crucial to improving outcomes. We hypothesize that sarcopenia, a severe depletion of skeletal muscles, is a predictor of morbidity and mortality in very elderly patients undergoing emergency surgery. A total of 170 patients older than the age of 80 underwent emergency surgery between 2008 and 2010 at a tertiary care facility; 100 of these patients had abdominal computed tomography images within 30 days of the operation that were adequate for the assessment of sarcopenia. The impact of sarcopenia on the operative outcomes was evaluated using both univariate and multivariate analysis. The mean patient age was 84 years, with an in-hospital mortality of 18%. Sarcopenia was present in 73% of patients. More sarcopenic patients had postoperative complications (45% sarcopenic versus 15% nonsarcopenic, P = .005) and more died in hospital (23 vs 4%, P = .037). There were no differences in duration of stay or requirement for intensive care unit postoperatively. After we controlled for confounding factors, increasing skeletal muscle index (per incremental cm(2)/m(2)) was associated with decreased in-hospital mortality (odds ratio ∼0.834, 95% confidence interval 0.731-0.952, P = .007) in multivariate analysis. Sarcopenia was independently predictive of greater complication rates, discharge disposition, and in-hospital mortality in the very elderly emergency surgery population. Using sarcopenia as an objective tool to identify high-risk patients would be beneficial in developing tailored preventative strategies and potentially resource allocation in the future. Copyright © 2014 Mosby, Inc. All rights reserved.

  1. Changes in Heart Rate and Autonomic Nervous Activity after Orthopedic Surgery in Elderly Japanese Patients.

    PubMed

    Tan, Chieko; Saito, Nao; Miyawaki, Ikuko

    2017-02-15

    Evidence regarding nursing support for delirium prevention is currently insufficient. An evaluation of changes in autonomic nervous activity over time after surgery would elucidate the features of autonomic nervous activity in patients with delirium. These results could provide a basis for effective nursing intervention and timing for preventing the onset of delirium. Here, we aimed to obtain basic data on effective nursing interventions for preventing the onset of postoperative delirium. Heart rate variability was recorded during the morning and nighttime on the day before surgery until 3 days postoperatively in elderly patients who underwent orthopedic surgery to investigate the manner in which heart rate and autonomic nervous activity changed over time. Data were collected over 11 months from July 2013 to November 2014. Surgical stress led to the maintenance of heart rate at a significantly higher value from the day of the surgery until postoperative day 3 compared to that before surgery. Moreover, the autonomic nervous activity remained unchanged during the morning, and it was significantly lower during the night from postoperative day 1 until postoperative day 3 than before the surgery. These results suggest that there is a decrease in parasympathetic nervous activity during the nighttime postoperatively.

  2. [Shoulder Surgery in the Elderly Patient].

    PubMed

    Meyer, Dominik C; Wieser, Karl

    2016-01-20

    Elderly patients may be different from the average population in regard to the treatment of shoulder disorders. Challenges are the decreased quality of bone, tendons and cartilage, decreased blood perfusion and a generally aged biology. The advantages however are the often more realistic expectations and more cautious use of the extremity, and the limited life expectancy of prosthetic implants is a less pressing issue. Local pathologies such as in the AC-joint or long head of the biceps may also in the aged patient be treated with infiltration or arthroscopic means. If however large rotator cuff tears and osteoarthritis are present, (reverse) total shoulder implants are the treatment of choice due to the high reliability and uncomplicated rehabilitation.

  3. Oral health problems in elderly rehabilitation patients.

    PubMed

    Andersson, P; Hallberg, I R; Lorefält, B; Unosson, M; Renvert, S

    2004-05-01

    A combination of poor oral hygiene and dry mouth may be hazardous to the oral health status. However, systematic assessments in order to detect oral health problems are seldom performed in the nursing care of the elderly. The aims of this study were to investigate the occurrence of oral health problems measured using the Revised Oral Assessment Guide (ROAG) and to analyse associations between oral health problems and age, gender, living conditions, cohabitation, reason for admission, number of drugs, and functional and nutritional status. One registered nurse performed oral health assessments using ROAG in 161 newly admitted elderly patients in rehabilitation care. Oral health problems were found in 71% of the patients. Thirty per cent of these patients had between four and eight problems. Low saliva flow and problems related to lips were the most frequent oral health problems. Problems in oral health status were significantly associated with presence of respiratory diseases (problems with gums, lips, alterations on the tongue and mucous membranes), living in special accommodation (low saliva flow, problems with teeth/dentures and alterations on the tongue), being undernourished (alterations on the tongue and low saliva flow) and being a woman (low saliva flow). The highest Odds ratio (OR) was found in problems with gums in relation with prevalence of respiratory diseases (OR 8.9; confidence interval (CI) 2.8-27.8; P < 0.0005). This study indicates the importance of standardised oral health assessments in order to detect oral health problems which can otherwise be hidden when the patients are admitted to the hospital ward.

  4. Postoperative Speech Outcomes and Complications in Submucous Cleft Palate Patients.

    PubMed

    Park, Tae Seo; Bae, Yong Chan; Nam, Su Bong; Kang, Kyung Dong; Sung, Ji Yoon

    2016-05-01

    The postoperative speech outcomes of submucous cleft palate (SMCP) surgery are known to be poorer than those of other types of cleft palate. We attempted to objectively characterize the postoperative complications and speech outcomes of the surgical treatment of SMCP through a comparison with the outcomes of incomplete cleft palate (ICP). This study included 53 SMCP patients and 285 ICP patients who underwent surgical repair from 1998 to 2015. The average age of the patients at the time of surgery was 3.9±1.9 years for the SMCP patients and 1.3±0.9 years for the ICP patients. A retrospective analysis was performed of the complications, the frequency of subsequent surgical correction for velopharyngeal dysfunction (VPD), and speech outcomes. In both the SMCP and ICP patients, no cases of respiratory difficulty, bleeding, or wound disruption were noted. Delayed wound healing and fistula occurred in 18.9% and 5.7% of the SMCP patients and in 14% and 3.2% of the ICP patients, respectively. However, no statistically significant difference in either delayed wound healing or fistula occurrence was observed between the two groups. The rate of surgical correction for VPD in the SMCP group was higher than in the ICP group. In the subset of 26 SMCP patients and 62 ICP patients who underwent speech evaluation, the median speech score value was 58.8 in the SMCP group and 66 in the ICP group, which was a statistically significant difference. SMCP and ICP were found to have similar complication rates, but SMCP had significantly worse speech outcomes.

  5. Peri-Operative Inflammatory Cytokines in Plasma of the Elderly Correlate in Prospective Study with Postoperative Changes in Cognitive Test Scores

    PubMed Central

    Kline, R; Wong, E; Haile, M; Didehvar, S; Farber, S; Sacks, A; Pirraglia, E; de Leon, MJ; Bekker, A

    2016-01-01

    Increasingly, postoperative cognitive dysfunction (POCD) is recognized as a complication after surgery in the elderly; but it's etiology remains unclear. Here we examine changes in cytokine levels during both the pre-operative and postoperative period, comparing them with long term variation in cognitive test scores. Forty-one patients aged 65 and older undergoing major surgery with general anesthesia were recruited after written consent in this IRB approved study. Thirty went on to complete this prospective, non-interven-tional and non-randomized study. Plasma levels of cytokines Il-6, Il-8, Il-10, and TNF were determined using ELISA with MILLIPLEX Multi-Analyte Profiling (Billerica, MA). All subjects had neurocognitive tests pre-operatively and 6 months post-surgery, including Paragraph Recall Immediate and Delayed, Digit Span Forward (DSF) and Backward (DSB), and Trail Making A and B. Spearman's Rho and repeated measure rank analysis were used to examine the dependence of z score changes in cognitive tests (baseline versus 6 months) as a function of 3 cytokine time points (presurgical, post anesthesia care unit (PACU), and post-operative day one (POD1)). A greater increase in PACU inflammatory burden correlated with a greater decline in performance on the DSB (IL6, IL8; r>−0.560; p<= 0.008). DSF changes correlated slightly better with pre-surgical cytokines, declining more with higher cytokines (IL6, r= −0.551, p=0.002; IL8, −0.468, 0.009). TNF, examining all 3 values, changed only slightly postoperatively, but still correlated with a decline in DSB (p=0.014). Thus, cognitive performance, over 6 months post surgery, declines with elevated perioperative inflammation. Specific cytokines at specific perioperative times may impact specific cognitive functions, serving as diagnostics as well as contributing causation. PMID:28317003

  6. The effect of patient sex on the incidence of early adverse effects in a population of elderly patients.

    PubMed

    Conti, D; Ballo, P; Boccalini, R; Boccherini, A; Cantini, S; Venni, A; Pezzati, S; Gori, S; Franconi, F; Zuppiroli, A; Pedullà, A

    2014-07-01

    Patient sex is known to influence the response to general and regional anaesthesia and recovery after surgery. However, most studies come from analyses carried out on middle-aged patients. As most of the patients admitted to the post-anaesthesia recovery room in our institution are elderly, we took the opportunity to investigate the association between sex and incidence of early adverse events in this older population of patients after major surgery. Consecutive patients undergoing general, orthopaedic, urological and gynaecological surgery, admitted to the recovery room of our institution over a 15-month period, were retrospectively studied. The following adverse events were considered in the analysis: shivering, postoperative nausea and vomiting, hypotension and hypertensive responses, new arrhythmias requiring treatment, acute respiratory failure and desaturation. A total of 1347 patients (mean age 73.3±15.1 years, 61.4% women) were included. Women showed a higher incidence of shivering (relative difference +48%, P=0.0003), postoperative nausea and vomiting (+91%, P<0.0001), hypotension (+32%, P=0.044) and desaturation (+60%, P=0.0030) than men. The incidence of hypertensive response, arrhythmias and acute respiratory failure were not statistically significantly different. The findings of this exploratory study suggest that women have a higher risk of early postoperative adverse events even in a more elderly population.

  7. Short-Term Complications of Distal Humerus Fractures in Elderly Patients

    PubMed Central

    Keswani, Aakash; Koehler, Steven M.; Kim, Jaehon; Hausman, Michael

    2016-01-01

    Background: The purpose of this study was to evaluate 30-day postoperative complications of open reduction and internal fixation [ORIF] and total elbow arthroplasty [TEA] for the treatment of distal humerus fractures in elderly patients using a validated national database. Methods: Review of the National Surgical Quality Improvement Program (NSQIP) Database identified all elderly patients (>65 years) who underwent TEA or ORIF for the treatment of closed intra-articular distal humerus fractures from 2007 to 2013. Bivariate and multivariate analyses of risk factors for 30-day adverse events as defined by NSQIP between ORIF and TEA groups were assessed using preoperative and intraoperative variables. Results: Among the 176 patients with distal humerus fractures, there were 33 TEA and 143 ORIF. There was no difference in age, medical comorbidities, or functional status. Total elbow arthroplasty was associated with an increased odds of severe adverse event compared to ORIF (odds ratio = 1.57, P = .16), although it did not achieve statistical significance. Infection rate was 0.7% in ORIF and 0.0% in TEA (P = .99). Insulin-dependent diabetes and functional status were significant independent predictors of postoperative adverse events. Operative time (165 minutes vs 140 minutes, P = .06) and postoperative length of stay (3.6 days vs 2.3 days, P = 0.03) were longer for TEA compared to ORIF. Conclusion: Open reduction and internal fixation and TEA have similar 30-day postoperative complications for the treatment of distal humerus fractures among elderly patients. Despite favorable trends for TEA in recent studies, additional clinical results are needed to understand complications and limitation of TEA. Level of evidence: Level III, prognostic study. PMID:26929856

  8. Prospective analysis of quality of life in elderly patients treated with adjuvant chemotherapy for non-small-cell lung cancer.

    PubMed

    Park, S; Kim, I R; Baek, K K; Lee, S J; Chang, W J; Maeng, C H; Hong, J Y; Choi, M K; Kim, Y S; Sun, J M; Ahn, J S; Park, K; Jo, J; Jung, S H; Ahn, M J

    2013-06-01

    Given the more comorbidities with a decline in physiologic reserve, it can be challenging to make appropriate treatment decisions in the elderly. Here, we prospectively evaluated and compared the health-related quality of life (HRQOL) of patients aged ≥ 65 with aged <65 who were treated with a postoperative chemotherapy for completely resected stage Ib, II or IIIa non-small-cell lung cancer (NSCLC). Either four cycles of paclitaxel (Taxol)-carboplatin (PC) or vinorelbine-cisplatin (NP) was used. The HRQOL was assessed with EORTC QLQ-C30 and EORTC QLQ-LC13. Between October 2008 and October 2011, a total of 139 patients (aged <65, n = 73; ≥ 65, n = 66) were enrolled, and 127 (91.4%) completed the questionnaire. Overall, the quality of life (QOL) in elderly patients did not significantly deteriorate with adjuvant chemotherapy and the time trend of QOL in elderly patients was similar to that of younger patients. Although the elderly suffered from increased treatment-related adverse events involving sore mouth, peripheral neuropathy and alopecia compared with the baseline, the same time trends were also observed in younger group. The mean dose intensities (MDIs) for PC and NP regimen were not significantly different between the two age groups. Postoperative chemotherapy did not substantially reduce HRQOL in elderly NSCLC patients, and HRQOL during and after adjuvant chemotherapy did not significantly differ by age.

  9. Quality of surgical care and readmission in elderly glioblastoma patients

    PubMed Central

    Nuño, Miriam; Ly, Diana; Mukherjee, Debraj; Ortega, Alicia; Black, Keith L.; Patil, Chirag G.

    2014-01-01

    Background Thirty-day readmissions post medical or surgical discharge have been analyzed extensively. Studies have shown that complex interactions of multiple factors are responsible for these hospitalizations. Methods A retrospective analysis was conducted using the Surveillance, Epidemiology and End Results (SEER) Medicare database of newly diagnosed elderly glioblastoma multiforme (GBM) patients who underwent surgical resection between 1991 and 2007. Hospitals were classified into high- or low-readmission rate cohorts using a risk-adjusted methodology. Bivariate comparisons of outcomes were conducted. Multivariate analysis evaluated differences in quality of care according to hospital readmission rates. Results A total of 1,273 patients underwent surgery in 338 hospitals; 523 patients were treated in 228 high-readmission hospitals and 750 in 110 low-readmission hospitals. Patient characteristics for high-versus low-readmission hospitals were compared. In a confounder-adjusted model, patients treated in high- versus low-readmission hospitals had similar outcomes. The hazard of mortality for patients treated at high- compared to low-readmission hospitals was 1.06 (95% CI, 0.095%–1.19%). While overall complications were comparable between high- and low-readmission hospitals (16.3% vs 14.3%; P = .33), more postoperative pulmonary embolism/deep vein thrombosis complications were documented in patients treated at high-readmission hospitals (7.5% vs 4.1%; P = .01). Adverse events and levels of resection achieved during surgery were comparable at high- and low-readmission hospitals. Conclusions For patients undergoing GBM resection, quality of care provided by hospitals with the highest adjusted readmission rates was similar to the care delivered by hospitals with the lowest rates. These findings provide evidence against the preconceived notion that 30-day readmissions can be used as a metric for quality of surgical and postsurgical care. PMID:26034614

  10. Postoperative wound infections after a proctectomy—Patient experiences

    PubMed Central

    Andersson, Kristin; Koinberg, Inga-Lill; Wennström, Berith

    2016-01-01

    Poor perineal wound healing and infections after proctectomy surgery cause a significant proportion of physical and psychological morbidities, such as pain, leakage, and abscesses. In the long run, some of these symptoms will lead to extended periods of hospitalization. These kinds of postoperative complications are also associated with delays in possible chemotherapy treatment. The aim of this study was to describe patient experiences of perineal wound infections following proctectomy due to rectal cancer, and the importance of the communication with and the self-care support from the nurse for these patients. Five women and five men (61–87 years, median age 71 years) were included and interviewed. A qualitative content analysis of the interviews was carried out and the following main categories emerged: “Managing postoperative complications,” “Being independent,” “Feeling safe,” and “Accepting the situation.” A perineal wound infection after a proctectomy is devastating for the individual patient. The limitations and changes to the patients’ lives turn into new daily routines, which force them to find new ways to live and to accept the situation. For many of them, the infections remained for several months and, sometimes, for years. The ability to lead an independent life is drastically reduced, but through continuity in care it is possible to create a feeling of safety. Information, communication, and self-care support are all important and valuable factors for recovery. Specialized care containing an action plan is therefore needed in clinical practice to reduce the number of perineal wound infections postoperatively and should be initiated when the patient is discharged from the ward and continue until recovery. PMID:26900139

  11. Safety of hepatectomy for elderly patients with hepatocellular carcinoma

    PubMed Central

    Oishi, Koichi; Itamoto, Toshiyuki; Kohashi, Toshihiko; Matsugu, Yasuhiro; Nakahara, Hideki; Kitamoto, Mikiya

    2014-01-01

    The number of elderly patients with hepatocellular carcinoma (HCC) has been increasing. Characteristics of elderly HCC patients are a higher proportion of females, a lower rate of positive hepatitis B surface antigen, and a higher rate of positive hepatitis C antibodies. Careful patient selection is vital for performing hepatectomy safely in elderly HCC patients. Treatment strategy should be decided by not only considering tumor stage and hepatic functional reserve, but also physiological status, including comorbid disease. Various assessment tools have been applied to predict the risk of hepatectomy. The reported mortality and morbidity rates after hepatectomy in elderly HCC patients ranged from 0% to 42.9% and from 9% to 51%, respectively. Overall survival rate after hepatectomy in elderly HCC patients at 5 years ranged from 26% to 75.9%. Both short-term and long-term results after hepatectomy for strictly selected elderly HCC patients are almost the same as those for younger patients. However, considering physiological characteristics and the high prevalence of comorbid disease in elderly patients, it is important to assess patients more meticulously and to select them strictly if scheduled to undergo major hepatectomy. PMID:25386051

  12. Does administering albumin to postoperative gastroschisis patients improve outcome?

    PubMed Central

    Tannuri, Ana Cristina A; Silva, Luanna M; Leal, Antonio José G; de Moraes, Augusto César F; Tannuri, Uenis

    2012-01-01

    OBJECTIVES: Newborns who undergo surgery for gastroschisis correction may present with oliguria, anasarca, prolonged postoperative ileus, and infection. New postoperative therapeutic procedures were tested with the objective of improving postoperative outcome. PATIENTS AND METHODS: One hundred thirty-six newborns participated in one of two phases. Newborns in the first phase received infusions of large volumes of crystalloid solution and integral enteral formula, and newborns in the second phase received crystalloid solutions in smaller volumes, with albumin solution infusion when necessary and the late introduction of a semi-elemental diet. The studied variables were serum sodium and albumin levels, the need for albumin solution expansion, the occurrence of anasarca, the length of time on parenteral nutrition, the length of time before initiating an enteral diet and reaching a full enteral diet, orotracheal intubation time, length of hospitalization, and survival rates. RESULTS: Serum sodium levels were higher in newborns in the second phase. There was a correlation between low serum sodium levels and orotracheal intubation time; additionally, low serum albumin levels correlated with the length of time before the initiation of an oral diet and the time until a full enteral diet was reached. However, the discharge weights of newborns in the second phase were higher than in the first phase. The other studied variables, including survival rates (83.4% and 92.0%, respectively), were similar for both phases. CONCLUSIONS: The administration of an albumin solution to newborns in the early postoperative period following gastroschisis repair increased their low serum sodium levels but did not improve the final outcome. The introduction of a semi-elemental diet promoted an increase in body weight at the time of discharge. PMID:22358234

  13. Antioxidants Supplementation in Elderly Cardiovascular Patients

    PubMed Central

    Vila, Susana; Azzato, F.; Milei, José

    2013-01-01

    Supplementation with antioxidants and its benefit-risk relationship have been largely discussed in the elderly population. We evaluated whether antioxidants supplementation improved the biochemical profile associated with oxidative metabolism in elderly cardiovascular patients. Patients (n = 112) received daily supplementation with α-TP 400 mg, beta-carotene 40 mg, and vitamin C 1000 mg for 2 months (treatment). Plasma concentrations of alpha-tocopherol (α-TP), β-carotene (βC), ubiquinol-10 (QH-10), glutathione, and thiobarbituric acid reactive substances (TBARS) were determined before and after treatment. Response to treatment was dependent on pretreatment α-TP and βC levels. Increase in α-TP and βC levels was observed only in patients with basal levels <18 μM for α-TP (P < 0.01) and <0.30 μM for βC (P < 0.02). Ubiquinol-10, glutathione, and TBARS were unaffected by treatment: QH-10 (+57%, F 1,110 = 3.611, P < 0.06, and N.S.), glutathione (+21%, F 1,110 = 2.92, P < 0.09, and N.S.), and TBARS (−29%, F 1,110 = 2.26, P < 0.14, and N.S.). Treatment reduced oxidative metabolism: 5.3% versus 14.6% basal value (F 1,110 = 9.21, P < 0.0003). Basal TBARS/α-TP ratio was higher in smokers compared to nonsmokers: 0.11 ± 0.02 versus 0.06 ± 0.01 (F 32,80 = 1.63, P < 0.04). Response to antioxidant supplementation was dependent on basal plasma levels of α-TP and βC. Smoking status was strongly associated with atherosclerotic cardiovascular disease and high TBARS/α-TP ratio (lipid peroxidation). PMID:24489984

  14. Assessment of selected cognitive processes in elderly patients after urologic surgery.

    PubMed

    Wioletta, Mędrzycka-Dąbrowska; Sebastian, Dąbrowski; Andrzej, Basiński

    2016-01-01

    The issue of postoperative disorders of cognitive functions is a highly topical problem as more and more elderly people undergo medical treatments. Patients may lose the ability of assimilating information and their linguistic functions may deteriorate. Cognitive disorders may result in the temporary exclusion of the patient from social activity. The purpose of the paper was to assess the incidence of certain cognitive disorders in the elderly after urological surgeries. The study was conducted in a group of 218 patients aged over 65, male and female, after an urological surgery under different types of anesthesia. Standardized neuropsychological tests of cognitive functions were employed in the study. Analysis of the data showed that in the control group were obtained similar results in the study of the first and second. However, in the test group demonstrated a reduction cognitive function in all the tests in a second study. The reduction of cognitive functions in the study group was observed in all the domains but it was the most marked in visual memory tests. Postoperative reduction of cognitive functions is correlated with the patient's age, education and mood. Postoperative reduction of cognitive functions is not correlated with the type of surgery, anesthesia and its duration. Copyright © 2016 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  15. Patient-Controlled Fentanyl Iontophoretic Transdermal System Improved Postoperative Mobility Compared to Intravenous Patient-Controlled Analgesia Morphine: A Pooled Analysis of Randomized, Controlled Trials.

    PubMed

    Oliashirazi, Ali; Wilson-Byrne, Timothy; Shuler, Franklin D; Parvizi, Javad

    2017-02-01

    Postoperative pain management protocols that use patient-controlled analgesia (PCA) can hinder mobility due to attached machinery and tubing. Immobility in the postoperative setting can increase complications, length of stay (LOS), and costs. Early and enhanced mobilization can reduce the cost of care while improving patient outcomes. A needle-free, compact, patient-activated, and portable fentanyl iontophoretic transdermal system (fentanyl ITS, IONSYS; The Medicines Company, Parsippany NJ) has been shown to provide comparable efficacy and tolerability to intravenous (IV) PCA morphine that promotes improved mobility. This pooled analysis of 1,882 patients across three randomized, controlled trials compared fentanyl ITS to IV PCA morphine for postoperative pain management. Outcomes of patient mobility were assessed by a validated Patient Ease of Care Questionnaire that was given to patients, patients' nurses, and physical therapists involved in patient care. Safety was assessed via spontaneously reported treatment-emergent adverse events (TEAE). Fentanyl ITS significantly improved overall patient mobility, each mobility subscore (P < 0.0001) across all demographics (male/female; elderly/non-elderly; normal BMI/overweight/obese/morbidly obese) and surgery types, and was consistent across nurses and physical therapists mobility assessments. TEAEs were generally similar between the two groups. However, more patients reported an opioid-related TEAE with morphine IV PCA than with fentanyl IV PCA (P = 0.003). Due to improved mobility with fentanyl ITS, complications are expected to be less frequent than with IV PCA and epidural PCA. Incorporation of this strategy into postoperative pain management protocols may reduce LOS and total hospital costs. © 2016 World Institute of Pain.

  16. [Optimal surgery for breast cancer elderly patients].

    PubMed

    Lin, Yan; Sun, Qiang; Guan, Heng; Zhou, Wei-xun; Xu, Ying; Wang, Bin

    2012-12-01

    To evaluate the feasibility of optimal surgery for breast cancer in elderly patients. The clinical data of 481 patients aged 70 years and above who were treated in our hospital from 1995 to 2009 were retrospectively analyzed. Based on their general conditions and clinical stages, 481 patients were divided into three groups to received different surgical procedures including modified radical mastectomy (MRM group, n=256), tumor extended resection (ER group, n=173), and simple mastectomy (SM group, n=52). The overall 5-and 10-year survival rates were 63.77%and 46.71%, respectively, and the 5-year (p=0.956) and 10-year (p=0.977) survival rates were not significantly among these three groups. However, patients in the ER group had significantly shorter hospital stay, smaller surgical wound, earlier recovery and less complications. It is feasible for female breast cancer patients over 70 years old choose the optimal surgical procedures according to their general conditions and clinical stages.

  17. Early antidepressant therapy for elderly patients.

    PubMed

    Freund, Karen M; Moskowitz, Mark A; Lin, Ting H; McKinlay, John B

    2003-01-01

    We studied factors affecting the management of depression in older patients, especially the use of early antidepressant therapy. We recruited 128 primary care physicians to view one version of a 5-minute videotape of an elderly patient with somatic symptoms that were suggestive of depression, and to complete an interview that assessed decision making. Using an experimental factorial design, 16 versions of the videotape were produced, holding constant the clinical features of the case, while varying the patient's age, race, sex, and socioeconomic status. Dependent variables were the physicians' probability assessment of depression and the recommendation of antidepressant medication after the first visit. Depression was considered a possible diagnosis by 121 physicians (95%) and the most likely diagnosis by 69 (54%). Sixteen physicians (13%) recommended antidepressant therapy after the first visit, and they were less likely than other physicians to order initial laboratory tests to assess the possibility of other conditions. Recommendations for antidepressant therapy was not associated with patient age, sex, race, or socioeconomic status, or with physician sex, race, or experience. Family physicians were more likely than internists to recommend an antidepressant (19% [12/64] vs. 6% [4/64], P = 0.04). Based on a 5-minute vignette, physicians were likely to recognize depression, independent of patient characteristics. Those recommending early antidepressant therapy were more likely to be in family medicine and less likely to investigate other diagnoses initially.

  18. High serum interleukin-6 level is associated with increased risk of delirium in elderly patients after noncardiac surgery: a prospective cohort study.

    PubMed

    Liu, Pei; Li, Ya-wei; Wang, Xiao-shan; Zou, Xi; Zhang, Da-zhi; Wang, Dong-xin; Li, Shi-zhong

    2013-01-01

    The relationship between inflammation and delirium remains to be determined. The purposes of this study were to investigate the association between serum interleukin-6 levels and the occurrence of delirium in elderly patients after major noncardiac surgery. A total of 338 elderly patients (60 years of age and over) undergoing major noncardiac surgery were enrolled. Blood samples were obtained before anesthesia and in the first postoperative morning and serum interleukin-6 concentrations were measured. Delirium was assessed twice daily by the confusion assessment method for the Intensive Care Unit during the first three postoperative days. Survival analyses were performed to assess the relationship between the serum IL-6 level and the occurrence of postoperative delirium. Postoperative delirium occurred in 14.8% (50 of 338) of patients. High serum interleukin-6 levelsafter surgery were significantly associated with increased risk of the occurrence of postoperative delirium (hazard ratio 1.514, 95% confidence interval 1.155-1.985, P = 0.003). Other independent predictors of delirium included increasing age, poor preoperative New York Heart Association classification, low preoperative Mini-Mental State Examination score, and high total postoperative Visual Analogue Scale pain score. Patients who developed delirium had a prolonged hospital stay after surgery. Delirium is a frequent complication in elderly patients after noncardiac surgery. High serum interleukin-6 level after surgery is associated with increased risk of the occurrence of postoperative delirium.

  19. How to optimally manage elderly bladder cancer patients?

    PubMed

    Soria, Francesco; Moschini, Marco; Korn, Stephan; Shariat, Shahrokh F

    2016-10-01

    Bladder cancer (BCa) is a disease of the elderly and as the population is aging, BCa will become an even bigger public health challenge in the future. Nowadays the correct management of BCa in the elderly remains controversial. The purpose of this article was to review the previous literature to summarize the current knowledge. Using Medline, a non-systematic review was performed including articles between January 2000 and February 2016 in order to describe the management of BCa in the elderly in all its aspects. English language original articles, reviews and editorials were selected based on their clinical relevance. In the literature, the definition of elderly is variable and based on chronological, not biological, age. BCa seems to be more aggressive in the elderly. The management of non-muscle invasive bladder cancer (NMIBC) does not strongly differ from younger patients, except for the role of adjuvant immunotherapy. In patients with muscle invasive bladder cancer (MIBC) the role of a multidisciplinary geriatric evaluation is potentially beneficial. The curative treatment in MIBC remains radical cystectomy (RC) and elderly patients should not be withheld a potentially life-saving intervention only based on chronological age. Patients unsuitable to a major surgical approach may be eligible for bladder-sparing techniques. Geriatric assessment could help identify the frail elderly and customize their perioperative care (i.e., pre and re habilitation). In conclusion the treatment of BCa in the elderly has to be patient-centered and focused on biological age and functional reserves.

  20. How to optimally manage elderly bladder cancer patients?

    PubMed Central

    Soria, Francesco; Moschini, Marco; Korn, Stephan

    2016-01-01

    Bladder cancer (BCa) is a disease of the elderly and as the population is aging, BCa will become an even bigger public health challenge in the future. Nowadays the correct management of BCa in the elderly remains controversial. The purpose of this article was to review the previous literature to summarize the current knowledge. Using Medline, a non-systematic review was performed including articles between January 2000 and February 2016 in order to describe the management of BCa in the elderly in all its aspects. English language original articles, reviews and editorials were selected based on their clinical relevance. In the literature, the definition of elderly is variable and based on chronological, not biological, age. BCa seems to be more aggressive in the elderly. The management of non-muscle invasive bladder cancer (NMIBC) does not strongly differ from younger patients, except for the role of adjuvant immunotherapy. In patients with muscle invasive bladder cancer (MIBC) the role of a multidisciplinary geriatric evaluation is potentially beneficial. The curative treatment in MIBC remains radical cystectomy (RC) and elderly patients should not be withheld a potentially life-saving intervention only based on chronological age. Patients unsuitable to a major surgical approach may be eligible for bladder-sparing techniques. Geriatric assessment could help identify the frail elderly and customize their perioperative care (i.e., pre and re habilitation). In conclusion the treatment of BCa in the elderly has to be patient-centered and focused on biological age and functional reserves. PMID:27785425

  1. Probiotic use in preventing postoperative infection in liver transplant patients

    PubMed Central

    Chen, Jim; Wu, Jinshan; Chalson, Helen; Merigan, Lynn; Mitchell, Andrew

    2013-01-01

    Background Although liver transplantation has been widely practised, post-operative bacterial infection is still a frequent complication which contributed to an increased risk of fatality. There were studies on preoperative use of probiotics for liver transplant patients and acquired reduction in postoperative sepsis and wound infection, but the relevant clinical experience with pre- and probiotics is still limited. Objectives This study is to assess fibre and probiotic use aimed at preventing bacterial sepsis and wound complications in patients undergoing liver transplantation. Study methods There were a total of sixty-seven adult patients scheduled for liver transplantation were included in a public teaching hospital. From January to December 2011, 34 continuous patients following liver transplantation were put on fibre + probiotics. In retrospectively, from January to December 2010, 33 continuous patients were collected as a control group and they were only received fibre post operation. The incidence of bacterial infections was compared in patients receiving either fibre and lactobacillus or fibre only. Statistical analysis was performed using SPSS 15. The t test, fisher’s and chi- square test was used to compare discrete variables. Results In summary, in the analysis of 67 liver transplant recipients, 8.8% group A patients developed infections compared to 30.3% group B patients. The difference between groups A and B was statistically significant in both cases. In addition, the duration of antibiotic therapy was significantly shorter in the lactobacillus-group. Wound infection was the most frequent infections and enterococci the most frequently isolated bacteria. Fibre and lactobacilli were well tolerated in most cases. The operating time, amount of intra- and post-operatively transfused units of blood, fresh frozen plasma and albumin did not differ significantly between the groups. Conclusions Combined fibre and probiotics could lower the incidence of

  2. Population Pharmacokinetics of Vancomycin in Postoperative Neurosurgical Patients.

    PubMed

    Li, Xingang; Wu, Yuanxing; Sun, Shusen; Mei, Shenghui; Wang, Jiaqing; Wang, Qiang; Zhao, Zhigang

    2015-11-01

    Neurosurgical procedures may damage the blood-brain barrier to allow more vancomycin distribution into the cerebrospinal fluid (CSF) from blood after intravenous administration. However, a large intersubject variability in CSF vancomycin concentration was observed. We aimed to develop a population pharmacokinetic model to guide vancomycin dosing in patients after neurosurgical operation. Blood and CSF samples were collected and determined from postoperative neurosurgical patients after vancomycin administration. A three-compartment (central, peripheral, and CSF) model was proposed to characterize the pharmacokinetics of vancomycin. A nonlinear mixed-effects modeling approach was applied to fit the blood and CSF data simultaneously. The covariate analysis found that the CSF albumin level was strongly associated with the clearance between central and CSF compartment. Visual predictive check indicated that the proposed population pharmacokinetic model agrees well with the observed vancomycin concentrations. Individualized vancomycin dosage regimens could be developed for postoperative neurosurgical patients with different CSF albumin levels through model simulations. The CSF albumin level is a determinant of CSF vancomycin concentration.

  3. Clinicopathological features and prognosis of triple-negative breast cancer: a comparison between younger (<60) and elderly (≥60) patients.

    PubMed

    Qiu, J D; Xue, X Y; Li, R; Wang, J D

    2016-11-01

    Triple-negative breast cancer (TNBC) has attracted more attention both clinically and experimentally because of its high-risk biological characteristics and lacking of effective treatment method. The tumour characteristics, patterns of recurrence and metastasis, therapy methods and prognosis in younger TNBC patients have been widely formulated, but the relevant data of the elderly people are lacking. We conducted this retrospective study to compare and analyse the above-related characteristics between the younger and elderly patients with TNBC to estimate the relevance for the elderly TNBC patients. A total of 1489 female patients with primary breast cancer were diagnosed and treated at the department of General Surgery, the Chinese PLA General Hospital, China, from January 2004 to December 2008. In the 1489 patients, 302 patients (20.28%) with TNBC histopathologically confirmed were retrospectively analysed. The 302 TNBC patients were divided into two groups: the younger (<60 years) group and the elderly (≥60 years) group. The relevant characteristics of the two groups were compared. There were no statistically significant differences between the two groups in common clinical data of the patients, clinicopathological features of tumour and the features of local recurrences and metastases of tumour, and the 5-year disease-free survival and overall survival were all significantly higher in the elderly group than those in the younger group, although the elderly group patients accepted significantly less radiotherapy and chemotherapy than the younger group patients. The elderly and younger TNBC patients may belong to different subtypes of TNBC and we probably could take a more conservative and cautious attitude in choosing the post-operative adjuvant treatment for the elderly patients with TNBC. © 2015 John Wiley & Sons Ltd.

  4. [Treating Elderly Coronary Heart Disease Patients by Different Approaches of Percutaneous Coronary Intervention: an Observation of Clinical Efficacy].

    PubMed

    Zhao, Gang; Li, Si-hai; Tan, Xi

    2015-09-01

    To observe thee efficacy of different ways of percutaneous coronary intervention (PCI) for treating elderly coronary heart disease (CHD) patients. Totally 470 elderly CHD patients were classified to three age brackets (equal to or more than 85 years old, 60 to 74 years old, 75 to 84 years old). They were assigned to the transradial intervention (TRI) group (236 cases) and the transfemoral intervention (TFI) group (234 cases) according to different intervention pathways. Correlated indices and postoperative clinical efficacy were compared between the two groups. A higher successful rate of surgery was obviously got in patients 85 years old or older than 85 than in those 60 to 74 years old and 75 to 84 years old (P <0. 05). The incidence of major cardiovascular events (MACE) was reduced at post-operative 12 and 24 months in patients 85 years old or older than 85 (P <0. 05). The case number for changing intervention pathway were increased in the TRI group with statistical difference (P <0. 05). Compared with the TFI group, the case number for changing intervention pathway was increased; the time for arteriopuncture, the time for catheterization, and the time for X-ray exposure were prolonged; the time for postoperative bedding were obviously shortened; the incidence of vascular complications at the puncture site were lowered. The incidence of postoperative 12-month MACE was lowered, all with statistical difference (all P <0. 05). The incidence of MACE within postoperative 24-month MACE decreased in patients 60 to 74 years old and 75 to 84 years old (P <0. 05). The incidence of MACE within postoperative 24 months increased in patients 85 years old or older than 85 of the TRI group with statistical difference (P <0. 05). TRI can be preferably chosen for PC in treating elderly CHD patients.

  5. Somatotype in elderly type 2 diabetes patients.

    PubMed

    Buffa, Roberto; Floris, Giovanni; Putzu, Paolo F; Carboni, Luciano; Marini, Elisabetta

    2007-09-01

    Somatotyping is a practical technique for the description of physique. Individuals with Type 2 diabetes are characterized by physical peculiarities, such as overweight, obesity and a central pattern of body fat distribution. Somatotype applications to diabetes are limited. The objective of this study is to describe the somatotype of elderly type 2 diabetes patients. The sample consisted of 110 patients with type 2 diabetes (45 men, mean age 69.4 +/- 7.0 years; 65 women, mean age 72.9 +/- 7.1 years). The pathological subjects were compared with a control group consisting of 280 healthy individuals (134 men, mean age 74.2 +/- 7.3 years; 146 women, mean age 74.9 +/- 7.4 years). The Heath-Carter somatotype was applied. Diabetic men and women (mean somatotype, respectively: 6.8-5.6-0.6 and 8.6-6.4-0.2) presented significantly higher values of endomorphy than the controls (p = 0.043 in men, p = 0.003 in women); men also had a lower mesomorphic component (p = 0.000). The somatotype method revealed physical peculiarities in type 2 diabetes patients. The marked endomorphy in the pathological individuals can be related to general fatness, which is a well known disease risk factor. The somatotype appears to be a suitable technique for the assessment of physique in type 2 diabetes patients.

  6. [Postoperative rehabilitation in patients with peripheral nerve lesions].

    PubMed

    Petronić, I; Marsavelski, A; Nikolić, G; Cirović, D

    2003-01-01

    Injuries of extremities can be followed by various neuromuscular complications. Injury of peripheral nerves directly depended on the topographic localization of injury (fractures, cuts, contusions). The neuromuscular complications were diagnosed and under follow-up, based on clinical, x-ray, neurologic and neurophysiological findings. The timing of physical treatment and assessment of the necessary neurosurgical intervention depended on the obtained findings. After surgeries, we continued to apply physical treatment and rehabilitation. The aim of the paper was to assess the significance of proper timing for surgery and adequate postoperative rehabilitation, as well as treatment results, depending on the extent of peripheral nerve injury. Based on the study condocted in the period from 2000-2002, most surgeries were done on the ulnar nerve (4 pts), median nerve (4 pts), radial nerve (3 pts), peroneal nerve (2 pts) and plexus brachialis (3 pts). Paresis and peripheral nerve paralysis, associated with sensibility disorders, predominated in clinical features. In most patients surgery was done during the first 3-6 months after injury. In early postoperative Postoperative rehabilitation in patients with peripherial treatment positioning of extremities with electrotherapy were most often used in early postoperative treatment, Bioptron and dosed kinesitherapy. Depending on the neurophysiological findings, in later treatment stage we included electrostimulation, thermotherapy, kinesitherapy and working therapy, with the necessary application of static and dynamic orthroses. Study results showed that the success of treatment depended on the extent of injury, i.e. whether suture of liberalization of the nerve had been done, on the adequate timing of surgery, as well as on the adequate timing and application of physical therapy and rehabilitation. More rapid and complete functional recovery was achieved if the interval between injury and surgery was shorter, as well as

  7. Differences in postoperative opioid consumption in patients prescribed patient-controlled analgesia versus intramuscular injection.

    PubMed

    Everett, Bronwyn; Salamonson, Yenna

    2005-12-01

    The purpose of this study was to examine differences in opioid consumption in patients prescribed patient-controlled analgesia (PCA) versus intramuscular injection (IMI) in the early postoperative period after open abdominal surgery. A retrospective audit of 115 patients elicited demographic and clinical data. No significant differences were found between the demographic variables of the PCA and IMI groups. There was a significant difference in the mean opioid dose used during the first 3 postoperative days (p < .01). Mean opioid consumption was 136.89 mg for the PCA group and 50.79 mg for the IMI group. Although there was a reduction in the amount of opioid consumed over the first 3 postoperative days, the PCA group consistently consumed more opioid analgesia compared with the IMI group. Furthermore, there was a disproportionate reduction in opioid consumption between the two groups from Day 1 (r = .34; p < .01) to Day 3 (r = .14; p = .14). This study shows that the amount of analgesia consumed during the postoperative period by patients who had abdominal surgery varied markedly depending on the mode of analgesia (PCA or IMI). The difference in analgesic consumption was also found to increase throughout the 3-day postoperative period. This divergence in the amount of opioid consumption between patients who were prescribed PCA and patients who were prescribed IM analgesia heightens the need for vigilance in assessment and management of pain during the early postoperative period, particularly in patients prescribed IM analgesia on an "as-needed" basis.

  8. [Effect of percutaneous nephrostolithotomy combined with flexible ureteroscopy on renal function in elderly patients with renal calculi].

    PubMed

    Zhao, Zhongwei; Zhang, Xiaobo; Chen, Xiong; Dai, Yuanqing; Li, Dongjie; Bai, Yao; Xiao, Xi

    2015-03-01

    To detect the levels of neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (Cys-C ) in blood and the level of kidney injury molecule 1 (KIM-1) in urine in elderly patients with renal calculi at diff erent times, and to explore the eff ect of percutaneous nephrostolithotomy (PCNL) combined with flexible ureteroscopy (FU) on early postoperative renal function. A total of 46 patients with renal calculi were selected, and their blood or urine specimens were collected respectively at preoperative and postoperative 2, 12, 24, 48, and 72 h. The concentrations of NGAL, Cys-C, KIM-1 were detected. The levels of NGAL and Cys-C began to increase respectively at postoperative 2 and 12 h, and reached peak at postoperative 12 to 24 h. There was significant difference in the levels of NGAL and Cys-C between the postoperative 12 and 2 h or between postoperative 48 and 24 h (all P<0.05). The levels of NGAL and Cys-C began to decline and eventually returned to preoperative levels respectively at postoperative 48 and postoperative 72 h. The KIM-1 began to increase at postoperative 2 h and peaked at postoperative 24 h, which was significant difference between the postoperative 24 and 12 h or postoperative 48 and 24 h (both P<0.05). The level of KIM-1 began to decline and eventually returned to preoperative levels at postoperative 48 h. After the combined treatment of percutaneous nephrostolithotomy with flexible ureteroscopy, the concentrations of NGAL, Cys-C and KIM-1 are significantly increased, suggesting injuries on renal function. The time of renal tubular injury and recovery is earlier than that of renal glomerulus.

  9. Resection of hepatocellular carcinoma in elderly patients and the role of energy balance.

    PubMed

    Cannistrà, Marco; Grande, Raffaele; Ruggiero, Michele; Novello, Matteo; Zullo, Alessandra; Bonaiuto, Elisabetta; Vaccarisi, Sebastiano; Cavallari, Giuseppe; Serra, Raffaele; Nardo, Bruno

    2016-09-01

    . The overall survival at 5 years was similar for both groups (n = 10 patients (43%) in Group 1 vs. n = 10 patients (45%) in Group 2). In the elderly population, survival is closely linked to postoperative morbidity and mortality. In our study, prolonged LOS was found to be related to delayed bioenergetic recovery. When limited, risk factors such as infections, neutropenia, and red blood cell transfusions could lower LOS and mortality of elderly patients with HCC. Higher age was associated with greater postoperative morbidity and successful hospital stay. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  10. Expiratory flow limitation in morbidly obese postoperative mechanically ventilated patients.

    PubMed

    Koutsoukou, A; Koulouris, N; Bekos, B; Sotiropoulou, C; Kosmas, E; Papadima, K; Roussos, C

    2004-10-01

    Although obesity promotes tidal expiratory flow limitation (EFL), with concurrent dynamic hyperinflation (DH), intrinsic PEEP (PEEPi) and risk of low lung volume injury, the prevalence and magnitude of EFL, DH and PEEPi have not yet been studied in mechanically ventilated morbidly obese subjects. In 15 postoperative mechanically ventilated morbidly obese subjects, we assessed the prevalence of EFL [using the negative expiratory pressure (NEP) technique], PEEPi, DH, respiratory mechanics, arterial oxygenation and PEEPi inequality index as well as the levels of PEEP required to abolish EFL. In supine position at zero PEEP, 10 patients exhibited EFL with a significantly higher PEEPi and DH and a significantly lower PEEPi inequality index than found in the five non-EFL (NEFL) subjects. Impaired gas exchange was found in all cases without significant differences between the EFL and NEFL subjects. Application of 7.5 +/- 2.5 cm H2O of PEEP (range: 4-16) abolished EFL with a reduction of PEEPi and DH and an increase in FRC and the PEEPi inequality index but no significant effect on gas exchange. The present study indicates that: (a) on zero PEEP, EFL is present in most postoperative mechanically ventilated morbidly obese subjects; (b) EFL (and concurrent risk of low lung volume injury) is abolished with appropriate levels of PEEP; and (c) impaired gas exchange is common in these patients, probably mainly due to atelectasis.

  11. Approach to the postoperative patient with Cushing's disease.

    PubMed

    Rutkowski, Martin J; Breshears, Jonathan D; Kunwar, Sandeep; Aghi, Manish K; Blevins, Lewis S

    2015-04-01

    Cushing's disease is a neuroendocrine disorder marked by hypercortisolemia secondary to overproduction of ACTH by a corticotropic pituitary adenoma. Due to the diverse and deleterious effects of hypercortisolemia including diabetes mellitus, hypertension, and cardiovascular disease, prompt and accurate diagnosis followed by surgical resection of the responsible corticotropic adenoma is critical. In the following review, we present a focused synopsis of recently published data and management strategies for the post-operative Cushing's disease patient with a particular focus on studies examining perioperative complications, establishment of biochemical remission, factors associated with disease remission, and predictors of recurrence. Although no standard definition of remission exists, we suggest measurement of serum cortisol level on the morning of postoperative day 1 given the preponderance of evidence in the published literature suggesting its association with long-term remission and relatively low rates of recurrence. Nevertheless, all patients should be counseled that recurrence can occur in a delayed fashion and that annual endocrine testing should be utilized to track and confirm disease status.

  12. Foot massage: effectiveness on postoperative pain in breast surgery patients.

    PubMed

    Ucuzal, Meral; Kanan, Nevin

    2014-06-01

    The aim of this study was to determine the effect of foot massage on pain after breast surgery, and provide guidance for nurses in nonpharmacologic interventions for pain relief. This was a quasiexperimental study with a total of 70 patients who had undergone breast surgery (35 in the experimental group and 35 in the control group). Patients in the control group received only analgesic treatment, whereas those in the experimental group received foot massage in addition to analgesic treatment. Patients received the first dose of analgesics during surgery. As soon as patients came from the operating room, they were evaluated for pain severity. Patients whose pain severity scored ≥4 according to the Short-Form McGill Pain Questionnaire were accepted into the study. In the experimental group, pain and vital signs (arterial blood pressure, pulse, and respiration) were evaluated before foot massage at the time patients complained about pain (time 0) and then 5, 30, 60, 90, and 120 minutes after foot massage. In the control group, pain and vital signs were also evaluated when the patients complained about pain (time 0) and again at 5, 30, 60, 90, and 120 minutes, in sync with the times when foot massage was completed in the experimental group. A patient information form was used to collect descriptive characteristics data of the patients, and the Short-Form McGill Pain Questionnaire was used to determine pain severity. Data were analyzed for frequencies, mean, standard deviation, chi-square, Student t, Pillai trace, and Bonferroni test. The results of the statistical analyses showed that patients in the experimental group experienced significantly less pain (p ≤ .001). Especially notable, patients in the experimental group showed a decrease in all vital signs 5 minutes after foot massage, but patients in the control group showed increases in vital signs except for heart rate at 5 minutes. The data obtained showed that foot massage in breast surgery patients was

  13. ESOPHAGEAL PERFORATION FOLLOWING OROGASTRIC SUCTION CATHETER INSERTION IN AN ELDERLY PATIENT.

    PubMed

    Kaddoum, Roland N; Farah, Fadi; Saroufim, Rita W; Zeineldine, Salah M

    2015-02-01

    Esophageal rupture has been described following iatrogenic manipulation. In this report, we present an elderly lady admitted to the operative theater for laparoscopic cholecystectomy. Multiple intra-operative attempts to place a flexible orogastric tube were unsuccessful because of failure to advance. Post-operatively, the patient developed sepsis and a right pleural effusion. She was transferred to the Intensive Care Unit and she was treated with antibiotics. Radiologic evaluation confirmed an esophago-pleural fistula. Surgical repair was urgently performed for closure of fistula and lung decortication. The patient recovered and was discharged home.

  14. Epidemiology and prognosis of candidaemia in elderly patients.

    PubMed

    Ramos-Martínez, Antonio; Vicente-López, Natalia; Sánchez-Romero, Isabel; Padilla, Belén; Merino-Amador, Paloma; Garnacho-Montero, José; Ruiz-Camps, Isabel; Montejo, Miguel; Salavert, Miguel; Mensa, José; Cuenca-Estrella, Manuel

    2017-08-23

    The aim of the study was to analyse the epidemiology and prognosis of candidaemia in elderly patients. We performed a comparison of clinical presentation of candidaemia according to age and a study of hazard factors within a prospective programme performed in 29 hospitals. One hundred and seventy-six episodes occurred in elderly patients (>75 years), 227 episodes in middle-aged patients (61-75 years) and 232 episodes in younger patients (16-60 years). Central venous catheter, parenteral nutrition, neutropenia, immunosuppressive therapy and candidaemia caused by Candida parapsilosis were less frequent in elderly patients. These patients received inadequate antifungal therapy (57.3%) more frequently than middle-aged and younger patients (40.5% P < .001). Mortality during the first week (20%) and 30 days (42%) was higher in elderly patients. The variables independently associated with mortality in elderly patients during the first 7 days were acute renal failure (OR: 2.64), Pitt score (OR: 1.57) and appropriate antifungal therapy (OR: 0.132). Primary candidaemia (OR: 2.93), acute renal failure (OR: 3.68), Pitt score (OR: 1.38), appropriate antifungal therapy (OR: 0.3) and early removal of the central catheter (OR: 0.47) were independently associated with 30-day mortality.In conclussion, inadequate antifungal treatment is frequently prescribed to elderly patients with candidaemia and is related with early and late mortality. © 2017 Blackwell Verlag GmbH.

  15. Long-term post-operative cognitive decline in the elderly: the effects of anesthesia type, apolipoprotein E genotype, and clinical antecedents

    PubMed Central

    Ancelin, Marie-Laure; De Roquefeuil, Guilhem; Scali, Jacqueline; Bonnel, François; Adam, Jean-François; Cheminal, Jean-Claude; Cristol, Jean-Paul; Dupuy, Anne-Marie; Carrière, Isabelle; Ritchie, Karen

    2010-01-01

    Cognitive dysfunction in the elderly commonly observed following anesthesia has been attributed to age-related neuronal changes exacerbated by pharmacotoxic effects. However, the extent to which these changes may persist following recovery from surgery is still largely unknown. This study investigates the long-term effects of anesthesia on cognitive functioning after orthopedic surgery in 270 elderly patients over the age of 65 who completed a computerized cognitive battery before and 8 days, 4 and 13 months after surgery. Their performance was compared to that of 310 elderly controls who completed the same neuro-psychiatric evaluation at baseline and one-year interval. Multivariate analyses adjusted for socio-demographic variables, depressive symptomatology, vascular pathology as well as baseline cognitive performance. We found early and transient post-operative decline in reaction time and constructional praxis. With regard to long-term changes we observed improvement compared to controls in most verbal tasks (probably due to learning effects). On the other hand, a clear dissociation effect was observed for several areas of visuospatial functioning which persisted up to the 13-month follow-up. This specific pattern of visuospatial deficit was found to be independent of apolipoprotein E genotype and closely resembles what has recently been termed vascular mild cognitive impairment, in turn associated with subtle sub-cortical vascular changes. The observation of only minor differences between persons operated by general and regional anesthesia makes it difficult to attribute these changes directly to the anesthetic agents themselves, suggesting that cognitive dysfunction may be attributable at least in part to peri-operative conditions, notably stress and glucocorticoid exposure. PMID:20858969

  16. Effectiveness of fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for elderly patients: a randomized trial.

    PubMed

    Wang, Q; Suo, J; Jiang, J; Wang, C; Zhao, Y-Q; Cao, X

    2012-08-01

    The aim of the study was to evaluate the efficacy and safety of fast-track rehabilitation in elderly patients over 65 years of age, following laparoscopic surgery to remove colorectal cancer. A total of 78 elderly patients with colorectal cancer who underwent laparoscopic colorectal resection were randomly assigned to receive either the fast-track care programme (n = 40) or the conventional perioperative care protocol (control group, n = 38). Medical personnel conducting the study were blinded to patients' clinical outcomes prior to statistical analysis. The fast-track protocol included no preoperative mechanical bowel irrigation, immediate oral alimentation and earlier postoperative ambulation exercise. The length of postoperative hospital stay, the length of time to regain bowel function and the rate of postoperative complications were compared between the two groups. The length of time to regain bowel function, including the passage of flatus[31 (26-40) h vs 38 (32-51) h, P = 0.001], to the first bowel movement [55 (48-63) h vs 64 (48-71) h, P = 0.009] and to start a liquid diet (12 [11-16] h vs 47 [35-50] h, P = 0.000) were significantly shorter in patients receiving the fast-track care protocol compared with those receiving the conventional care protocol. A shorter duration of postoperative hospital stay was recorded in patients receiving the fast-track program than in those receiving conventional care (P = 0.0001). A reduced percentage of patients who developed general complications was also observed in the fast-track group (5.0%vs 21.1%, P = 0.045). This randomized controlled trial has shown that in the elderly undergoing laparoscopic colorectal surgery, the fast-track recovery programme resulted in a more rapid postoperative recovery, earlier discharge from hospital and fewer general complications compared with a conventional postoperative protocol. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and

  17. Rotator Cuff Tears in the Elderly Patients

    PubMed Central

    Geary, Michael B.

    2015-01-01

    Rotator cuff tears (RCT) are a common clinical problem in the geriatric population, and debate exists over how to best provide pain relief and restore shoulder function. Treatment options can be broadly divided into nonsurgical and surgical, with the majority of patients initially placed on a trial of conservative therapy. For those with irreparable RCT, low functional demand, or interest in nonoperative management, there are a number of nonsurgical treatments to consider, including rehabilitation and injections of corticosteroids, hyaluronate, and platelet-rich plasma. Surgical treatment is increasingly common, as geriatric patients remain active with high functional demands. Studies in elderly populations have demonstrated satisfactory healing and clinical results following surgical repair. Predictors of poor outcome after repair are large tear size as well as higher stages of fatty infiltration. Decompression is a less invasive surgical option that has been shown to provide short-term pain relief, though the lasting effects may deteriorate over time. A number of factors must be weighed when considering which patients are likely to benefit from surgical intervention. PMID:26328240

  18. Cimetidine in elderly patients: review of uses and risks.

    PubMed

    Jenike, M A

    1982-03-01

    Cimetidine is widely prescribed but has numerous potential side effects, especially in elder patients, who require a lower dosage, e.g., 300 mg twice daily. Antacids may be more effective than cimetidine in preventing acute gastrointestinal bleeding in critically ill elderly patients. Cimetidine increases the risk of toxicity of other commonly used drugs such as phenytoin, diazepam, chlordiazepoxide, propranolol, theophylline, warfarin, and carbamazepine. Elderly patients taking cimetidine are at risk for neuropsychiatric changes, which may be temporarily reversed by physostigmine. Other side effects and indications for use are reviewed.

  19. [Role of surgery for lung cancer in elderly patients].

    PubMed

    Benko, István; Horváth, Ors Péter; Nagy, Klára; Sárosi, Veronika; Balikó, Zoltán; Potó, László; Molnár, F Tamás

    2008-02-01

    Lung cancer is a leading cause of death in the civilised world. Surgical resection, which play a crucial role in the complex oncological treatment, has to be offered in older ages than it was done before, due to an ageing population. Results of surgical treatment of patients older than 75 years are investigated retrospectively in the present paper. A retrospectively analysis was carried out of 54 from a total of 884 lung resections for primary lung cancer performed for patients older than 75 years between 1995-2005. Twelve of these patients were above 80 years. Kaplan-Meier analysis was performed to calculate survival and multifactor analysis for the risk factors. Average age was 77.5 years (75-85). Two pneumonectomies, two bilobectomies, 41 lobectomies, seven sublobar resections and two lobectomies with chest wall resections were performed. The average hospital stay was 11.4 days (8-36). Mortality: 7.4% (n = 4), morbidity: 52% (n = 28) including: sputum retention: 43%, arrhythmia 33%, atelectasia: 15%. There were two bronchial stump insufficiencies (4%) and three reoperations were performed (5%). The average follow up was: 32 months and the five year survival 33.7% (median 43 months). Multifactorial analysis show that extended resection, male gender, age above 80 years are risk factors for adverse outcome. Female gender, stage Ia and lobectomy are considered as predictive factors for long survival. We conclude, that with proper patient selection (below ASA3, early stage) and with carefully conducted postoperative care (physiotherapy, monitoring) surgical resection should be offered to elderly lung cancer patients as well.

  20. Rib Fracture Protocol Advancing the Care of the Elderly Patient.

    PubMed

    Leininger, Susan

    This article discusses unique factors associated with rib fractures in the elderly patient population and explains the process used in one facility to develop a revised protocol for the management of elderly patients with a rib fracture. The goals were to eliminate gaps in early trauma care management and employ a care routine that would improve outcomes for this vulnerable group of patients with fracture.

  1. [A sheet for deciphering the cries of hospitalized elderly patients].

    PubMed

    Gomas, Jean-Marie; Tribout, Didier; Knorreck, Fanny; Denis, Michel; Petrognani, Annie; Sales, Elodie

    2014-01-01

    Crying out is not an insignificant act and it is important to fight against this misconception. Any caregiver can be confronted with this phenomenon with elderly hospitalised patients. Their cries must be understood, analysed and taken into account as they correspond to a particular situation experienced by the elderly patient. There are tools to help caregivers diagnose and reflect on this clinical context. This article presents the example of an interpretation sheet which can help caregivers decipher patients' cries.

  2. Clinical strategies to accelerate recovery after surgery orthopedic femur in elderly patients

    PubMed Central

    Imbelloni, Luiz Eduardo; Gomes, Danielly; Braga, Rafaela Lopes; de Morais Filho, Geraldo Borges; da Silva, Alberto

    2014-01-01

    Background: The prevalence of hip fracture is increasing with the continued aging of the population. The aim of this study was to compare the results after implementing the project accelerated post-operative recovery after surgery femur in patients aged over 60 years. Methods: Patients were observed during two distinct periods: Before implantation and after the implementation of the project Acerto. Patients underwent spinal anesthesia with post-operative analgesia by lumbar plexus block. Data evaluation was carried out in four stages of the study in both groups: Before arrival to the operating room during surgery, post-anesthesia care unit and on the ward in the morning of day 1 post-operatively. Results: The project implementation significantly reduces the length of stay, the number of suspension of surgery, duration of fasting, the incidence of hunger and thirst and the reintroduction of oral feeding. Oral feeding 2-4 h before surgery with dextrinomaltose not attended with nausea and vomiting. All patients were able to discharge on day 1 post-operatively. Conclusions: The use of clinical measures of accelerating patient recovery decreased length of stay, the number of suspensions of surgery, the time of fasting, the time of oral food reintroduction, high earlier and faster return to family life, working as humanization of treatment to the elderly. PMID:25886219

  3. Postoperative total parenteral nutrition in patients with liver disorders.

    PubMed

    Okuno, M; Nagayama, M; Takai, T; Rai, A; Nakao, S; Kamino, K; Umeyama, K

    1985-08-01

    Sixty-one patients with liver disorders receiving total parenteral nutrition (TPN) for about 14 postoperative days were divided into three groups based on the parenteral nutritional regimen. The influence of these TPN solutions on the liver function tests and the nutritional assessments, and the availability of the specially formulated amino acid solution were studied. Glucose alone as energy source was infused in Group Ia. The mixture of glucose and fructose was infused in Group Ib. In these patients (Group I), a commercially available amino acid solution was administered simultaneously. A specially formulated amino acid, rich in branched-chain amino acids but poor in aromatic amino acids was infused with the mixture of glucose and fructose in Group II. There was no remarkable elevation of blood glucose and lactate levels in all patients. Blood glucose levels in Group Ib were maintained lower than that in Group Ia. Except for serum alkaline phosphatase, no remarkable abnormality was observed in liver function tests. Body weight changes were less than 5% in each group. Average nitrogen balances were -44.5 mg/kg/day in Group Ia, -5.5 mg/kg/day in Group Ib, -51.5 mg/kg/day in Group II. While the abnormalities in serum amino acid pattern and molar ratio of leucine, isoleucine, and valine to phenylalanine and tyrosine tend to be more enhanced in Group I, these abnormalities returned to near normal in Group II during TPN. By multiple linear regression analyses, 45 kcal/kg/day of energy intake would be required to maintain nitrogen equilibrium and zero body weight change. And when nitrogen intakes were 159 mg/kg/day in Group Ia, 114 mg/kg/day in Group Ib, and 189 mg/kg/day in Group II at 45 kcal/kg/day in energy intake, nitrogen balances were expected to be equivalent. These results suggest that postoperative TPN is good for nutritional support in patients with liver disorders. And also, the combination of glucose and fructose has better effect on nitrogen balance. The

  4. Epidemiology and outcome of patients with postoperative abdominal fistula.

    PubMed

    Wercka, Janaina; Cagol, Patricia Paola; Melo, André Luiz Parizi; Locks, Giovani de Figueiredo; Franzon, Orli; Kruel, Nicolau Fernandes

    2016-01-01

    to present the epidemiological profile, incidence and outcome of patients who developing postoperative abdominal fistula. This observational, cross-sectional, prospective study evaluated patients undergoing abdominal surgery. We studied the epidemiological profile, the incidence of postoperative fistulas and their characteristics, the outcome of this complication and the predictors of mortality. The sample consisted of 1,148 patients. The incidence of fistula was 5.5%. There was predominance of biliary fistula (26%), followed by colonic fistulas (22%) and stomach (15%). The average time to onset of fistula was 6.3 days. For closure, the average was 25.6 days. The mortality rate of patients with fistula was 25.4%. Predictors of mortality in patients who developed fistula were age over 60 years, presence of comorbidities, fistula closure time more than 19 days, no spontaneous closure of the fistula, malnutrition, sepsis and need for admission to the Intensive Care Unit. abdominal postoperative fistulas are still relatively frequent and associated with significant morbidity and mortality. apresentar o perfil epidemiológico, incidência e desfecho em pacientes que evoluíram com fístula abdominal pós-operatória. trata-se de um estudo prospectivo transversal observacional que avaliou pacientes submetidos à cirurgia abdominal. Foram estudados o perfil epidemiológico, a incidência das fístulas pós-operatórias e suas características, desfecho desta complicaçãoe fatores preditivos de mortalidade. a amostra constou de 1148 pacientes. A incidência de fístula foi 5,5%. Houve predominância de fístulas biliares (26%), seguidas de fístulas colônicas (22%) e gástricas (15%). O tempo médio para o surgimento da fístula foi 6,3 dias. Para o fechamento, a média foi 25,6 dias. A taxa de mortalidade dos pacientes com fístula foi 25,4%. Os fatores preditivos de mortalidade nos casos que desenvolveram fístula foram idade maior do que 60 anos, presença de

  5. Pacemaker implantation complication rates in elderly and young patients.

    PubMed

    Ozcan, Kazım Serhan; Osmonov, Damirbek; Altay, Servet; Dönmez, Cevdet; Yıldırım, Ersin; Türkkan, Ceyhan; Güngör, Barış; Ekmekçi, Ahmet; Alper, Ahmet Taha; Gürkan, Kadir; Erdinler, Izzet

    2013-01-01

    To evaluate the complication rate differences between elderly and younger patients who receive a permanent pacemaker implantation. We reviewed all cases admitted to our institution between January 2008 and June 2009 with symptomatic bradyarrhythmia for whom a permanent pacemaker was implanted. Beginning in June 2009, we prospectively collected data from all patients with the same diagnosis and procedure. The frequency of complications due to the pacemaker implantation procedure was evaluated and compared between young (<70 years old) and elderly (≥70 years old) patients. Among 574 patients with a permanent pacemaker, 259 patients (45.1%) were below and 315 patients (54.9%) were above or at 70 years of age. There were 240 (92.7%) and 19 (7.3%) dual-chamber pacemaker (DDD) and single-chamber pacemaker (VVI) implanted patients in the younger group, and 291 (76.8%) and 73 (23.2%) DDD and VVI pacemaker implanted patients in the elderly group, respectively. The complication rate was 39 (15.1%) out of 259 young patients and 24 (7.6%) out of 315 elderly patients. Postprocedural complications were statistically lower in the elderly patients than in younger patients (P = 0.005). A pacemaker implantation performed by an experienced operator is a safe procedure for patients of advanced age. The patients who are above 70 years old may have less complication rates than the younger patients.

  6. Corpus callosum involvement and postoperative outcomes of patients with gliomas.

    PubMed

    Chen, Ko-Ting; Wu, Tai-Wei Erich; Chuang, Chi-Cheng; Hsu, Yung-Hsin; Hsu, Peng-Wei; Huang, Yin-Cheng; Lin, Tzu-Kang; Chang, Chen-Nen; Lee, Shih-Tseng; Wu, Chieh-Tsai; Tseng, Chen-Kan; Wang, Chun-Chieh; Pai, Ping-Ching; Wei, Kuo-Chen; Chen, Pin-Yuan

    2015-09-01

    Corpus callosum involvement is associated with poorer survival in high grade glioma (HGG), but the prognostic value in low grade glioma (LGG) is unclear. To determine the prognostic impact of corpus callosum involvement on progression free survival (PFS) and overall survival (OS) in HGG and LGG, the records of 233 glioma patients treated from 2008 to 2011 were retrospectively reviewed. Preoperative magnetic resonance (MR) images were used to identify corpus callosum involvement. Age, sex, preoperative Karnofsky performance scale, postoperative Eastern Cooperative Oncology Group (ECOG) score and extent of resection (EOR) were evaluated with respect to PFS and OS. The incidence of corpus callosum involvement was similar among HGG (14 %) and LGG (14.5 %). Univariate analysis revealed that PFS and OS were significantly shorter in both WHO grade II and grade IV glioma with corpus callosum involvement (both, p < 0.05). Multivariate analysis showed that grade II glioma with corpus callosum involvement have shorter PFS (p = 0.03), while EOR, instead of corpus callosum involvement (p = 0.16), was an independent factor associated with PFS in grade IV glioma (p < 0.05). Corpus callosum involvement was no longer significantly associated with OS after adjusting age, gender, EOR, preoperative and postoperative performance status (p = 0.16, 0.17 and 0.56 in grade II, III and IV gliomas, respectively). Corpus callosum involvement happened in both LGG and HGG, and is associated with lower EOR and higher postoperative ECOG score both in LGG and HGG. Corpus callosum involvement tends to be an independent prognostic factor for PFS in LGG, but not for OS in LGG or in HGG.

  7. [Elderly patients with glioblastoma: state of the art].

    PubMed

    Biau, Julian; Dalloz, Pierre; Durando, Xavier; Hager, Marie-Odile; Ouédraogo, Zangbéwendé Guy; Khalil, Toufic; Lemaire, Jean-Jacques; Chautard, Emmanuel; Verrelle, Pierre

    2015-03-01

    The incidence of glioblastoma increases with age, with a median age, at diagnosis, of 65 years. Indeed, the optimization of standard of care of elderly glioblastoma patients in an aging population in Western countries becomes crucial. The age remains the main prognostic factor of glioblastoma. Survival among elderly patients is significantly less than among younger patients. The median survival of elderly glioblastoma patients is generally inferior to 6 months. More aggressive tumor behavior, less aggressive treatments, increased toxicity of therapies and more unfavorable clinical factors and comorbidities could explain a higher severity of the disease in the elderly. The balance between treatment efficacy and quality of life is a major focus because of the shorter life expectancy of patients. The standard of care of glioblastoma in elderly patients remains controversial. Large optimal resection, when achievable, should be preferred to biopsy. Survival is longer after adjuvant radiotherapy, either normofractionated over 6-weeks course or hypofractionated over 3-weeks course, for patients with good clinical status. Hypofractionation is often preferred because of shorter procedure. Chemotherapy alone with temozolomide can be proposed to patients with methylated MGMT promoter. A phase III randomized study, testing short-course adjuvant radiotherapy with or without temozolomide in elderly patients with good clinical status, is ongoing. Copyright © 2015 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

  8. Lower muscle density is associated with major postoperative complications in older patients after surgery for colorectal cancer.

    PubMed

    Margadant, C C; Bruns, E R J; Sloothaak, D A M; van Duijvendijk, P; van Raamt, A F; van der Zaag, H J; Buskens, C J; van Munster, B C; van der Zaag, E S

    2016-11-01

    Reduced muscle density is associated with an increased risk of postoperative complications. We examined the prognostic value of muscle density as a predictor of postoperative complications in elderly patients undergoing surgery for colorectal cancer. Patients (≥70 years) who underwent surgery for colorectal cancer between 2006 and 2013 were selected from a prospective single centre database. The Hounsfield Unit Average (HUA or HU/mm(2)) of the psoas muscles at the level of the third lumbar vertebra was calculated on the scan. High and low muscle density groups were identified based on the lowest gender specific HUAC quartile. Major postoperative complications (Clavien-Dindo (CD) ≥3) within 30 days after surgery were retrospectively documented. Logistic regression analysis was used to identify risk factors for postoperative complications. A total of 373 patients (median age = 78 years) were included in this study. The mean muscle density score was 24.5 ± 4.3 HU/mm(2) for males and 26.3 ± 5.0 HU/mm(2) for females. The cut-off point for the lowest gender specific quartile was ≤22.0 HU/mm(2) for males and ≤23.5 HU/mm(2) for females. After multivariable regression, there was a statistically significant association between muscle density and CD ≥ 3 (OR = 1.84 (95% CI 1.11-3.06), p = 0.019). Anastomotic leakage in patients with a primary anastomosis (n = 287) occurred more often in patients with low muscle density (11.7% vs 23.3%, p = 0.016). The associations remained significant after correction for confounders. Low muscle density is associated with major postoperative complications in older patients who undergo surgery for colorectal cancer. Published by Elsevier Ltd.

  9. Colorectal cancer care in elderly patients: Unsolved issues.

    PubMed

    Aparicio, Thomas; Pamoukdjian, Frederic; Quero, Laurent; Manfredi, Sylvain; Wind, Philippe; Paillaud, Elena

    2016-10-01

    Colorectal cancers are common in elderly patients. However, cancer screening is poorly used after 75. Elderly patients form a heterogeneous population with specific characteristics. Standards of care cannot therefore be transposed from young to elderly patients. Tumour resection is frequently performed but adjuvant chemotherapy is rarely prescribed as there are no clearly established standards of care. In a metastatic setting, recent phase III studies have demonstrated that doublet front-line chemotherapy provided no survival benefit. Moreover, several studies have established the benefit of bevacizumab in association with chemotherapy. There is a lack of evidence for the efficacy of anti-epidermal growth factor antibodies in elderly patients. Geriatric assessments could help to select the adequate treatment strategy for individual patients. Geriatric oncology is now the challenge we have to face, and more specific trials are needed.

  10. Postoperative nausea and vomiting: comparison of the effect of postoperative meperidine or morphine in gynecologic surgery patients.

    PubMed

    Ezri, Tiberiu; Lurie, Samuel; Stein, Arnold; Evron, Shmuel; Geva, Daniel

    2002-06-01

    To evaluate the incidence and severity of postoperative nausea and vomiting in women receiving postoperative intravenous morphine or meperidine following gynecologic surgery. Prospective, double-blind, randomized study. Tertiary-care academic medical center. 200 ASA physical status I, II, and III patients scheduled for elective gynecologic surgery. Patients received either postoperative IV morphine (n = 100) or meperidine (n = 100) following gynecologic surgery. We compared pain scores, sedation scores, nausea scores, well-being scores, vomiting rate, and patient satisfaction in both groups 15, 30, 60, and 120 minutes after arrival in the postoperative anesthesia care unit. The vomiting rate was 8/100 versus 7/100 (at 15 min), 4/100 versus 26/100 (at 30 min) (p < 0.05), 3/100 versus 23/100 (at 60 min) (p < 0.05), and 0/100 versus 0/100 (at 120 min) in the morphine or meperidine groups, respectively. The pain and sedation scores were similar in both groups. No major complications were noted in either group. Our study demonstrates an advantage of the use of morphine rather than meperidine for pain control in the immediate postoperative period following gynecologic surgery.

  11. Postoperative prophylaxis with norfloxacin in patients requiring bladder catheters.

    PubMed

    Verbrugh, H A; Mintjes-de Groot, A J; Andriesse, R; Hamersma, K; van Dijk, A

    1988-08-01

    The effect of once daily doses of 200 mg oral norfloxacin on the occurrence of catheter-associated bacteriuria (greater than 1000 CFU/ml) and pyuria was studied in 105 post-operative gynaecologic patients. Norfloxacin was given from the second day after surgery until catheter removal. Bacteriuria developed in 32 of 51 (63%) control patients compared to 8 of 54 (15%) patients receiving norfloxacin (p less than 0.001). Pyuria was present in 22 of 51 (43%) control subjects versus only 3 of 54 (5%) patients treated with norfloxacin (p less than 0.001). Bacteria isolated from control patients comprised species of Enterobacteriaceae (40%), Staphylococcus (35%), and Streptococcus (17%); seven isolates were resistant to multiple antibiotics reflecting their nosocomial origin. In contrast, strains isolated from norfloxacin-treated patients comprised non-fermenting gram-negative rods (79%, usually Alcaligenes or Acinetobacter spp.) and faecal streptococci (12%). It is concluded that once daily doses of 200 mg oral norfloxacin are effective in reducing the rate of catheter-associated bacteriuria and pyuria following reconstructive gynaecologic surgery.

  12. Temporal variability of readmission determinants in postoperative vascular surgery patients

    PubMed Central

    Lin, MJ; Baky, F; Housley, BC; Kelly, N; Pletcher, E; Balshi, JD; Stawicki, SP; Evans, DC

    2016-01-01

    Introduction: Clinical information continues to be limited regarding changes in the temporal risk profile for readmissions during the initial postoperative year in vascular surgery patients. We set out to describe the associations between demographics, clinical outcomes, comorbidity indices, and hospital readmissions in a sample of patients undergoing common extremity revascularization or dialysis access (ERDA) procedures. We hypothesized that factors independently associated with readmission will evolve from “short-term” to “long-term” determinants at 30-, 180-, and 360-day postoperative cutoff points. Methods: Following IRB approval, medical records of patients who underwent ERDA at two institutions were retrospectively reviewed between 2008 and 2014. Abstracted data included patient demographics, procedural characteristics, the American Society of Anesthesiologists score, Goldman Criteria for perioperative cardiac assessment, the Charlson comorbidity index, morbidity, mortality, and readmission (at 30-, 180-, and 360-days). Univariate analyses were performed for readmissions at each specified time point. Variables reaching statistical significance of P < 0.20 were included in multivariate analyses for factors independently associated with readmission. Results: A total of 450 of 744 patients who underwent ERDA with complete medical records were included. Patients underwent either an extremity revascularization (e.g. bypass or endarterectomy, 406/450) or a noncatheter dialysis access procedure (44/450). Sample characteristics included 262 (58.2%) females, mean age 61.4 ± 12.9 years, 63 (14%) emergent procedures, and median operative time 164 min. Median hospital length of stay (index admission) was 4 days. Cumulative readmission rates at 30-, 180-, and 360-day were 12%, 27%, and 35%, respectively. Corresponding mortality rates were 3%, 7%, and 9%. Key factors independently associated with 30-, 180-, and 360-day readmissions evolved over the study period

  13. Gender differences in post-operative pain and patient controlled analgesia use among adolescent surgical patients.

    PubMed

    Logan, Deirdre E; Rose, John B

    2004-06-01

    The aim of this study was to explore gender differences in anticipatory emotional distress, coping strategies, post-operative pain perception, and patient-controlled analgesia (PCA) use among adolescent surgical patients. One hundred and two 12-18-year-old adolescents undergoing surgeries with overnight hospital stay were recruited. Participants completed pre-operative measures of anxiety and anticipated pain. Post-operatively, they reported on coping skills, post-operative anxiety, and pain. Data on PCA use were recorded from medical records. Girls reported higher levels of pre-operative state anxiety and anticipated more pain. After surgery, girls and boys differed on their lowest daily pain ratings and average daily pain ratings, with girls reporting more pain in both cases. Reports of highest daily pain were similar across genders. Gender was found to moderate the relationship between anticipatory distress and post-operative pain, such that higher anticipatory distress before surgery predicted more post-operative pain for girls, but not for boys. Patterns of PCA use did not vary by gender on post-operative days 0 or 1. Findings suggest that adolescent boys' and girls' pain experiences are different in several important respects, although somewhat less divergent than has been reported in samples of adult males and females. Results have implications for the development of targeted intervention strategies to help adolescents cope effectively with acute post-operative pain.

  14. [Comparison of postoperative deglutition disorder in patients with laryngeal carcinoma after different types of supracricoid partial laryngectomy].

    PubMed

    Lin, Ren-Yu; Chen, Jian-Fu; Guo, Zhi-Qiang; Jia, Ming-Hui; Peng, Jian-Hua

    2011-01-01

    To Evaluate the incidence rates and extents of deglutition disorder in patients with laryngeal carcinoma after different types of supracricoid partial laryngectomy. Retrospective analysis of postoperative deglutition disorder in patients with laryngeal carcinoma after different types of supracricoid partial laryngectomy treated in our department from 2005 to 2009. The extents of postoperative deglutition disorder were evaluated using a homemade quantitative score table at 5-20 days postoperation. The score of deglutition disorder was 2.71 ± 0.31 in the supracricoid partial laryngectomy-cricohyoidoepiglottopexy (SCPL-CHEP) operation group and 3.43 ± 0.64 in the supracricoid partial laryngectomy-cricohyoidopexy (SCPL-CHP) group, respectively. The deference was statistically significant between the two groups (P < 0.001). The coefficient between age and score of postoperative deglutition disorder was assessed by Pearson correlation analysis. The coefficient of correlation was 0.947 (P < 0.0001) in the SCPL-CHEP group and 0.907 (P < 0.0001) in the SCPL-CHP group. The incidence rate of deglutition disorder was 1/37 in the SCPL-CHEP group and 7/30 in the SCPL-CHP group, evaluated at 8 weeks postoperation (P = 0.012). The deference between the two groups was significant. The type of operation procedure is an important factor affecting the occurrence of postoperative deglutition disorder in the patients after supracricoid partial laryngectomy, more serious in the SCPL-CHP group. The severity of postoperative deglutition disorder is more serious along with the increase of patient's age. For the elderly (> 70 years of age) patients with laryngeal carcinoma, the choice of surgical procedure should be more cautious, especially with the SCPL-CHP operation.

  15. Total knee arthroplasty in elderly osteoporotic patients.

    PubMed

    Spinarelli, Antonio; Petrera, Massimo; Vicenti, Giovanni; Pesce, Vito; Patella, Vittorio

    2011-04-01

    Often in daily practice the choice of a prosthesis does not rise out of considerations about literature evidences, but it seems to be related to the personal experience and "surgical philosophy" of surgeon. The choice of prosthesis in total joint replacement is usually justified by biological and mechanical parameters that the surgeon considers before surgery. Osteoporosis is a disease characterized by a reduced bone mass and a degeneration of the bone tissue; it leads to bone fragility, so to a higher risk of fractures. Bone resistance, as all the changes in the microarchitecture of the bone tissue, is linked to bone density. Because of the bone density variation and/or the changes in the bone micro-architecture, as the bone strength decreases, the risk of fractures increases. It is important to understand all the factors taking part in both normal and abnormal bone remodelling. Osteoporosis does not imply a concrete bone loss, but a change of the bone micro-architecture itself. In these cases the choice of the patient and implant design are very important. In the period between March 1997-July 2002, we implanted 100 consecutive TKA (total knee arthroplasty) Genesis II in 97 subjects (79 female); mean age was 77.1 years old. All TKA were performed because of primary osteoarthritis of the knee. All patients had complete pain relief and excellent knee score. The surgical and medical complications were in accordance with the published literature. We must consider all existing medical conditions, the state of the knee and local needs of the elderly patient. Thus, within these limits, the total knee can improve the ability of patients to manage the activities of daily living and improve their quality of life.

  16. Preoperative plasma leptin levels predict delirium in elderly patients after hip fracture surgery.

    PubMed

    Chen, Xue-Wu; Shi, Jun-Wu; Yang, Ping-Shan; Wu, Zhu-Qi

    2014-07-01

    Leptin is considered to be a modulator of the immune response. Hypoleptinemia increases the risk for Alzheimer's disease and vascular dementia. The present study aimed to investigate the ability of plasma leptin level to predict delirium in elderly patients after hip fracture surgery. Postoperative delirium (pod) was evaluated using the Confusion Assessment Method. Prolonged postoperative delirium (ppod) was defined as delirium lasting more than 4 weeks. Plasma leptin levels of 186 elderly patients and 186 elderly controls were measured by an enzyme-linked immunosorbent assay. Plasma leptin level was substantially lower in patients than in controls (4.6±2.2ng/ml vs. 7.5±1.8ng/ml, P<0.001). It was identified as an independent predictor for pod [odds ratio, 0.385; 95% confidence interval (CI), 0.286-0.517; P<0.001] and ppod (odds ratio, 0.283; 95% CI, 0.152-0.527; P<0.001) using a multivariate analysis, and had high area under receiver operating characteristic curve for pod [area under curve (AUC), 0.850; 95% CI, 0.790-0.898] and ppod (AUC, 0.890; 95% CI, 0.836-0.931). The predictive value of leptin was markedly bigger than that of age for pod (AUC, 0.705; 95% CI, 0.634-0.770; P=0.002) and ppod (AUC, 0.713; 95% CI, 0.642-0.777; P=0.019). In a combined logistic-regression model, leptin improved the AUC of age to 0.890 (95% CI, 0.836-0.931) (P<0.001) for pod and 0.910 (95% CI, 0.860-0.947) (P=0.005) for ppod. Thus, preoperative plasma leptin level may be a useful, complementary tool to predict delirium and also prolonged delirium in elderly patients after hip fracture surgery.

  17. The effect of therapeutic touch on postoperative patients.

    PubMed

    Coakley, Amanda Bulette; Duffy, Mary E

    2010-09-01

    Therapeutic Touch (TT) is a complementary modality that has been demonstrated to reduce psychological distress and help patients to relax. It is unclear if there is an impact of TT on biobehavioral markers such as cortisol and natural killer cells (NKCs). There is some preliminary evidence that suggests relaxation may have positive effects on the immune system. To test the efficacy of TT on pain and biobehavioral markers in patients recovering from vascular surgery. The study was grounded in a psychoneuroimmunology framework to address how complementary therapies affect pain and biobehavioral markers associated with recovery in surgical patients. This was a between-subjects intervention study. Twenty-one postoperative surgical patients. Measures of level of pain and levels of cortisol and NKCs were obtained before and after a TT treatment. Compared with those who received usual care, participants who received TT had significantly lower level of pain, lower cortisol level, and higher NKC level. Evidence supports TT as a beneficial intervention with patients. Future research on TT is still needed to learn more about how it functions. However, there is evidence to support incorporating TT into nursing practice.

  18. Physical therapy in postoperative cardiac surgery: patient's perception.

    PubMed

    Lima, Paula Monique Barbosa; Cavalcante, Hermanny Evanio Freitas; Rocha, Angelo Roncalli Miranda; Brito, Rebeca Taciana Fernandes de

    2011-01-01

    Many strategies to improve services provided by for physiotherapy are based on patients satisfaction. Listen and observe the behavior of patients in a hospital is crucial to understanding and improvement of service and the hospital. This study aimed to identify the patient's perception undergoing cardiac surgery on the physiotherapy service provided to wards of hospitals for heart surgery reference in the city of Maceió, AL, Brazil, and from that information detect what actions are perceived as priorities for which are noteworthy plans for improvements in quality of care. Cross-sectional study, conducted in quality and quantity of reference hospitals in cardiac surgery in the city of Maceio, AL, Brazil, in the period from September to November 2008. The study included 30 users of the Sistema Único de Saúde, of which 12 (40%) female and 18 (60%) males. The average age of this sample was 49.2 ± 11.9 years and most belonged to socioeconomic class D (36.7%). It was found that only 16.7% had contact with the physiotherapist before surgery. Regarding educational guidelines about postoperative period, only 2.9% patients reported having received them. However, 56.8% rated the care as good and 100% of patients reported believing that physiotherapy could improve their health status. We suggest the implementation of preoperative physical therapy protocols with preventive measures and educational as well as new researchs that may characterize the population of users of health plans/private.

  19. [Cognitive impairment in elderly patients with acute hypertensive encephalopathy].

    PubMed

    Baev, V M; Kozlov, D B

    2012-01-01

    Acute hypertensive encephalopathy in elderly patients appears reversible mild cognitive impairment. The erythrocyte sedimentation rate and blood creatinine measured during a hypertensive crisis are predictors of decline of visual-spatial orientation after two weeks of treatment.

  20. Prevention of Post-operative Delirium in the Elderly Using Pharmacological Agents

    PubMed Central

    Tremblay, Patrice; Gold, Susan

    2016-01-01

    Introduction Post-operative delirium (POD) is a serious surgical complication that can cause significant morbidity and mortality. It is associated with prolonged hospital stay, delayed admission to rehabilitation programs, persistent cognitive deficits, marked health-care costs, and more. The pathophysiology is multi-factorial and not completely understood, which complicates the optimal management. Non-pharmacological measures have been the mainstay of treatment, but there has been an ongoing interest in the medical literature on the prevention of post-operative delirium using medications. The purpose of this review is to critically analyze the current evidence on pharmacological prevention of POD. Methods A literature review was conducted using PubMed and Embase databases, using the following search terms: delirium, anti-psychotics, cholinesterase inhibitors, and statins. Results A total of 1,152 articles were screened and 25 articles were reviewed. Fourteen articles found a reduced incidence of post-operative delirium using pharmacological agents: eight with antipsychotics, two with statins, one with melatonin, one with dexamethasone, one with gabapentin, and one with diazepam. However, study designs, methodological issues, or authors’ interpretations raise questions on these conclusions. Conclusions Further double-blinded randomized clinical trials should be conducted before administering pharmacological agents to reduce POD in a non-research setting. PMID:27729950

  1. Cognitive decline in an elderly hospitalized patient with primary leptomeningeal melanomatosis.

    PubMed

    Bobba, Ravi; Arsura, Edward

    2004-11-01

    Delirium is one of the most common disorders in hospitalized patients. The authors present the case of an elderly male patient with postoperative cognitive decline that did not resolve with the conventional treatment. The diagnosis was only established on autopsy. A 75-year-old man was evaluated after a fall. Initial evaluation revealed voluntary guarding in the right epigastric region, and free air was detected under the right hemidiaphragm on abdominal radiography. An exploratory laparotomy revealed a perforation that had apparently sealed off. After surgery, he had initial improvement toward baseline; however, after several days, his postoperative course was complicated by a progressive deterioration in mental status, recurrent seizures, and aspiration pneumonia. Computed tomographic scan of the brain showed communicating hydrocephalus. Examination of the cerebrospinal fluid revealed an elevated opening pressure and elevated protein. His mental status continued to deteriorate, and he died. Autopsy revealed the pathologic diagnosis of primary leptomeningeal melanomatosis.

  2. Disseminated Herpes Zoster in an Immunocompetent Elderly Patient

    PubMed Central

    Kim, Su Hwa; Lee, Eun Ha; Choi, Ji Hye

    2013-01-01

    Herpes zoster is a cutaneous infection that is characterized by an acute vesicobullous rash with ipsilateral one or two dermatomal distribution and painful allodynia, while predominantly being found in the elderly. Extensive cutaneous dissemination has been reported in immune-compromised patients, such as those who suffer from HIV infections, cancer, chemotherapy, and corticosteroid therapy patients. However, we report a case of disseminated herpes zoster infection in an immuno-competent elderly individual. PMID:23614086

  3. Postoperative cystoid macular oedema in a patient on fingolimod.

    PubMed

    Gaskin, Jennifer Chen-Chia Fan; Coote, Michael

    2015-05-12

    We describe the first case of fingolimod-associated bilateral cystoid macular oedema (CMO) following uncomplicated cataract surgery. A 57-year-old woman has been on fingolimod for the past 2 years for the treatment of relapsing-remitting multiple sclerosis. She underwent uneventful consecutive cataract surgery 2 weeks apart. Three weeks following the second cataract operation, she reported gradual-onset blurred vision bilaterally. Examination revealed mildly reduced visual acuity and bilateral CMO. Treatment with topical corticosteroids and non-steroidal anti-inflammatory eye drops, as well as cessation of fingolimod in collaboration with the neurologist, resulted in complete resolution of the CMO. Patients on fingolimod are likely to be at increased risk of developing postoperative CMO. 2015 BMJ Publishing Group Ltd.

  4. Risk factors of patients with and without postoperative nausea (PON).

    PubMed

    Dienemann, Jacqueline; Hudgens, Amanda N; Martin, Dana; Jones, Holly; Hunt, Ronald; Blackwell, Richard; Norton, H James; Divine, George

    2012-08-01

    This purpose of this analysis was to study risk factors of postoperative nausea (PON) and their strength. Data were obtained during the screening phase of a controlled clinical trial of aromatherapy for PON. In a sample of 1151 postsurgical subjects, 301 (26.2%) reported PON. Significant risk factors identified in the order of odds ratios for nausea were female gender, gastrointestinal surgery, use of volatile anesthesia gases, history of PON, history of motion sickness, and use of opioids after surgery. Although still over 1.0, the risk factors of length of surgery over 1 hour and gynecologic surgery had the lowest odds ratios. Likelihood of nausea increased significantly with the number of significant risk factors (P<.0001). Administration of preventive antiemetic medication also increased with the number of significant risk factors (P<.0001). Among 301 subjects reporting nausea, 49 (16.28%) received preventive medication. Despite prevention efforts, PON remains a substantial side effect for many surgical patients.

  5. Unplanned Reoperations in Neurosurgical Patients Due to Postoperative Bleeding

    PubMed Central

    Zheng, Xin-Rui; Chen, Tao; Yang, Yue-Fan; Rao, Wei; Wang, Guan-Ying; Zhang, Shan-Hong; Fei, Zhou

    2015-01-01

    Abstract The aim of this study is to investigate the incidence of unplanned reoperations from all causes due to bleeding in neurosurgical patients. The medical records of patients who received neurosurgical procedures at our hospital were retrospectively reviewed and data of patients who received reoperations were extracted and summarized. A literature review was conducted of the Medline, Cochrane, EMBASE, and Google Scholar databases up to November 2013. The main outcome measure was the rate of unplanned reoperations due to bleeding. At our hospital, 68 patients with a mean age of 41.5 ± 21.5 years (range, 7 months to 76 years) received an unplanned reoperation. More than 70% of the patients were older than 18 years, 64.7% were males, and 94.1% had cranial surgery. Almost 60% of the patients received >1 blood transfusion (58.8%) after the first surgery. Of the 68 patients, 35 (51.5%) received a second operation due to bleeding. Univariate logistic regression analysis only showed that an increasing time interval between the first and second surgery was associated with a decreased chance of the reoperation being performed due to bleeding (odds ratio [OR] = 0.843, 95% confidence interval [CI]: 0.720–0.987; P = .033). Of 229 studies identified, 5 retrospective reports with a total of 1375 patients were included in the analysis. The rate of reoperations for bleeding in the 5 studies ranged from 4.2% to 31.5%. Employing measures to reduce postoperative bleeding may help reduce the rate of unplanned neurosurgical reoperations. PMID:26061301

  6. Function of the Respiratory System in Elderly Patients After Aortic Valve Replacement.

    PubMed

    Stoliński, Jarosław; Plicner, Dariusz; Gawęda, Bogusław; Musiał, Robert; Fijorek, Kamil; Wąsowicz, Marcin; Andres, Janusz; Kapelak, Bogusław

    2016-10-01

    To compare the function of the respiratory system after aortic valve replacement through median sternotomy (AVR) or the minimally invasive right anterior minithoracotomy (RAT-AVR) approach among elderly (aged≥75 years) patients. Observational cohort study. University hospital. The study included 65 elderly patients scheduled for RAT-AVR and 82 for standard AVR. Pulmonary function tests (PFT) were performed preoperatively, 1 week, 1 month, and 3 months after surgery. In addition, respiratory complications were analyzed. Respiratory complications occurred in 12.3% of patients in the RAT-AVR group and 18.3% of patients in the AVR group (p = 0.445). Mechanical ventilation time in the intensive care unit was 7.7±3.6 hours for RAT-AVR patients and 9.7±5.4 hours for AVR patients (p = 0.003). Most PFT were worse in the AVR group than in the RAT-AVR group when performed 1 week after surgery. After 1 month, forced expiratory volume in the first second, vital capacity, and total lung capacity differed significantly in favor of the RAT-AVR group (p = 0.002, p<0.001, and p = 0.001, respectively). After 3 months, the PFT parameters still had not returned to preoperative values, but the differences were no longer significant between the RAT-AVR and AVR groups. The multivariable median regression analysis demonstrated that RAT-AVR surgery was a key factor in a patient's higher postoperative PFT parameter values. RAT-AVR surgery resulted in shorter postoperative mechanical ventilation time and improved the recovery of pulmonary function in elderly patients, but it did not reduce the incidence of pulmonary complications when compared with surgery performed through a median sternotomy. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Comminuted Patella Fracture in Elderly Patients: A Systematic Review and Case Report.

    PubMed

    Matthews, Brent; Hazratwala, Kaushik; Barroso-Rosa, Sergio

    2017-09-01

    To review comminuted patella fracture in the elderly patients and examine the surgical options to avoid complications such as fixation failure and poor functional outcome. To provide an example of mesh augmentation in comminuted patella fracture in the elderly patients. A literature review was conducted by the authors independently using Ovid, Medline, Cochrane, PubMed, and Clinical Key in English. We aimed to review data on patients older than 65 with comminuted patella fracture. Search conducted between July and December 2015. Search terms included patella fracture, elderly, and fixation failure. Abstracts were included if they were a case report, cohort series, or randomized control trial. Further inclusion criteria were that they were available in full text and included patient age(s), operative details, follow-up, and outcome discussion. Each study was assessed according to its level of evidence, number of patients, age of patients, fracture patterns described, complications of treatment, and results summarized. Paucity of data and heterogeneity of studies limited statistical analysis. Data are presented as a review table with the key points summarized. In patella fracture, age >65 years and comminuted fracture pattern are predictors of increased fixation failure and postoperative stiffness, warranting special consideration. There is a trend toward improved functional outcomes when augmented fixation using mesh or plates is used in this group. Further level 1 studies are required to compare and validate new treatment options and compared them to standard surgical technique of tension band wire construct.

  8. Postoperative patient-controlled epidural analgesia in patients with spondylodiscitis and posterior spinal fusion surgery.

    PubMed

    Gessler, Florian; Mutlak, Haitham; Tizi, Karima; Senft, Christian; Setzer, Matthias; Seifert, Volker; Weise, Lutz

    2016-06-01

    OBJECTIVE The value of postoperative epidural analgesia after major spinal surgery is well established. Thus far, the use of patient-controlled epidural analgesia (PCEA) has been denied to patients undergoing debridement and instrumentation in spondylodiscitis, with the risk of increased postoperative pain resulting in prolonged recovery. The value of PCEA with special regard to infectious complications remains to be clarified. The present study examined the value of postoperative PCEA in comparison with intravenous analgesia in patients with spondylodiscitis undergoing posterior spinal surgery. METHODS Thirty-two patients treated surgically for spondylodiscitis of the thoracic and lumbar spine were prospectively included in a database and retrospectively reviewed for this study. Postoperative antibiotic treatment, functional capacity, pain levels, side effects, and complications were documented. Sixteen patients were given patient-demanded intravenous analgesia (PIA) followed by 16 patients assigned to PCEA. If PCEA was applied, the insertion of an epidural catheter was performed under the direct visual guidance of the surgeon at the end of the surgery. RESULTS Three patients intended for PCEA treatment were excluded due to predefined exclusion criteria. Postoperative pain was significantly lower in the PCEA group during the first 48 hours after surgery (p = 0.03). As determined by the trunk control test conducted at 8 (p < 0.001), 24 (p = 0.004), 48 (p = 0.015), 72 (p = 0.0031), and 96 hours (p < 0.001), patients in the PCEA treatment group displayed significantly increased mobilization capacity compared with those of the PIA group. Time until normal accomplishment of all mobilization maneuvers was reduced in the PCEA group compared with that in the PIA group (p = 0.04). No differences in complication rates were observed between the 2 groups (p = 0.52). CONCLUSIONS PCEA may reduce postoperative pain and lead to earlier achievement of functional capacity at a low

  9. Postoperative bleeding in a patient with normal screening coagulation tests.

    PubMed

    Nourbakhsh, Eva; Anvari, Reza; D'cunha, Nicholas; Thaxton, Lauren; Malik, Asim; Nugent, Kenneth

    2011-09-01

    A 54-year-old man was brought to the emergency room after a head-on collision. He had multiple fractures in his lower extremities and required immediate surgery. After surgery, the patient had a persistent drop in hemoglobin, hematocrit and platelets despite red blood cell transfusions. Laboratory studies included normal prothrombin time, activated partial thromboplastin time, normal plasminogen functional activity, negative antiplatelet antibodies, normal platelet functional analysis and negative disseminated intravascular coagulation screen. Factor XIII antigen levels were 25% of predicted, and the diagnosis of factor XIII deficiency was made. The patient was treated with cryoprecipitate, and the bleeding stopped. Patients with factor XIII deficiency have either a rare congenital or acquired coagulation disorder. Both presentations have normal standard laboratory clotting tests, and the diagnosis requires an assay measuring factor XIII activity or antigen levels. The usual treatment includes cryoprecipitate, fresh-frozen plasma or recombinant factor XIII. This deficiency should be considered in patients with unexplained spontaneous, traumatic or postoperative bleeding.

  10. Total hip replacement as primary treatment of unstable intertrochanteric fractures in elderly patients.

    PubMed

    Sidhu, Amarjit Singh; Singh, Ajay Pal; Singh, Arun Pal; Singh, Sukhraj

    2010-08-01

    Fifty-three patients with A2.2 and A2.3 intertrochanteric fracture according to the Muller classification were treated with total hip replacement between April 2000 and February 2004. The average age of the patients was 77 years. Average follow-up period was 3.7 years. We studied postoperative complications, mortality rate, functional outcome using the Harris hip score, time to return to normal activities, and radiographic evidence of healing. Two patients died on the third and fifth postoperative days. Seven more patients died within one year. The Harris hip score at one month was 66 +/- 7 (mean +/- standard deviation); at three months 72 +/- 6; at one year 74 +/- 5; at three years 76 +/- 6 and in the 27 patients who completed five year follow-up it was 76 +/- 8. Mobilisation and weight-bearing was started immediately in the postoperative period. Average time taken to return to normal daily activities was 28 days (range 24-33). No loosening or infection of the implants was observed. Total hip arthroplasty is a valid treatment option for mobile and mentally healthy elderly patients with intertrochanteric fractures. This procedure offers quick recovery with little risk of mechanical failure, avoids the risks associated with internal fixation and enables the patient to maintain a good level of function immediately after surgery.

  11. Pulmonary arterial hypertension in critically ill elderly patients

    PubMed Central

    Zhang, Yun-yun; Xu, Fan; Chu, Ming; Bi, Li-qing

    2017-01-01

    Objective: To assess the incidence, possible risk factors and prognosis of pulmonary arterial hypertension (PAH) in critically ill elderly patients. Methods: We selected 122 cases admitted to the ICU, ages 60–93 years old. An echocardiography examination was performed within four days after admission to the ICU. PAH is usually suspected if the patient’s pulmonary artery systolic pressure ≥ 40 mmHg. We collected echocardiography data, relevant clinical data and routine laboratory data; we then used a statistical method to analyze the risk factors for PAH in critically ill elderly patients and examined its impact on the prognosis. Results: Total 51 patients were diagnosed with PAH. The prevalence of critically ill elderly patients with PAH was 41.8%. The ANOVA analysis showed that if patients had COPD (P = 0.031) and/or respiratory failure (P = 0.021), they were more prone to PAH. An enlarged left atrium (P = 0.038) and/or right ventricle (P = 0.029), a declining left ventricle fractional shortening rate (P = 0.038), and an elevated amount of the brain natriuretic peptides (P = 0.046) were all associated with the occurrence of PAH. Multivariate regression analysis showed that the left atrial diameter (P = 0.045) was the risk factor in critically ill elderly patients with PAH. The 30-day mortality rate was 33.3% for elderly patients with PAH, which is statistically significant (P = 0.035) when compared with the mortality rate of patients with normal pulmonary artery pressure. Our multivariate regression analysis also showed that, for critically ill elderly patients admitted in the ICU, PAH (P = 0.039) is risk factor for increased mortality. Conclusions: A higher incidence of PAH occurs in critically ill elderly patients. PAH is more likely to occur in patients with an enlarged left atrium, and these problems adversely impact the prognosis. PMID:28367167

  12. Does postoperative delirium limit the use of patient-controlled analgesia in older surgical patients?

    PubMed

    Leung, Jacqueline M; Sands, Laura P; Paul, Sudeshna; Joseph, Tim; Kinjo, Sakura; Tsai, Tiffany

    2009-09-01

    BACKGROUNDPostoperative pain Is an independent predictor of postoperative delirium. Whether postoperative delirium limits patient-controlled analgesia (PCA) use has not been determined. The authors conducted a nested cohort study in older patients undergoing noncardiac surgery and used PCA for postoperative analgesia. Delirium was measured by using the Confusion Assessment Method. The authors computed a structural equation model to determine the effects of pain and opioid consumption on delirium status and the effect of delirium on opioid use. Of 335 patients, 108 (32.2%) developed delirium on postoperative day (POD) 1, and 120 (35.8%) on POD 2. Postoperative delirium did not limit the use of PCA. Patients with postoperative delirium used more PCA in a 24-h period (POD 2) compared to those without delirium (mean dose of hydromorphone +/- SE adjusted for covariates was 2.24 +/- 0.71 mg vs. 1.25 +/- 0.67 mg, P = 0.02). Despite more opioid use, patients with delirium reported higher Visual Analogue Scale scores than those without delirium (POD 1: mean visual analog scale +/- SE at rest 4.2 +/- 0.23 vs. 3.3 +/- 0.22, P = 0.0051; POD 2: 3.3 +/- 0.23 vs. 2.5 +/- 0.19, P = 0.004). Path coefficients from structural equation model revealed that pain and opioid use affect delirium status, but delirium does not affect subsequent opioid dose. Postoperative delirium did not limit PCA use. Despite more opioid use, visual analog scale scores were higher in patients with delirium. Future studies on delirium should consider the role of pain and pain management as potential etiologic factors.

  13. Family Involvement in the Care of Hospitalized Elderly Patients.

    PubMed

    Nayeri, Nahid Dehghan; Gholizadeh, Leila; Mohammadi, Eesa; Yazdi, Khadijeh

    2015-09-01

    Family participation in caregiving to elderly inpatients is likely to improve the quality of care to older patients. This qualitative design study applied semi-structured interviews to elicit experiences from nurses, families, and patients on the notion of family participation in the care of elderly patients in two general teaching hospitals in Iran. Data were gathered using individual interviews, field notes, and participant observations. Interviews were recorded, transcribed verbatim, and analyzed using manifest and latent content analysis. The following main themes emerged through the data analysis process: (a) safety and quality in patient care and (b) unplanned and unstructured patient care participation. The study concludes that family involvement in caregiving to elderly patients is important, yet the participation should be based upon a planned and structured framework to ensure a safe and satisfying experience for patients, families, and health care team. © The Author(s) 2013.

  14. Management of hyperkeratotic lesions in the elderly patient.

    PubMed

    George, D H

    1993-01-01

    Many factors contribute in the development of hyperkeratotic lesions in the elderly patient. The internal and external causes render the elderly foot more susceptible to limited ambulation, increased incidence of infection, ulceration, and eventual loss of the limb. Once the lesion is classified and the causes identified, a beneficial treatment plan can evolve. Reduction of the lesion(s), appropriate padding, shielding, splinting, accommodative orthoses, insoles, emollients, and mild keratolytics on regular treatment intervals are helpful in maintaining comfort and allowing function of the elderly foot. If the bony abnormalities or abnormal position of the foot do not respond to conservative measures, then surgical intervention should be considered based on the medical and vascular status of the patient. The evaluation of the elderly patient's presenting footwear, and patient education on the need for proper shoe gear size, shape, and materials cannot be overemphasized. Proper footwear and fitting is essential for the elderly in managing hyperkeratotic lesions. When regular footwear is not beneficial special shoes should be considered to accommodate the foot and treatment plan (e.g., accommodative orthoses, and so forth). The Extra Depth Inlay Thermold, Ambulator, Bunion last and Keystone last are options. If special shoes are too heavy for the elderly patient, there is a wide variety of athletic shoes that are shock absorbent and lightweight. Success in management includes a proper identification of the problem, relief of the symptoms, regular follow-up care, and periodic review of footwear to ascertain the need for repair or modification.

  15. Preliminary study on the effect of oral care on recovery from surgery in elderly patients.

    PubMed

    Sato, M; Yoshihara, A; Miyazaki, H

    2006-11-01

    This study aimed to clarify the effectiveness of post-operative oral care, including tooth brushing, denture cleaning and tongue cleaning, after digestive tract surgery. Subjects included 30 elderly patients aged 60-98 years (74.9 +/- 7.8 years) who underwent digestive tract surgery. Subjects were randomly divided into an intervention group and a control group. In the intervention group, the following oral care was provided daily over a 5-min period in the morning starting at baseline (day of surgery) and continued for 5 days: gargling with povidone iodine, tooth brushing, denture cleaning using a special brush and tongue cleaning using a tongue brush. In the control group, the subjects only gargled with povidone iodine. We compared the following variables between the two groups at baseline and 5 days later: the sensation of dry mouth, intra-oral gas concentration, pulmonary sounds, body temperature and bacterial flora. The number of patients with abnormal pulmonary sounds (dry or moist rales) increased from 1 to 2 in the intervention group and from 0 to 4 in the control group (P < 0.05). The average number of bacterial species per subject for the control group was 3.64 +/- 1.34 pre-operatively and 3.50 +/- 1.74 post-operatively, whereas that for the intervention group was 3.08 +/- 0.95 pre-operatively and 2.62 +/- 0.65 post-operatively. In the intervention group, there was a significant decrease in the number of bacterial species (P < 0.05). These findings indicate that post-operative oral care in elderly patients undergoing digestive tract surgery lowers the number of bacterial species found in the oral cavity. This effect, in turn, might improve respiratory function.

  16. Cardiac Biomarkers Predict 1-Year Mortality in Elderly Patients Undergoing Hip Fracture Surgery.

    PubMed

    Katsanos, Spyridon; Mavrogenis, Andreas F; Kafkas, Nikolaos; Sardu, Celestino; Kamperidis, Vasileios; Katsanou, Panagiota; Farmakis, Dimitrios; Parissis, John

    2017-05-01

    This prospective study included 152 elderly patients (mean age, 80 years; range, 72-88 years) with a hip fracture treated surgically. Comorbidities were evaluated, and B-type natriuretic peptide was measured at baseline and at postoperative days 4 and 5 in addition to troponin I. Major cardiac events were recorded, and 1-year mortality was assessed. Comorbidity models with the important multivariate predictors of 1-year mortality were analyzed. Overall, 9 patients (6%) experienced major cardiac events postoperatively during their hospitalization. Three patients (2%) died postoperatively, at days 5, 7, and 10, from autopsy-confirmed myocardial infarction. Three patients (2%) experienced a nonfatal myocardial infarction, and 3 patients (2%) experienced acute heart failure. At 1-year follow-up, 37 patients (24%) had died. Age older than 80 years (P=.000), renal failure (P=.016), cardiovascular disease (P=.003), respiratory disease (P=.010), Parkinson disease (P=.024), and dementia (P=.000) were univariate predictors of 1-year mortality. However, in the multivariate model, only age older than 80 years (P=.000) and dementia (P=.024) were important predictors of 1-year mortality. In all comorbidity models, age older than 80 years and dementia were important predictors of 1-year mortality. Postoperative increase in B-type natriuretic peptide was the most important predictor of 1-year mortality. Receiver operating characteristic curve analysis showed a threshold of 90 ng/mL of preoperative B-type natriuretic peptide (area under the curve=0.773, 95% confidence interval, 0.691-0.855, P<.001) had 82% sensitivity and 62% specificity to predict 1-year mortality. Similarly, a threshold of 190 ng/mL of postoperative B-type natriuretic peptide (area under the curve=0.753, 95% confidence interval, 0.662-0.844, P<.001) had 70% sensitivity and 77% specificity to predict the study endpoint. [Orthopedics. 2017; 40(3):e417-e424.]. Copyright 2017, SLACK Incorporated.

  17. Medical admission of elderly trauma patients with isolated injuries.

    PubMed

    Self, Michael; Mangram, Alicia; Dunn, Ernest

    2007-09-01

    We sought to evaluate the outcomes of trauma patients admitted to medical services rather than to the general trauma team, particularly those elderly patients with isolated injuries of a specialty nature. Over the 2-year retrospective study period, 3017 trauma patients were admitted. The trauma service directed care in 2740 (90.8%) of this group versus the 277 (9.2%) admitted to medical services (MS). The patients in each group were then classified according to age younger than 55 years or older than 55 years (elderly). Of the 277 patients admitted to the MS, 177 (63.8%) were elderly compared with only 13 per cent of the trauma service group. Smaller proportions (16.9%) of the elderly medical patients were admitted to the intensive care unit as compared with the trauma group (22.1%). There was a higher morbidity rate, 41.9 per cent, in the trauma service group as compared with the MS group, 20 per cent. No patients on the MS underwent a laparotomy for intraabdominal injuries nor were there any missed injuries of a general surgical nature. Allowing elderly trauma patients with isolated specialty injuries to be managed by the MS is not associated with increased morbidity or mortality.

  18. Elder law, Medicare, and legal issues in older patients.

    PubMed

    Birke, Margot G

    2004-04-01

    Elder law is a specialty area of law directed at the specific needs of older clients and clients with disabilities. This review discusses major legal issues faced by older patients, their families, and their health care providers, including the capacity to consent to treatment, advance directives, and surrogate decision-making. In addition, public benefit programs such as Medicare, Social Security Disability Insurance, Medicaid, and Supplemental Security Income are examined. Available options for long-term care, both institutional and community-based are also highlighted. Finally, elder abuse is discussed. All who provide care to an elder must be aware of the potential signs of abuse and the remedies available.

  19. Antiviral Therapy in Elderly Patients With Hepatitis C Virus Infection.

    PubMed

    Rheem, Justin; Sundaram, Vinay; Saab, Sammy

    2015-05-01

    The emergence of direct-acting antiviral (DAA) agents has revolutionized the treatment schema for hepatitis C virus (HCV) infection. From cure rates to tolerability, DAA agents have shown outstanding profiles compared with the prior therapy of pegylated interferon with ribavirin. However, the efficacy and safety profiles of DAA therapy in older patients, particularly the elderly, have been unclear, and patients in the 1945 to 1965 birth cohort constitute the largest proportion of the HCV population in the United States. Treating elderly patients with pegylated interferon and ribavirin has been challenging due to the frequent presence of multiple comorbidities in the elderly and high discontinuation rates caused by adverse events. Now, as more DAA agents have become widely studied and approved, subgroup analyses for the elderly population are being elucidated. Analysis of the current literature shows that these agents have been effective, well tolerated, and safe in the elderly population. This article highlights the efficacy and safety differences in interferon-based therapy and interferon-free regimens for elderly patients with HCV infection.

  20. Antiviral Therapy in Elderly Patients With Hepatitis C Virus Infection

    PubMed Central

    Rheem, Justin; Sundaram, Vinay

    2015-01-01

    The emergence of direct-acting antiviral (DAA) agents has revolutionized the treatment schema for hepatitis C virus (HCV) infection. From cure rates to tolerability, DAA agents have shown outstanding profiles compared with the prior therapy of pegylated interferon with ribavirin. However, the efficacy and safety profiles of DAA therapy in older patients, particularly the elderly, have been unclear, and patients in the 1945 to 1965 birth cohort constitute the largest proportion of the HCV population in the United States. Treating elderly patients with pegylated interferon and ribavirin has been challenging due to the frequent presence of multiple comorbidities in the elderly and high discontinuation rates caused by adverse events. Now, as more DAA agents have become widely studied and approved, subgroup analyses for the elderly population are being elucidated. Analysis of the current literature shows that these agents have been effective, well tolerated, and safe in the elderly population. This article highlights the efficacy and safety differences in interferon-based therapy and interferon-free regimens for elderly patients with HCV infection. PMID:27482173

  1. Efficacy and safety of febuxostat in elderly female patients

    PubMed Central

    Mizuno, Tomohiro; Hayashi, Takahiro; Hikosaka, Sayo; Shimabukuro, Yuka; Murase, Maho; Takahashi, Kazuo; Hayashi, Hiroki; Yuzawa, Yukio; Nagamatsu, Tadashi; Yamada, Shigeki

    2014-01-01

    Background Maintenance of low serum urate levels is important for the management of gout. Achieving the recommended serum urate levels of less than 6.0 mg/dL is difficult in elderly (65 years of age or older) patients with renal impairment. Xanthine oxidase inhibitors allopurinol and febuxostat are used for this purpose. Although febuxostat had been shown to be efficacious in elderly patients, its safety and efficacy in elderly female patients with hyperuricemia remain unclear. Objective The aim of this study was to assess the efficacy and safety of febuxostat in elderly female patients. Methods We studied a retrospective cohort study. The study included elderly Japanese patients (65 years of age or older) who were treated with febuxostat at Fujita Health University Hospital from January 2012 to December 2013. The treatment goal was defined as achievement of serum urate levels of 6.0 mg/dL or lower within 16 weeks; this was the primary endpoint in the present study. Adverse events of febuxostat were defined as more than twofold increases in Common Terminology Criteria for adverse events scores from baseline. Results We evaluated 82 patients treated with febuxostat during the observation period and classified them into male (n=53) and female (n=29) groups. The mean time to achievement of the treatment goal was significantly shorter in the female group (53 days) than in the male group (71 days). There were no significant differences in adverse events between the 2 groups. Conclusion Our findings suggest that the efficacy of febuxostat in elderly female patients is superior to that in elderly male patients and that the safety is equivalent. PMID:25214776

  2. Efficacy and safety of febuxostat in elderly female patients.

    PubMed

    Mizuno, Tomohiro; Hayashi, Takahiro; Hikosaka, Sayo; Shimabukuro, Yuka; Murase, Maho; Takahashi, Kazuo; Hayashi, Hiroki; Yuzawa, Yukio; Nagamatsu, Tadashi; Yamada, Shigeki

    2014-01-01

    Maintenance of low serum urate levels is important for the management of gout. Achieving the recommended serum urate levels of less than 6.0 mg/dL is difficult in elderly (65 years of age or older) patients with renal impairment. Xanthine oxidase inhibitors allopurinol and febuxostat are used for this purpose. Although febuxostat had been shown to be efficacious in elderly patients, its safety and efficacy in elderly female patients with hyperuricemia remain unclear. The aim of this study was to assess the efficacy and safety of febuxostat in elderly female patients. We studied a retrospective cohort study. The study included elderly Japanese patients (65 years of age or older) who were treated with febuxostat at Fujita Health University Hospital from January 2012 to December 2013. The treatment goal was defined as achievement of serum urate levels of 6.0 mg/dL or lower within 16 weeks; this was the primary endpoint in the present study. Adverse events of febuxostat were defined as more than twofold increases in Common Terminology Criteria for adverse events scores from baseline. We evaluated 82 patients treated with febuxostat during the observation period and classified them into male (n=53) and female (n=29) groups. The mean time to achievement of the treatment goal was significantly shorter in the female group (53 days) than in the male group (71 days). There were no significant differences in adverse events between the 2 groups. Our findings suggest that the efficacy of febuxostat in elderly female patients is superior to that in elderly male patients and that the safety is equivalent.

  3. Dexmedetomidine in Postoperative Analgesia in Patients Undergoing Hysterectomy

    PubMed Central

    Ren, Chunguang; Chi, Meiying; Zhang, Yanwei; Zhang, Zongwang; Qi, Feng; Liu, Zhong

    2015-01-01

    Abstract Both dexmedetomidine and sufentanil modulate spinal analgesia by different mechanisms, and yet no human studies are available on their combination for analgesia during the first 72 hours after abdominal hysterectomy. This CONSORT-prospective, randomized, double-blinded, controlled trial sought to evaluate the safety and efficacy of the combination of dexmedetomidine and sufentanil in intravenous patient-controlled analgesia (PCA) for 72 hours after abdominal hysterectomy. Ninety women undergoing total abdominal hysterectomy were divided into 3 equal groups that received sufentanil (Group C; 0.02 μg/kg/h), sufentanil plus dexmedetomidine (Group D1; 0.02 μg/kg/h, each), or sufentanil (0.02 μg/kg/h) plus dexmedetomidine (0.05 μg/kg/h) (Group D2) for 72 hours after surgery in this double-blinded, randomized study. The primary outcome measure was the postoperative sufentanil consumption, whereas the secondary outcome measures were pain intensity (visual analogue scale), requirement of narcotic drugs during the operation, level of sedation, Bruggrmann comfort scale, and concerning adverse effects. The postoperative sufentanil consumption was significantly lower in Groups D1 and D2 than in Group C during the observation period (P < 0.05), but lower in Group D2 than in Group D1 at 24, 48, and 72 hours after surgery (P < 0.05). The heart rate after intubation and incision was lower in Groups D1 and D2 than in Group C (P < 0.05). On arrival at the recovery room, Groups D1 and D2 had lower mean blood pressure than Group C (P < 0.05). The intraoperative requirement of sevoflurane was 30% lesser in Groups D1 and D2 than in Group C. The sedation levels were greater in Groups D1 and D2 during the first hour (P < 0.05). Compared with Groups C and D1, Group D2 showed lower levels of the overall incidence of nausea and vomiting (P < 0.05). Among the tested PCA options, the addition of dexmedetomidine (0.05 μg/kg/h) and sufentanil (0

  4. Extended lymphadenectomy in elderly and/or highly co-morbid gastric cancer patients: A retrospective multicenter study.

    PubMed

    Rausei, S; Ruspi, L; Rosa, F; Morgagni, P; Marrelli, D; Cossu, A; Cananzi, F C M; Lomonaco, R; Coniglio, A; Biondi, A; Cipollari, C; Graziosi, L; Fumagalli, U; Casella, F; Bertoli, P; di Leo, A; Alfieri, S; Vittimberga, G; Roviello, F; Orsenigo, E; Quagliuolo, V; Montemurro, S; Baiocchi, G; Persiani, R; Bencivenga, M; Donini, A; Rosati, R; Sansonetti, A; Ansaloni, L; Zanoni, A; Galli, F; Dionigi, G

    2016-12-01

    Gastrectomy with extended lymphadenectomy is considered the gold standard treatment for advanced gastric cancer, with no age- or comorbidity-related limitations. We evaluated the safety and efficacy of curative gastrectomy with extended nodal dissection, verifying survival in elderly and highly co-morbid patients. In a retrospective multicenter study, we examined 1322 non-metastatic gastric-cancer patients that underwent curative gastrectomy with D2 versus D1 lymphadenectomy from January 2000 to December 2009. Postoperative complications, overall survival (OS), and disease-specific survival (DSS) according to age and the Charlson Comorbidity Score were analyzed in relation to the extent of lymphadenectomy. Postoperative morbidity was 30.4%. Complications were more frequent in highly co-morbid elderly patients, and, although general morbidity rates after D2 and D1 lymphadenectomy were similar (29.9% and 33.2%, respectively), they increased following D2 in highly co-morbid elderly patients (39.6%). D2-lymphadenectomy significantly improved 5-year OS and DSS (48.0% vs. 37.6% in D1, p < 0.001 and 72.6% vs. 58.1% in D1, p < 0.001, respectively) in all patients. In elderly patients, this benefit was present only in 5-year DSS. D2 nodal dissection induced better 5-year OS and DSS rates in elderly patients with positive nodes (29.7% vs. 21.2% in D1, p = 0.008 and 47.5% vs. 30.6% in D1, p = 0.001, respectively), although it was present only in DSS when highly co-morbid elderly patients were considered. Extended lymphadenectomy confirmed better survival rates in gastric cancer patients. Due to high postoperative complication rate and no significant improvement of the OS, D1 lymphadenectomy should be considered in elderly and/or highly co-morbid gastric cancer patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Mechanical circulatory support for elderly heart failure patients.

    PubMed

    Butler, Craig R; Jugdutt, Bodh I

    2012-09-01

    End-stage systolic heart failure is an increasingly common problem in elderly patients and is associated with high cost, poor quality of life, and poor outcomes. Mechanical circulatory support is a promising therapy as both a bridge to transplantation and destination therapy. Elderly patients are frequently ineligible for heart transplantation because of their age and comorbidities, and the application of mechanical circulatory support for destination therapy in this population is not well defined. A review of the literature was undertaken to better characterize our experience to date with mechanical circulatory support in older heart failure populations. Mechanical circulatory support is being employed increasingly for destination therapy indications in older patients. The newer continuous flow devices appear to have disproportionate advantage in elderly patients, which has translated into marked improvement in 1- and 2-year survival. The rational implementation of MCS devices in elderly heart failure patients needs to focus on (1) continuous flow devices that appear to have particular benefit in this population, (2) extensive pre-MCS assessment including variables relating to frailty, and (3) intervening before these patients develop cardiogenic shock. More data are needed on the cost-benefit analysis of routine use of CF devices as destination therapy in elderly patients with heart failure.

  6. Staff Ratings of Relocation Risk in Elderly Patients.

    ERIC Educational Resources Information Center

    Rusak, Judith M.; And Others

    Patients in long-term care facilities are often moved from one living area to another within an institution. While the staff often consider such moves as part of the daily work load, even intrainstitutional relocation has been observed to have negative consequences for the elderly patient. If staff could identify those patients who might…

  7. Evidence-based nutritional support of the elderly cancer patient.

    PubMed

    Bozzetti, Federico

    2015-04-01

    The papers included in this section represent the effort of the Task Force on Nutrition of the International Society of Geriatric Oncology to synthetize the evidence-based concepts on nutritional support of the elderly cancer patients. In the attempt of presenting a comprehensive overview of the topic, the panel included experts from different specialties: basic researchers, nutritionists, geriatricians, nurses, dieticians, gastroenterologists, oncologists. Cancer in elderly people is a growing problem. Not only in almost every country, the proportion of people aged over 60 years is growing faster than any other age group, but cancer per se is also a disease of old adult-elderly people, hence the oncologists face an increasing number of these patients both now and in the next years. The are several studies on nutrition of elderly subjects and many other on nutrition of cancer patients but relatively few specifically devoted to the nutritional support of the elderly cancer patients. However, the awareness that elderly subjects account for a high proportion of the mixed cancer patients population, in some way legitimates us to extend some conclusions of the literature also to the elderly cancer patients. Although the topics of this Experts' Consensus have been written by specialists in different areas of nutrition, the final message is addressed to the oncologists. Not only they should be more directly involved in the simplest steps of the nutritional care (recognition of the potential existence of a "nutritional risk" which can compromise the planned oncologic program, use of some oral supplements, etc.) but, as the true experts of the natural history of their cancer patient, they should also coordinate the process of the nutritional support, integrating this approach in the overall multidisciplinary cancer care. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Results of distal revascularization in elderly patients for critical ischemia of the lower limbs.

    PubMed

    Illuminati, G; Calio, F G; Bertagni, A; Piermattei, A; Vietri, F; Martinelli, V

    1999-04-01

    Thirty eight patients over 75 years of age were operated upon of 40 distal arterial revascularizations for critical ischaemia of the lower limbs. Arterial reconstruction was proposed to ambulatory, self sufficient patients, with a patent artery of the leg or the foot in continuity with pedal arch, at arteriography. The revascularized artery was the peroneal in 14 cases, the anterior tibial in 11, the posterior tibial in 9, the dorsalis pedis in 5, and the external plantar artery in 1 case. Postoperative mortality was 2.6%. No postoperative arterial occlusion occurred and no postoperative amputation needed to be performed. The mean follow-up of 37 patients surviving operation was 21 months (ext. 2-52 months). At 36 months interval, patients' survival was 43%, primary patency rate was 57%, and limb salvage rate was 76%, at life-table analysis. Distal revascularization enables a good number of elderly patients in critical ischaemia of the lower limb, to enjoy an active, independent life, with a viable limb.

  9. Preoperative Nutritional Assessment in Elderly Cancer Patients Undergoing Elective Surgery: MNA or PG-SGA?

    PubMed

    Dubhashi, S P; Kayal, Akshat

    2015-12-01

    This study aims to evaluate and compare the use of patient-generated subjective global assessment (PG-SGA) and mini nutritional assessment (MNA) as a preoperative nutritional assessment tool in elderly cancer patients. This was a prospective study carried out on 47 patients, 45 years and above suffering from cancer and admitted to Padmashree Dr. D.Y. Patil Medical College and Hospital, Pune. The patients were evaluated with PG-SGA and MNA tools at the time of admission and baseline data were collected. All patients had undergone surgeries as per indications. Postoperatively, the surgical outcomes and adverse events were noted and statistically evaluated. The average age of the study sample was 61.46 years and 29 patients were females. The patients classified by PG-SGA were ten in group A and 37 in group B and C. The patients classified by MNA were five in no risk group and 42 in group with patients at risk and malnourished. When evaluated with PG-SGA in group B and C, wound infections and requirement of change of antibiotic were seen in 86.4 % patients and their average day of onset of infection was 5.6 days. Antibiotics were administered to these patients for an average of 14.2 days and their average duration of stay was 29 days. On the other hand, the evaluation of patients with MNA, at risk and malnourished patients, wound infections, and requirement of change of antibiotic were seen in 81 % of patients and their average day of onset of infection was 5.6 days. Antibiotics were administered to these patients for an average of 13.8 days and their average duration of stay was 27 days. The results were statistically significant. The mini nutritional assessment is more exhaustive in identifying patients at risk and is useful in screening populations to identify frail elderly persons allowing us to intervene earlier, thereby improving the patient prognosis. The patient-generated subjective global assessment is a more comprehensive tool for elderly cancer

  10. Pharmacokinetics of alvimopan and its metabolite in healthy volunteers and patients in postoperative ileus trials.

    PubMed

    Foss, J F; Fisher, D M; Schmith, V D

    2008-05-01

    Alvimopan, a mu-opioid antagonist without anti-analgesic effects, is being developed to manage postoperative ileus. We characterized the population pharmacokinetics of orally administered alvimopan and its primary metabolite in healthy subjects/special populations, and surgical patients at risk for ileus. Models were consistent with known physiology/pharmacology. Alvimopan's model had two compartments with first-order elimination. Metabolite was modeled with a catenary chain and lag for alvimopan's metabolism within the gut followed by absorption, one systemic compartment with first-order elimination. Weight, gender, and renal function did not affect alvimopan or metabolite. Steady-state alvimopan and metabolite concentrations were 87 and 40% higher, respectively, in patients. Alvimopan concentrations were 35% higher in the elderly, but were not affected by race, acid blockers, or antibiotics. Metabolite concentrations were 43 and 82% lower in African Americans and Hispanics, respectively, compared to Caucasians, 49% lower with acid blockers and 81% lower with preoperative antibiotics. Although alvimopan's pharmacokinetics was described with a traditional model, its metabolite required a novel model accommodating gut metabolism.

  11. A winter survey of domestic heating among elderly patients.

    PubMed Central

    Morgan, R; Blair, A; King, D

    1996-01-01

    Elderly people have a greater need for domestic heating given the time they spend at home and the decline in the body thermoregulation that occurs with ageing. The use of domestic heating by 200 mentally competent newly admitted elderly in patients was evaluated by means of a questionnaire survey. Most patients (69%) were aware of the addition of value added tax (VAT) to their fuel bill and 31% said they had reduced the amount of heating they use because of this. A third of patients (29.5%) said they had difficulty keeping warm prior to this admission. The majority of patients said they could not manage to keep warm in the winter without financial hardship. In addition, 29% said they had reduced the amount spent on food in order to pay for fuel bills. This study suggests that cold may contribute to hospital admissions in elderly patients. This should have implications for government spending and taxation policy on domestic heating. PMID:8683507

  12. Pilot clinical trial of gabapentin to decrease postoperative delirium in older patients.

    PubMed

    Leung, J M; Sands, L P; Rico, M; Petersen, K L; Rowbotham, M C; Dahl, J B; Ames, C; Chou, D; Weinstein, P

    2006-10-10

    In this randomized pilot clinical trial, the authors tested the hypothesis that using gabapentin as an add-on agent in the treatment of postoperative pain reduces the occurrence of postoperative delirium. Postoperative delirium occurred in 5/12 patients (42%) who received placebo vs 0/9 patients who received gabapentin, p = 0.045. The reduction in delirium appears to be secondary to the opioid-sparing effect of gabapentin.

  13. Evidence-based clinical audit criteria for the prevention and management of delirium in the postoperative patient with a hip fracture.

    PubMed

    Holly, Cheryl; Rittenmeyer, Leslie; Weeks, Susan Mace

    2014-01-01

    Delirium is a frequent, yet often unrecognized, occurrence in elderly hospitalized patients. In patients with hip fracture, the incidence of delirium is reported to be as high as 62% and even greater if over 65 years of age. One approach to the prevention and management of postoperative delirium in elderly patients with hip fracture is the clinical audit. A clinical audit is a retrospective assessment of clinical care of patients and is guided by criteria that are evidence-based statements of best practice. The use of measurable, objective criterion, with an agreed standard of performance is the hallmark of an audit. The clinical audit criteria presented in this article for the prevention and management of delirium in hospitalized elderly with hip fracture were determined by a compilation of systematic reviews and existing evidence-based clinical guidelines. The following 5 audit criteria are discussed: (1) All elderly patients with a hip fracture are assessed for risk factors for developing delirium daily using a valid and reliable tool; (2) the environment of the patient with hip fracture is assessed daily for conduciveness to maintaining sensory orientation; (3) all patients with hip fracture receive essential nursing care; (4) appropriate clinical criteria are applied to confirm a diagnosis of delirium in patients with hip fracture; and (5) nonpharmacologic interventions are employed before pharmacologic interventions in patients with hip fracture with a diagnosis of delirium.

  14. Management of insomnia in elderly patients using eszopiclone.

    PubMed

    Kirkwood, Cynthia; Breden, Ericka

    2010-01-01

    Insomnia is a common sleep complaint in the elderly. The safety and efficacy of eszopiclone, a non-benzodiazepine hypnotic, in elderly patients with chronic insomnia has been established in two 2-week and one 12-week randomized, double-blind, placebo-controlled trials. Eszopiclone 1 mg was effective in reducing sleep latency. Eszopiclone 2 mg was effective in reducing latency to sleep and for increasing sleep maintenance. Eszopiclone doses of 1 mg and 2 mg reduced the number of daytime naps and decreased the duration of naps in elderly patients. Eszopiclone 2 mg improved the quality of life measures for mood, physical health, household activities, medication, leisure activities, and self-report of physical functioning and vitality in the 2-week trials, and vitality and general health in the 12-week trial. The most commonly reported side effects in the elderly included unpleasant taste, dry mouth, dizziness, and somnolence. The concurrent use of drugs that inhibit or induce the cytochrome P450 enzyme CYP3A4 can alter concentrations of eszopiclone and the dose may need to be adjusted. The recommended starting dose of eszopiclone for difficulty falling asleep is 1 mg at bedtime. For elders who complain of difficulty maintaining sleep, eszopiclone should be initiated at 2 mg at bedtime. Overall, eszopiclone is a safe and well-tolerated treatment option for elderly patients with insomnia.

  15. Serum trace elements in elderly frail patients with oropharyngeal dysphagia.

    PubMed

    Leibovitz, Arthur; Lubart, Emilia; Wainstein, Julio; Dror, Yosef; Segal, Refael

    2009-01-01

    Microelements have an important role in many vital enzymatic functions. Their optimal intake and serum concentration are not properly defined. For nursing home residents, this issue is further complicated by the high prevalence of oropharyngeal dysphagia. The purpose of this study was to measure microelement concentrations in 3 groups of elderly subjects that differ in their feeding methods and functional state. Forty-six frail elderly patients, in stable clinical condition, 15 on naso-gastric tube (NGT) feeding, 15 orally fed (OF), from skilled nursing departments were recruited to this study. As controls, we studied a group of 16 elderly independent ambulatory patients. A battery of 16 microelements was examined using the Inductively Coupled Plasma Atomic Emission Spectrometry (ICP-AES) and Inductively Coupled Plasma Mass Spectrometry (ICP-MS). The OF frail elderly patients had significantly lower levels of chromium as compared to the NGT fed and the control group. Both frail elderly groups had lower levels of zinc and copper as compared to the controls. In contrast, in the nursing groups, we found higher levels of aluminum, boron, barium, bromine and nickel. Elderly, in particular frail and disabled subjects, are vulnerable to insufficiency or overload of microelements. There is a need to evaluate the actual requirements for each microelement for this population.

  16. Recognition and management of anxiety and depression in elderly patients.

    PubMed

    Martin, L M; Fleming, K C; Evans, J M

    1995-10-01

    To describe important aspects of the recognition and management of anxiety and depression in elderly patients. We reviewed pertinent recent articles in the medical literature and compiled guidelines for diagnosing and treating anxiety and depression in the geriatric population. Depression and anxiety are common in the elderly population. The development of depression in elderly subjects is associated with a higher risk of death from suicide than for any other age-group. Recognition of depression in elderly patients is often hampered by an inability or reluctance on the part of these patients to report depressive symptoms. In addition, anxiety and depression are often attributed to organic illness in this age-group. Pharmacotherapy is effective; however, older patients are probably more likely than young patients to experience adverse effects. Using medications at lower doses, choosing drugs with shorter half-lives, and avoiding drugs with potent anticholinergic side effects are often advisable. Anxiety and depression are common conditions among the elderly population. Correct recognition, attention to underlying precipitating factors, and compassionate, supportive care can vastly improve the quality of the lives of these patients.

  17. Assessment and treatment relevance in elderly glioblastoma patients

    PubMed Central

    Bauchet, Luc; Zouaoui, Sonia; Darlix, Amélie; Menjot de Champfleur, Nicolas; Ferreira, Ernestine; Fabbro, Michel; Kerr, Christine; Taillandier, Luc

    2014-01-01

    Glioblastoma (GBM) is the most common malignant primary brain tumor. Its incidence continues to increase in the elderly because the older segment of the population is growing faster than any other age group. Most clinical studies exclude elderly patients, and “standards of care” do not exist for GBM patients aged >70 years. We review epidemiology, tumor biology/molecular factors, prognostic factors (clinical, imaging data, therapeutics), and their assessments as well as classic and specific endpoints plus recent and ongoing clinical trials for elderly GBM patients. This work includes perspectives and personal opinions on this topic. Although there are no standards of care for elderly GBM patients, we can hypothesize that (i) Karnofsky performance status (KPS), probably after steroid treatment, is one of the most important clinical factors for determining our oncological strategy; (ii) resection is superior to biopsy, at least in selected patients (depending on location of the tumor and associated comorbidities); (iii) specific schedules of radiotherapy yield a modest but significant improvement; (iv) temozolomide has an acceptable tolerance, even when KPS <70, and could be proposed for methylated elderly GBM patients; and (v) the addition of concomitant temozolomide to radiotherapy has not yet been validated but shows promising results in some studies, yet the optimal schedule of radiotherapy remains to be determined. In the future, specific assessments (geriatric, imaging, biology) and use of new endpoints (quality of life and toxicity measures) will aid clinicians in determining the balance of potential benefits and risks of each oncological strategy. PMID:24792440

  18. The effect of Postoperative Spinal Infections on Patient Mortality.

    PubMed

    Casper, David S; Zmistowski, Benjamin; Hollern, Douglas A; Hilibrand, Alan S; Vaccaro, Alexander R; Schroeder, Gregory D; Kepler, Christopher K

    2017-06-09

    Retrospective, matched cohort study OBJECTIVES.: This study aims to (a) investigate the association between SSI and mortality and (b) ascertain any factors that predict mortality in those diagnosed with SSI. Despite significant efforts towards mitigation, surgical site infection (SSI), including deep infection remains a common complication following spine surgery, Considerable morbidity may be associated with infection, including hospital readmission, revision surgery, and delayed rehabilitation. However, it is not known whether this increase in morbidity is associated with increased mortality. Patients from a single center requiring reoperation for SSI following elective spine surgery between 2005 and 2013 were identified in a retrospective fashion. These patients were then matched one-to-three with patients undergoing elective spine surgery without SSI. Patients were matched for age, gender, body mass index (BMI), Charlson comorbidity index, year of surgery, spine region, and approach. The Social Security Death Index was utilized to identify deceased patients and their time of death. Univariate statistics were then utilized to compare mortality rates between the two groups. In addition, the SSI cohort was evaluated for predictors of mortality following SSI. One-hundred and ninety-five patients developed SSI at a mean of 27.4 (range: 1-467) days from the index surgery. Ninety day, one-year, two-year, and five-year mortality rates were 1.54% versus 1.03% (p = 0.70), 4.62% versus 1.2% (p = 0.006), 7.73% versus 2.25% (p = 0.001), and 15.45% versus 3.43% (p = 0.0002) for SSI versus control patients, respectively. Predictors of two-year mortality in the SSI cohort were increased age (p = 0.02) and increased Charlson Comorbidity Index (p < 0.001). Region and approach of surgery, days to infection, and reason for elective surgery did not influence mortality. Surgical site infection results in significant morbidity in the postoperative period, with

  19. Role of eosinophilic inflammation and atopy in elderly asthmatic patients

    PubMed Central

    Siripongpun, Sitthisak; Rerkpattanapipat, Ticha

    2016-01-01

    Background Asthma in the elderly is severe and associated with poor treatment outcome. Although atopy has an important role in pathogenesis, its role in the elderly is unclear, partly due to immune senescence. Objective We aimed to examine the associations of Th2-mediated inflammation with asthma severity in the elderly. Methods Consecutive asthmatics older than 60 years without severe exacerbation within 8 weeks were enrolled. Atopic status was determined by positive serum specific IgE or skin prick test to common aeroallergens. Serum total IgE was measured simultaneously to exhaled fractional concentration of nitric oxide (FeNO). Asthma control level was assessed by using Thai Asthma Control Test (ACT) score. Results Total of 44 elderly asthmatic patients were enrolled. The mean age was 68.9 years and mean age of asthma diagnosis was 46.6 years. Seventy-seven percent of patients were female. Atopic status was found in 45.5% of patients. Uncontrolled asthma classified as ACT score < 20 was noted in 25% of elderly asthma, but its association with either high serum total IgE (≥120 IU/mL), high FeNO (≥50 ppb) or atopic status was not detected. Conclusion One-fourth of elderly asthmatics were clinically uncontrolled, while atopy was confirmed in 45.5%. Neither high total IgE, high FeNO nor atopic status was associated with uncontrolled asthma in the elderly. Other factors might play role in asthma severity in the elderly, and has to be further investigated. PMID:27489791

  20. Nursing postoperative visit as a quality indicator for surgical patient care.

    PubMed

    Silva, R; Martins, M M; Jardim, H G

    2016-06-01

    The postoperative visit as a quality indicator for surgical patient care, demands some consideration from perioperative nurses. We evaluated the nursing perioperative interventions on postoperative visits, and adjusted them to the needs of the patients with postoperative pain. Our study indicated that 73% of patients visited didn't have postoperative pain whereas 27% had pain. The pain is aggravated when the patient is mobilised, one of the most common signs and symptoms being gastrointestinal changes. Pharmacological and non-pharmacological measures were used in pain management. The results showed that the percentage of patients with postoperative visits needs to be improved. We aim to have high quality perioperative nursing interventions which raise levels of patient satisfaction.

  1. The Need for a Step-up in Postoperative Medical Care is Predictable in Orthopedic Patients Undergoing Elective Surgery.

    PubMed

    Urban, Michael K; Mangini-Vendel, Michele; Lyman, Stephen; Pan, Ting Jung; Magid, Steven K

    2016-02-01

    The goal of elective orthopedic surgery is to return patients to their expected level of activity without an increased incidence of postoperative complications. The first step is identifying patient and/or surgical characteristics responsible for these complications. This study sought to identify predictors of a step-up in medical care after non-ambulatory elective orthopedic surgery. At a single specialty orthopedic hospital, we identified all in-hospital postoperative patients who were transferred to a higher level of medical care ((PACU) post-anesthesia care unit). The characteristics of both transferred and non-transferred patients were compared. A model was built which incorporated predictors of return to a higher level of care. During a 1-year period, 155 of 7967 patients (1.95%) required transfer to the PACU within 5 days of surgery. Cardiac complications were the major reason for transfer (50.3%), followed by pulmonary (11.0%) and neurological complications (9.7%). Patients who returned to the PACU were older, had more Exlihauser comorbidities, and had obstructive sleep apnea (OSA). In a model adjusting for all patient characteristics: age, American Society of Anesthesiologists (ASA) status, congestive heart failure (CHF), the Charlson comorbidity index and OSA predicted return to the PACU. In an elderly population with multiple comorbidities undergoing elective common major orthopedic procedures, approximately 2% of patients required readmission to the PACU. The most common problems requiring this step-up in care were cardiac and pulmonary, which resulted in an increased length of hospital stay. Patients with OSA and multiple comorbidities undergoing total knee arthroplasty carry an increased risk for postoperative complications.

  2. Assessment of visual function in institutionalized elderly patients.

    PubMed

    Carcenac, Guillaume; Hérard, Marie-Eve; Kergoat, Marie-Jeanne; Lajeunesse, Yvette; Champoux, Nathalie; Barsauskas, Allan; Kergoat, Hélène

    2009-01-01

    To describe the visual function and ocular health of frail elderly patients institutionalized in a tertiary care university-affiliated geriatric hospital. Retrospective file review. A university-affiliated geriatric hospital. 440 patient files. The archived clinical files of patients from the long-term care beds of the Institut universitaire de gériatrie de Montréal, who had died between April 2000 and 2004 were reviewed. Pertinent medical and visual characteristics were extracted and entered into a database for analysis. The age of the patients ranged from 65 to 104 years. The major ocular conditions observed were cataract, pseudophakia, conjunctivitis-blepharitis, age-related macular degeneration, and glaucoma. Of the 231 patients referred for a partial or full eye examination, visual acuity was available in 178. Visual impairment was considered absent in 87 patients; mild in 52; moderate in 17; and 22 patients were legally blind. Of the 105 patients referred for a full eye examination, an evaluation of the refraction, visual acuity, and ocular health was possible in 89, irrespective of their cognitive status. These data demonstrate that the vast majority of severely disabled elderly patients examined retained good visual acuity into advanced age. The most prevalent ocular conditions observed are treatable, thereby emphasizing the importance of regular eye care for the institutionalized frail elderly. The results clearly demonstrate that it is possible to perform a complete evaluation of visual function and ocular health in the elderly institutionalized patient, independent of age, cognitive status, or communication disorders.

  3. Pharmacokinetics and pharmacodynamics of edrophonium in elderly surgical patients.

    PubMed

    Matteo, R S; Young, W L; Ornstein, E; Schwartz, A E; Silverberg, P A; Diaz, J

    1990-10-01

    The effect of age (over 70 yr) on the pharmacokinetics and pharmacodynamics of edrophonium was evaluated in seven patients aged 76-87 yr and in seven patients aged 27-57 yr. When elderly patients were compared with younger controls, the elderly exhibited a statistically significant decreased plasma clearance (5.9 +/- 2 versus 12.1 +/- 4 mL.kg-1.min-1) and a prolonged elimination half-life (84.2 +/- 17 versus 56.6 +/- 16 min). Pharmacodynamically, a higher concentration of edrophonium is required in elderly patients to produce the same effect as in the younger controls. This observation may be explained in part by changes in neuromuscular transmission that are a function of the aging process. In addition, even though plasma concentrations were significantly greater at every sampling point in the elderly than the younger group, there was no difference between either the maximum duration or the total duration of action of edrophonium in the two groups. The maximum duration of action of edrophonium in both groups was very brief (1.3-2.2 min). These results contrast with a previous study of the anticholinesterases neostigmine and pyridostigmine, in which the action of these drugs was significantly prolonged in elderly patients. Explanations for the observed differences between edrophonium and other anticholinesterases may relate to differences in chemical structure and the possibility that edrophonium produces antagonism of neuromuscular blockade by a different mechanism than neostigmine or pyridostigmine.

  4. Treatment and Prevention of Oral Candidiasis in Elderly Patients.

    PubMed

    Sakaguchi, Hideo

    2017-01-01

    The incidence of oral candidiasis has increased in the elderly in recent years. Although the increase of the elderly population plays a big role in this rise of oral candidiasis, the broader recognition that elderly people have higher infection rates for oral candidiasis is considered to be also an important factor. Oral candidiasis can be categorized into three types. Pseudomembranous oral candidiasis is characterized by the appearance of white moss, erythematous oral candidiasis by the eruption of erythema, and hyperplastic oral candidiasis by mucosal hyperplasia. Miconazole has been commonly used when treating oral candidiasis. Elderly patients, however, have a tendency to develop oral candidiasis repeatedly. It is therefore critical to take measures to prevent recurrence. We recommend the use an oral moisturizer containing hinokitiol, an antifungal substance, on a regular basis, to help prevent recurrence of oral candidiasis.

  5. Mianserin and imipramine in the treatment of elderly depressed patients.

    PubMed

    Eklund, K; Dunbar, G C; Pinder, R M; Steffensen, K

    1985-01-01

    Fifty elderly depressed patients were randomly assigned to double-blind treatment, using a flexible dose schedule, with either mianserin 20-60 mg or imipramine 75-150 mg. Medication was continued for four weeks. Eleven patients withdrew from the study. At the end of treatment there were no significant differences between mianserin and imipramine in antidepressant efficacy. A significantly greater number of side-effects occurred in the imipramine group (dry mouth, days 7 and 14; faintness, dizziness, weakness, day 21). When treating elderly depressed patients mianserin may be preferred to imipramine because of a lower incidence of induced side-effects.

  6. Changes in quality of life associated with surgical risk in elderly patients undergoing cardiac surgery.

    PubMed

    Romero, Paola Severo; de Souza, Emiliane Nogueira; Rodrigues, Juliane; Moraes, Maria Antonieta

    2015-10-01

    The study aims to verify quality of life of elderly patients submitted to cardiac surgery, and correlating surgical risk to health-related quality of life instrument domains. Prospective cohort study, performed at a cardiology hospital. It included elderly patients who had undergone elective cardiac surgery. Pre- and postoperative quality of life was evaluated by applying the World Health Organization Quality of Life-Old (WHOQOL-OLD) scale and the Short-Form Health Survey (SF-36) questionnaire. Surgical risk was stratified using the European System for Cardiac Operative Risk Evaluation (EuroSCORE). Fifty-four patients, mostly men (64.8%), were included, with a mean age of 69.3 ± 5.7 years. The eight domains of the SF-36 questionnaire, and the four facets presented for the WHOQOL-OLD scale showed improved quality of life 6 months after surgery (P < 0.001). No difference was found in the association of EuroSCORE with the domains of the health-related quality of life instruments. The data showed improved quality of life of elderly people submitted to cardiac surgery, unrelated to surgical risk. © 2014 Wiley Publishing Asia Pty Ltd.

  7. Management of asthma in the elderly patient.

    PubMed

    Melani, Andrea S

    2013-01-01

    A significant number of older asthmatics, more often than in previous ages, have poorly controlled asthma, leading to increased morbidity and mortality. On the other hand, current guidelines suggest that most asthmatics can obtain achievement and maintenance of disease control and do not include sections specific to the management of asthma in the elderly so that it is more evident the contrast between poor control of asthma in the elderly and the lack of specific guidance from guidelines on asthma management in older asthmatics. Inhaled corticosteroids are the cornerstone for older asthmatics, eventually with add-on inhaled long-acting beta-agonists; inhaled short acting beta-agonists can be used as rescue medications. Triggers exacerbating asthma are similar for all ages, but inhaled viruses and drug interactions have greater clinical significance in the elderly. Older asthmatics have an increased likelihood of comorbidities and polypharmacy, with possible worsening of asthma control and reduced treatment adherence. Physicians and older asthmatics probably either do not perceive or accept a poor asthma control. We conclude that specific instruments addressed to evaluate asthma control in the elderly with concomitant comorbidities and measurements for improving self-management and adherence could assure better disease control in older asthmatics.

  8. Renal replacement therapy in elderly patients: peritoneal dialysis.

    PubMed

    Catizone, Luigi; Malacarne, Franco; Bortot, Alessia; Annaloro, Mariangela; Russo, Giorgia; Barillà, Antonio; Storari, Alda

    2010-01-01

    Management of chronic uremia in elderly patients presents several clinic and organizational difficulties. Hemodialysis (HD) and chronic peritoneal dialysis (CPD) are both available for the elderly, and the choice depends on the individual, clinical and familial conditions. Several reports have compared the outcomes for older patients treated by HD or peritoneal dialysis, with those for younger or older patients undergoing peritoneal dialysis. CPD is a successful dialysis option for elderly patients, in both patient and technique survival terms. All nutritional parameters are of pivotal importance. Several barriers, such as medical and social factors, physician bias, late referral and education irrespective of the needs of older patients, influence the choice of CPD. The development of assisted peritoneal dialysis, using community-based nurses or health care assistants, can overcome some of the barriers and enable frail older patients to have home-based dialysis treatment. Increasing age is associated with higher peritonitis rates among patients who started CPD in the 1990s, while age is not associated with peritonitis in more recent CPD cohorts, and no greater frequency of adverse outcomes of peritonitis has been seen among those who began CPD after the year 2000. In elderly dialysis patients, the management of quality of life (QOL) is important as well as adequacy of dialysis, nutritional status and survival rate. To obtain a good standard of QOL, it is essential to select carers who are properly educated and who can access an adequate support system, both physical and psychological, to help them cope with their burden.

  9. Hepatocellular carcinoma in extremely elderly patients: An analysis of clinical characteristics, prognosis and patient survival

    PubMed Central

    Tsukioka, Gengo; Kakizaki, Satoru; Sohara, Naondo; Sato, Ken; Takagi, Hitoshi; Arai, Hirotaka; Abe, Takehiko; Toyoda, Mitsuo; Katakai, Kenji; Kojima, Akira; Yamazaki, Yuichi; Otsuka, Toshiyuki; Matsuzaki, Yutaka; Makita, Fujio; Kanda, Daisuke; Horiuchi, Katsuhiko; Hamada, Tetsuya; Kaneko, Mieko; Suzuki, Hideyuki; Mori, Masatomo

    2006-01-01

    AIM: To identify the clinical and prognostic features of patients with hepatocellular carcinoma (HCC) aged 80 years or more. METHODS: A total of 1310 patients with HCC were included in this study. Ninety-one patients aged 80 years or more at the time of diagnosis of HCC were defined as the extremely elderly group. Two hundred and thirty-four patients aged ≥ 50 years but less than 60 years were regarded as the non-elderly group. RESULTS: The sex ratio (male to female) was significantly lower in the extremely elderly group (0.90:1) than in the non-elderly group (3.9:1, P < 0.001). The positive rate for HBsAg was significantly lower in the extremely elderly group and the proportion of patients negative for HBsAg and HCVAb obviously increased in the extremely elderly group (P < 0.001). There were no significant differences in the following parameters: diameter and number of tumors, Child-Pugh grading, tumor staging, presence of portal thrombosis or ascites, and positive rate for HCVAb. Extremely elderly patients did not often receive surgical treatment (P < 0.001) and they were more likely to receive conservative treatment (P < 0.01). There were no significant differences in survival curves based on the Kaplan-Meier methods in comparison with the overall patients between the two groups. However, the survival curves were significantly worse in the extremely elderly patients with stage I/II, stage I/II and Child-Pugh grade A cirrhosis in comparison with the non-elderly group. The causes of death did not differ among the patients, and most cases died of liver-related diseases even in the extremely elderly patients. CONCLUSION: In the patients with good liver functions and good performance status, aggressive treatment for HCC might improve the survival rate, even in extremely elderly patients. PMID:16440416

  10. Outcomes of Elderly Patients after Predialysis Vascular Access Creation.

    PubMed

    Lee, Timmy; Thamer, Mae; Zhang, Yi; Zhang, Qian; Allon, Michael

    2015-12-01

    Uniform vascular access guidelines for elderly patients may be inappropriate because of the competing risk of death, high rate of arteriovenous fistula (AVF) maturation failure, and poor vascular access outcomes in this population. However, the outcomes in elderly patients with advanced CKD who receive permanent vascular access before dialysis initiation are unclear. We identified a large nationally representative cohort of 3418 elderly patients (aged ≥ 70 years) with CKD undergoing predialysis AVF or arteriovenous graft (AVG) creation from 2004 to 2009, and assessed the frequencies of dialysis initiation, death before dialysis initiation, and dialysis-free survival for 2 years after vascular access creation. In all, 67% of patients with predialysis AVF and 71% of patients with predialysis AVG creation initiated dialysis within 2 years of access placement, but the overall risk of dialysis initiation was modified by patient age and race. Only one half of patients initiated dialysis with a functioning AVF or AVG; 46.8% of AVFs were created <90 days before dialysis initiation. Catheter dependence at dialysis initiation was more common in patients receiving predialysis AVF than in patients receiving AVG (46.0% versus 28.5%; P<0.001). In conclusion, most elderly patients with advanced CKD who received predialysis vascular access creation initiated dialysis within 2 years. As a consequence of late predialysis placement or maturation failure, almost one half of patients receiving AVFs initiated dialysis with a catheter. Insertion of an AVG closer to dialysis initiation may serve as a "catheter-sparing" approach and allow delay of permanent access placement in selected elderly patients with CKD. Copyright © 2015 by the American Society of Nephrology.

  11. Outcomes of Elderly Patients after Predialysis Vascular Access Creation

    PubMed Central

    Lee, Timmy; Thamer, Mae; Zhang, Yi; Zhang, Qian

    2015-01-01

    Uniform vascular access guidelines for elderly patients may be inappropriate because of the competing risk of death, high rate of arteriovenous fistula (AVF) maturation failure, and poor vascular access outcomes in this population. However, the outcomes in elderly patients with advanced CKD who receive permanent vascular access before dialysis initiation are unclear. We identified a large nationally representative cohort of 3418 elderly patients (aged ≥70 years) with CKD undergoing predialysis AVF or arteriovenous graft (AVG) creation from 2004 to 2009, and assessed the frequencies of dialysis initiation, death before dialysis initiation, and dialysis-free survival for 2 years after vascular access creation. In all, 67% of patients with predialysis AVF and 71% of patients with predialysis AVG creation initiated dialysis within 2 years of access placement, but the overall risk of dialysis initiation was modified by patient age and race. Only one half of patients initiated dialysis with a functioning AVF or AVG; 46.8% of AVFs were created <90 days before dialysis initiation. Catheter dependence at dialysis initiation was more common in patients receiving predialysis AVF than in patients receiving AVG (46.0% versus 28.5%; P<0.001). In conclusion, most elderly patients with advanced CKD who received predialysis vascular access creation initiated dialysis within 2 years. As a consequence of late predialysis placement or maturation failure, almost one half of patients receiving AVFs initiated dialysis with a catheter. Insertion of an AVG closer to dialysis initiation may serve as a “catheter-sparing” approach and allow delay of permanent access placement in selected elderly patients with CKD. PMID:25855782

  12. Characteristics and mortality of elderly patients admitted to the Intensive Care Unit of a district hospital

    PubMed Central

    Reyes, José Carlos Llamas; Alonso, Joaquín Valle; Fonseca, Javier; Santos, Margarita Luque; Jiménez, María de los Ángeles Ruiz-Cabello; Braniff, Jay

    2016-01-01

    Aim: To study all the elderly patients (≥75 years) who were admitted in an Intensive Care Unit (ICU) of a Spanish hospital and identify factors associated with mortality. Patients and Methods: A retrospective, observational data collected prospectively in patients ≥75 years recruited from the ICU in the period of January 2004 to December 2010. Results: During the study period, 1661 patients were admitted to our unit, of whom 553 (33.3%) were older than 75 years. The mean age was 79.9 years, 317 (57.3%) were male, and the overall in-hospital mortality was 94 patients (17% confidence interval 14–20.3%). When comparing patients who survived to those who died, we found significant differences in mean age (P = 0.001), Acute Physiologic Assessment and Chronic Health Evaluation II and Simplified Acute Physiology Scoring II (SAPS II) on admission (P < 0.0001, postoperative patients (P = 0.001), and need for mechanical ventilation (P < 0.0001). Comparing age groups, we found statistically significant differences in SAPS II (P = 0.007), diagnosis of non-ST-segment elevation myocardial infarction (P = 0.014), complicated postoperative period (P = 0.001), and pacemaker (P = 0.034). Mortality between the groups was statistically significant (P = 0.004). The survival between the group of 65 and 74 years and patients >75 years was not significant (P = 0.1390). Conclusions: The percentage of elderly patients in our unit is high, with low mortality rates. The age itself is not the sole determinant for admission to the ICU and other factors should be taken into account. PMID:27555692

  13. Patients' preoperative expectations and postoperative satisfaction of dysgnathic patients operated on with resorbable osteosyntheses.

    PubMed

    Ballon, Alexander; Laudemann, Katharina; Sader, Robert; Landes, Constantin A

    2011-03-01

    This study evaluated whether personal expectations and satisfaction throughout orthognathic surgery were fulfilled. In addition, patients were interrogated about their experience of resorbable osteosynthesis. A total of 50 patients were interviewed 3 times each throughout the study by a mixed questionnaire of standard psychologic tests and a tailored itemized questionnaire regarding their expectations regarding resorbable osteofixation and their postoperative satisfaction. A postoperative increase in self-esteem and approach to life were evident. An examination of Oral Health-Related Quality of Life showed constant quality of life; an examination of Oral Health Impact Profile-Germany) showed no postoperative difficulties in dental hygiene and nutrition. No statistically significant change in any of the tests could be expressly determined. Avoidance of secondary surgery motivated 94% to choose resorbable osteofixations, although a mere 66% had heard of them before; 90% of patients were satisfied with the operation result. Orthognathic surgery cannot change preexistent depression or a problematic social background. Mastication and oral health improved, and postoperative happiness and confidence increased. When given the choice between resorbable fixation and titanium osteofixation, patients generally preferred resorbable fixations.

  14. Surgical treatment for infective endocarditis in elderly patients.

    PubMed

    Ramírez-Duque, N; García-Cabrera, E; Ivanova-Georgieva, R; Noureddine, M; Lomas, J M; Hidalgo-Tenorio, C; Plata, A; Gálvez-Acebal, J; Ruíz-Morales, J; de la Torre-Lima, J; Reguera, J M; Martínez-Marcos, F J; de Alarcón, A

    2011-08-01

    We evaluate the clinical, echographic and prognostic characteristics of infective endocarditis (IE) in a large population of elderly patients, and the results of surgical approach. Multicentric, prospective, observational cohort study with 961 consecutive left-sided IE: 356 patients aged ≥65 years were compared with 605 younger. Indications for cardiac surgery, potential surgical risk, time and outcome, were compared. Hospital-acquired endocarditis, comorbidity, renal failure and septic shock were more frequent in elderly, but embolisms were less. Intracardiac destruction and ventricular failure were similar in both groups, but significantly fewer elderly patients underwent cardiac surgery (36% vs 51%; p < 0.01), and this group showed a worse outcome (43.2% of mortality vs 27% in younger; p < 0.01), resulting age as an independent predictor of mortality (OR: 1.02 CI95%: 1.01-1.03). Compared with medical treatment, surgery showed lower percentages of mortality compared with medical treatment (23.3% vs 31.3%; p = 0.03) in younger group, but a high mortality was observed with both procedures (47.6% vs 40.3%; p = 0.1) in the elderly. Although similar percentages of heart failure and intracardiac complications, increasing age is associated with higher mortality in IE. Lower rates of surgical treatment and a worse outcome after operation are common features in elderly patients. Copyright © 2011 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

  15. Lipid-lowering drug therapy in elderly patients.

    PubMed

    Berthold, Heiner K; Gouni-Berthold, Ioanna

    2011-01-01

    Coronary heart disease (CHD) is the leading cause of death among elderly patients and >80% of all coronary deaths occur in patients >65 years. Cerebrovascular events are also associated with older age. Since elevated cholesterol concentrations are a risk factor for cardiovascular disease, lipid-lowering drugs, especially statins, are in widespread use for prevention. There is substantial underutilization of statins in the elderly population although meta-analyses of randomized trials have shown that in elderly secondary prevention patients they reduce all-cause mortality by approximately 22%, CHD mortality by 30%, non-fatal myocardial infarction (MI) by 26% and stroke by 25% over a treatment period of 5 years. Relative risk reduction is greater or at least equal to the one in younger patients, but absolute risk reduction is greater in the elderly because the event rate is higher. The benefit from statin treatment seems to start beyond 1 year of treatment. Data on primary prevention in the elderly are less clear. There is a significant reduction in CHD events, CHD deaths and all-cause mortality but numbers needed to treat (NNT) are higher than in secondary prevention. Treatment decisions have to consider the individual patient's situation regarding multimorbidity, polypharmacy and patient wishes. Economic considerations have to be made in some health systems. Statins have no role in the prevention or the treatment of dementia. Statins are generally safe and safety is equal in younger and older age groups. Their prescription should not be denied to patients for reasons of age alone. Other lipid-lowering drugs play only a minor role in cardiovascular disease (CVD) event prevention because convincing outcome studies are largely missing. A primary prevention statin trial in the very elderly is urgently needed.

  16. Learning Style Preferences of Elderly Coronary Artery Disease Patients.

    ERIC Educational Resources Information Center

    Theis, Saundra L.; Merritt, Sharon L.

    1992-01-01

    The Patient Learning Styles Questionnaire derived from Canfield and administered to 134 elderly coronary artery disease patients revealed the following order of learning preferences: structure, iconics, listening, direct experience, reading, achievement, affiliation, and eminence. Level of education significantly influenced preferred learning…

  17. Learning Style Preferences of Elderly Coronary Artery Disease Patients.

    ERIC Educational Resources Information Center

    Theis, Saundra L.; Merritt, Sharon L.

    1992-01-01

    The Patient Learning Styles Questionnaire derived from Canfield and administered to 134 elderly coronary artery disease patients revealed the following order of learning preferences: structure, iconics, listening, direct experience, reading, achievement, affiliation, and eminence. Level of education significantly influenced preferred learning…

  18. Relationship between cobalamin deficiency and delirium in elderly patients undergoing cardiac surgery.

    PubMed

    Sevuk, Utkan; Baysal, Erkan; Ay, Nurettin; Altas, Yakup; Altindag, Rojhat; Yaylak, Baris; Alp, Vahhac; Demirtas, Ertan

    2015-01-01

    Delirium is common after cardiac surgery and is independently associated with increased morbidity, mortality, prolonged hospital stays, and higher costs. Cobalamin (vitamin B12) deficiency is a common cause of neuropsychiatric symptoms and affects up to 40% of elderly people. The relationship between cobalamin deficiency and the occurrence of delirium after cardiac surgery has not been examined in previous studies. We examined the relationship between cobalamin deficiency and delirium in elderly patients undergoing coronary artery bypass grafting (CABG) surgery. A total of 100 patients with cobalamin deficiency undergoing CABG were enrolled in this retrospective study. Control group comprised 100 patients without cobalamin deficiency undergoing CABG. Patients aged 65 years or over were included. Diagnosis of delirium was made using Intensive Care Delirium Screening Checklist. Delirium severity was measured using the Delirium Rating Scale-revised-98. Patients with cobalamin deficiency had a significantly higher incidence of delirium (42% vs 26%; P=0.017) and higher delirium severity scores (16.5±2.9 vs 15.03±2.48; P=0.034) than patients without cobalamin deficiency. Cobalamin levels were significantly lower in patients with delirium than patients without delirium (P=0.004). Delirium severity score showed a moderate correlation with cobalamin levels (ρ=-0.27; P=0.024). Logistic regression analysis demonstrated that cobalamin deficiency was independently associated with postoperative delirium (OR 1.93, 95% CI 1.03-3.6, P=0.038). The results of our study suggest that cobalamin deficiency may be associated with increased risk of delirium in patients undergoing CABG. In addition, we found that preoperative cobalamin levels were associated with the severity of delirium. This report highlights the importance of investigation for cobalamin deficiency in patients undergoing cardiac surgery, especially in the elderly.

  19. Antithrombotic treatment in elderly patients with atrial fibrillation.

    PubMed

    Suárez Fernández, C; Camafort, M; Cepeda Rodrigo, J M; Díez-Manglano, J; Formiga, F; Pose Reino, A; Tiberio, G; Mostaza, J M

    2015-04-01

    Atrial fibrillation (AF) in the elderly is a complex condition due to the high number of frequently associated comorbidities, such as cardiovascular and kidney disease, cognitive disorders, falls and polypharmacy. Except when contraindicated, anticoagulation is necessary for preventing thromboembolic events in this population. Both vitamin K antagonists and direct oral anticoagulants (dabigatran, rivaroxaban and apixaban) are indicated in this context. Renal function should be closely monitored for this age group when these drugs are used. In recent years, various clinical practice guidelines have been published on patients with AF. The majority of these guidelines make specific recommendations on the clinical characteristics and treatment of elderly patients. In this update, we review the specific comments on the recommendations concerning antithrombotic treatment in elderly patients with nonvalvular AF. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  20. Malignant melanoma in elderly patients: biological, surgical and medical issues.

    PubMed

    Russo, Alessia E; Ferraù, Francesco; Antonelli, Giovanna; Priolo, Domenico; McCubrey, James A; Libra, Massimo

    2015-01-01

    Malignant melanoma is an aggressive tumor with a poor prognosis for patients with advanced disease. Over the last decades, its incidence and mortality has increased in elderly population, impacting significantly on healthcare costs, considering the increase in average age of the world population. Older age is recognized as an independent poor prognostic factor for melanoma, but the scientific community now is wondering if elderly melanoma patients have worse outcome because they are not receiving the same treatment as their younger counterparts. This article summarizes current data on elderly melanoma prevention and early detection and its subsequent management, underling the differences observed between older and younger patients. It also describes age-associated alterations in immunity and how these may impact on anti-melanoma response.

  1. Elderly Peritoneal Dialysis Compared with Elderly Hemodialysis Patients and Younger Peritoneal Dialysis Patients: Competing Risk Analysis of a Korean Prospective Cohort Study

    PubMed Central

    Kim, Hyunsuk; An, Jung Nam; Kim, Dong Ki; Kim, Myoung-Hee; Kim, Ho; Kim, Yong-Lim; Park, Ki Soo; Oh, Yun Kyu; Lim, Chun Soo; Kim, Yon Su; Lee, Jung Pyo

    2015-01-01

    The outcomes of peritoneal dialysis (PD) in elderly patients have not been thoroughly investigated. We aimed to investigate the clinical outcomes and risk factors associated with PD in elderly patients. We conducted a prospective observational nationwide adult end-stage renal disease (ESRD) cohort study in Korea from August 2008 to March 2013. Among incident patients (n = 830), patient and technical survival rate, quality of life, and Beck’s Depression Inventory (BDI) scores of elderly PD patients (≥65 years, n = 95) were compared with those of PD patients aged ≤49 years (n = 205) and 50~64 years (n = 192); and elderly hemodialysis (HD) patients (n = 315). The patient death and technical failure were analyzed by cumulative incidence function. Competing risk regressions were used to assess the risk factors for survival. The patient survival rate of elderly PD patients was inferior to that of younger PD patients (P<0.001). However, the technical survival rate was similar (P = 0.097). Compared with elderly HD patients, the patient survival rate did not differ according to dialysis modality (P = 0.987). Elderly PD patients showed significant improvement in the BDI scores, as compared with the PD patients aged ≤49 years (P = 0.003). Low albumin, diabetes and low residual renal function were significant risk factors for the PD patient survival; and peritonitis was a significant risk factor for technical survival. Furthermore, low albumin and hospitalization were significant risk factors of patient survival among the elderly. The overall outcomes were similar between elderly PD and HD patients. PD showed the benefit in BDI and quality of life in the elderly. Additionally, the technical survival rate of elderly PD patients was similar to that of younger PD patients. Taken together, PD may be a comparable modality for elderly ESRD patients. PMID:26121574

  2. Clinical and urodynamic studies in 100 elderly incontinent patients.

    PubMed Central

    Castleden, C M; Duffin, H M; Asher, M J

    1981-01-01

    Clinical details were noted and urodynamic studies carried out on 100 elderly patients referred to an incontinence clinic, of whom 48 attended as day patients. Thirty patients had no problem apart from their incontinence, and only 38 had a clinically detectable neurological lesion. The average mental orientation score in 48 of the patients was 7.6, 23 patients scoring the top score of 10. Most patients were mobile without assistance from another person. Patients could be placed into one of four diagnostic groups according to the appearance of the cystometric tracings, but no bladder capacity or pressure was characteristic of any group. The maximum urethral closure pressure and functional profile length were similar for each group within each sex. There was no correlation between clinical and urodynamic findings, yet each of the four diagnostic categories have different therapeutic implications. It is concluded that urodynamic investigation is necessary in elderly incontinent patients before treatment. PMID:6786455

  3. HYPERNATREMIA AND COPEPTIN LEVELS IN THE ELDERLY HOSPITALIZED PATIENT.

    PubMed

    Liber, Michal; Sonnenblick, Moshe; Munter, Gabriel

    2016-12-01

    Elderly patients have a high prevalence of hypernatremia. The aim of this study was to determine demographic and clinical characteristics of the elderly hypernatremic patient hospitalized in the internal medicine ward and to enhance understanding of the role of antidiuretic hormone (ADH) secretion in the pathogenesis of hypernatremia. Case-control study performed in an internal medicine ward in a university-affiliated hospital. Thirtythree elderly hypernatremic patients (admission sodium, >150 mEq/L; age, >70 years) were compared with 34 normonatremic patients. Demographic, functional (mental status and activities of daily living), clinical data (Acute Physiology and Chronic Health Evaluation [APACHE] II score), and serum copeptin levels as a marker of ADH secretion, were collected at admission. Mortality and change in the functional status were followed up to 30 days from discharge. Patients with hypernatremia presented with significantly lower baseline functional and cognitive states and higher APACHE II score (21.3 ± 8.6 vs. 15.4 ± 6.7; P<.01). Mortality within 30 days after discharge was higher in the hypernatremic group (58% vs. 32%; P<.05). Higher copeptin levels were found in the hypernatremic group compared to the normonatremic group (100.2 ± 60.6 pmol/L vs. 66.5 ± 57.2 pmol/L; P<.05). High levels of copeptin were associated with higher in-hospital (P<.05) and 30-day (P<.01) mortality. Sodium levels were found correlated with copeptin levels; yet, an even stronger correlation was found between copeptin levels and APACHE II score (r = 0.52; P<.001). Hypernatremia in the elderly at admission is associated with a high mortality rate. Copeptin level in the elderly seems to be a good single disease severity marker. ADH is strongly secreted in elderly hypernatremic patients. ADH = antidiuretic hormone APACHE = Acute Physiology and Chronic Health Evaluation.

  4. Efficiency of postoperative statin treatment for preventing new-onset postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass grafting: A prospective randomized study.

    PubMed

    Aydın, Ufuk; Yılmaz, Mehmet; Düzyol, Çağrı; Ata, Yusuf; Türk, Tamer; Orhan, Ahmet Lütfullah; Koçoğulları, Cevdet Uğur

    2015-06-01

    Recent studies have demonstrated that preoperative statin therapy reduces the incidence of postoperative atrial fibrillation (AF). The objective of this study was to assess the efficacy of statin therapy started in the early postoperative period for the prevention from new-onset AF after isolated coronary artery bypass grafting (CABG). This prospective and randomized study consisted of 60 consecutive patients who underwent elective isolated CABG. Patients were divided into two groups to examine the influence of statins: those with postoperative statin therapy (statin group, n=30) and those without it (non-statin group, n=30). Patient data were collected and analyzed prospectively. In the statin group, each extubated patient was given 40 mg of atorvastatin per day, starting from an average of 6 hours after the operation. The overall incidence of postoperative AF was 30%. Postoperative AF occurred in 5 patients (16.7%) in the statin group. This was significantly lower compared with 13 patients (43.3%) in the non-statin group (p=0.049). According to the multivariate analysis, postoperative atorvastatin reduced the risk of postoperative AF by 49% [odds ratio (OR) 0.512, 95% confidence interval (CI) 0.005 to 0.517, p=0.012]. Also, age was an independent predictor of postoperative AF (OR 1.299, 95% CI 1.115 to 1.514, p=0.001). Postoperative statin therapy seems to reduce new-onset AF after isolated CABG in our study.

  5. The management of gastric volvulus in elderly patients.

    PubMed

    Zuiki, Toru; Hosoya, Yoshinori; Lefor, Alan Kawarai; Tanaka, Hiroyuki; Komatsubara, Toshihide; Miyahara, Yuzo; Sanada, Yukihiro; Ohki, Jun; Sekiguchi, Chuji; Sata, Naohiro

    2016-01-01

    Gastric volvulus is torsion of the stomach and requires immediate treatment. The optimal treatment strategy for patients with gastric volvulus is not established, because of significant variations in the cause and clinical course of this condition. We describe our experience with six elderly patients with gastric volvulus caused by different conditions using various approaches. This includes two patients managed with endoscopic reduction, followed by endoscopic or laparoscopic gastropexy. Endoscopy is a necessary first step to determine the optimal treatment strategy, and endoscopic reduction is often effective. The indications for surgical repair of gastric volvulus depend on the patient's overall condition, and several options are available. In some elderly patients with severe comorbidities, major surgery may have an unacceptably high risk. We propose a novel treatment strategy for gastric volvulus in the elderly and a review of the literature. Early endoscopy is necessary in patients with gastric volvulus. Endoscopic or laparoscopic gastropexy may be adequate therapy in selected elderly patients. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  6. Selective spinal anesthesia using 1 mg of bupivacaine with opioid in elderly patients for transurethral resection of prostate.

    PubMed

    Kim, Na Young; Kim, So Yeon; Ju, Hyang Mi; Kil, Hae Keum

    2015-03-01

    This study was to evaluate the characteristics of selective spinal anesthesia using 1 mg of bupivacaine combined with fentanyl or sufentanil in elderly patients undergoing transurethral resection of prostate. Fifty-six patients were randomized into two groups. The Fentanyl group received 0.5% hyperbaric bupivacaine 0.2 mL+fentanyl 20 μg+5% dextrose 1.4 mL, and the Sufentanil group received 0.5% hyperbaric bupivacaine 0.2 mL+sufentanil 5 μg+5% dextrose 1.7 mL intrathecally. Intraoperative and postoperative characteristics were evaluated. Patient satisfaction was assessed postoperatively. Twenty-six patients in each group completed the study. The median peak sensory block level was similar between two groups, but sensory regression time was longer in the Sufentanil group than the Fentanyl group (p=0.017). All patients were able to move themselves to the bed without any aid when they arrived at the admission room. Pain scores were lower in the Sufentanil group than the Fentanyl group at postoperative 6, 12, and 18 hours (p=0.001). Compared to the Fentanyl group, the Sufentanil group required less postoperative analgesia (p=0.023) and the time to the first analgesic request was longer (p=0.025). Twenty-four of 26 patients (92.3%) in each group showed "good" satisfaction level. Selective spinal anesthesia using 1 mg of bupivacaine with fentanyl or sufentanil provided appropriate sensory block level with spared motor function for transurethral resection of the prostate in elderly patients. Intrathecal sufentanil was superior to fentanyl in postoperative analgesic quality.

  7. Selective Spinal Anesthesia Using 1 mg of Bupivacaine with Opioid in Elderly Patients for Transurethral Resection of Prostate

    PubMed Central

    Kim, Na Young; Kim, So Yeon; Ju, Hyang Mi

    2015-01-01

    Purpose This study was to evaluate the characteristics of selective spinal anesthesia using 1 mg of bupivacaine combined with fentanyl or sufentanil in elderly patients undergoing transurethral resection of prostate. Materials and Methods Fifty-six patients were randomized into two groups. The Fentanyl group received 0.5% hyperbaric bupivacaine 0.2 mL+fentanyl 20 µg+5% dextrose 1.4 mL, and the Sufentanil group received 0.5% hyperbaric bupivacaine 0.2 mL+sufentanil 5 µg+5% dextrose 1.7 mL intrathecally. Intraoperative and postoperative characteristics were evaluated. Patient satisfaction was assessed postoperatively. Results Twenty-six patients in each group completed the study. The median peak sensory block level was similar between two groups, but sensory regression time was longer in the Sufentanil group than the Fentanyl group (p=0.017). All patients were able to move themselves to the bed without any aid when they arrived at the admission room. Pain scores were lower in the Sufentanil group than the Fentanyl group at postoperative 6, 12, and 18 hours (p=0.001). Compared to the Fentanyl group, the Sufentanil group required less postoperative analgesia (p=0.023) and the time to the first analgesic request was longer (p=0.025). Twenty-four of 26 patients (92.3%) in each group showed "good" satisfaction level. Conclusion Selective spinal anesthesia using 1 mg of bupivacaine with fentanyl or sufentanil provided appropriate sensory block level with spared motor function for transurethral resection of the prostate in elderly patients. Intrathecal sufentanil was superior to fentanyl in postoperative analgesic quality. PMID:25684006

  8. Greater risks of chemotherapy toxicity in elderly patients with cancer.

    PubMed

    Repetto, Lazzaro

    2003-01-01

    Complications of cytotoxic chemotherapy are more common in older patients (65 years of age and older) with cancer than in younger patients, and the occurrence of myelosuppression, mucositis, cardiodepression, peripheral neuropathy, and central neurotoxicity can complicate treatment. Age-related physiologic changes that can increase the toxicity of chemotherapy are decreased stem-cell reserves, decreased ability to repair cell damage, progressive loss of body protein, and accumulation of body fat. A decline in organ function can alter the pharmacokinetics of many of the commonly used chemotherapeutic agents in some elderly patients, making toxicity less predictable. Comorbidities increase the risk of toxicity through their effects on the body. Furthermore, the drugs used to treat comorbidities may interact with chemotherapeutic drugs, potentially increasing toxicity in elderly patients. Prospective trials in older patients with lymphoma or solid tumors have found that age is a risk factor for chemotherapy-induced neutropenia and its complications. Anemia may be present because of the disease or its treatment, and, if left uncorrected, it can alter drug activity and increase toxicity. Being able to predict which elderly patients are at greater risk of toxicity on the basis of pretreatment factors would be valuable, and there is a need for prospective trials to determine regimen- and patient-specific prognostic factors. Effective management of the toxicity associated with chemotherapy with appropriate supportive care is crucial, especially in the elderly population, to give them the best chance of cure and survival, or to provide palliation. For example, management of neutropenic complications with colony-stimulating factors makes treatment with standard-dose chemotherapy possible, which can lead to better outcomes. A better understanding of drug activity and toxicity in older patients is necessary for developing guidelines for safe and effective treatment. Few

  9. Surgical Stress Reduction in Elderly Patients Undergoing Elective Colorectal Laparoscopic Surgery within an ERAS Protocol.

    PubMed

    Mari, Giulio; Costanzi, Andrea; Crippa, Jacopo; Falbo, Rosanna; Miranda, Angelo; Rossi, Michele; Berardi, Valter; Maggioni, Dario

    2016-01-01

    ERAS program applied to colorectal laparoscopic surgery is well known to reduce hospitalization improving short terms outcomes and minimizing the Surgical Stress Response. However its effectiveness in elderly population is yet to be demonstrated. The primary aim of this study is to compare the level of immune and nutritional serum indexes across surgery in patients aged over 70 years old undergoing elective colorectal laparoscopic surgery within an ERAS protocol or according to a Standard program. 83 patients undergoing colorectal laparoscopic surgery were enrolled and randomized in two groups (ERAS Group 40, Standard Group 43) within a larger randomized trial on a general population. Surgical stress parameters were collected preoperatively, 1, 3 and 5 days after surgery. Nutritional parameters were collected preoperatively, 1 and 5 days after surgery. Short Term Outcomes were also prospectively assessed. IL-6 levels were lower in the EG on 1, 3, and 5 days post-operatively (p 0.05). IL-6 levels in the Enhanced group returned to pre operative level 3 days after surgery. C-reactive protein level was lower in the Enhanced group on day 1, 3, and 5 (p 0.05). There was no difference in Cortisol and Prolactin levels between groups. Prealbumin serum level was higher on day 5 (p 0.05) compared to standard group. Postoperative outcomes in terms of normal bowel function and length of hospital stay were significantly improved in the ERAS group. Colorectal laparoscopic surgery within an ERAS prototcol in elderly patients affects Surgical Stress Response, decreasing IL-6 and CRP levels postoperatively and improving Prealbumin post operative synthesis.

  10. Dysbiosis of upper respiratory tract microbiota in elderly pneumonia patients.

    PubMed

    de Steenhuijsen Piters, Wouter A A; Huijskens, Elisabeth G W; Wyllie, Anne L; Biesbroek, Giske; van den Bergh, Menno R; Veenhoven, Reinier H; Wang, Xinhui; Trzciński, Krzysztof; Bonten, Marc J; Rossen, John W A; Sanders, Elisabeth A M; Bogaert, Debby

    2016-01-01

    Bacterial pneumonia is a major cause of morbidity and mortality in elderly. We hypothesize that dysbiosis between regular residents of the upper respiratory tract (URT) microbiome, that is balance between commensals and potential pathogens, is involved in pathogen overgrowth and consequently disease. We compared oropharyngeal microbiota of elderly pneumonia patients (n=100) with healthy elderly (n=91) by 16S-rRNA-based sequencing and verified our findings in young adult pneumonia patients (n=27) and young healthy adults (n=187). Microbiota profiles differed significantly between elderly pneumonia patients and healthy elderly (PERMANOVA, P<0.0005). Highly similar differences were observed between microbiota profiles of young adult pneumonia patients and their healthy controls. Clustering resulted in 11 (sub)clusters including 95% (386/405) of samples. We observed three microbiota profiles strongly associated with pneumonia (P<0.05) and either dominated by lactobacilli (n=11), Rothia (n=51) or Streptococcus (pseudo)pneumoniae (n=42). In contrast, three other microbiota clusters (in total n=183) were correlated with health (P<0.05) and were all characterized by more diverse profiles containing higher abundances of especially Prevotella melaninogenica, Veillonella and Leptotrichia. For the remaining clusters (n=99), the association with health or disease was less clear. A decision tree model based on the relative abundance of five bacterial community members in URT microbiota showed high specificity of 95% and sensitivity of 84% (89% and 73%, respectively, after cross-validation) for differentiating pneumonia patients from healthy individuals. These results suggest that pneumonia in elderly and young adults is associated with dysbiosis of the URT microbiome with bacterial overgrowth of single species and absence of distinct anaerobic bacteria. Whether the observed microbiome changes are a cause or a consequence of the development of pneumonia or merely coincide with

  11. Dysbiosis of upper respiratory tract microbiota in elderly pneumonia patients

    PubMed Central

    de Steenhuijsen Piters, Wouter A A; Huijskens, Elisabeth G W; Wyllie, Anne L; Biesbroek, Giske; van den Bergh, Menno R; Veenhoven, Reinier H; Wang, Xinhui; Trzciński, Krzysztof; Bonten, Marc J; Rossen, John W A; Sanders, Elisabeth A M; Bogaert, Debby

    2016-01-01

    Bacterial pneumonia is a major cause of morbidity and mortality in elderly. We hypothesize that dysbiosis between regular residents of the upper respiratory tract (URT) microbiome, that is balance between commensals and potential pathogens, is involved in pathogen overgrowth and consequently disease. We compared oropharyngeal microbiota of elderly pneumonia patients (n=100) with healthy elderly (n=91) by 16S-rRNA-based sequencing and verified our findings in young adult pneumonia patients (n=27) and young healthy adults (n=187). Microbiota profiles differed significantly between elderly pneumonia patients and healthy elderly (PERMANOVA, P<0.0005). Highly similar differences were observed between microbiota profiles of young adult pneumonia patients and their healthy controls. Clustering resulted in 11 (sub)clusters including 95% (386/405) of samples. We observed three microbiota profiles strongly associated with pneumonia (P<0.05) and either dominated by lactobacilli (n=11), Rothia (n=51) or Streptococcus (pseudo)pneumoniae (n=42). In contrast, three other microbiota clusters (in total n=183) were correlated with health (P<0.05) and were all characterized by more diverse profiles containing higher abundances of especially Prevotella melaninogenica, Veillonella and Leptotrichia. For the remaining clusters (n=99), the association with health or disease was less clear. A decision tree model based on the relative abundance of five bacterial community members in URT microbiota showed high specificity of 95% and sensitivity of 84% (89% and 73%, respectively, after cross-validation) for differentiating pneumonia patients from healthy individuals. These results suggest that pneumonia in elderly and young adults is associated with dysbiosis of the URT microbiome with bacterial overgrowth of single species and absence of distinct anaerobic bacteria. Whether the observed microbiome changes are a cause or a consequence of the development of pneumonia or merely coincide with

  12. Factors associated with polypharmacy in elderly home-care patients.

    PubMed

    Komiya, Hitoshi; Umegaki, Hiroyuki; Asai, Atsushi; Kanda, Shigeru; Maeda, Keiko; Shimojima, Takuya; Nomura, Hideki; Kuzuya, Masafumi

    2017-08-08

    Polypharmacy, which is often observed in elderly patients, has been associated with several unfavorable outcomes, including an increased risk of potentially inappropriate medications, medication non-adherence, drug duplication, drug-drug interactions, higher healthcare costs and adverse drug reactions. A significant association between polypharmacy and adverse outcomes among older people living in the community has also been confirmed. A reduction in the number of medications should thus be pursued for many older individuals. Nevertheless, the factors associated with polypharmacy in elderly home-care patients have not been reported. Here, we investigated those factors in elderly home-care patients in Japan. We used the data of the participants in the Observational Study of Nagoya Elderly with Home Medical investigation. Polypharmacy was defined as the current use of six or more different medications. We carried out univariate and multivariate logistic regression analyses to assess the associations between polypharmacy and each of several factors. A total of 153 home-care patients were registered. The mean number of medications used per patient was 5.9, and 51.5% of the patients belonged to the polypharmacy group. The multivariate model showed that the patients' scores on the Charlson Comorbidity Index and the Mini-Nutrition Assessment Short Form were inversely associated with polypharmacy, and potentially inappropriate medication was most strongly associated with polypharmacy (odds ratio 4.992). The present findings showed that polypharmacy was quite common among the elderly home-care patients, and they suggest that home-care physicians should prescribe fewer medications in accord with the deterioration of home-care patients' general condition. Geriatr Gerontol Int 2017; ••: ••-••. © 2017 Japan Geriatrics Society.

  13. Adjuvant Chemotherapy for Elderly Patients with Gastric Cancer after D2 Gastrectomy

    PubMed Central

    Zhang, Dong-sheng; Ren, Chao; Bai, Long; Luo, Hui-yan; Wang, Zhi-qiang; Wang, Feng-hua; Li, Yu-hong; Xu, Rui-hua

    2013-01-01

    Background A phase III clinical trial has already shown the survival benefits of postoperative chemotherapy in gastric cancer. However, there are limited published data concerning the elderly. This study aims to investigate the use of adjuvant chemotherapy for gastric cancer after D2 gastrectomy among the elderly and identify its impact on survival. Methods We retrospectively reviewed 360 patients who had undergone D2 gastrectomy, aged 65 years or older, with non-metastatic gastric cancer in a single institution. We analyzed the predictors and survival benefits of adjuvant chemotherapy use in the elderly. Further, we analyzed the survival benefits of adjuvant chemotherapy by dividing the patients into groups according to disease stages and chemotherapeutic regimens. Results Among the 360 patients, only 34.7% of patients received adjuvant chemotherapy. Age, tumor location, lymph node involvement and tumor invasion were associated with the receipt of adjuvant chemotherapy. Adjuvant chemotherapy improved the overall survival for non-metastatic elderly patients (HR 0.60, 95%CI 0.42–0.83, P = 0.003). Significant survival benefits were found with adjuvant chemotherapy in stage III patients (HR 0.67, 95%CI 0.47–0.97, P = 0.033), but not in stage I patients or in stage II patients (HR 0.52, 95%CI 0.21–1.30 P = 0.161). Compared to adjuvant chemotherapy without platinum, no significant survival benefits were observed with platinum-containing chemotherapy (HR 0.84, 95%CI 0.49–1.45, P = 0.530). Besides adjuvant chemotherapy, other independent prognostic factors of survival included tumor location, tumor size, histologic grade, depth of tumor invasion, and lymph node status. Conclusions This study demonstrated the survival benefits of adjuvant fluoropyrimidine-based chemotherapy among the elderly patients with non-metastatic gastric cancer after D2 gastrectomy. However, due to the limitations of this study, further well-designed prospective studies with

  14. Proficiency of eye drop instillation in postoperative cataract patients in Ghana.

    PubMed

    Liu, Yang; Murdoch, Amanda; Bassett, Ken; Dharamsi, Shafik

    2013-01-01

    The purpose of the study was to evaluate the efficacy of postoperative instruction on proficiency of eye drop instillation following cataract surgery, and to determine whether such proficiency correlates with the prevalence and/or duration of irritation and pain experienced in operated eyes. This was a prospective, nonrandomized control trial with an educational intervention conducted via a single eye clinic in Accra, Ghana. The 218 subjects who completed the study were postoperative cataract surgery patients whose surgery had been funded by the nongovernmental organization Unite for Sight. Patients were evaluated on their ability to administer eye drops correctly on their first attempt on postoperative day one. If unsuccessful, patients were given an educational session that consisted of verbal instructions and an educational video. Both groups (successful and unsuccessful) on the first postoperative day were tested again for proficiency on postoperative day 30. The baseline group was evaluated only on postoperative day 30 and consisted of 36 patients. Of the 133 patients who received the educational session on eye drop instillation, 112 (84%) exhibited proficiency on postoperative day 30 as compared with 29 of 49 patients (59%) who did not receive the intervention. Additionally, there were fewer reports of pain and irritation following cataract extraction in the patients who received the educational session. This study supports the efficacy of patient education in improving proficiency in eye drop instillation and in reducing pain and irritation following cataract extraction surgeries.

  15. Sepsis and Immunosenescence in the Elderly Patient: A Review

    PubMed Central

    Martín, Silvia; Pérez, Alba; Aldecoa, Cesar

    2017-01-01

    Sepsis is a prevalent, serious medical condition with substantial mortality and a significant consumption of health-care resources. Its incidence has increased around 9% annually in general population over the last years and specially in aged patients group. Several risk factors such as comorbidities, preadmission status, malnutrition, frailty, and an impared function in the immune system called immunosenescence are involved in the higher predisposition to sepsis in the elderly patients. Immunosenescence status consists in a functional impairment in both cell-mediated immunity and humoral immune responses and increases not only the risk for develop sepsis but also lead to more severe presentation of infection and may be is also related with a higher mortality. There is a also a concern about to admit patients in the intensive care units taking into account that the outcome of elderly patients is poorer compared to younger people. Nevertheless, the management of septic elderly patients does not differ substantially from younger people. In addition, the quality of life in septic elderly survivors is also lower than in younger people. But age, as alone factor, should not be used to determine treatment options because the poorer outcomes is thought to be due to the increased comorbidities and frailty in this group of patients. PMID:28293557

  16. Outcomes of Major Lung Resection After Induction Therapy for Non-Small Cell Lung Cancer in Elderly Patients

    PubMed Central

    Yang, Chi-Fu Jeffrey; Mayne, Nicholas R.; Wang, Hanghang; Meyerhoff, Ryan R.; Hirji, Sameer; Tong, Betty C.; Hartwig, Matthew; Harpole, David; D’Amico, Thomas A.; Berry, Mark

    2016-01-01

    Background This study analyzes the impact of age on perioperative outcomes and long-term survival of patients undergoing surgery after induction chemotherapy for non-small cell lung cancer. Methods Short- and long-term outcomes of patients with non-small cell lung cancer who were at least 70 years and received induction chemotherapy followed by major lung resection (lobectomy or pneumonectomy) from 1996 to 2012 were assessed using multivariable logistic regression, Kaplan-Meier, and Cox proportional hazard analysis. The outcomes of these elderly patients were compared with those of patients younger than 70 years who underwent the same treatment from 1996 to 2012. Results Of the 317 patients who met the study criteria, 53 patients were at least 70 years. The median age was 74 years (range, 70 to 82 years) in the elderly group, and induction chemoradiation was used in 24 (45%) patients. Thirty-day mortality was similar between the younger (n = 12) and elderly (n = 3) patients (5% versus 6%; p = 0.52). There were no significant differences in the incidence of postoperative complications between younger and elderly patients (49% versus 57%; p = 0.30). Patients younger than 70 years had a median overall survival (30 months; 95% confidence interval [CI], 24 to 43) and a 5-year survival (39%; 95% CI, 33 to 45) that was not significantly different from patients at least 70 years (median overall survival, 30 months; 95% CI, 18 to 68; and 5-year overall survival, 36%; 95% CI, 21 to 51). However, there was a trend toward worse survival in the elderly group after multivariable adjustment (hazard ratio, 1.43; 95% CI, 0.97 to 2.12; p = 0.071). Conclusions Major lung resection after induction chemotherapy can be performed with acceptable short-and long-term results in appropriately selected patients at least 70 years, with outcomes that are comparable to those of younger patients. PMID:27234579

  17. Treatment of hypothyroidism in elderly patients and in patients with cardiac disease.

    PubMed

    Feldt-Rasmussen, Ulla

    2007-07-01

    Hypothyroidism is often associated with adverse cardiovascular risk factors such as high cholesterol together with hypertension, endothelial dysfunction, and other atherosclerotic cardiovascular risk factors. The changed hemodynamic characteristics result in reduced cardiac index, and the renal perfusion is impaired with hyponatremia, and low renin and aldosterone production. The ischemic abnormalities are probably related to long-term consequences of a slow development of hypothyroidism, while the hemodynamic changes can develop in very short-term hypothyroidism. Replacement of hypothyroidism with levothyroxine is associated with a normalization of basal metabolic rate. Most patients with preexisting angina experience a gradual amelioration of symptoms, but in some cases the initial therapy may precipitate an unrecognized ischemic state, worsen a preexisting angina, or even result in myocardial infarction. It is therefore advisable to start replacement slowly and if needed perform a stress test and/or coronary angiography before. It may also in some cases be necessary to monitor the patients closely in a hospital setting during initiation of levothyroxine. Elderly hypothyroid patients with unstable angina pose a particular challenging problem, especially if coronary vascular surgery is indicated. No increased risk of peri- or postoperative death has been noted in small studies, although more complications have been described. It may be relevant to treat the cardiac vascular occlusion before starting replacement with levothyroxine in some cases, after careful weighting of pros and cons in each individual case.

  18. Prognosis of papillary thyroid carcinoma in elderly patients after thyroid resection

    PubMed Central

    Chereau, Nathalie; Trésallet, Christophe; Noullet, Severine; Godiris-Petit, Gaelle; Tissier, Frederique; Leenhardt, Laurence; Menegaux, Fabrice

    2016-01-01

    Abstract The size of the elderly population and the incidence of papillary thyroid carcinoma (PTC) in this group appear to be rapidly increasing, although published information based on more detailed older age groupings are lacking. This study aimed to determine the clinical features and outcomes of elderly patients in PTC. All consecutive patients who received surgery for PTC in our Department from 1978 to 2014 were included. We compared 3 patient groups: young (<65 years), older (65–75 years), and very old patients (>75 years). Total thyroidectomy was performed with lymph node (LN) dissection in most cases, and radioiodine therapy was administered as needed. A total of 3835 patients (3257 young patients, 450 older patients, and 128 very old patients) were identified. Very old patients were more likely to have advanced (III/IV) tumor, nodes, metastases (TNM) stage, greater tumor size, number of tumors, and extracapsular invasion compared with young and older patients. For the 2289 patients with LN dissection (60%), metastatic LNs were more frequent in the very old group (44%) than in the other groups (34% young and 33% older patients) (P = 0.01). Very old patients had more frequent distant metastases (5%) than the older (2%) and young groups (1%) (P < 0.001). The overall postoperative morbidity was not significantly different between the 3 age groups. Recurrence was documented in 202 (6.2%) young, 29 (6.4%) older, and 15 (11.7%) very old PTC patients (P = 0.04). The 5-year disease-free survival was 81.3% for very old, 92.9% for older, and 94.7% for young group (P < 0.001). Very old patients should be considered high-risk PTC patients and their therapeutic strategy may benefit from aggressive treatment. PMID:27893690

  19. Treatment of intertrochanteric fractures in elderly highrisk patients: dynamic hip screw vs. external fixation.

    PubMed

    Kazemian, G H; Manafi, A R; Najafi, F; Najafi, M A

    2014-03-01

    Although the use of a dynamic hip screw (DHS) is considered to be the preferred treatment for intertrochanteric fractures, the external fixation device could produce clinical outcomes comparable to the outcomes obtained with conventional treatment. Furthermore, because external fixation is minimally invasive, we expected a lower rate of morbidity. Therefore, we compared the two treatments in a clinical trial of elderly patients with intertrochanteric fracture. 60 elderly high-risk patients with an average age of 78 years were treated for intertrochanteric fracture, resulting from a low energy trauma. Patients were randomly divided in two groups regarding to treatment. In Group A the patients were treated with DHS, while in Group B were treated with external fixator. The fixator was well accepted and no patient had significant difficulties while sitting or lying. The average intraoperative time was 73 min in Group A and 15 min in Group B (p<0.05). 27 patients of Group A need blood transfusion postoperatively and none in Group B (p<0.05). The mean duration of hospitalization in Group A and Group B was 8.4 and 2.2 days, respectively (p<0.05). 9 of patients Group B had pin-track infection grade 2 that all were treated by oral antibiotics. There were no differences in comorbidities, quality of reduction, screw cut out, bed sore and HHS between the two groups. Treatment with external fixator is an effective treatment for intertrochanteric fractures in elderly highrisk patients. The advantages include quick and simple application, minimal blood loss, less radiation exposure, adequate fixation, pain reduction, early discharge from hospital, low costs and favourable functional outcomes. Copyright © 2013 Elsevier Ltd. All rights reserved.

  20. Elderly Patients with Schizophrenia and Depression: Diagnosis and Treatment

    PubMed Central

    Felmet, Kandi; Zisook, Sidney; Kasckow, John W.

    2011-01-01

    Background The treatment of older patients with schizophrenia and depressive symptoms poses many challenges for clinicians. Current classifications of depressive symptoms in patients with schizophrenia include: Major Depressive Episodes that occur in patients with schizophrenia and are not classified as schizoaffective disorder, Schizoaffective Disorder, and Schizophrenia with subsyndromal depression in which depressive symptoms do not meet criteria for Major Depression. Research indicates that the presence of any of these depressive symptoms negatively impacts the lives of patients suffering from schizophrenia-spectrum disorders. Purpose The purpose of this paper is to review the literature related to older patients with schizophrenia-spectrum disorders and co-occurring depressive symptoms, and to guide mental health professionals to better understand the diagnosis and treatment of depressive symptoms in patients with schizophrenia. Conclusions The treatment of elderly patients with schizophrenia and depressive symptoms includes first reassessing the diagnosis to make sure symptoms are not due to a comorbid condition, metabolic problems or medications. If these are ruled out, pharmacological agents in combination with psychosocial interventions are important treatments for older patients with schizophrenia and depressive symptoms. A careful assessment of each patient is needed in order to determine which antipsychotic would be optimal for their care; second-generation antipsychotics are the most commonly used antipsychotics. Augmentation with an antidepressant medication can be helpful for the elderly patient with schizophrenia and depressive symptoms. More research with pharmacologic and psychosocial interventions is needed, however, to better understand how to treat this population of elderly patients. PMID:21177241

  1. [Peculiarities of treatment of the aged and elderly patients with acute pancreatitis].

    PubMed

    Shevchuk, I M; Kuzenko, R T

    2013-11-01

    The results of treatment of 99 elderly and senile patients, suffering an acute pancreatitis in period of 2005 - 2013 yrs, were analyzed. Interstitial acute pancreatitis was diagnoses in 36 (36.3%) patients, focal pancreatic necrosis--in 32 (32.3%), total-subtotal pancreonecrosis--in 31 (31.3%). Miniinvasive interventions were performed in 40 (63.4%) patients, the open--in 24 (38%). The main indication for laparotomy conduction were purulent-septic complications, which is impossible to eliminate while miniinvasive methods application. Due to application of the staged treatment tactics with predominant application of miniinvasive methods, extracorporeal detoxication and improvement of the intensive therapy measures postoperative lethality in necrotic acute pancreatitis have had lowered from 16.7 to 10.3%.

  2. Tolerability of Combined Modality Therapy for Rectal Cancer in Elderly Patients Aged 75 Years and Older

    SciTech Connect

    Margalit, Danielle N.; Mamon, Harvey J.; Ryan, David P.; Blaszkowsky, Lawrence S.; Clark, Jeffrey; Willett, Christopher G.; Hong, Theodore S.

    2011-12-01

    Purpose: To determine the rate of treatment deviations during combined modality therapy for rectal cancer in elderly patients aged 75 years and older. Methods and Materials: We reviewed the records of consecutively treated patients with rectal cancer aged 75 years and older treated with combined modality therapy at Massachusetts General Hospital and Brigham and Women's Hospital from 2002 to 2007. The primary endpoint was the rate of treatment deviation, defined as a treatment break, dose reduction, early discontinuation of therapy, or hospitalization during combined modality therapy. Patient comorbidity was rated using the validated Adult Comorbidity Evaluation 27 Test (ACE-27) comorbidity index. Fisher's exact test and the Mantel-Haenszel trend test were used to identify predictors of treatment tolerability. Results: Thirty-six eligible patients had a median age of 79.0 years (range, 75-87 years); 53% (19/36) had no or mild comorbidity and 47% (17/36) had moderate or severe comorbidity. In all, 58% of patients (21/36) were treated with preoperative chemoradiotherapy (CRT) and 33% (12/36) with postoperative CRT. Although 92% patients (33/36) completed the planned radiotherapy (RT) dose, 25% (9/36) required an RT-treatment break, 11% (4/36) were hospitalized, and 33% (12/36) had a dose reduction, break, or discontinuation of concurrent chemotherapy. In all, 39% of patients (14/36) completed {>=}4 months of adjuvant chemotherapy, and 17% (6/36) completed therapy without a treatment deviation. More patients with no to mild comorbidity completed treatment than did patients with moderate to severe comorbidity (21% vs. 12%, p = 0.66). The rate of deviation did not differ between patients who had preoperative or postoperative CRT (19% vs. 17%, p = 1.0). Conclusions: The majority of elderly patients with rectal cancer in this series required early termination of treatment, treatment interruptions, or dose reductions. These data suggest that further intensification of

  3. Ten-year study of postoperative complications following dental extractions in patients with inherited bleeding disorders.

    PubMed

    Hsieh, J-T; Klein, K; Batstone, M

    2017-09-01

    Dental extractions challenge the body's haemostatic mechanism. Postoperative bleeding from dental extraction can be prolonged, or even life threatening in patients with inherited bleeding disorders. Pre- and postoperative clotting factor replacements or systemic desmopressin (ddAVP) have been advocated at our institution to prevent bleeding complications in these patients. This study aimed to assess the postoperative bleeding rate in patients with inherited bleeding disorders that underwent dental extractions at our institution between 2003 and 2012. Patients with inherited bleeding disorders such as haemophilia A, haemophilia B, and von Willebrand's disease were included. Retrospective chart review was conducted. The result showed 53 extraction events occurred in 45 patients over the 10-year period. Ten out of 53 extraction events (18.9%) had postoperative bleeding requiring further factor replacement or ddAVP. Postoperative bleeding in one patient with mild haemophilia A was complicated by the development of inhibitors. Type and severity of bleeding disorder, bone removal, and use of a local haemostatic agent did not have any significant effect on postoperative bleeding. Despite the use of perioperative factors and desmopressin, the postoperative bleeding rates remain high for patients with inherited bleeding disorders. More studies are required to assess the safety and effectiveness of using local haemostatic control to achieve haemostasis following extractions. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  4. Streptococcus pneumoniae vaccinal coverage in hospitalized elderly patients in France.

    PubMed

    Rouveix, E; Gherissi Cherni, D; Dupont, C; Beauchet, A; Sordet Guepet, H; Gavazzi, G; Gaillat, J

    2013-01-01

    In France, there is little data on vaccinal coverage in elderly people at risk for invasive pneumococcal infections (IPI). The study objective was to assess the pneumococcal vaccination coverage and traceability in hospitalized elderly people (>75 years of age). A multicentric point prevalence survey was made on volunteers over 75 years of age, hospitalized in internal medicine, geriatrics, and infectious diseases units. Nine hundred and three patients in 63 units of 28 hospitals were included (mean 85 years of age) in the study between April and May 2011. Ten percent (93/903) were vaccinated against the pneumococcus. Thirty-eight percent of the patients had at least one risk factor for IPI and 20.5% of these had been vaccinated. There was a traceability back-up in 59% of the cases. Vaccination was not considered by the hospital for 83% of patients with IPI risk factor but not vaccinated (task delegated to the family physician in 50% of the cases). Vaccination coverage against the pneumococcus in France is very low in hospitalized patients over 75 years of age even though more than one out of three presents at least one risk factor for IPI. The rate of traceability is also poor. Hospitalization should be an opportunity to offer pneumococcal vaccination to elderly patients at risk for IPI in France because of unclear recommendations for elderly individuals and lack of political will to improve vaccination coverage. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  5. Should general anaesthesia be avoided in the elderly?

    PubMed Central

    Strøm, C.; Rasmussen, L. S.; Sieber, F. E.

    2016-01-01

    Summary Surgery and anaesthesia exert comparatively greater adverse effects on the elderly than on the younger brain, manifest by the higher prevalence of postoperative delirium and cognitive dysfunction. Postoperative delirium and cognitive dysfunction delay rehabilitation, and are associated with increases in morbidity and mortality among elderly surgical patients. We review the aetiology of postoperative delirium and cognitive dysfunction in the elderly with a particular focus on anaesthesia and sedation, discuss methods of diagnosing and monitoring postoperative cognitive decline, and describe the treatment strategies by which such decline may be prevented. PMID:24303859

  6. Post-recurrence survival of elderly patients 75 years of age or older with surgically resected non-small cell lung cancer.

    PubMed

    Takenaka, Tomoyoshi; Inamasu, Eiko; Yoshida, Tsukihisa; Toyokawa, Gouji; Nosaki, Kaname; Hirai, Fumihiko; Yamaguchi, Masafumi; Seto, Takashi; Takenoyama, Mitsuhiro; Ichinose, Yukito

    2016-04-01

    The purpose of this study was to evaluate the outcomes of elderly patients 75 years of age or older with recurrent non-small cell lung cancer (NSCLC). A total of 1237 consecutive patients with NSCLC underwent pulmonary resection at our institution. Of these patients, 280 experienced postoperative recurrence. The rate of the post-recurrence survival and predictors were analyzed independently in a group of younger patients (<75 years) and a group of elderly patients (≥75 years). There were 215 younger patients (<75 years) and 65 elderly (≥75 years) patients at the time of diagnosis of recurrence. The median post-recurrence survival time and the five-year survival rate of all cases were 25 months and 20.8%, respectively. There were no significant survival differences between the younger and elderly groups (p = 0.20). A univariate analysis determined that gender, Eastern Cooperative Oncology Group performance status, smoking status, histological type and epithelial growth factor receptor (EGFR) mutation status were factors influencing the post-recurrence survival among the elderly patients. In addition, a multivariate analysis determined the EGFR mutation status to be an independent prognostic factor for the post-recurrence survival. Elderly patients 75 years of age or older in this study achieved satisfactory long-term outcomes.

  7. [Effects of autogenic training in elderly patients].

    PubMed

    Kircher, T; Teutsch, E; Wormstall, H; Buchkremer, G; Thimm, E

    2002-04-01

    Autogenic training (AT) is a widely available relaxation method with beneficial outcome on physiological and psychological functioning. In our study, we wanted to test the effects of an AT course in cognitively impaired, frail elderly. After a 3 month waiting period (control), AT courses (intervention) of 3 months duration were offered in 2 nursing homes. Thirty-two frail elderly took part in the study, 24 of them had a psychiatric diagnosis (mean age 82.1 +/- 7.2 years, CAMCOG 75.5 +/- 15.7, MMSE 23.3 +/- 4.3, HAMD 10.0 +/- 3.6, NOSGER 57.2 +/- 18.4, AT-SYM 32.9 +/- 17.6 points). Eight participants dropped out during the waiting period, 8 during the course. From the 16 participants, 15 (94%) were able to learn the AT according to subjective, 9 (54%) according to objective criteria. The ability to practice the AT successfully correlated with the CAMCOG (p = 0.001) and the NOSGER (p = 0.01) score. Participants with a dementia syndrome had major difficulties, whereas age, depressiveness, and number of complaints (AT-SYM) had no influence on the ability to learn the AT. There was no intervention effect, measured with the HAMD, NOSGER, AT-SYM and MMSE. In the pre-post comparison of training sessions, a significant improvement in general well being was found (p < 0.001). Mentally impaired, frail elderly participants are able to learn the AT. Cognitive impairment is disadvantageous for a successful participation.

  8. Ethical Consideration in Wound Treatment of the Elderly Patient

    PubMed Central

    Shah, Prachi; Aung, Thet Han; Ferguson, Richard; Ortega, Gerardo; Shah, Jayesh

    2016-01-01

    Today, an advance in clinical medicine and public health has given patients the opportunity to live longer and more productive lives despite progressive illnesses. For some patients, however, this progress has resulted in prolonged dying which is associated with huge emotional and financial expenses. A review article is written based on proceedings of panel discussion on Ethical Consideration in wound treatment of the elderly patient on July 25, 2015, Baptist Wound Symposium at Marriot Northwest, San Antonio, Texas. PMID:27104145

  9. Salmonella-related urinary tract infection in an elderly patient.

    PubMed

    Klosterman, Scott Anthony

    2014-09-05

    An elderly female patient with an uncomplicated urinary tract infection from Salmonella newport is presented. Radiological and laboratory studies were performed because of her systemic and exposure risk factors as well as prior urinary tract abnormalities. While this patient was successfully treated as an outpatient with oral antibiotics, complications and recurrence are common and deserve close follow-up with repeat urine cultures at a minimum. Further laboratory and radiological testing should be guided by patient gender, risk factors and recurrence.

  10. Ethical Consideration in Wound Treatment of the Elderly Patient.

    PubMed

    Shah, Prachi; Aung, Thet Han; Ferguson, Richard; Ortega, Gerardo; Shah, Jayesh

    2014-12-01

    Today, an advance in clinical medicine and public health has given patients the opportunity to live longer and more productive lives despite progressive illnesses. For some patients, however, this progress has resulted in prolonged dying which is associated with huge emotional and financial expenses. A review article is written based on proceedings of panel discussion on Ethical Consideration in wound treatment of the elderly patient on July 25, 2015, Baptist Wound Symposium at Marriot Northwest, San Antonio, Texas.

  11. Depression as an independent predictor of postoperative delirium in spine deformity patients undergoing elective spine surgery.

    PubMed

    Elsamadicy, Aladine A; Adogwa, Owoicho; Lydon, Emily; Sergesketter, Amanda; Kaakati, Rayan; Mehta, Ankit I; Vasquez, Raul A; Cheng, Joseph; Bagley, Carlos A; Karikari, Isaac O

    2017-08-01

    OBJECTIVE Depression is the most prevalent affective disorder in the US, and patients with spinal deformity are at increased risk. Postoperative delirium has been associated with inferior surgical outcomes, including morbidity and mortality. The relationship between depression and postoperative delirium in patients undergoing spine surgery is relatively unknown. The aim of this study was to determine if depression is an independent risk factor for the development of postoperative delirium in patients undergoing decompression and fusion for deformity. METHODS The medical records of 923 adult patients (age ≥ 18 years) undergoing elective spine surgery at a single major academic institution from 2005 through 2015 were reviewed. Of these patients, 255 (27.6%) patients had been diagnosed with depression by a board-certified psychiatrist and constituted the Depression group; the remaining 668 patients constituted the No-Depression group. Patient demographics, comorbidities, and intra- and postoperative complication rates were collected for each patient and compared between groups. The primary outcome investigated in this study was rate of postoperative delirium, according to DSM-V criteria, during initial hospital stay after surgery. The association between depression and postoperative delirium rate was assessed via multivariate logistic regression analysis. RESULTS Patient demographics and comorbidities other than depression were similar in the 2 groups. In the Depression group, 85.1% of the patients were taking an antidepressant prior to surgery. There were no significant between-group differences in intraoperative variables and rates of complications other than delirium. Postoperative complication rates were also similar between the cohorts, including rates of urinary tract infection, fever, deep and superficial surgical site infection, pulmonary embolism, deep vein thrombosis, urinary retention, and proportion of patients transferred to the intensive care unit. In

  12. Fluvoxamine pharmacokinetics in healthy elderly subjects and elderly patients with chronic heart failure

    PubMed Central

    Orlando, Rocco; De Martin, Sara; Andrighetto, Laura; Floreani, Maura; Palatini, Pietro

    2010-01-01

    AIMS To investigate the effects of age and chronic heart failure (CHF) on the oral disposition kinetics of fluvoxamine. METHODS A single fluvoxamine dose (50 mg) was administered orally to 10 healthy young adults, 10 healthy elderly subjects and 10 elderly patients with CHF. Fluvoxamine concentration in plasma was measured for up to 96 h. RESULTS With the exception of apparent distribution volume, ageing modified all main pharmacokinetic parameters of fluvoxamine. Thus, peak concentration was about doubled {31 ± 19 vs. 15 ± 9 ng ml−1; difference [95% confidence interval (CI)] 16 (3, 29), P < 0.05}, and area under the concentration–time curve was almost three times higher [885 ± 560 vs. 304 ± 84 ng h ml−1; difference (95% CI) 581 (205, 957), P < 0.05]; half-life was prolonged by 63% [21.1 ± 6.2 vs. 12.9 ± 6.4 h; difference (95% CI) 8.2 (2.3, 14.1), P < 0.01], and oral clearance was halved (1.12 ± 0.77 vs. 2.25 ± 0.66 l h−1 kg−1; difference (95% CI) −1.13 (−1.80, −0.46), P < 0.001]. A significant inverse correlation was consistently observed between age and oral clearance (r=−0.67; P < 0.001). The coexistence of CHF had no significant effect on any pharmacokinetic parameters in elderly subjects. CONCLUSIONS Ageing results in considerable impairment of fluvoxamine disposition, whereas CHF causes no significant modifications. Therefore, adjustment of initial dose and subsequent dose titrations may be required in elderly subjects, whereas no further dose reduction is necessary in elderly patients with CHF. PMID:20233199

  13. Patient controlled intravenous analgesia (PCIA) in postoperative surgical patients: an audit.

    PubMed

    Zafar, S U; Hamid, M; Hoda, M Q U

    2004-07-01

    We conducted an audit for the evaluation of the effectiveness, adverse effects and degree of patient satisfaction with Patient Controlled Intravenous Analgesia (PCIA) for postoperative pain control in surgical patients. This was an observational study. Patient, scheduled for different surgical procedures, were informed about PCIA a day before surgery and were offered PCIA for pain control after surgery. All the patients were asked to fill a questionnaire 24 hours after the start of PCIA, that contained the relevant questions reflecting the objectives of the study. Seventy-six patients participated in the study of whom 91% had a visual analogue pain score of <3 at rest and 83% had a score of <3 at movement on visual analogue scale of 0-10. Eighty percent of patients rated the convenience of pain control as being excellent, whereas 92% stated that the dependence on nursing staff for pain management was nil. The incidence of drowsiness and nausea was 28% each, while 21% of the patients complained of restricted mobility. Patient controlled intravenous analgesia is an excellent method of postoperative pain relief, which provides a high degree of satisfaction to the patients.

  14. [Clinical application of the plasma substitutes in patients with postoperative complications after surgeries for brain meningioma].

    PubMed

    Kvasha, M S; Iarotskiĭ, R Iu; Ivashenko, V I; Gavrish, R V; Dmitrieva, N Iu; Ivanovich, I N; Pushkareva, T M

    2011-04-01

    The issues on optimization of the restoration treatment of patients, suffering the brain meningioma, were discussed, basing on analysis of 498 observations. Tactics of the patients management in noncomplicated, complicated and severe course of postoperative period is adduced. The indices of survival and lethality, peculiarities of the infusion therapy were analyzed. The role of plasm-restituting preparations was demonstrated in complicated course of postoperative period. Rational complex approach to the restoration measures and intensive therapy conduction promotes the treatment efficacy raising, the patients fair quality of life securing in the brain meningioma in postoperative period.

  15. Survey of willingness to accept chemotherapy among elderly Malaysian patients.

    PubMed

    Razali, Rizah Mazzuin; Bee, Ping Chong; Gan, Gin Gin

    2013-01-01

    The geriatric population in Malaysia is predicted to increase from 4% of the total population in 1998 to 9.8% by 2020, in parallel with developments in the socioeconomy. Cancer is expected to be a major medical issue among this population. However, the decision for treatment in Malaysia is always decided by the caregivers instead of the elderly patients themselves. The aim of the study was to assess the willingness to accept chemotherapy among elderly Malaysians. In this cross-sectional study, patients aged 60 and above from various clinics/wards were recruited. Those giving consent were interviewed using a questionnaire. A total of 75 patients were recruited, 35 patients (47%) with a history of cancer. The median age was 73 years old. There were 29 Chinese (38.7%), 22 Indian (29.3%), 20 Malay (26.7%) and four other ethnicity patients. Some 83% and 73% of patients willing to accept strong and mild chemotherapy, respectively. Patients with cancer were more willing to accept strong and mild chemotherapy compared to the non-cancer group (88.6% vs 62.5%, P=0.005, 94% vs 80%, P=0.068). On sub-analysis, 71.4% and 42.9% of Chinese patients without a history of cancer were not willing to receive strong and mild chemotherapy, respectively. The majority of elderly patients in UMMC were willing to receive chemotherapy if they had cancer. Experience with previous treatment had positive influence on the willingness to undergo chemotherapy.

  16. Actinobaculum schaalii causing epididymitis in an elderly patient.

    PubMed

    van Aarle, S; Arents, N L A; de Laet, K

    2013-07-01

    Actinobaculum schaalii is a Gram-positive coccoid rod that causes various infections in humans and is easily overlooked in cultures. A. schaalii has long been thought to be of low prevalence and limited invasive potential, causing benign cystitis in elderly patients with underlying urological conditions. Here, we report the first case of epididymitis caused by this bacterium.

  17. A practical program for preventing delirium in hospitalized elderly patients.

    PubMed

    Inouye, Sharon K

    2004-11-01

    Delirium in hospitalized elderly patients is common and often unrecognized (especially the hypoactive type), and can lead to serious complications. A systematic program can improve the rate of recognition of this problem and decrease its incidence, and is cost-effective.

  18. Effects of an Individualized Activity Program on Elderly Patients

    ERIC Educational Resources Information Center

    Salter, Carlota de Lerma; Salter, Charles A.

    1975-01-01

    A combined program of Reality Orientation, Activities of Daily Living, and Recreational Activities, together with environmental stimulation, was applied on an individualized basis to 21 elderly patients suffering from both psychological disorders and long-term physical illness. The motivation to participate in the available activities increased…

  19. [Speech therapy for cognitive disorders in elderly patients].

    PubMed

    Marquis, Florence

    2014-01-01

    The aim of providing speech therapy to elderly patients, in the framework of a personalised approach, is to help them maintain their autonomy and delay their move to a specialised hospital. The family and caregivers play an essential role in ensuring the success of this therapy.

  20. Update of nutrient-deficiency anemia in elderly patients.

    PubMed

    Andrès, Emmanuel; Federici, Laure; Serraj, Khalid; Kaltenbach, Georges

    2008-11-01

    Anemia, defined as a hemoglobin level < 13 g/dL in men and < 12 g/dL in women, is an important healthcare concern among the elderly. Nutrient-deficiency anemia represents one third of all anemias in elderly patients. About two thirds of nutrient-deficiency anemia is associated with iron deficiency and most of those cases are the result of chronic blood loss from gastrointestinal lesions. The remaining cases of nutrient-deficiency anemia are usually associated with vitamin B12, most frequently related to food-cobalamin malabsorption, and/or folate deficiency and are easily treated (nutrient-deficiency replacement).

  1. Patient refusal for regional anesthesia in elderly orthopedic population: A cross-sectional survey at a tertiary care hospital

    PubMed Central

    Salam, Asma Abdus; Afshan, Gauhar

    2016-01-01

    Background and Aims: Improvements in pain management techniques in the last decade have had a major impact on the practice of orthopedic surgeries, for example, total hip arthroplasty and total knee arthroplasty. Although there are a number of treatment options for postoperative pain, a gold standard has not been established. In our institution, both general anesthesia and regional anesthesia (RA), are being offered to the elderly orthopedic population but RA is not frequently accepted by elderly population. The objective of this study was to determine the frequency of various reasons for refusal of RA in elderly patients undergoing orthopedic surgeries. Material and Methods: A prospective study conducted over a period of 1 year, had 549 patients with ages above 60 years who underwent different types of elective orthopedic procedures 182 patients who refused RA were interviewed according to a structured questionnaire designed to assess the reasons of refusal. Results: Most common reason for the refusal of RA was surgeon's choice (38.5%), whereas 20.3% of the patients were unaware about the RA. There was a significant association between female gender and refusing RA due to backache (17.2%) and fear of being awake during the operation (24.1%) respectively. Conclusion: This survey showed that the main reasons among elderly female population were the fear of remaining awake and backache. However, overall it was the surgeon's choice which made patients refuse RA, and the anesthesiologists were the main source of information. PMID:27006550

  2. Pre- and postoperative evaluation of renal function in patients with staghorn calculi utilizing quantitative renal scanning.

    PubMed

    Stage, K H; Lewis, S

    1981-01-01

    Differential quantitative renal scans using 99-technetium diethylene triaminepentaacetic acid (DTPA) or 131I Hippuran were obtained properatively on 12 patients with unilateral or bilateral staghorn calculi. Of the 14 renal units studied, 12 kidneys underwent anatrophic nephrolithotomy, pyelolithotomy, or a combination of both techniques; 2 patients underwent nephrectomy based on poor function of the affected side preoperatively. Postoperative follow-up scans were obtained on the 12 kidneys undergoing stone cleanout. Seven of 12 kidneys (58 per cent) studied pre- and postoperatively showed moderate to significant improvement in per cent contribution to total renal function. Seven of 10 kidneys (70 per cent) studied pre- and postoperatively showed improvement in glomerular filtration rate or effective renal plasma flow. The scans revelaed no dramatic difference in postoperative functional loss between pyelolithotomy and anatrophic nephrolithotomy. The computerizewd quantitative renal scan helps in selection of surgical technique and objective postoperative assessment of surgical results.

  3. Risk factors for deep venous thrombosis of lower limbs in postoperative neurosurgical patients

    PubMed Central

    Li, Qiang; Yu, Zongxue; Chen, Xiao; Wang, Jinjun; Jiang, Guixi

    2016-01-01

    Objectives: To detect the risk factors for deep venous thrombosis (DVT) in patients after neurosurgery. Methods: Three hundred and seventy-six patients treated in the department of neurosurgery of our hospital from February 2013 to November 2015 were reviewed retrospectively. The clinical data including age, gender, hospital stay, operation time, occupation type, hypertension, coronary heart disease, diabetes, smoking status, drinking status, postoperative exercises, malignant tumor, and postoperative hormone or dehydrating agent were collected. Results: In this study, 52 patients were included in the DVT group and 295 patients in the Non-DVT group. There was significant difference in age, hypertension, occupation type, malignant tumors, operation time, smoking status, and postoperative exercises between the two groups (p<0.05). However, there was no significant difference in gender, drinking status, coronary heart disease, diabetes, hospital stay, and postoperative hormone or dehydrating agent (p>0.05). In multivariate analysis, age, malignant tumor, hypertension were independent risk factors, while physical labour and postoperative exercises were protective factor for DVT. Conclusion: The postoperative patients with older age, malignant tumor or hypertension should be paid high attention to prevent DVT, and postoperative exercises should be selected as precautionary measures. PMID:27882003

  4. Multicenter study on adult growth hormone level in postoperative pituitary tumor patients.

    PubMed

    Cheng, Jing-min; Gu, Jian-wen; Kuang, Yong-qin; Ma, Yuan; Xia, Xun; Yang, Tao; Lu, Min; He, Wei-qi; Sun, Zhi-yong; Zhang, Yan-chao

    2015-03-01

    The objective of this study is to observe the adult growth hormone level in postoperative pituitary tumor patients of multi-centers, and explore the change of hypophyseal hormones in postoperative pituitary tumor patients. Sixty patients with pituitary tumor admitted during March, 2011-March, 2012 were selected. Postoperative hypophyseal hormone deficiency and the change of preoperative, intraoperative, and postoperative growth hormone levels were recorded. Growth hormone hypofunction was the most common hormonal hypofunction, which took up to 85.0 %. Adrenocortical hormone hypofunction was next to it and accounted for 58.33 %. GH + ACTH + TSH + Gn deficiency was the most common in postoperative hormone deficiency, which took up to 40.00 %, and GH + ACTH + TSH + Gn + AVP and GH deficiencies were next to it and accounted for 23.33 and 16.67 %, respectively. The hormone levels in patients after total pituitary tumor resection were significantly lower than those after partial pituitary tumor resection, and the difference was statistically significant; growth hormone and serum prolactin levels after surgery in two groups were decreased, and the difference was statistically significant. The incidence rate of growth hormone deficiency in postoperative pituitary tumor patients is high, which is usually complicated with deficiency of various hypophyseal hormones. In clinical, we should pay attention to the levels of the hypopnyseal hormones, and take timely measures to avoid postoperative complications.

  5. Neuropsychological impairments in elderly Neurofibromatosis type 1 patients.

    PubMed

    Costa, Danielle de Souza; de Paula, Jonas Jardim; de Rezende, Nilton Alves; Rodrigues, Luiz Oswaldo Carneiro; Malloy-Diniz, Leandro Fernandes; Romano-Silva, Marco Aurélio; Miranda, Débora Marques de

    2014-04-01

    Cognitive performance is compromised in Neurofibromatosis type 1 (NF1) patients, but neuropsychological data including elderly NF1 are extremely sparse. We compared the cognitive performance of a small elderly NF1 group (n = 5) with an age-matched healthy control group (n = 49). NF1 group performed worse than control group on a global cognitive impairment task, verbal working memory, and visuospatial functioning. The results suggest that cognitive impairment is an important feature of NF1 across lifespan, including elderly individuals. Future studies approaching the NF1 cognitive profile might benefit from looking at the mechanisms linked to the age-related aspects of cognitive decline. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  6. Geriatric multidimensional assessment for elderly patients with acute respiratory diseases.

    PubMed

    Bellelli, Giuseppe; Bruni, Adriana; Malerba, Mara; Mazzone, Andrea; Aliberti, Stefano; Pesci, Alberto; Annoni, Giorgio

    2014-04-01

    The case of an 87-year-old woman who falls at home and is admitted to the Emergency Department of an acute hospital with delirium exemplify a common situation that physicians face in their everyday clinical practice. We describe the typical context of frailty in which acute illnesses frequently present in frail elderly patients and, in particular, the relationship between comorbidity, disability and frailty. We also report the current knowledge about frailty theories and we focus on the "atypical" presentation of many acute illnesses. Major attention is devoted on delirium and on mobility impairment, two of the most common atypical symptoms of elderly frail subjects. Finally we describe the evidence on the comprehensive geriatric assessment, i.e., the method that is required to identify and understand the ultimate needs of elderly complex subjects.

  7. [Postoperative respiratory failure in patients with cancer of esophagus and gastric cardia].

    PubMed

    Mao, You-sheng; Zhang, De-chao; He, Jie; Zhang, Ru-gang; Cheng, Gui-yu; Sun, Ke-lin; Wang, Liang-jun; Yang, Lin

    2005-12-01

    We retrospectively analyzed the cause and death risk of 114 postoperative respiratory failure patients found in 3519 patients with esophageal cancer and 1495 patients with carcinoma of gastric cardia surgically treated between January 1992 and May 2003. To analyze the reasons causing postoperative respiratory failure in surgically treated esophageal or gastric cardia cancer patients, and the correlation between the death risk of postoperative respiratory failure and preoperative pulmonary function tests, postoperative complications, operation modes, history of preoperative accompanying diseases and so on using Binary Logistic Regression analysis and Chi-square tests (chi(2)) in SSPS statistics software. In this series, postoperative respiratory failure developed in 97 of 3519 (2.76%) esophageal cancer patients and 17 of 1495 (1.14%) gastric cardia cancer patients, which were mainly caused by severe respiratory tract infection (37.7%, 43/114) and operative complications (35.1%, 40/114) such as: anastomotic leakage or perforation of thoracic stomach, extensive bleeding during operation, chylothorax, etc, totally accounting for 72.8% (83/114). In contrast with lung cancer patients, most of the postoperative respiratory failure (69.3%) occurred in the patients who had perioperative complications but almost always normal preoperative pulmonary function tests. Other reasons to cause postoperative respiratory failure were: extubation in unconscious patients at the end of general anesthesia; over-infusion during operation; pulmonary artery embolism; severe arrhythmia and so on. All patients except 2 were treated in ICU by mechanic ventilation through intubation and/or tracheotomy. Eighty patients (70.2%) were intubated and/or had tracheotomy within 3 days postoperatively. Seventy patients (61.4%) were rescued successfully, whereas 44 cases (38.6%) died of postoperative respiratory failure and/or other postoperative complications. Univariate analysis and multivariate

  8. Postoperative hemorrhagic complications after elective laparoscopic cholecystectomy in patients receiving long-term anticoagulant therapy.

    PubMed

    Ercan, Metin; Bostanci, Erdal B; Ozer, Ilter; Ulas, Murat; Ozogul, Yusuf B; Teke, Zafer; Akoglu, Musa

    2010-03-01

    Among patients on long-term anticoagulant therapy who undergo laparoscopic cholecystectomy (LC), bleeding complications have not been extensively investigated. The objective of this study was therefore to investigate postoperative bleeding complications prospectively in patients on chronic oral anticoagulation. In the period of January 2002 to December 2007, 44 patients on long-term anticoagulation with warfarin, an oral anticoagulant (OAC), underwent LC in our center. Oral anticoagulant was discontinued 5 days before the planned date of surgery, and patients were admitted to the hospital 3 days before. Upon admission, bridging anticoagulation with enoxaparin, a low molecular weight heparin (LMWH), was started. When their international normalized ratio (INR) decreased to <1.5, patients underwent LC. In the absence of postoperative bleeding complications, OAC and LMWH were resumed on the evening of the day of surgery, and LMWH was continued until each patient's target INR was reached. A comparison group was comprised by 1,421 consecutively enrolled patients with no comorbid disease who underwent LC during the same period. In the comparison group, postoperative bleeding was encountered in 21 patients (1.5%). In the anticoagulation group, postoperative bleeding was encountered in 11 patients (25%) and ranged from minor oozing from a port incision in one patient to hemorrhage, sepsis, and fatality in one patient. In the anticoagulation group, no significant differences were found between patients with and without postoperative bleeding in terms of age, gender, body mass index, American Society of Anesthesiologists score, INR, or other hemostasis parameters. In patients who underwent LC with bridging anticoagulation, postoperative bleeding was markedly more frequent than expected and was not predicted by the usual coagulation parameters. This suggests a need for methods that can indicate which patients on long-term anticoagulation are at risk for postoperative bleeding.

  9. Primary IgA nephropathy in elderly patients.

    PubMed

    Cheungpasitporn, Wisit; Nasr, Samih H; Thongprayoon, Charat; Mao, Michael A; Qian, Qi

    2015-06-01

    Data on clinicopathological features, treatment and outcomes of IgA nephropathy (IgAN) in elderly patients are limited. Native kidney biopsies with a pathological diagnosis of IgAN (n = 1084) from Mayo Clinic Rochester in the years 1994-2013 were examined. After exclusion of the secondary IgAN, 45 elderly IgAN patients (age ≥65 years) were identified. One hundred sixty-two younger adults (age 18-64 years) with IgAN were randomly selected for comparison. Compared with younger adults, elderly patients showed a higher rate of chronic hypertension (62.2 vs 27.2%), higher pulse pressures (65 ± 17 vs 51 ± 15 mmHg), requiring greater number of antihypertensive medications (2.5 ± 1.2 vs 1.7 ± 0.7) and lower blood haemoglobin (11.1 ± 2.3 vs 12.7 ± 2.1 g/dL) at time of kidney biopsy, all P < 0.001. Pathologically, elderly kidneys showed a higher degree of tubulointerstitial fibrosis (P = 0.04) and vascular sclerosis (P < 0.001). Treatments (including the use of angiotensin-converting enzyme inhibitor (ACEI) inhibitor, angiotensin II receptor blocker (ARB) and immunosuppressants) were similar in the two cohorts. Elderly patients had more end-stage renal disease at 6 months (HR 5.51; 95% CI 1.46-22.3, P = 0.01) and higher 6-month and 5-year mortality (HR 2.31; 95% CI 1.04-5.17, P = 0.04) after adjusting the age and comorbidities. IgAN diagnosed at age >65 years tends to have a faster renal disease progression and higher patient mortality. © 2015 Asian Pacific Society of Nephrology.