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Frailty surgery

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https://www.readbyqxmd.com/read/28298244/frailty-related-to-anesthesia-guided-by-the-index-bispectral-frail-study-study-protocol-for-a-randomized-controlled-trial
#1
Morgan Le Guen, Marie Herr, Antoine Bizard, Caroline Bichon, Nathalie Boichut, Thierry Chazot, Ngai Liu, Joel Ankri, Marc Fischler
BACKGROUND: Currently, patients older than 60 years of age represent 25% of the population and are at an increased risk during surgery. Therefore, reducing postoperative morbidity and mortality is a major concern in medical research and practice. Dependence on caregivers and cognitive impairment represent two major risk factors in the elderly, especially in frail patients after surgery under general anesthesia. In this context, continuous monitoring of the depth of anesthesia using a bispectral index (BIS) sensor may reduce the occurrence of impairments by gaining better control of the anesthetic depth...
March 16, 2017: Trials
https://www.readbyqxmd.com/read/28265844/frailty-as-a-risk-predictor-of-morbidity-and-mortality-following-liver-surgery
#2
Faiz Gani, Marcelo Cerullo, Neda Amini, Stefan Buettner, Georgios A Margonis, Kazunari Sasaki, Yuhree Kim, Timothy M Pawlik
BACKGROUND: Given the increasing number of elderly and comorbid patients undergoing surgery, there is increased interest in preoperatively identifying patients at high risk of morbidity and mortality following liver resection. We sought to develop and validate the use of a frailty index (FI) to predict poor postoperative outcomes following liver surgery. METHODS: Patients undergoing a liver resection were identified using the National Surgical Quality Improvement Program Hepatectomy-targeted database for 2014 and randomized into a training or validation cohort...
March 6, 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/28265210/transcatheter-aortic-valve-replacement-comprehensive-review-and-present-status
#3
REVIEW
Sameer Arora, Jacob A Misenheimer, Radhakrishnan Ramaraj
Aortic stenosis is the most common valvular heart disease in the developed world. About 7% of the population over age 65 years suffers from degenerative aortic stenosis. The prognosis of patients with symptomatic severe aortic stenosis is dismal without valve replacement. Even though the American College of Cardiology recommends aortic valve replacement to treat this condition as a class I recommendation, approximately one third of these patients over the age of 75 years are not referred for surgery. Typically, this is from concern about prohibitive surgical risk associated with patient frailty, comorbidities, age, and severe left ventricular dysfunction...
February 2017: Texas Heart Institute Journal
https://www.readbyqxmd.com/read/28259489/association-between-frailty-and-readmission-within-one-year-after-gastrectomy-in-older-patients-with-gastric-cancer
#4
Yu-Ri Choe, Ju-Youn Joh, Yeon-Pyo Kim
OBJECTIVE: The incidence of gastric cancer in older people is increasing. Because older patients are at increased risk of postoperative complications and mortality, preoperative risk assessment in this population is important. This study explored whether preoperative assessment of frailty could be useful for predicting the postoperative outcome in patients with gastric cancer. MATERIALS AND METHODS: We investigated 223 patients (136 men and 87 women) over 65years of age who underwent gastric cancer surgery from April 2012 to March 2015 at a single institution in Korea...
March 1, 2017: Journal of Geriatric Oncology
https://www.readbyqxmd.com/read/28242771/improving-outcomes-from-high-risk-surgery-a-multimethod-evaluation-of-a-patient-centred-advanced-care-planning-intervention
#5
Amanda Selwood, Siva Senthuran, Brette Blakely, Paul Lane, John North, Robyn Clay-Williams
INTRODUCTION: Patients who are frail, have multiple comorbidities or have a terminal illness often have poor outcomes from surgery. However, sole specialists may recommend surgery in these patients without consultation with other treating clinicians or allowing for patient goals. The Patient-Centred Advanced Care Planning (PC-ACP) model of care provides a framework in which a multidisciplinary advanced care plan is devised to incorporate high-risk patients' values and goals. Decision-making is performed collaboratively by patients, their family, surgeons, anaesthetists, intensivists and surgical case managers...
February 27, 2017: BMJ Open
https://www.readbyqxmd.com/read/28226343/-diagnosis-and-risk-assessment-of-postoperative-complications-of-gastric-cancer-in-japan-and-korea
#6
Xiang Hu, Chi Zhang
Radical surgery of gastric cancer (D2 lymph node dissection) as the standard operation is widely used in clinical practice and satisfactory prognosis can be obtained in patients who receive radical gastrectomy. But surgical invasion can cause high morbidity of complications and mortality. The data of large-scale evidence-based medical clinical trials and large databases in Japan and Korea showed that anastomotic leakage, pancreatic leakage and abdominal abscess were the most common complications after gastrectomy, and the morbidity of complication was about 20% and mortality was about 1%...
February 25, 2017: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/28182802/the-association-of-geriatric-syndromes-with-hospital-outcomes
#7
Roman Romero-Ortuno, Duncan R Forsyth, Kathryn Jane Wilson, Ewen Cameron, Stephen Wallis, Richard Biram, Victoria Keevil
BACKGROUND: Frailty, history of dementia (HoD), and acute confusional states (ACS) are common in older patients admitted to hospital. OBJECTIVE: To study the association of frailty (≥6 points in the Clinical Frailty Scale [CFS]), HoD, and ACS with hospital outcomes, controlling for age, gender, acute illness severity (measured by a Modified Early Warning Score in the emergency department), comorbidity (Charlson Comorbidity Index), and discharging specialty (general medicine, geriatric medicine, surgery)...
February 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28179415/factors-related-to-receipt-of-non-cancer-related-transurethral-prostatectomy-findings-from-a-large-prospective-study-of-106%C3%A2-769-middle-aged-and-older-australian-men
#8
Grace Joshy, Kay Soga, Rosemary J Korda, Manish I Patel, Emily Banks
BACKGROUND: Transurethral prostatectomy (TURP) is a common surgical intervention for chronic lower urinary tract symptoms (LUTS). Little large-scale evidence exists on factors related to receipt of non-cancer-related TURP. METHODS: A prospective study of men aged ≥45 years participating in the 45 and Up Study, a large Australian cohort study, without prior prostatectomy and/or bowel/genital/urinary-tract cancer; questionnaire data were linked to hospitalisations and deaths...
February 8, 2017: BMJ Open
https://www.readbyqxmd.com/read/28157134/association-of-the-hospital-volume-of-frail-surgical-patients-cared-for-with-outcomes-after-elective-major-noncardiac-surgery-a-retrospective-population-based-cohort-study
#9
Daniel I McIsaac, Duminda N Wijeysundera, Allen Huang, Gregory L Bryson, Carl van Walraven
BACKGROUND: Frailty is a risk factor for adverse postoperative outcomes. Hospitals that perform higher volumes of surgery have better outcomes than low-volume providers. We hypothesized that frail patients undergoing elective surgery at hospitals that cared for a higher volume of similarly frail patients would have improved outcomes. METHODS: We conducted a retrospective, population-based cohort study using linked administrative data in Ontario, Canada. We identified all adult major, elective noncardiac surgery patients who were frail according to the validated Johns Hopkins Adjusted Clinical Groups (ACG) frailty-defining diagnoses indicator...
April 2017: Anesthesiology
https://www.readbyqxmd.com/read/28152784/breast-cancer-patient-functional-status-and-comorbidities-and-their-impact-on-treatment-aggressiveness-a-population-based-study
#10
Ramsankar Basak, Ronald C Chen
306 Background: The ASCO Choosing Wisely Campaign and other published guidelines recommend avoidance of aggressive treatments in early-stage cancer patients with limited life expectancy. However, patients with more advanced cancers are likely to benefit from aggressive treatment. The population-based SEER-MHOS (Medicare Health Outcomes Survey) provides unique data to allow assessment of aggressiveness of cancer treatment by cancer stage and patient frailty. METHODS: MHOS includes patient-reported functional deficits in a sample of Medicare beneficiaries, and has been linked with SEER data which provide diagnostic and treatment data...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28090814/personalized-dynamic-prediction-of-death-according-to-tumour-progression-and-high-dimensional-genetic-factors-meta-analysis-with-a-joint-model
#11
Takeshi Emura, Masahiro Nakatochi, Shigeyuki Matsui, Hirofumi Michimae, Virginie Rondeau
Developing a personalized risk prediction model of death is fundamental for improving patient care and touches on the realm of personalized medicine. The increasing availability of genomic information and large-scale meta-analytic data sets for clinicians has motivated the extension of traditional survival prediction based on the Cox proportional hazards model. The aim of our paper is to develop a personalized risk prediction formula for death according to genetic factors and dynamic tumour progression status based on meta-analytic data...
January 1, 2017: Statistical Methods in Medical Research
https://www.readbyqxmd.com/read/28069729/systematic-review-on-the-predictive-ability-of-frailty-assessment-measures-in-cardiac-surgery
#12
REVIEW
Yusuf S Abdullahi, Leonidas V Athanasopoulos, Roberto P Casula, Marco Moscarelli, Mark Bagnall, Hutan Ashrafian, Thanos Athanasiou
OBJECTIVES: Patient frailty is increasingly recognised as contributing to adverse postoperative outcomes in cardiothoracic surgery. The goal of this review is to evaluate the predictive ability of frailty scoring systems and their limitations in risk assessment of patients undergoing cardiac surgery. METHODS: Frailty studies were identified by searching electronic databases. Studies in which the measuring instrument was defined as a multidimensional tool focusing on a population undergoing cardiac operations were included...
January 9, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28059648/validation-of-effectiveness-of-keyhole-clipping-in-nonfrail-elderly-patients-with-unruptured-intracranial-aneurysms
#13
Kentaro Mori, Kojiro Wada, Naoki Otani, Arata Tomiyama, Terushige Toyooka, Kazuya Fujii, Kosuke Kumagai, Satoru Takeuchi, Satoshi Tomura, Takuji Yamamoto, Yasuaki Nakao, Hajime Arai
OBJECTIVE Advanced age is known to be associated with a poor prognosis after surgical clipping of unruptured intracranial aneurysms (UIAs). Keyhole clipping techniques have been introduced for less invasive treatment of UIAs. In this study, the authors compared the complications and clinical and radiological outcomes after keyhole clipping between nonfrail elderly patients (≥ 70 years) and nonelderly patients. METHODS Keyhole clipping (either supraorbital or pterional) was performed to treat 260 cases of relatively small (≤ 10 mm) anterior circulation UIAs...
January 6, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28031245/robotic-enhanced-coronary-surgery-in-octogenarians
#14
Apostolos Roubelakis, Filip Casselman, Johan van der Merwe, Bernard Stockman, Ivan Degrieck, Frank Van Praet
OBJECTIVES: Robotic-enhanced minimally invasive direct coronary artery bypass grafting surgery (RE-MIDCAB) is based on the use of a robotic console and instrumentation for the dissection of the left internal thoracic artery (LITA). The LITA to left anterior descending (LAD) artery anastomosis is subsequently constructed through a mini thoracotomy. The purpose of this study is to present our experience of RE-MIDCAB outcomes in elderly patients. METHODS: From 2002 until 2015, 44 octogenarians (the mean age of 82...
December 27, 2016: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28000268/implants-for-elderly-patients
#15
REVIEW
Martin Schimmel, Frauke Müller, Valérie Suter, Daniel Buser
In the developed world, the large birth cohorts of the so-called baby boomer generation have arrived in medical and dental practices. Often, elderly patients are 'young-old' baby boomers in whom partial edentulism is the predominant indication for implant therapy. However, the generation 85+ years of age represents a new challenge for the dental profession, as their lives are frequently dominated by dependency, multimorbidity and frailty. In geriatric implant dentistry, treatment planning is highly individualized, as interindividual differences become more pronounced with age...
February 2017: Periodontology 2000
https://www.readbyqxmd.com/read/27999879/-perioperative-patient-management-in-orthogeriatrics
#16
P Moldzio, J Peters
The management of major orthopedic surgery in the elderly prototypically reflects the perioperative risks of geriatric, often very frail patients reflecting an aging population. To improve outcome, the risks of anesthesia and surgery as well as of patient comorbidities must be thoroughly assessed and balanced using a multidisciplinary approach. Particular risks include cardiopulmonary morbidity, anemia, risk of hemorrhage and the management by anticoagulation, cerebral impairments as well as frailty and limited physiological reserves in general...
January 2017: Der Orthopäde
https://www.readbyqxmd.com/read/27989724/frailty-is-associated-with-morbidity-in-adults-undergoing-elective-anterior-lumbar-interbody-fusion-alif-surgery
#17
Kevin Phan, Jun S Kim, Nathan J Lee, Sulaiman Somani, John Di Capua, Parth Kothari, Dante Leven, Samuel K Cho
BACKGROUND CONTEXT: Prior studies have suggested no significant differences in functional status and postoperative complications of elderly versus nonelderly patients undergoing posterior lumbar interbody fusion; however, similar studies have not been comprehensively investigated in the setting of anterior lumbar interbody fusion (ALIF). PURPOSE: The objective was to quantify the ability of the modified Frailty Index (mFI) to predict postoperative events in patients undergoing ALIF...
October 27, 2016: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/27986531/patient-function-and-the-value-of-surgical-care-for-kidney-cancer
#18
Hung-Jui Tan, Joseph D Shirk, Karim Chamie, Mark S Litwin, Jim C Hu
PURPOSE: Frailty and functional status have emerged as significant predictors of morbidity and mortality for patients undergoing cancer surgery. To articulate the impact on value (ie quality per cost), we compared perioperative outcomes and expenditures according to patient function for older adults undergoing kidney cancer surgery. MATERIALS AND METHODS: Using linked SEER (Surveillance, Epidemiology and End Results)-Medicare data, we identified 19,129 elderly patients with kidney cancer treated with nonablative surgery from 2000 to 2009...
December 13, 2016: Journal of Urology
https://www.readbyqxmd.com/read/27979468/sarcopenia-in-emergency-abdominal-surgery
#19
Rebecca C Dirks, Brandy L Edwards, Elizabeth Tong, Basil Schaheen, Florence E Turrentine, Amber Shada, Philip W Smith
BACKGROUND: Sarcopenia, a loss of skeletal muscle mass associated with aging, is a practical measure of frailty and has been previously identified as a predictor of outcomes in surgical cohorts including cancer resection and elderly patients. We hypothesized that sarcopenia, as measured by preoperative computerized tomography (CT) scan, predicts mortality and morbidity in emergent laparotomy. METHODS: Institutional American College of Surgeons National Surgical Quality Improvement Program data were queried for adult patients who underwent open emergency abdominal surgery between 2008 and 2013...
January 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/27942414/lung-cancer-in-elderly-patients
#20
REVIEW
Federico Venuta, Daniele Diso, Ilaria Onorati, Marco Anile, Sara Mantovani, Erino A Rendina
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...
November 2016: Journal of Thoracic Disease
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