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Frailty surgery

Amrita Aranake-Chrisinger, Jenny Zhao Cheng, Maxwell R Muench, Rose Tang, Angela Mickle, Hannah Maybrier, Nan Lin, Troy Wildes, Eric Lenze, Michael Simon Avidan
INTRODUCTION: Postoperative delirium (POD) is a common complication in elderly patients, characterised by a fluctuating course of altered consciousness, disordered thinking and inattention. Preliminary research has linked POD with persistent cognitive impairment and decreased quality of life. However, these findings maybe confounded by patient comorbidities, postoperative complications and frailty. Our objective is to determine whether POD is an independent risk factor for persistent impairments in attention and executive function after elective surgery...
March 17, 2018: BMJ Open
Maria Loreto Alvarez-Nebreda, Nathalie Bentov, Richard D Urman, Sabeena Setia, Joe Chin-Sun Huang, Kurt Pfeifer, Katherine Bennett, Thuan D Ong, Deborah Richman, Divya Gollapudi, G Alec Rooke, Houman Javedan
Frailty is an age-related, multi-dimensional state of decreased physiologic reserve that results in diminished resiliency and increased vulnerability to stressors. It has proven to be an excellent predictor of unfavorable health outcomes in the older surgical population. There is agreement in recommending that a frailty evaluation should be part of the preoperative assessment in the elderly. However, the consensus is still building with regards to how it should affect perioperative care. The Society for Perioperative Assessment and Quality Improvement (SPAQI) convened experts in the fields of gerontology, anesthesiology and preoperative assessment to outline practical steps for clinicians to assess and address frailty in elderly patients who require elective intermediate or high risk surgery...
March 15, 2018: Journal of Clinical Anesthesia
Xiaosong Meng, Benjamin Press, Audrey Renson, James S Wysock, Samir S Taneja, William C Huang, Marc A Bjurlin
BACKGROUND: The American Society of Anesthesiologists physical status classification system, modified Charlson Comorbidity Index (mCCI), and modified Frailty Index have been associated with complications after urologic surgery. No study has compared the predictive performance of these indexes for postoperative complications after radical cystectomy (RC) for bladder cancer. MATERIALS AND METHODS: Data from 1516 patients undergoing elective RC for bladder cancer were extracted from the 2005 to 2011 American College of Surgeons National Surgical Quality Improvement Program for a retrospective review...
February 26, 2018: Clinical Genitourinary Cancer
Hemalkumar Mehta, Ayodele Osasona, Yong Shan, James S Goodwin, Ikenna C Okereke
OBJECTIVE: Video-assisted thoracoscopic surgery may be associated with less morbidity than open lobectomy/segmentectomy, but some studies have questioned the benefit of thoracoscopic surgery. The study aimed to determine trends and factors associated with patient's likelihood of undergoing thoracoscopic lobectomy/segmentectomy and to compare outcomes with each approach. METHODS: This retrospective study included adult patients undergoing pulmonary lobectomy/segmentectomy from the American College of Surgeons National Surgical Quality Improvement Project from 2007-2015 (n=14,717)...
March 13, 2018: Seminars in Thoracic and Cardiovascular Surgery
Arianna Barbetta, Meier Hsu, Kay See Tan, Dessislava Stefanova, Koby Herman, Prasad S Adusumilli, Manjit S Bains, Matthew J Bott, James M Isbell, Yelena Y Janjigian, Geoffrey Y Ku, Bernard J Park, Abraham J Wu, David R Jones, Daniela Molena
OBJECTIVE: Definitive chemoradiotherapy (CRT) remains the most commonly used treatment for locally advanced esophageal squamous cell carcinoma (SCC), because of perceptions that esophagectomy offers an unclear survival advantage. We compare recurrence, overall survival (OS), and disease-free survival (DFS) in patients treated with definitive CRT or neoadjuvant CRT followed by surgery (trimodality). METHODS: This was a retrospective cohort study of patients with stage II and III SCC of the middle and distal esophagus in patients who completed CRT...
February 15, 2018: Journal of Thoracic and Cardiovascular Surgery
Robert B Hawkins, J Hunter Mehaffey, Eric J Charles, John A Kern, D Scott Lim, Nicholas R Teman, Gorav Ailawadi
BACKGROUND: Frailty is an important predictor of outcomes after cardiac surgery, but utility is limited by difficult assessment and quantification. We hypothesize that sarcopenia defined as psoas muscle cross-sectional area is a useful predictor of surgical aortic valve replacement (SAVR) outcomes in moderate to high-risk patients. METHODS: Moderate to high-risk (predicted risk of mortality [PROM] >3%) patients who underwent SAVR with or without coronary bypass were extracted from an institutional database (2009-2016)...
March 9, 2018: Annals of Thoracic Surgery
Pelumi Adedayo, Kimberly Resnick, Sareena Singh
OBJECTIVE: Our objective was to examine the association of the modified frailty index (mFI) and non-home discharge in patients undergoing surgery for endometrial cancer (EMCA). METHODS: Patients who underwent surgery for EMCA from 2011 to 2012 were identified from the American College of Surgeons - Nastional Surigical Quality Improvement Project (ACS-NSQIP) database. Current Procedural Terminology (CPT) codes were used to identify surgical characteristics. We excluded patients who were already living in a non-home facility...
March 9, 2018: Journal of Geriatric Oncology
Pragya Ajitsaria, Sabry Z Eissa, Ross K Kerridge
Purpose of Review: The central question of preoperative assessment is not "What can be done?" but "What should be done and how?" Predicting a patient's risk of unwanted outcomes is vital to answering this question. This review discusses risk prediction tools currently available and anticipates future developments. Recent Findings: Simple, parsimonious risk scales and scores are being replaced by complex risk prediction models as high-capacity information systems become ubiquitous...
2018: Current Anesthesiology Reports
P A MacIntyre, M Scott, R Seigne, A Clark, F Deveer, I Minchin
This prospective multicentre observational study investigated the risk of non-cardiac surgery in patients with moderate or severe aortic stenosis (AS). Patients with AS undergoing non-cardiac surgery in five New Zealand hospitals between August 2011 and September 2015 were studied. Preoperative variables were analysed for a significant association with postoperative major adverse cardiac events (MACE) and 30-day mortality. Of the 147 patients recruited, 13 (9%) died within 30 days and 33 (22%) had a MACE. Using univariate analysis, patients with severe AS had four times higher 30-day mortality than patients with moderate AS (16% versus 4%, <i>P</i>=0...
March 2018: Anaesthesia and Intensive Care
Fiammetta Monacelli, Alessio Signori, Matteo Prefumo, Chiara Giannotti, Alessio Nencioni, Emanuele Romairone, Stefano Scabini, Patrizio Odetti
Background/Aims: Postoperative delirium (POD) is more frequent in elderly patients undergoing major cancer surgery. The interplay between individual clinical vulnerability and a series of perioperative factors seems to play a relevant role. Surgery is the first-line treatment option for cancer, and fast-track surgery (FTS) has been documented to decrease postoperative complications. The study sought to assess, after comprehensive geriatric assessment (CGA) and frailty stratification (Rockwood 40 items index), which perioperative parameters were predictive of POD development in elderly patients undergoing FTS for colorectal cancer...
January 2018: Dementia and Geriatric Cognitive Disorders Extra
N Rudarakanchana, M Hamady, S Harris, E Afify, Rgj Gibbs, C D Bicknell, M P Jenkins
Objective Despite centralisation of the provision of vascular care, not all areas in England and Wales are able to offer emergency treatment for patients with acute conditions affecting the aorta proximal to the renal arteries. While cardiothoracic centres have made network arrangements to coordinate care for the repair of type A dissections, a similar plan for vascular care is lacking. This study investigates early outcomes in patients with ruptured suprarenal aortic aneurysm or dissection (rSRAD) transferred to a specialist centre...
February 27, 2018: Annals of the Royal College of Surgeons of England
J Trotter, J Johnston, A Ng, M Gatt, J MacFie, C McNaught
Introduction Studies have reported on the use of frailty as a prognostic indicator in patients undergoing elective surgery. Similar data do not exist for patients undergoing emergency surgery. The aim of this study was to evaluate the effect of preoperative sarcopenia measured by computed tomography (CT) on outcome following emergency laparotomy. MATERIALS AND METHODS Data from the National Emergency Laparotomy Audit database were retrieved for patients who had undergone an emergency laparotomy over 12 months at York NHS Foundation Trust...
February 27, 2018: Annals of the Royal College of Surgeons of England
Catalina Mosquera, Juan M Bermudez, Jessica L Evans, Konstantinos Spaniolas, Dougald C MacGillivary, Timothy L Fitzgerald
BACKGROUND: An association between frailty and mortality exists; we hypothesized this is secondary to failure to rescue (F2R). STUDY DESIGN: Data were obtained from the National Surgical Quality Improvement Program (2005-2012) for patients undergoing thoracoabdominal surgery. Using the modified frailty index (MFI), patients were classified as not (0 points), mildly (1 point), moderately (2 points), and severely (=/>3) frail. RESULTS: 962,913 patients were included; a majority were non-frail (52...
February 23, 2018: Journal of the American College of Surgeons
Mitsuru Yagi, Nobuyuki Fujita, Eijiro Okada, Osahiko Tsuji, Narihito Nagoshi, Takashi Tsuji, Takashi Asazuma, Masaya Nakamura, Morio Matsumoto, Kota Watanabe
STUDY DESIGN: Retrospective review of surgically treated 481 adult patients with spinal disorders OBJECTIVE.: To elucidate the effect of frailty and comorbidities on postoperative health-related quality of life (HRQoL) and complication rates. SUMMARY OF BACKGROUND DATA: Elective surgeries for spinal disorders improve clinical outcomes but also have high complication rates. METHODS: We retrospectively reviewed the results of consecutive elective spine surgeries for 156 adult spinal deformity (ASDs:65±9yrs), 152 degenerative spondylolisthesis (DSs:64 ± 10yrs), or 173 lumbar spinal canal stenosis (LSCSs:71 ± 9yrs) with followed at least 2 years...
February 22, 2018: Spine
Roman Mayr, Michael Gierth, Florian Zeman, Marieke Reiffen, Philipp Seeger, Felix Wezel, Armin Pycha, Evi Comploj, Matteo Bonatti, Manuel Ritter, Bas W G van Rhijn, Maximilian Burger, Christian Bolenz, Hans-Martin Fritsche, Thomas Martini
OBJECTIVE: A multicentre study was conducted to investigate the impact of sarcopenia as an independent predictor of oncological outcome after radical cystectomy for bladder cancer. METHODS: In total, 500 patients with available digital computed tomography scans of the abdomen obtained within 90 days before surgery were identified. The lumbar skeletal muscle index was measured using pre-operative computed tomography. Cancer-specific survival (CSS) and overall survival (OS) were estimated using Kaplan-Meier curves...
February 25, 2018: Journal of Cachexia, Sarcopenia and Muscle
Mohamed Macki, Mohamed Fakih, Pridvi Kandagatla, Ilan Rubinfeld, Victor Chang
OBJECTIVE: Because of the healthcare initiative on quality improvement projects in academic healthcare, this study explores the impact of different postgraduate years (PGYs) on unexpected re-operation rates. METHODS: Using National Surgical Quality Improvement Program 2005-2014, adult neurosurgical cases were divided into subspecialties: spine, open-vascular, cranial, and functional. Comparison groups: cases involving junior residents [PGY 1-PGY 3], mid-level residents [PGY 4+PGY 5], and senior residents [PGY 6+PGY 7]...
February 21, 2018: World Neurosurgery
Jun Hayashi, Tetsuro Uchida, Azumi Hamasaki, Atsushi Yamashita, Ken Nakamura, Kimihiro Kobayashi, Mitsuaki Sadahiro
An 84-year-old man with chronic obstructive pulmonary disease (COPD) was referred to our institution for further treatment of severe swelling of the left lower extremity. The left iliac vein was compressed by the abdominal aortic aneurysm and a right common iliac arterial aneurysm measuring 62 mm and 45 mm in diameter and was partially thrombosed. Multiple pulmonary artery embolisms were also noted. Endovascular repair of the abdominal aortic aneurysm and the right common iliac arterial aneurysm was performed because of his respiratory dysfunction...
February 16, 2018: Annals of Thoracic and Cardiovascular Surgery
Jakub Kenig, Kinga Mastalerz, Katarzyna Lukasiewicz, Maria Mitus-Kenig, Urszula Skorus
The Surgical Apgar Score (SAS) is a simple and rapid scoring system predicting postoperative mortality and morbidity. However, it remains unknown whether it might be useful in fit and frail older patients undergoing abdominal emergency surgery. METHODS: Consecutive patients ≥65 years, needing emergency abdominal surgery were enrolled in this prospective study. Additionally to the SAS, the G8 screening score was used to determine the frailty status. The logistic regression analysis was conducted investigating the association between the scores and 30-day postoperative outcomes...
February 10, 2018: Archives of Gerontology and Geriatrics
Gabriella Bettelli
Universally recognized goals of preoperative anesthesia assessment are the evaluation of patient's health status to define the entity of the surgical risk, and the anticipation of possible complications while optimizing and planning preventive strategies. Data obtained by Comprehensive Geriatric Assessment (CGA) and frailty evaluation are of extreme usefulness in surgical risk evaluation in older patients and in the decision about surgery. It is from the team-based discussion of such results that the most appropriate treatment can be individuated, surgery invasiveness and duration critically analyzed and if needed modified, and the best perioperative strategy carefully tailored...
February 14, 2018: Aging Clinical and Experimental Research
Daniel I McIsaac, Coralie A Wong, Gregory L Bryson, Carl van Walraven
BACKGROUND: Polypharmacy is increasingly prevalent in older patients and is associated with adverse events among medical patients. The impact of polypharmacy on outcomes after elective surgery is poorly described. The authors' objective was to measure the association of polypharmacy with survival, complications, and resource use among older patients undergoing elective surgery. METHODS: After registration (NCT03133182), the authors identified all individuals older than 65 yr old having their first elective noncardiac surgery in Ontario, Canada, between 2002 and 2014...
February 14, 2018: Anesthesiology
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