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Geriatric Perioperative

Tyler Sheetz, Cheryl T Lee
PURPOSE OF REVIEW: As the population ages, urologic oncologists are caring for older and more vulnerable patients that must withstand complex surgical treatments. Our healthcare environment emphasizes surgical quality, reductions in length of hospital stay, reduced readmission rates, and high patient satisfaction. So those who manage urologic malignancies must be able to optimize their patients. Understanding the concept of frailty, how to diagnose it in a timely and reliable manner, appreciate its perioperative impact, and consider interventions to reduce its effects may improve surgical outcomes...
March 13, 2018: Current Opinion in Urology
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
Ekin Ozturk, Marianne van Iersel, Karsten van Loon, Corry den Rooijen, Eric van Dongen, Rob de Lind van Wijngaarden, Joost Klaase, Harry van Goor
INTRODUCTION: Surgical specialists and residents lack knowledge to adequately manage frail older patients. This study aims to evaluate the effects of an interactive online course regarding attitude, self-confidence and knowledge in perioperative management of the elderly patient. METHODS: The six-weeks course consisted of expert videos, literature readings, quizzes and forum discussions. Surgical consultants with geriatric expertise and geriatricians moderated online discussions and stimulated interaction...
February 10, 2018: American Journal of Surgery
Lauren Styan, Skyle Murphy, Aisling Fleury, Brian McGowan, Martin Wullschleger
BACKGROUND: The purpose of this study was to assess the impact of a perioperative geriatric service (PGS) in an acute surgical unit (ASU) on patient and organizational outcomes. METHODS: Single centre retrospective cohort study. Inclusion criteria were patients over the age of 65 admitted to the ASU between January and June 2014 (pre-PGS) and 2015 (post-PGS). Chart reviews were performed to identify outcomes of interest including in-hospital morbidity and mortality, length of stay (LOS), 30-day representation and mortality...
February 18, 2018: ANZ Journal of Surgery
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
Patawut Bovonratwet, Daniel D Bohl, Glenn S Russo, Nathaniel T Ondeck, Denis Nam, Craig J Della Valle, Jonathan N Grauer
BACKGROUND: Patients with geriatric hip fractures may be at increased risk for postoperative Clostridium difficile colitis, which can cause severe morbidity and can influence hospital quality metrics. However, to our knowledge, no large database study has calculated the incidence of, factors associated with, and effect of C. difficile colitis on geriatric patients undergoing hip fracture surgery. QUESTIONS/PURPOSES: To use a large national database with in-hospital and postdischarge data (National Surgical Quality Improvement Program [NSQIP®]) to (1) determine the incidence and timing of C...
March 2018: Clinical Orthopaedics and related Research
Ryan P McLynn, Taylor D Ottesen, Nathaniel T Ondeck, Jonathan J Cui, Lee E Rubin, Jonathan N Grauer
BACKGROUND: The Rothman Index is a comprehensive measure of overall patient status in the inpatient setting already in use at many medical centers. It ranges from 100 (best score) to -91 (worst score) and is calculated based on 26 variables encompassing vital signs, routine laboratory values, and organ system assessments from nursing rounds from the electronic medical record. Past research has shown an association of Rothman Index with complications, readmission, and death in certain populations, but it has not been evaluated in geriatric patients with hip fractures, a potentially vulnerable patient population...
February 5, 2018: Clinical Orthopaedics and related Research
Joseph J Ruzbarsky, Elizabeth B Gausden, Elan M Goldwyn, Isaac P Lowenwirt, Vitaly Kotlyar
Background: Early surgical intervention for hip fractures in the elderly has proven efficacious. However, surgical delays commonly occur in this patient population due to comorbid conditions that put these patients at a high risk for hypotension-related complications of general or neuraxial anesthesia or anticoagulants that delay the safe use of neuraxial anesthesia. Questions/Purposes: The questions/purposes of this study are (1) to investigate if a fascia iliaca block in conjunction with light to moderate sedation could provide adequate analgesia throughout open surgery for intertrochanteric hip fractures (AO/OTA 31-1) without requiring conversion to general anesthesia with airway support and (2) to assess its perioperative complication profile...
February 2018: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
Bruno Neuner, Daniel Hadzidiakos, Gabriella Bettelli
Postoperative delirium (POD) is an adverse clinical outcome characterized by cognitive, affective and behavioral symptoms with typically an acute onset and a fluctuating course. POD is attributed to certain patients' predisposing factors as well as to treatment-related precipitating factors. While there are several single-component interventions for the prevention of POD, evolving evidence suggests the importance of a system approach in the prevention of POD. This involves strategies by multidisciplinary teams with additional geriatric consultation services to identify risk factors for POD and to modify their impact on the perioperative course...
January 20, 2018: Aging Clinical and Experimental Research
Kahli Zietlow, Shelley R McDonald, Richard Sloane, Jeffrey Browndyke, Sandhya Lagoo-Deenadayalan, Mitchell T Heflin
OBJECTIVES: To compare postoperative outcomes of individuals with and without cognitive impairment enrolled in the Perioperative Optimization of Senior Health (POSH) program at Duke University, a comanagement model involving surgery, anesthesia, and geriatrics. DESIGN: Retrospective analysis of individuals enrolled in a quality improvement program. SETTING: Tertiary academic center. PARTICIPANTS: Older adults undergoing surgery and referred to POSH (N = 157)...
January 13, 2018: Journal of the American Geriatrics Society
Nirav H Amin, Jacob A West, Travis Farmer, Hrayr G Basmajian
Introduction: Hip fracture is a common occurrence in the elderly population with high morbidity and mortality due to postoperative pain and opioid use. The goal of this article is to review the current literature on the neuroanatomy of the hip and the use of localized nerve block in controlling hip fracture pain. Methods: A thorough search of MEDLINE/PubMed, Embase, and the Cochrane Database of Systematic Reviews was conducted using the search terms "hip fracture" and "fascia iliaca block (FICB)...
December 2017: Geriatric Orthopaedic Surgery & Rehabilitation
Shelley R McDonald, Mitchell T Heflin, Heather E Whitson, Thomas O Dalton, Michael E Lidsky, Phillip Liu, Cornelia M Poer, Richard Sloane, Julie K Thacker, Heidi K White, Mamata Yanamadala, Sandhya A Lagoo-Deenadayalan
Importance: Older adults undergoing elective surgery experience higher rates of preventable postoperative complications than younger patients. Objective: To assess clinical outcomes for older adults undergoing elective abdominal surgery via a collaborative intervention by surgery, geriatrics, and anesthesia focused on perioperative health optimization. Design, Setting, and Participants: Perioperative Optimization of Senior Health (POSH) is a quality improvement initiative with prospective data collection...
January 3, 2018: JAMA Surgery
Daniel I McIsaac, Tim Jen, Nikhile Mookerji, Abhilasha Patel, Manoj M Lalu
BACKGROUND: Frailty is an important prognostic factor for adverse outcomes and increased resource use in the growing population of older surgical patients. We identified and appraised studies that tested interventions in populations of frail surgical patients to improve perioperative outcomes. METHODS: We systematically searched Cochrane, CINAHL, EMBASE and Medline to identify studies that tested interventions in populations of frail patients having surgery. All phases of study selection, data extraction, and risk of bias assessment were done in duplicate...
2017: PloS One
Wan-Chi Liu, Chao-Shun Lin, Chun-Chieh Yeh, Hsin-Yun Wu, Yuarn-Jang Lee, Chi-Li Chung, Yih-Giun Cherng, Ta-Liang Chen, Chien-Chang Liao
Background: Limited information is available on the association between influenza vaccination and postoperative outcomes. Methods: Using Taiwan's National Health Insurance Research Database reimbursement claims data from 2008-2013, we conducted a matched cohort study of 16903 patients aged >66 years who received influenza vaccinations and later underwent major surgery. Using a propensity score matching procedure adjusted for sociodemographic characteristics, medical condition, surgery type, and anesthesia type, 16903 controls who underwent surgery but were not vaccinated were selected...
February 14, 2018: Journal of Infectious Diseases
P Merloz
Proximal femoral fracture in elderly subjects is a major event that is life-threatening in the medium-to-long term. Advanced age, male gender and number of comorbidities largely account for high mortality and require geriatric expertise. Protein-energy malnutrition and bone demineralization increase mortality. Mortality can, on the other hand, be reduced by acting on two variables accessible to medical intervention: daily activities and nutritional status. Functional and neurocognitive assessment allow the risk of dependency to be evaluated, and global geriatric work-up can prevent sudden breakdown of homeostasis...
February 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
Shamsuddin Akhtar
PURPOSE OF REVIEW: This review discusses the pharmacology of contemporary anesthetic medications in geriatric patients, neurophysiological changes with aging, current recommendations for dosing anesthetic drugs. It also addresses current practice patterns and ongoing studies, which are likely to affect future anesthetic drug management in the elderly. RECENT FINDINGS: Potency of anesthetic drugs is increased in the elderly. In addition to changes at the receptor level, neurophysiological changes in functional connectivity with aging contributes to increased sensitivity of anesthetic drugs...
February 2018: Current Opinion in Anaesthesiology
Mateusz Klukowski, Rafał Kowalczyk, Grzegorz Górniewski, Paweł Łęgosz, Marek Janiak, Janusz Trzebicki
BACKGROUND: Fractures of the proximal femur in elderly patients are a challenge for orthopedics, anesthe-sio-logy and geriatrics. Early mobilization reduces postoperative mortality among these patients. Effective anal-gesia is necessary to achieve this goal. MATERIAL AND METHODS: A retrospective analysis of perioperative medical records of 78. patients undergoing surgical treatment of proximal femur fractures was performed. Group 1 (n=35)consisted of patients who were treated with pharmacologic analgesia only (systemic analgesics) and Group 2 (n=43) involved patients who re-ceived a preoperative fascia iliaca compartment block (FICB) and pharmacologic analgesia...
October 31, 2017: Ortopedia, Traumatologia, Rehabilitacja
Frédéric Pamoukdjian, Evelyne Liuu, Philippe Caillet, Mathilde Gisselbrecht, Stéphane Herbaud, Pascaline Boudou-Rouquette, Laurent Zelek, Elena Paillaud
Cancer is a disease of the elderly as demonstrated by the epidemiological evolution of Western countries. Indeed, two third of cancers newly diagnosed occur over 65 years. However, older cancer patients have been often excluded from clinical trials in oncology and the extrapolation of cancer treatments in this population remains difficult in practice. Scientific societies recommend that a comprehensive geriatric assessment (CGA) be performed in patients aged 70 and over and selected using screening tools for frailty such as the G8 index...
November 2017: Bulletin du Cancer
Rami Alrezk, Nicholas Jackson, Mohanad Al Rezk, Robert Elashoff, Nancy Weintraub, David Elashoff, Gregg C Fonarow
BACKGROUND: Surgical patients aged 65 and over face a higher risk of cardiac complications from noncardiac surgery. The Revised Cardiac Risk Index (RCRI) and the Gupta Myocardial Infarction or Cardiac Arrest (MICA) calculator are widely used to predict this risk, but they are not specifically designed to predict MICA in geriatric patients. Our hypothesis is that a new geriatric-sensitive index, derived from geriatric data, will capture this population's unique response to risk factors...
November 16, 2017: Journal of the American Heart Association
Jong Min Choi, Man Kyu Choi, Sung Bum Kim
Objective: As increasing the size of the geriatric population, the number of elderly patients, who need the surgery for painful degenerative spinal stenosis has been increasing. The geriatric population may be relatively high complications, because of age and age-associated medical conditions. However, there is a lack of studies addressing the perioperative complications and outcomes in elderly patients with posterior lumbar inter body fusion with screw augmentation (PLIF). Methods: We retrospectively reviewed the medical records and radiographic studies of geriatric patients who had spine surgery of PLIF due to spinal stenosis for 11 years...
November 2017: Journal of Korean Neurosurgical Society
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