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Geriatric Perioperative

D Eschbach, T Kirchbichler, T Wiesmann, L Oberkircher, C Bliemel, S Ruchholtz, B Buecking
BACKGROUND: Most studies focusing on improving the nutritional status of geriatric trauma patients exclude patients with cognitive impairment. These patients are especially at risk of malnutrition at admission and of worsening during the perioperative fasting period. This study was planned as a feasibility study to identify the difficulties involved in including this high-risk collective of cognitively impaired geriatric trauma patients. PATIENTS AND METHODS: This prospective intervention study included cognitively impaired geriatric patients (Mini-Mental State Examination <25, age >65 years) with hip-related fractures...
2016: Clinical Interventions in Aging
René Aigner, Constantin Salomia, Philipp Lechler, Roman Pahl, Michael Frink
BACKGROUND: The incidence of geriatric ankle fractures has increased during the last few decades. In contrast to younger patients, increased complication rates have been observed. Thus, the goal of the present study was to identify risk factors for perioperative complications following open reduction and internal fixation of geriatric ankle fractures. METHODS: Two hundred thirty-seven patients over the age of 65 years (mean, 72.5 ± 6.1 years) treated for ankle fractures in our institution between 2004 and 2014 were included...
September 23, 2016: Foot & Ankle International
Antonio Graham, Charles H Brown
Older adults make up an ever-increasing number of patients presenting for surgery, and a significant percentage of these patients will be frail. Frailty is a geriatric syndrome that has been conceptualized as decreased reserve when confronted with stressors, although the precise definition of frailty has not been easy to standardize. The 2 most popular approaches to define frailty are the phenotypic approach and the deficit accumulation approach, although at least 20 tools have been developed, which has made comparison across studies difficult...
September 12, 2016: Anesthesia and Analgesia
Judith H Tomlinson, Judith S L Partridge
Postoperative delirium is a common complication in the older surgical population, occurring in 10-50 % of cases. It is thought to be more common if an individual is identified as frail. Postoperative delirium is associated with poor outcome including higher mortality rates, prolonged length of hospital stay, increased care needs on discharge and longer term post-traumatic stress disorder. Guidelines from the American Geriatric Society and the National Institute for Health and Care Excellence highlight the importance of risk assessment at the time of the preoperative visit...
2016: Perioperative Medicine
Lee Eric Rubin, Travis D Blood, Julio C Defillo-Draiby
A rapidly aging population is currently reshaping the demographic profile of the United States. Among older patients, the cohort aged >80 years is not only living longer but also is electing to undergo more total hip and knee arthroplasties. To improve perioperative safety, orthopaedic surgeons should understand the risks and clinical outcomes of arthroplasty in patients of advanced age. Although morbidity and mortality rates are higher for patients aged >80 years than for younger patients undergoing total hip and knee arthroplasties and revision surgeries, functional outcomes, pain relief, and patient satisfaction are consistent between groups...
October 2016: Journal of the American Academy of Orthopaedic Surgeons
M Thaeter, M Knobe, M Vande Kerckhove, F Böhle, J Herold, E Verhaven, H-C Pape
PURPOSE: Interleukin-6 is a mainly proinflammatory interleukin and an indicator for the magnitude of surgery. The IL-6 serum concentration correlates with injury severity, the extent of tissue trauma and has negative impact on prognosis. To date it is unclear whether the immunologic changes assessed are age dependent. The aim of this study is to compare the surgical inflammatory response in different age groups. METHODS: Data were collected at a level-1 university trauma center in a prospective, consecutive cohort study...
October 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Joseph A Molnar, Lucian G Vlad, Tuna Gumus
There is increasing awareness that chronic wound healing is very dependent on the patient's nutritional status, but there are no clearly established and accepted assessment protocols or interventions in clinical practice. Much of the data used as guidelines for chronic wound patients are extrapolated from acutely wounded trauma patients, but the 2 groups are very different patient populations. While most trauma patients are young, healthy, and well-nourished before injury, the chronic wound patient is usually old, with comorbidities and frequently malnourished...
September 2016: Plastic and Reconstructive Surgery
Shaunak S Adkar, Ryan S Turley, Ehsan Benrashid, Sandhya Lagoo, Cynthia K Shortell, Leila Mureebe
OBJECTIVE: The initiation of bundled payment for care improvement (BPCI) by Centers for Medicare & Medicaid Services (CMS) has led to increased financial and performance accountability. As the majority of vascular surgery patients are elderly and reimbursed via CMS, improving their outcomes will be critical for durable financial stability. As a first step in forming a multi-disciplinary pathway for the elderly vascular patient, we sought to identify modifiable perioperative variables in geriatric patients undergoing lower extremity arterial bypass (LEB)...
August 12, 2016: Annals of Vascular Surgery
F Vogt, S Wicklein, K Singler, S Pfeiffer, T Fischlein, J Schwab, M Pauschinger, J Jessl
The treatment of severe symptomatic aortic valve stenosis by conventional aortic valve replacement (AVR) or by transcatheter aortic valve implantation (TAVI) has a good perinterventional prognosis even for patients of advanced age. Having a heart team select the best management strategies based on current guidelines for each individual patient is essential for success. Especially in elderly and increasingly multimorbid patients with sometimes severe preconditions, the detection of functional deficits is relevant not only for the mortality but also for perioperative and postoperative complications as well as the functional outcome...
October 2016: Zeitschrift Für Gerontologie und Geriatrie
Nicoleta Stoicea, Ramya Baddigam, Jennifer Wajahn, Angela C Sipes, Carlos E Arias-Morales, Nicholas Gastaldo, Sergio D Bergese
The elderly population in the United States is increasing exponentially in tandem with risk for frailty. Frailty is described by a clinically significant state where a patient is at risk for developing complications requiring increased assistance in daily activities. Frailty syndrome studied in geriatric patients is responsible for an increased risk for falls, and increased mortality. In efforts to prepare for and to intervene in perioperative complications and general frailty, a universal scale to measure frailty is necessary...
2016: Frontiers in Public Health
Daisuke Makiura, Rei Ono, Junichiro Inoue, Miyuki Kashiwa, Taro Oshikiri, Tetsu Nakamura, Yoshihiro Kakeji, Yoshitada Sakai, Yasushi Miura
OBJECTIVES: The number of geriatric patients with esophageal cancer has been increasing. Geriatric syndromes such as sarcopenia might adversely affect postoperative recovery. The aim of this study was to evaluate the relationships between sarcopenia and postoperative complications, and the associations between sarcopenia and perioperative functional changes in patients with esophageal cancer following esophagectomy. MATERIALS AND METHODS: Participants comprised 104 patients who underwent esophagectomy from July 2011 to April 2015...
July 21, 2016: Journal of Geriatric Oncology
Ross Coomber, Matthew Porteous, Matthew J W Hubble, Martyn J Parker
When treating a hip fracture with a total hip replacement (THR) the surgical technique may differ in a number of aspects in comparison to elective arthroplasty. The hip fracture patient is more likely to have poor bone stock secondary to osteoporosis, be older, have a greater number of co-morbidities, and have had limited peri-operative work-up. These factors lead to a higher risk of complications, morbidity and perioperative mortality. Consideration should be made to performing the THR in a laminar flow theatre, by a surgeon experienced in total hip arthroplasty, using an anterolateral approach, cementing the implant in place, using a large head size and with repair of the joint capsule...
October 2016: Injury
Qiang Wang, Zhu Zhang, Shiyan Zhang, Shirun Chen
OBJECTIVE: To review and analyze the risk factors of postoperative surgical site infection (SSI) in geriatric patients who undergo surgical treatment of oral squamous cell carcinoma. METHODS: A retrospective study was conducted on 143 geriatric patients who have undergone surgical treatment of oral squamous cell carcinoma. Factors were classified into four types, namely, characteristics, tumor factors, general comorbidity factors, and perioperative factors. The primary outcome variable was the presence of SSI...
April 2016: Hua Xi Kou Qiang Yi Xue za Zhi, Huaxi Kouqiang Yixue Zazhi, West China Journal of Stomatology
Elisa R Trowbridge, Dahea Kim, Kathryn Barletta, Victoria Fitz, Sarah Larkin, Kathie L Hullfish
BACKGROUND: Impaired cognition has been correlated with adverse postoperative outcomes, such as an increased incidence of delirium, a longer length of hospital stay, and higher 6 month mortality. The incidence of cognitive impairment in the elderly is high. Per the Centers for Disease Control and Prevention, 1 in 8 adults aged 60 years and older deal with memory loss and confusion, and less than 20% inform their health care providers. Most studies in the elderly or cognitively impaired have been conducted at Veterans Administration hospitals, in which the majority of patients are male...
June 16, 2016: American Journal of Obstetrics and Gynecology
A Probst, N Reimers, A Hecht, R Langenhan
Background: Perioperative infection prophylaxis with cephalosporins is standard in surgical treatment of proximal femoral fractures (PFF). Geriatric patients (pat.) are at risk of chronic infections and the bacteria from these can lead to unknown hygienic problems in an early operation. We therefore characterised the colonisation of the urinary tract in pat. (≥ 65 years) with PFF and observed bacterial development in deep wound infections over a period of 10 years. The aim was to discover gaps in perioperative infection prophylaxis...
June 13, 2016: Zeitschrift Für Orthopädie und Unfallchirurgie
G Kastanis, A Topalidou, K Alpantaki, M Rosiadis, K Balalis
Hip fractures are the second cause of hospitalization in geriatric patients. The American Society of Anesthesiologists (ASA) classification scheme is a scoring system for the evaluation of the patients' health and comorbidities before an operative procedure. The purpose of this study was to determine whether the ASA score is a predictive factor for perioperative and postoperative complications and a cause of readmission of geriatric patients with hip fractures. The study included 198 elderly patients. The mean values of hospitalization were 6...
2016: Scientifica
L Pearce, J Bunni, K McCarthy, J Hewitt
Introduction Many older surgical patients are exposed to high risks of morbidity and mortality when undergoing both elective and emergency surgery. Methods We provide an overview of perioperative care teams and the educational opportunities available to surgeons who undertake surgery in the older person. Findings The number of older people undergoing surgery is increasing at a rate faster than the proportion of older people in the overall population. Management of the older surgical patient throughout the surgical pathway forms part of the Specialty Training Curriculum for Geriatric Medicine...
July 2016: Annals of the Royal College of Surgeons of England
Thomas J Luger, Markus F Luger
Elderly patients increasingly need to undergo surgery under anesthesia, especially following trauma. A timely interdisciplinary approach to the perioperative management of these patients is decisive for the long-term outcome. Orthogeriatric co-management, which includes geriatricians and anesthesiologists from an early stage, is of great benefit for geriatric patients. Patient age, comorbidities and self-sufficiency in activities of daily life are decisive for an anesthesiological assessment of the state of health and preoperative risk stratification...
April 2016: Zeitschrift Für Gerontologie und Geriatrie
Tsutomu Kawaguchi, Shuhei Komatsu, Daisuke Ichikawa, Y U Kimura, Sousuke Komiyama, Hiroo Konishi, Shuichi Kin, Sadao Kawakami, Toshiyuki Kosuga, Kazuma Okamoto, Eigo Otsuji
BACKGROUND: The proportion of geriatric gastric cancer (GC) patients with comorbidities has been increasing in Japan. This study was designed to evaluate the prognostic influence of the extent of lymph node dissection (END) and perioperative morbidities in patients with GC. PATIENTS AND METHODS: Between 2008 and 2013, total of 167 patients with GC who underwent curative gastrectomy were enrolled in the study. Clinicopathological findings including the END and perioperative morbidities were analyzed...
April 2016: Anticancer Research
Sanjay Mohanty, Ronnie A Rosenthal, Marcia M Russell, Mark D Neuman, Clifford Y Ko, Nestor F Esnaola
No abstract text is available yet for this article.
May 2016: Journal of the American College of Surgeons
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