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Geriatric Perioperative

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https://www.readbyqxmd.com/read/28216064/internal-fixation-of-acetabular-fractures-in-an-older-population-using-the-timi-approach-midterm-results-of-a-prospective-study
#1
Rene Aigner, Ralf Hellige, Sabine Knippel, Ludwig Oberkircher, Steffen Ruchholtz, Benjamin Buecking
INTRODUCTION: The incidence of geriatric acetabular fractures continues to increase due to demographic changes. In the elderly, anterior column fractures are common, and standard approaches are associated with a considerable risk for surgery-associated complications. Therefore, a minimally invasive approach was developed in our department. The aim of this study was to examine early and mid-term results regarding the use of this novel two-incision minimally invasive (TIMI) approach in patients aged over 55 years with acetabular fractures...
February 3, 2017: Injury
https://www.readbyqxmd.com/read/28207554/isolated-cardiac-troponin-rise-does-not-modify-the-prognosis-in-elderly-patients-with-hip-fracture
#2
Hélène Vallet, Alice Breining, Yannick Le Manach, Judith Cohen-Bittan, Anthony Mézière, Mathieu Raux, Marc Verny, Bruno Riou, Frédéric Khiami, Jacques Boddaert
Perioperative myocardial infarction remains a life-threatening complication in noncardiac surgery and even an isolated troponin rise (ITR) is associated with significant mortality. Our aim was to assess the prognostic value of ITR in elderly patients with hip fracture.In this cohort study, all patients admitted between 2009 and 2013 in our dedicated geriatric postoperative unit after hip fracture surgery with a cardiac troponin I determination were included and divided into Control, ITR, and acute coronary syndrome (ACS) groups...
February 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28194414/acetabular-fractures-in-the-elderly-midterm-outcomes-of-column-stabilisation-and-primary-arthroplasty
#3
A Ortega-Briones, S Smith, M Rickman
Background. Interest in arthroplasty techniques for periarticular or intra-articular fractures in the elderly/osteoporotic patient continues to rise, including for geriatric acetabular fractures. In line with this, many acetabular fracture surgeons are now undertaking acute total hip arthroplasty in elderly/osteoporotic patients. Little is known however of the outcomes of this procedure, beyond the first year after surgery. Questions/Purposes. We determined the clinical outcomes of a series of elderly osteoporotic patients (mean age at surgery 77...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28134674/clostridium-difficile-infection-an-orthopaedic-surgeon-s-guide-to-epidemiology-management-and-prevention
#4
Paul A Anderson, James Bernatz, Nasia Safdar
Clostridium difficile infection is a growing concern in health care and is a worrisome complication in orthopaedics. The incidence and severity of this infection are increasing, although the incidence following orthopaedic surgery is comparatively lower than that seen in patients in most other surgical specialties. The typical geriatric orthopaedic patient may have many risk factors that increase the likelihood of C difficile infection, including advanced age, residence in a long-term care facility, multiple comorbidities, the use of perioperative antibiotics, and a long length of stay...
March 2017: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/28062326/the-impact-of-comorbidity-on-surgical-outcomes-in-older-adults-with-cancer
#5
REVIEW
Virginia Sun, Peggy S Burhenn, Lily Lai, Arti Hurria
OBJECTIVES: To provide an overview of the impact of comorbidity on surgical outcomes and postoperative geriatric events in older adults with cancer, and review key components of quality perioperative nursing care of older adults with cancer. DATA SOURCES: Journal articles, research reports, state of the science papers, position papers, and clinical guidelines from professional organizations. CONCLUSION: The high prevalence of multiple comorbidities and the associated burden of geriatric events in older adults after cancer surgery have a substantial impact on surgical outcomes, quality of life, and health care costs...
February 2017: Seminars in Oncology Nursing
https://www.readbyqxmd.com/read/28061830/age-nutrition-chirugie-anc-study-impact-of-a-geriatric-intervention-on-the-screening-and-management-of-undernutrition-in-elderly-patients-operated-on-for-colon-cancer-a-stepped-wedge-controlled-trial
#6
Marine Dupuis, Elisabetta Kuczewski, Laurent Villeneuve, Sylvie Bin-Dorel, Max Haine, Claire Falandry, Thomas Gilbert, Guillaume Passot, Olivier Glehen, Marc Bonnefoy
BACKGROUND: Undernutrition prior to major abdominal surgery is frequent and increases morbidity and mortality, especially in older patients. The management of undernutrition reduces postoperative complications. Nutritional management should be a priority in patient care during the preoperative period. However undernutrition is rarely detected and the guidelines are infrequently followed. Preoperative undernutrition screening should allow a better implementation of the guidelines. METHODS/DESIGN: The ANC ("Age Nutrition Chirurgie") study is an interventional, comparative, prospective, multicenter, randomized protocol based on the stepped wedge trial design...
January 7, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/27999879/-perioperative-patient-management-in-orthogeriatrics
#7
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/27997467/functional-outcomes-of-operative-management-of-scapula-fractures-in-a-geriatric-cohort
#8
Peter A Cole, Jeffrey A Gilbertson, Peter A Cole
OBJECTIVES: To analyze functional outcomes, motion, and strength in patients 65 years of age and older who underwent operative management of a scapula fracture. DESIGN: Retrospective review of prospective database. SETTING: A single level-1 teaching trauma center. PATIENTS/PARTICIPANTS: Two hundred fifty patients with scapula fractures were operated between January 2002 and March 2014. A review identified 16 geriatric patients 65 years of age and older...
January 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/27986531/patient-function-and-the-value-of-surgical-care-for-kidney-cancer
#9
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/27977443/anterior-versus-posterior-approaches-for-odontoid-fracture-stabilization-in-patients-older-than-65-years-30-day-morbidity-and-mortality-in-a-national-database
#10
Joseph T Patterson, Alexander A Theologis, David Sing, Bobby Tay
STUDY DESIGN: Retrospective cohort analysis. OBJECTIVE: To compare 30-day perioperative clinical outcomes of surgical odontoid stabilization by an anterior or posterior operative approach in elderly patients. SUMMARY OF BACKGROUND DATA: Surgical stabilization of odontoid fractures is superior to nonoperative management in geriatric patients. How elderly patients with odontoid fractures fare after anterior and posterior approaches, however, is not well defined...
December 13, 2016: Clinical Spine Surgery
https://www.readbyqxmd.com/read/27903336/-the-development-of-geriatric-anesthesia-in-china-based-on-the-concept-of-perioperative-medicine
#11
T L Wang, D X Wang
No abstract text is available yet for this article.
November 22, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/27785425/how-to-optimally-manage-elderly-bladder-cancer-patients
#12
REVIEW
Francesco Soria, Marco Moschini, Stephan Korn, Shahrokh F Shariat
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...
October 2016: Translational Andrology and Urology
https://www.readbyqxmd.com/read/27672318/nutritional-intervention-in-cognitively-impaired-geriatric-trauma-patients-a-feasibility-study
#13
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
https://www.readbyqxmd.com/read/27664167/relationship-of-prolonged-operative-time-and-comorbidities-with-complications-after-geriatric-ankle-fractures
#14
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...
January 2017: Foot & Ankle International
https://www.readbyqxmd.com/read/27622718/frailty-aging-and-cardiovascular-surgery
#15
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
https://www.readbyqxmd.com/read/27594990/preoperative-discussion-with-patients-about-delirium-risk-are-we-doing-enough
#16
EDITORIAL
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
https://www.readbyqxmd.com/read/27579814/total-hip-and-knee-arthroplasty-in-patients-older-than-age-80-years
#17
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
https://www.readbyqxmd.com/read/27561640/perioperative-inflammatory-response-in-major-fracture-do-geriatric-patients-behave-differently
#18
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
https://www.readbyqxmd.com/read/27556777/nutrition-and-chronic-wounds-improving-clinical-outcomes
#19
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
https://www.readbyqxmd.com/read/27531088/perioperative-optimization-of-geriatric-lower-extremity-bypass-in-the-era-of-increased-performance-accountability
#20
COMPARATIVE STUDY
Shaunak S Adkar, Ryan S Turley, Ehsan Benrashid, Sandhya Lagoo, Cynthia K Shortell, Leila Mureebe
BACKGROUND: The initiation of bundled payment for care improvement by Centers for Medicare and Medicaid Services (CMS) has led to increased financial and performance accountability. As most 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 multidisciplinary pathway for the elderly vascular patients, we sought to identify modifiable perioperative variables in geriatric patients undergoing lower extremity bypass (LEB)...
January 2017: Annals of Vascular Surgery
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