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Geriatric surgery

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https://www.readbyqxmd.com/read/28742701/postoperative-delirium-as-a-target-for-surgical-quality-improvement
#1
Julia R Berian, Lynn Zhou, Marcia M Russell, Melissa A Hornor, Mark E Cohen, Emily Finlayson, Clifford Y Ko, Ronnie A Rosenthal, Thomas N Robinson
OBJECTIVE: To explore hospital-level variation in postoperative delirium using a multi-institutional data source. BACKGROUND: Postoperative delirium is closely related to serious morbidity, disability, and death in older adults. Yet, surgeons and hospitals rarely measure delirium rates, which limits quality improvement efforts. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Geriatric Surgery Pilot (2014 to 2015) collects geriatric-specific variables, including postoperative delirium using a standardized definition...
July 24, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28741427/receptor-activator-of-nuclear-factor-kappa-b-ligand-rankl-induced-local-osteoporotic-canine-mandible-model-for-the-evaluation-of-peri-implant-bone-regeneration
#2
Chang Ah Ryum, Tae Hyung Cho, Soon Jung Hwang
The canine mandible is useful for studying bone regeneration after dental implant placement. However, it is limited in investigations of peri-implant osteogenesis under osteoporotic conditions due to the insignificant osteoporotic effect of ovariectomy. This study aimed to establish a local osteoporotic model without ovariectomy using receptor activator of nuclear factor kappa-B ligand (RANKL) in a canine mandible model. This new model was used to evaluate the effects of injectable β-tricalcium phosphate microsphere bone grafts (TCP) on peri-implant bone regeneration under osteoporotic conditions with combinations of human recombinant bone morphogenetic protein-2 (rhBMP-2)...
July 25, 2017: Tissue Engineering. Part C, Methods
https://www.readbyqxmd.com/read/28741396/intraoperative-nerve-monitoring-reduces-recurrent-laryngeal-nerve-injury-in-geriatric-patients-undergoing-thyroid-surgery
#3
Huang Kai, Lin Xixia, Long Miaoyun, Chen Qinchang, Peng Xinzhi, Luo Dingyuan, Li Honghao
OBJECTIVE: This research was aimed to investigate whether the intraoperative nerve monitoring (IONM) can reduce the incidence of recurrent laryngeal nerve (RLN) injury in geriatric patients undergoing thyroid surgery. METHODS: This retrospective cohort study included 522 geriatric patients undergoing thyroid surgery between January 2013 and June 2016 in the Sun Yat-sen Memorial Hospital. Patients with IONM during the surgery (n = 340) were compared with patients without IONM (n = 212)...
July 25, 2017: Acta Oto-laryngologica
https://www.readbyqxmd.com/read/28739158/assessment-and-management-of-radiotherapy-induced-toxicity-in-older-patients
#4
Anita O'Donovan, Michelle Leech, Charles Gillham
Radiotherapy is an attractive treatment option for older adults, especially where surgery and chemotherapy pose too great a risk. Radiotherapy toxicity may be divided into acute/early and late effects of treatment. The latter may have limited relevance to an older patient with competing causes of mortality due to significant comorbidity. Altered fractionation regimes have been employed in numerous sites, with no significant toxicity impact. These offer greater convenience in the elderly, especially those with limited social support or in active caregiving roles...
July 21, 2017: Journal of Geriatric Oncology
https://www.readbyqxmd.com/read/28734776/a-preoperative-score-to-predict-early-death-after-pancreatic-cancer-resection
#5
Gianpaolo Balzano, Erica Dugnani, Stefano Crippa, Marina Scavini, Valentina Pasquale, Francesca Aleotti, Daniela Liberati, Alessandra Gandolfi, Giulio Belfiori, Michele Reni, Claudio Doglioni, Giacomo Ruffo, Cristina Marmorale, Massimo Falconi, Lorenzo Piemonti
BACKGROUND: This study aimed to develop and validate a preoperative prognostic model for death within one year post-surgery in patients with resectable pancreatic ductal adenocarcinoma (PDAC). METHODS: A derivation cohort study of 296 patients who underwent surgical resection of PDAC was prospectively enrolled in an observational study. Preoperative predictors of one year mortality were used to develop a risk score which was then validated in an external cohort of 182 patients with resectable PDAC...
July 1, 2017: Digestive and Liver Disease
https://www.readbyqxmd.com/read/28733982/postoperative-complications-in-individuals-aged-70-and-over-undergoing-elective-surgery-for-colorectal-cancer
#6
Katleen Fagard, Julie Casaer, Albert Wolthuis, Johan Flamaing, Koen Milisen, Jean-Pierre Lobelle, Hans Wildiers, Cindy Kenis
AIM: This study aims to describe the nature, incidence, severity and outcomes of in-hospital postoperative complications (POCs) in older patients undergoing elective surgery for colorectal cancer (CRC).. METHOD: Patients were identified from a prospectively collected database (2009-2015) focusing on the implementation of geriatric screening and assessment in patients with cancer. Medical and surgical POCs were retrieved retrospectively from the medical records, and the severity of the POCs was graded by the Clavien-Dindo (CD) grading system...
July 22, 2017: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
https://www.readbyqxmd.com/read/28733108/first-line-management-of-distal-humerus-fracture-by-total-elbow-arthroplasty-in-geriatric-traumatology-results-in-a-21-patient-series-at-a-minimum-2-years-follow-up
#7
D Lami, M Chivot, A Caubere, A Galland, J N Argenson
INTRODUCTION: Total elbow arthroplasty (TEA) is one option in distal humerus fracture in elderly osteoporotic patients. HYPOTHESIS: The study hypothesis was that, in patients aged 70 years or more,TEA provides functional results and ranges of motion compatible with everyday activity, with a complications rate equal to or lower than with internal fixation, and no loss of autonomy or cognitive impairment. MATERIALAND METHODS: In this retrospective study, 21 patients receiving TEA for distal humerus fracture were included...
July 18, 2017: Orthopaedics & Traumatology, Surgery & Research: OTSR
https://www.readbyqxmd.com/read/28717977/-challenges-of-implementing-a-geriatric-trauma-network-a-regional-structure
#8
Carsten Schoeneberg, Bjoern Hussmann, Thomas Wesemann, Ludger Pientka, Marie-Christin Vollmar, Christine Bienek, Markus Steinmann, Benjamin Buecking, Sven Lendemans
BACKGROUND: At present, there is a high percentage and increasing tendency of patients presenting with orthogeriatric injuries. Moreover, significant comorbidities often exist, requiring increased interdisciplinary treatment. These developments have led the German Society of Trauma Surgery, in cooperation with the German Society of Geriatrics, to establish geriatric trauma centers. METHODS: As a conglomerate hospital at two locations, we are cooperating with two external geriatric clinics...
July 17, 2017: Der Unfallchirurg
https://www.readbyqxmd.com/read/28715824/preoperative-geriatric-assessment-reduced-hospital-stay-and-complications-in-patients-%C3%A2-%C3%A2-65-y-having-vascular-surgery
#9
Harrison G Weed
No abstract text is available yet for this article.
July 18, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28705182/chemoradiation-in-elderly-esophageal-cancer-patients-rationale-and-design-of-a-phase-i-ii-multicenter-study-osage
#10
Stéphanie Servagi-Vernat, Gilles Créhange, Franck Bonnetain, Cécile Mertens, Etienne Brain, Jean François Bosset
BACKGROUND: The management of elderly patients with cancer is a therapeutic challenge and a public health problem. Definitive chemoradiotherapy (CRT) is an accepted standard treatment for patients with locally advanced esophageal cancer who cannot undergo surgery. However, there are few reports regarding tolerance to CRT in elderly patients. We previously reported results for CRT in patients aged ≥75 years. Following this first phase II trial, we propose to conduct a phase I/II study to evaluate the combination of carboplatin and paclitaxel, with concurrent RT in unresectable esophageal cancer patients aged 75 years or older...
July 13, 2017: BMC Cancer
https://www.readbyqxmd.com/read/28699223/outcomes-of-head-and-neck-cancer-surgery-in-the-geriatric-population-based-on-case-volume-at-academic-centers
#11
Scharukh Jalisi, Samuel J Rubin, Kevin Y Wu, Diana N Kirke
OBJECTIVES/HYPOTHESIS: Evaluate the impact of case volume and other variables on cost and mortality after head and neck oncologic surgery in the geriatric population. STUDY DESIGN: Cross-sectional study. METHODS: The Vizient database was accessed for data on geriatric patients (age ≥65 years) who underwent surgery for head and neck cancers (excluding thyroid and skin cancer) at full member academic medical centers between 2009 and 2012. Multivariate, linear regression analyses, χ(2) tests, and analysis of variance were applied to evaluate significant associations between hospital case volume and independent variables including cost, cost index, mortality, mortality index, length of stay, length of stay index, and readmission rates...
July 12, 2017: Laryngoscope
https://www.readbyqxmd.com/read/28698343/protocol-for-an-observational-study-of-delirium-in-the-post-anaesthesia-care-unit-pacu-as-a-potential-predictor-of-subsequent-postoperative-delirium
#12
Victoria Cui, Catherine M Tedeschi, Vanessa L Kronzer, Sherry L McKinnon, Michael S Avidan
INTRODUCTION: Postoperative delirium can be a serious consequence of major surgery, associated with longer hospital stays, readmission, cognitive and functional deterioration and mortality. Delirium is an acute, reversible disorder characterised by fluctuating course, inattention, disorganised thinking and altered level of consciousness. Delirium occurring in the hours immediately following anaesthesia and delirium occurring in the postoperative period of 1-5 days have been described as distinct clinical entities...
July 10, 2017: BMJ Open
https://www.readbyqxmd.com/read/28697074/repair-of-bimalleolar-ankle-fracture
#13
Nina Fisher, Abiola Atanda, Stephanie Swensen, Kenneth A Egol
PURPOSE: The incidence of ankle fractures is rapidly increasing in geriatric populations. Of the 4 fracture patterns described by the Lauge-Hansen classification system, supination-external rotation (SER) accounts for most ankle fractures. This video demonstrates surgical repair of a SER type 4 ankle fracture in a geriatric patient. METHODS: SER type 4 ankle fractures are considered unstable and are generally treated with surgical fixation. After placement of plate and screws, intraoperative stress tests can be used to assess for syndesmotic widening...
August 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28693934/frailty-in-older-adults-undergoing-aortic%C3%A2-valve-replacement-the-frailty-avr-study
#14
Jonathan Afilalo, Sandra Lauck, Dae H Kim, Thierry Lefèvre, Nicolo Piazza, Kevin Lachapelle, Giuseppe Martucci, Andre Lamy, Marino Labinaz, Mark D Peterson, Rakesh C Arora, Nicolas Noiseux, Andrew Rassi, Igor F Palacios, Philippe Généreux, Brian R Lindman, Anita W Asgar, Caroline A Kim, Amanda Trnkus, José A Morais, Yves Langlois, Lawrence G Rudski, Jean-Francois Morin, Jeffrey J Popma, John G Webb, Louis P Perrault
BACKGROUND: Frailty is a geriatric syndrome that diminishes the potential for functional recovery after a transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) procedure; however, its integration in clinical practice has been limited by a lack of consensus on how to measure it. OBJECTIVES: This study sought to compare the incremental predictive value of 7 different frailty scales to predict poor outcomes following TAVR or SAVR...
July 1, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28685198/-geriatric-urology-increasingly-important-in-urological-care
#15
REVIEW
A Wiedemann
Urology will benefit by demographic change more than other disciplines in the next 10 years. Both number of patients and their intensity of treatment will increase. This implies the need of a reorientation of urology away from oncologic topics towards geriatric urology. Relevant issues are functional disorders of the lower urinary tract, infectiology, hematuria, and benign prostate hyperplasia. The legislature of North Rhine-Westphalia has already made the first step towards geriatric urology by the foundation of the ISAR screening for each geriatric patient outside geriatrics, which constitutes the possibility of beginning an early interdisciplinary dialogue...
July 6, 2017: Der Urologe. Ausg. A
https://www.readbyqxmd.com/read/28675571/five-year-survival-after-surgery-in-nonagenarian-patients
#16
Roberto Fariña-Castro, Cristina Roque-Castellano, Joaquín Marchena-Gómez, Aurelio Rodríguez-Pérez
AIM: In countries with longer life expectancies, the nonagenarian population is increasing. Therefore, there is greater demand for healthcare, including surgical procedures. The aim of the present study was to determine the outcomes of surgery carried out on nonagenarians in terms of long-term survival after the procedure. METHODS: We carried out a cross-longitudinal study on a cohort of 159 nonagenarian patients, who underwent a non-cardiac, non-traumatic surgical procedure in our institution between January 1999 and December 2011...
July 4, 2017: Geriatrics & Gerontology International
https://www.readbyqxmd.com/read/28666049/does-preoperative-pneumonia-affect-complications-of-geriatric-hip-fracture-surgery
#17
Joseph T Patterson, Daniel D Bohl, Bryce A Basques, Alexander H Arzeno, Jonathan N Grauer
Preoperative pneumonia, reported in 0.3% to 3.2% of hip fracture patients, may be a risk factor for adverse outcomes of hip fracture repair. No studies have reported on baseline differences or adverse outcomes in surgically managed geriatric hip fracture patients with and without preoperative pneumonia, and no data argue for or against delaying surgery in these patients. A retrospective cohort of geriatric patients with operatively treated hip fractures from 2005 to 2012 was identified in the National Surgical Quality Improvement Program database...
May 2017: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28655864/early-surgery-for-hong-kong-chinese-elderly-patients-with-hip-fracture-reduces-short-term-and-long-term-mortality
#18
S Kk Liu, A Wh Ho, S H Wong
INTRODUCTION: Studies have shown that early surgery reduces hospital and 1-year mortality in elderly patients with hip fracture, but no major study has examined such relationship in Hong Kong. This study aimed to explore the relationship of early surgery and mortality in a Chinese elderly population with hip fracture. METHODS: This observational study included patients attending public hospitals in Hong Kong. All patients who underwent surgery for geriatric hip fracture in public hospitals from January 2000 to December 2011 were studied...
June 28, 2017: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
https://www.readbyqxmd.com/read/28654541/caring-for-older-surgical-patients-contemporary-attitudes-knowledge-practices-and-needs-of-general-surgeons-and-residents
#19
Tyler R Chesney, George Pang, Najma Ahmed
OBJECTIVE: To gain contemporary insights from residents and surgeons regarding the care of older surgical patients. BACKGROUND DATA: With worldwide aging, efforts over the past decade have attempted to increase surgeons' abilities to care for older adults, but a current understanding of attitudes, knowledge, practices, and needs is missing. METHODS: Between July 2016 and September 2016 we conducted a national Web-based survey sampling all general surgery residents and academic general surgeons using a questionnaire designed and tested for this purpose...
June 26, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28649755/preoperative-geriatric-assessment-and-tailored-interventions-in-frail-older-patients-with-colorectal-cancer-a-randomised-controlled-trial
#20
Nina Ommundsen, Torgeir B Wyller, Arild Nesbakken, Arne O Bakka, Marit S Jordhøy, Eva Skovlund, Siri Rostoft
BACKGROUND: Colorectal cancer (CRC) is prevalent in the older population, and surgery is the mainstay in curative treatment. A preoperative geriatric assessment (GA) can identify frail older patients at risk for developing postoperative complications. In this randomised controlled trial we wanted to investigate whether tailored interventions based on a preoperative GA could reduce the frequency of postoperative complications in frail patients operated for CRC. METHODS: Patients >65 years scheduled for elective CRC surgery and fulfilling predefined criteria for frailty were randomised to either a preoperative GA followed by a tailored intervention, or care as usual...
June 26, 2017: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
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