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Frailty and 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
Saeid Safiri, Hossein Safari, Mostafa Qorbani
No abstract text is available yet for this article.
February 2018: World Neurosurgery
D Wagner, K Marsoner, A Tomberger, J Haybaeck, J Haas, G Werkgartner, H Cerwenka, H Bacher, H J Mischinger, P Kornprat
INTRODUCTION: Low skeletal muscle mass is a known predictor of morbidity and mortality in patients undergoing major pancreatic surgeries. We sought to combine low skeletal muscle mass with established risk predictors to improve their prognostic capacity for postoperative outcome and morbidity. METHODS: As established parameters to predict preoperative mortality risk for patients, the ASA classification and the Charlson Comorbidity Index (CCI) were used. The Hounsfield Units Average Calculation (HUAC) was measured to define low skeletal muscle mass in 424 patients undergoing pancreatic resections for malignancies...
February 7, 2018: European Journal of Surgical Oncology
Jun Lu, Hua-Long Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Qi-Yue Chen, Long-Long Cao, Mi Lin, Ru-Hong Tu, Chang-Ming Huang, Chao-Hui Zheng
BACKGROUND: The proportion of elderly patients who undergo surgery has rapidly increased. However, clinical indicators that predict outcomes are limited. Frailty is thought to estimate physiological reserves, although its use has not been evaluated in laparoscopic surgical patients. This study aimed to evaluate the significance of preoperative modified frailty index (PMFI) in octogenarians undergoing a laparoscopic gastrectomy. METHODS: We reviewed prospectively collected data from 119 patients with gastric cancer (GC) aged 80 years or older who underwent a radical laparoscopic gastrectomy (RLG) between January 2007 and December 2012...
February 8, 2018: Surgical Endoscopy
Lesley B Conrad, Haitham Awdeh, Stefany Acosta-Torres, Steven A Conrad, April A Bailey, David S Miller, Jayanthi S Lea
BACKGROUND AND OBJECTIVES: Age and frailty have been correlated with poor clinical outcomes in cancer. Core muscle index (CMI) and nutritional status are integral in assessing frailty. We explored the effect of pre-operative serum albumin and body composition on clinical outcomes in patients with epithelial ovarian cancer (EOC). METHODS: We identified stage III-IV EOC patients undergoing primary cytoreductive surgery from 2007 to 2015. Data were abstracted from medical records...
February 6, 2018: Journal of Surgical Oncology
Arudo Hiraoka, Kazuya Saito, Genta Chikazawa, Toshinori Totsugawa, Kentaro Tamura, Atsuhisa Ishida, Taichi Sakaguchi, Hidenori Yoshitaka
OBJECTIVES: The aim of this study was to seek a new predictor of mid-term survival of surgical total aortic arch replacement (SAR) by evaluating indices relevant to frailty. METHODS: Between October 2012 and March 2017, 113 consecutive patients underwent elective surgical total aortic arch replacement with antegrade cerebral perfusion under circulatory arrest at a single cardiovascular institute. In addition to common parameters, Katz index of activities of daily living, nutritional status, skeletal muscle mass volume, swallowing and motor functions were used to evaluate patients' frailty...
February 2, 2018: European Journal of Cardio-thoracic Surgery
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