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Frailty and surgery

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https://www.readbyqxmd.com/read/28616346/emergent-aortic-surgery-in-octogenarians-is-the-advanced-age-a-contraindication
#1
REVIEW
Mario Castaño, Javier Gualis, Jose M Martínez-Comendador, Elio Martín, Pasquale Maiorano, Laura Castillo
Surgery of both the ascending and descending aortic segments in the context of an acute aortic syndrome is one of the greatest challenges for the cardiac surgeon. In the case of surgery of the descending aorta, surgical risk increases due to the technical complexity, the required aggressive approach and because surgical indication is usually established as a result of complications and therefore involves, almost always, critically ill patients. The aging of the population is causing such surgery to be considered in an increasing number of octogenarians...
May 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28602153/frailty-as-a-predictor-of-mortality-in-the-elderly-emergency-general-surgery-patient
#2
Jens Goeteyn, Louis A Evans, Siem De Cleyn, Sigrid Fauconnier, Caroline Damen, Jonathan Hewitt, Wim Ceelen
BACKGROUND: The number of surgical procedures performed in elderly and frail patients has greatly increased in the last decades. However, there is little research in the elderly emergency general surgery patient. The aim of this study was to assess the prevalence of frailty in the emergency general surgery population in Belgium. Secondly, we examined the length of hospital stay, readmission rate and mortality at 30 and 90 days. METHODS: We conducted a prospective observational study at Ghent University Hospital...
June 10, 2017: Acta Chirurgica Belgica
https://www.readbyqxmd.com/read/28592272/betaine-promotes-cell-differentiation-of-human-osteoblasts-in-primary-culture
#3
Isabella Villa, Pamela Senesi, Anna Montesano, Anita Ferraretto, Fernanda Vacante, Alice Spinello, Michela Bottani, Simona Bolamperti, Alessandro Rubinacci, Livio Luzi, Ileana Terruzzi
BACKGROUND: Betaine (BET), a component of many foods, is an essential osmolyte and a source of methyl groups; it also shows an antioxidant activity. Moreover, BET stimulates muscle differentiation via insulin like growth factor I (IGF-I). The processes of myogenesis and osteogenesis involve common mechanisms with skeletal muscle cells and osteoblasts sharing the same precursor. Therefore, we have hypothesized that BET might be effective on osteoblast cell differentiation. METHODS: The effect of BET was tested in human osteoblasts (hObs) derived from trabecular bone samples obtained from waste material of orthopedic surgery...
June 7, 2017: Journal of Translational Medicine
https://www.readbyqxmd.com/read/28589402/the-preoperative-assessment-and-optimization-of-patients-undergoing-major-urological-surgery
#4
REVIEW
Helen W Cui, Benjamin W Turney, John Griffiths
PURPOSE OF REVIEW: Improving patient outcomes from major urological surgery requires not only advancement in surgical technique and technology, but also the practice of patient-centered, multidisciplinary, and integrated medical care of these patients from the moment of contemplation of surgery until full recovery. This review examines the evidence for recent developments in preoperative assessment and optimization that is of relevance to major urological surgery. RECENT FINDINGS: Current perioperative medicine recommendations aim to improve the short-term safety and long-term effectiveness of surgical treatments by the delivery of multidisciplinary integrated medical care...
July 2017: Current Urology Reports
https://www.readbyqxmd.com/read/28587892/the-modified-frailty-index-to-predict-morbidity-and-mortality-for-retroperitoneal-sarcoma-resections
#5
Jiwon Sarah Park, Sarah B Bateni, Richard J Bold, Amanda R Kirane, Daniel J Canter, Robert J Canter
BACKGROUND: The modified frailty index (mFI) is an important method to risk-stratify surgical patients and has been validated for general surgery and selected surgical subspecialties. However, there are currently no data assessing the efficacy of the mFI to predict acute morbidity and mortality in patients undergoing surgery for retroperitoneal sarcoma. METHODS: Using the American College of Surgeons' National Surgical Quality Improvement Program from 2007 to 2012, we performed a retrospective analysis of patients with a diagnosis of primary malignant retroperitoneal neoplasm who underwent surgical resection...
May 11, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28561149/-preoperative-evaluation-and-arrangements-the-elderly-patient
#6
Cynthia Olotu-Steffen, Simone Gurlit, Rainer Kiefmann
With a constantly growing portion of elderly within our population and the advances of modern medicine, surgery on aged and very aged patients has become a daily hospital routine. Due to the physical and mental features of ageing these patients face special perioperative risks. They display a higher rate of complications, morbidity and cognitive deficits which might in the end lead to persisting need of care. Even in the healthy elderly, most organ functions are "physiologically" instable or deficient and the homeostasis of health and disease is fragile...
May 2017: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/28559045/physical-activity-and-frailty-as-indicators-of-cardiorespiratory-reserve-and-predictors-of-surgical-prognosis-general-and-digestive-surgery-population-characterization
#7
F Dana, D Capitán, M Ubré, A Hervás, R Risco, G Martínez-Pallí
INTRODUCTION: Frailty and low physical activity and cardiorespiratory reserve are related to higher perioperative morbimortality. The crucial step in improving the prognosis is to implement specific measures to optimize these aspects. It is critical to know the magnitude of the problem in order to implement preoperative optimization programmes. OBJECTIVE: To characterize surgical population in a university hospital. METHODS: All patients undergoing preoperative evaluation for abdominal surgery with admission were prospectively included during a 3-month period...
May 27, 2017: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/28527727/patient-outcomes-following-lower-leg-major-amputations-for-peripheral-arterial-disease-a-series-review
#8
Susan Monaro, Sandra West, Janice Gullick
INTRODUCTION: Despite improvements in revascularization, major amputation remains a significant part of the case-mix in vascular surgical units. These patients tend to be elderly with complex pathology, resulting in poor outcomes and longer lengths of stay (LOS). AIM: This series review provides a description of the patient complexities and outcomes in an Australian cohort undergoing major lower limb amputation for peripheral arterial disease. METHOD: Medical records coded for major amputation between July 2012 and June 2013 in an Australian government funded, tertiary hospital were retrospectively reviewed and descriptively analyzed...
June 2017: Journal of Vascular Nursing: Official Publication of the Society for Peripheral Vascular Nursing
https://www.readbyqxmd.com/read/28493165/minimally-invasive-distal-pancreatectomy-greatest-benefit-for-the-frail
#9
Ioannis T Konstantinidis, Aaron Lewis, Byrne Lee, Susanne G Warner, Yanghee Woo, Gagandeep Singh, Yuman Fong, Laleh G Melstrom
OBJECTIVE: The benefits of minimally invasive distal pancreatectomy (MIDP) over open surgery continue to be investigated. Frailty is a known predictor of postoperative outcome. We hypothesized that the benefit of minimally invasive distal pancreatectomy is the greatest for the frailest of patients. METHODS: Data from the pancreas-targeted National Surgical Quality Improvement Program (NSQIP) database for 2014 were reviewed. A modified frailty index (mFI) with 11 preoperative variables previously validated for use in NSQIP was used to determine the correlation between frailty and postoperative outcomes, including Clavien grade IV complications...
May 10, 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/28467535/association-of-the-modified-frailty-index-with-30-day-surgical-readmission
#10
Tyler S Wahl, Laura A Graham, Mary T Hawn, Joshua Richman, Robert H Hollis, Caroline E Jones, Laurel A Copeland, Edith A Burns, Kamal M Itani, Melanie S Morris
Importance: Frail patients are known to have poor perioperative outcomes. There is a paucity of literature investigating how the Modified Frailty Index (mFI), a validated measure of frailty, is associated with unplanned readmission among military veterans following surgery. Objective: To understand the association between frailty and 30-day postoperative unplanned readmission. Design, Setting, and Participants: A retrospective cohort study was conducted among adult patients who underwent surgery and were discharged alive from Veterans Affairs hospitals for orthopedic, general, and vascular conditions between October 1, 2007, and September 30, 2014, with a postoperative length of stay between 2 and 30 days...
May 3, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28462224/the-impact-of-frailty-on-mortality-after-transcatheter-aortic-valve-replacement
#11
EDITORIAL
Charat Thongprayoon, Wisit Cheungpasitporn, Kianoush Kashani
Frailty is a notably common problem in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) evaluation. Studies have demonstrated significant associations between frailty and worse outcomes in patients undergoing TAVR including higher risks of disability and mortality and admissions to long-term care facility. While there are multiple methods to identify and measure frailty, there is a critical need for a precise definition of frailty and its standardized assessment protocol based on well-established tests covering all aspects of the frailty, as a syndrome...
March 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28449296/frailty-index-intensive-care-unit-complications-in-head-and-neck-oncologic-regional-and-free-flap-reconstruction
#12
Nicholas B Abt, Yanjun Xie, Sidharth V Puram, Jeremy D Richmon, Mark A Varvares
BACKGROUND: Head and neck extirpations requiring reconstruction are challenging surgeries with high postoperative complication risk. METHODS: Regional and free flap reconstructions of head and neck defects were collected from the 2006-2013 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. The modified frailty index was made of 15 variables, with increasing index scores indicative of frailer patients. Intensive care unit (ICU)-level complications were defined by Clavien-Dindo classification IV and analyzed with multivariable logistic regression...
April 27, 2017: Head & Neck
https://www.readbyqxmd.com/read/28431425/the-association-of-frailty-with-outcomes-and-resource-use-after-emergency-general-surgery-a-population-based-cohort-study
#13
Daniel I McIsaac, Husein Moloo, Gregory L Bryson, Carl van Walraven
BACKGROUND: Older patients undergoing emergency general surgery (EGS) experience high rates of postoperative morbidity and mortality. Studies focused primarily on elective surgery indicate that frailty is an important predictor of adverse outcomes in older surgical patients. The population-level effect of frailty on EGS is poorly described. Therefore, our objective was to measure the association of preoperative frailty with outcomes in a population of older patients undergoing EGS. METHODS: We created a population-based cohort study using linked administrative data in Ontario, Canada, that included community-dwelling individuals aged >65 years having EGS...
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28411349/effect-of-low-appendicular-lean-mass-grip-strength-and-gait-speed-on-the-functional-outcome-after-surgery-for-distal-radius-fractures
#14
Young Hak Roh, Jung Ho Noh, Hyun Sik Gong, Goo Hyun Baek
Patients with low appendicular lean mass plus slow gait speed or weak grip strength are at risk for poor functional recovery after surgery for distal radius fracture, even when they have similar radiologic outcomes. INTRODUCTION: Loss of skeletal muscle mass and consequent loss in muscle function associate with aging, and this condition negatively impacts the activities of daily living and increases elderly individuals' frailty to falls. Thus, patients with low appendicular lean mass would show different functional recovery compared to those without this condition after surgery for distal radius fracture (DRF)...
December 2017: Archives of Osteoporosis
https://www.readbyqxmd.com/read/28391587/ageism-and-surgical-treatment-of-breast-cancer-in-italian-hospitals
#15
Mirko Di Rosa, Carlos Chiatti, Joseph M Rimland, Marina Capasso, Valerio M Scandali, Emilia Prospero, Andrea Corsonello, Fabrizia Lattanzio
AIM: To determine if age is a factor influencing the type of breast cancer surgery (radical versus conservative) in Italy and to investigate the regional differences in breast cancer surgery clinical practice. METHODS: Retrospective study is based on national hospital discharge records. The study draws on routinely collected data from hospital discharge records in Italy in 2010. The following exclusion criteria were applied: day hospital stays, patients younger than 17 years, males, patients without an ICD-9CM code indicating breast cancer and breast surgery, and repeated hospital admission of the same patient...
April 8, 2017: Aging Clinical and Experimental Research
https://www.readbyqxmd.com/read/28381513/outcome-of-intracerebral-hemorrhage-associated-with-different-oral-anticoagulants
#16
MULTICENTER STUDY
Duncan Wilson, David J Seiffge, Christopher Traenka, Ghazala Basir, Jan C Purrucker, Timolaos Rizos, Oluwaseun A Sobowale, Hanne Sallinen, Shin-Joe Yeh, Teddy Y Wu, Marc Ferrigno, Rik Houben, Floris H B M Schreuder, Luke A Perry, Jun Tanaka, Marion Boulanger, Rustam Al-Shahi Salman, Hans R Jäger, Gareth Ambler, Clare Shakeshaft, Yusuke Yakushiji, Philip M C Choi, Julie Staals, Charlotte Cordonnier, Jiann-Shing Jeng, Roland Veltkamp, Dar Dowlatshahi, Stefan T Engelter, Adrian R Parry-Jones, Atte Meretoja, David J Werring
OBJECTIVE: In an international collaborative multicenter pooled analysis, we compared mortality, functional outcome, intracerebral hemorrhage (ICH) volume, and hematoma expansion (HE) between non-vitamin K antagonist oral anticoagulation-related ICH (NOAC-ICH) and vitamin K antagonist-associated ICH (VKA-ICH). METHODS: We compared all-cause mortality within 90 days for NOAC-ICH and VKA-ICH using a Cox proportional hazards model adjusted for age; sex; baseline Glasgow Coma Scale score, ICH location, and log volume; intraventricular hemorrhage volume; and intracranial surgery...
May 2, 2017: Neurology
https://www.readbyqxmd.com/read/28367285/are-frailty-scales-better-than-anesthesia-or-surgical-scales-to-determine-risk-in-cardiac-surgery
#17
Judit Kovacs, Liviu Moraru, Krisztina Antal, Adrian Cioc, Septimiu Voidazan, Attila Szabo
BACKGROUND: In the last year there has been an increasing interest for using frailty scales for risk stratification of elderly patients undergoing major surgery. We planned to compare two frailty scales with risk scales already used in cardiac surgery, to study which of these scores have better prognostic value predicting postoperative outcome in open heart surgery. METHODS: We conducted a prospective clinical trial, including 57 patients over 65 years. We calculated Cardiac Anesthesia Risk Evaluation score, EuroScore II, Clinical Frailty Scale, Edmonton Frail Scale for each patient and followed the postoperative complications, length of mechanical ventilation, length of stay in the intensive care unit and hospital, and in-hospital death related to these risk and frailty scores...
April 2017: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/28359793/preoperative-hypoalbuminemia-is-a-risk-factor-for-early-and-late-mortality-in-patients-undergoing-endovascular-juxtarenal-and-thoracoabdominal-aortic-aneurysm-repair
#18
Max Wohlauer, Corey Brier, Yuki Kuramochi, Matthew Eagleton
BACKGROUND: Advances in endovascular aneurysm repair now allow surgeons to treat high-risk patients with complex aortic aneurysms. Stringent selection criteria for repair exist from an anatomic and technical perspective; however, there is a paucity of literature examining frailty in patients being evaluated for fenestrated and branched endovascular aortic repair (FEVAR). As a marker of frailty well supported in the literature, we hypothesized that preoperative hypoalbuminemia would increase risk for short-term mortality after endovascular juxtarenal and thoracoabdominal aortic aneurysm repair...
March 27, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28359689/frailty-measure-is-more-predictive-of-outcomes-after-curative-therapy-for-endometrial-cancer-than-traditional-risk-factors-in-women-60-and-older
#19
Jane A Driver, Akila N Viswanathan
OBJECTIVES: To determine if readily obtainable markers of frailty predict disease-free survival (DFS) in elderly women with endometrial cancer treated with curative intent. METHODS: 88 consecutive women≥age 60 treated with surgery, chemotherapy and radiation for stage I-IV endometrial cancer were included. We considered the following health deficits as markers of "frailty": albumin <3.5mg/dL, hemoglobin <10mg/dL, BMI<20kg/m,(2) unintentional weight loss, ECOG performance status ≥2, history of osteopenia or osteoporosis and Charlson comorbidity score...
June 2017: Gynecologic Oncology
https://www.readbyqxmd.com/read/28329143/epidermal-growth-factor-receptor-mutations-are-linked-to-skip-n2-lymph-node-metastasis-in-resected-non-small-cell-lung-cancer-adenocarcinomas
#20
Francesco Guerrera, Stéphane Renaud, Fabrizio Tabbó, Anne-Claire Voegeli', Pier Luigi Filosso, Michèle Legrain, Monica Boita, Mickaël Schaeffer, Michèle Beau-Faller, Enrico Ruffini, Pierre-Emmanuel Falcoz, Giorgio Inghirami, Alberto Oliaro, Gilbert Massard
OBJECTIVES: The impact of skip N2 metastases (i.e. N2 lymph node metastases without N1) on survival in surgically resected non-small lung cancer remains an intriguing and rarely investigated topic. The goal of our study was to elucidate (i) skip N2 influence on overall survival (OS) and time to recurrence (TTR) in patients with resected lung adenocarcinoma and (ii) its link with epidermal growth factor receptor ( EGFR ) and v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog ( KRAS ) mutations...
April 1, 2017: European Journal of Cardio-thoracic Surgery
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