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Frailty and surgery

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https://www.readbyqxmd.com/read/28807801/impact-of-diabetes-mellitus-on-clinical-outcomes-and-quality-of-life-after-transcatheter-aortic-valve-implantation-for-severe-aortic-valve-stenosis
#1
Tomasz Tokarek, Artur Dziewierz, Agata Wiktorowicz, Maciej Bagienski, Lukasz Rzeszutko, Danuta Sorysz, Pawel Kleczynski, Dariusz Dudek
BACKGROUND: Diabetes mellitus (DM) has been considered as a marker of poor prognosis after cardiac surgery. We sought to investigate the impact of DM on clinical outcomes and quality of life (QoL) after transcatheter aortic valve implantation (TAVI). METHODS: A total of 148 consecutive patients with symptomatic, severe aortic stenosis who underwent TAVI were included. Baseline characteristics, procedural and long-term clinical outcomes as well as the results of frailty and QoL assessment with EQ-5D-3L questionnaire were compared between patients with and without DM...
August 11, 2017: Hellenic Journal of Cardiology: HJC, Hellēnikē Kardiologikē Epitheōrēsē
https://www.readbyqxmd.com/read/28802765/disparities-in-care-for-elderly-women-with-endometrial-cancer-adversely-effects-survival
#2
Anna Torgeson, Dustin Boothe, Matthew M Poppe, Gita Suneja, David K Gaffney
PURPOSE: Elderly women with endometrial cancer are at increased risk of local recurrence and cancer-specific death compared to younger women. We sought to investigate adjuvant radiotherapy (RT) practice patterns and effects on survival in elderly women with endometrial cancer. METHODS: Women from the National Cancer Data Base (NCDB) with FIGO IA grade 3 to FIGO IVA endometrial cancer diagnosed from 2004-2013 were included. Chi square analysis was used to compare the elderly (80+) and non-elderly women (18-79) and women who received RT and those that did not...
August 9, 2017: Gynecologic Oncology
https://www.readbyqxmd.com/read/28777289/sarcopenia-increases-risk-of-long-term-mortality-in-elderly-patients-undergoing-emergency-abdominal-surgery
#3
Erika L Rangel, Arturo J Rios-Diaz, Jennifer W Uyeda, Manuel Castillo-Angeles, Zara Cooper, Olubode A Olufajo, Ali Salim, Aaron D Sodickson
BACKGROUND: Frailty is associated with poor surgical outcomes in elderly patients but is difficult to measure in the emergency setting. Sarcopenia, or the loss of lean muscle mass, is a surrogate for frailty and can be measured using cross-sectional imaging. We sought to determine the impact of sarcopenia on one-year mortality after emergency abdominal surgery in elderly patients. METHODS: Sarcopenia was assessed in patients ≥70 years old who underwent emergency abdominal surgery at a single hospital from 2006-2011...
August 3, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28765416/the-physician-s-role-in-perioperative-management-of-older-patients-undergoing-surgery
#4
Adam L Gordon, Barry J Evans, Jugdeep Dhesi
Life-sustaining and life-improving surgical interventions are increasingly available to older, frailer patients, many of whom have multimorbidity. Physicians can help support perioperative multidisciplinary teams with assessment and preoperative optimisation of physiological reserve, comorbidities and associated geriatric syndromes. Similar structured support can be useful in the postoperative period where older patients are at increased risk of delirium, medical complications, increased functional dependency and where discharge planning can prove more difficult than in younger cohorts...
July 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28760787/bridging-the-age-gap-in-breast-cancer-evaluation-of-decision-support-interventions-for-older-women-with-operable-breast-cancer-protocol-for-a-cluster-randomised-controlled-trial
#5
Karen Collins, Malcolm Reed, Kate Lifford, Maria Burton, Adrian Edwards, Alistair Ring, Katherine Brain, Helena Harder, Thompson Robinson, Kwok Leung Cheung, Jenna Morgan, Riccardo Audisio, Susan Ward, Paul Richards, Charlene Martin, Tim Chater, Kirsty Pemberton, Anthony Nettleship, Christopher Murray, Stephen Walters, Oscar Bortolami, Fiona Armitage, Robert Leonard, Jacqui Gath, Deirdre Revell, Tracy Green, Lynda Wyld
INTRODUCTION: While breast cancer outcomes are improving steadily in younger women due to advances in screening and improved therapies, there has been little change in outcomes among the older age group. It is inevitable that comorbidities/frailty rates are higher, which may increase the risks of some breast cancer treatments such as surgery and chemotherapy, many older women are healthy and may benefit from their use. Adjusting treatment regimens appropriately for age/comorbidity/frailty is variable and largely non-evidence based, specifically with regard to rates of surgery for operable oestrogen receptor-positive disease and rates of chemotherapy for high-risk disease...
July 31, 2017: BMJ Open
https://www.readbyqxmd.com/read/28756048/frailty-assessments-in-surgical-practice-what-is-frailty-and-how-can-it-be-used-in-prosthetic-health
#6
REVIEW
Matthew S Brennan, Ryan M Barlotta, Jay Simhan
INTRODUCTION: Surgical frailty is a previously unrecognized clinical entity that objectifies a multiorgan decrease in physiologic reserve in those undergoing surgery. Although penile implantation has been demonstrated to be an effective means of restoring erectile function in patients whose previous conservative measures have failed, there are limited data regarding the assessment of frailty in patients undergoing penile implantation. AIM: To review the various objective methods used to describe surgical frailty in medical and surgical disciplines, report on methodologies of frailty assessment, and discuss the relevance of surgical frailty in the preoperative evaluation of patients undergoing implantation of an inflatable penile prosthesis...
July 26, 2017: Sexual Medicine Reviews
https://www.readbyqxmd.com/read/28754387/cost-of-cardiac-surgery-in-frail-compared-with-nonfrail-older-adults
#7
Michael Goldfarb, Melissa Bendayan, Lawrence G Rudski, Jean-Francois Morin, Yves Langlois, Felix Ma, Kevin Lachapelle, Renzo Cecere, Benoit DeVarennes, Christo I Tchervenkov, James M Brophy, Jonathan Afilalo
BACKGROUND: Frailty is a risk factor for mortality, morbidity, and prolonged length of stay after cardiac surgery, all of which are major drivers of hospitalization costs. The incremental hospitalization costs incurred in frail patients have yet to be elucidated. METHODS: Patients aged ≥ 60 years were evaluated for frailty before coronary artery bypass grafting or heart valve surgery at 2 academic centres between 2013 and 2015 as part of the McGill Frailty Registry...
August 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28751850/anmco-sic-sici-gise-sicch-executive-summary-of-consensus-document-on-risk-stratification-in-elderly-patients-with-aortic-stenosis-before-surgery-or-transcatheter-aortic-valve-replacement
#8
Giovanni Pulignano, Michele Massimo Gulizia, Samuele Baldasseroni, Francesco Bedogni, Giovanni Cioffi, Ciro Indolfi, Francesco Romeo, Adriano Murrone, Francesco Musumeci, Alessandro Parolari, Leonardo Patanè, Paolo Giuseppe Pino, Annalisa Mongiardo, Carmen Spaccarotella, Roberto Di Bartolomeo, Giuseppe Musumeci
Aortic stenosis is one of the most frequent valvular diseases in developed countries, and its impact on public health resources and assistance is increasing. A substantial proportion of elderly people with severe aortic stenosis is not eligible to surgery because of the advanced age, frailty, and multiple co-morbidities. Transcatheter aortic valve implantation (TAVI) enables the treatment of very elderly patients at high or prohibitive surgical risk considered ineligible for surgery and with an acceptable life expectancy...
May 2017: European Heart Journal Supplements: Journal of the European Society of Cardiology
https://www.readbyqxmd.com/read/28747535/palliative-care-in-end-stage-valvular-heart-disease
#9
REVIEW
Jill M Steiner, Stephanie Cooper, James N Kirkpatrick
Valvular heart disease (VHD), particularly aortic valve disease, is prevalent with increasing incidence. When surgery is not possible, or when risks outweigh benefits, percutaneous treatment options may offer effective alternatives. However, procedures may not always go as planned, and frail patients or those whose symptoms are caused by other comorbidities may not benefit from valve intervention at all. Significant effort should be made to assess frailty, comorbidities and patient goals prior to intervention...
August 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28742855/decreases-in-heart-rate-variability-are-associated-with-postoperative-complications-in-hip-fracture-patients
#10
Gernot Ernst, Leiv Otto Watne, Frede Frihagen, Torgeir Bruun Wyller, Andreas Dominik, Morten Rostrup
BACKGROUND: To explore relevant associations between deviations in linear and nonlinear heart rate variability (HRV) scores, and short-term morbidity and mortality in patients undergoing hip-surgery after a fracture. METHODS: 165 patients with hip fractures being admitted for surgery at two hospitals were included in a prospective cohort study. A short-term ECG was recorded within 24 hours of arrival. 15 patients had to be excluded due to insufficient quality of the ECG recordings...
2017: PloS One
https://www.readbyqxmd.com/read/28739453/modified-frailty-index-can-be-used-to-predict-adverse-outcomes-and-mortality-after-lower-extremity-bypass-surgery
#11
Tarik Ali, Erik Lehman, Faisal Aziz
OBJECTIVES: Frailty has been increasingly used as a prognostic indicator for various surgical operations. Patients with peripheral arterial disease represent a cohort of population with advanced medical comorbidities. The aim of this study is to correlate the postoperative outcomes after lower extremity bypass surgery with pre operative modified frailty index. METHODS: Using 2010 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, patients undergoing infrainguinal arterial bypass surgery were identified...
July 21, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28739158/assessment-and-management-of-radiotherapy-induced-toxicity-in-older-patients
#12
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/28734627/the-impact-of-frailty-on-functional-survival-in-patients-1%C3%A2-year-after-cardiac-surgery
#13
James Lytwyn, Andrew N Stammers, D Scott Kehler, Patrick Jung, Bryce Alexander, Brett M Hiebert, Chris Dubiel, Dustin Kimber, Naomi Hamm, Mekayla Clarke, Carly Fraser, Brittany Pedreira, Todd A Duhamel, Navdeep Tangri, Rakesh C Arora
OBJECTIVE: This study determined whether frailty provides incremental value to the European System for Cardiac Operative Risk Evaluation II in identifying patients at risk of poor 1-year functional survival. METHODS: This prospective study in patients undergoing cardiac surgery defined frailty using 3 common definitions: (1) the Modified Fried Criteria; (2) the Short Physical Performance Battery; and (3) the Clinical Frailty Scale. The primary outcome was functional survival, defined as being alive at 1 year postsurgery with a health-related quality of life score greater than 60 on the EuroQol-Visual Analogue Scale...
June 24, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28734497/functional-not-chronologic-age-frailty-index-predicts-outcomes-in-advanced-ovarian-cancer
#14
Amanika Kumar, Carrie L Langstraat, Stephanie R DeJong, Michaela E McGree, Jamie N Bakkum-Gamez, Amy L Weaver, Nathan K LeBrasseur, William A Cliby
OBJECTIVES: To assess the impact of frailty as measured by a frailty deficit index (FI) on outcomes in advanced epithelial ovarian cancer (EOC) after primary debulking surgery (PDS). METHODS: Women with Stage IIIC/IV EOC who underwent PDS between 1/1/2003-12/31/2011 were included. Medical records were reviewed for patient characteristics and outcomes. The FI includes 30 items scored at 0, 0.5 or 1 and is calculated by summing across all the item scores and dividing by the total...
July 19, 2017: Gynecologic Oncology
https://www.readbyqxmd.com/read/28731537/frailty-and-cancer-implications-for-oncology-surgery-medical-oncology-and-radiation-oncology
#15
REVIEW
Cecilia G Ethun, Mehmet A Bilen, Ashesh B Jani, Shishir K Maithel, Kenneth Ogan, Viraj A Master
Answer questions and earn CME/CNE The concept of frailty has become increasingly recognized as one of the most important issues in health care and health outcomes and is of particular importance in patients with cancer who are receiving treatment with surgery, chemotherapy, and radiotherapy. Because both cancer itself, as well as the therapies offered, can be significant additional stressors that challenge a patient's physiologic reserve, the incidence of frailty in older patients with cancer is especially high-it is estimated that over one-half of older patients with cancer have frailty or prefrailty...
July 21, 2017: CA: a Cancer Journal for Clinicians
https://www.readbyqxmd.com/read/28731497/the-effect-of-frailty-on-short-term-outcomes-after-head-and-neck-cancer-surgery
#16
Carrie L Nieman, Karen T Pitman, Anthony P Tufaro, David W Eisele, Kevin D Frick, Christine G Gourin
OBJECTIVE: To determine the relationship between frailty and comorbidity, in-hospital mortality, postoperative complications, length of hospital stay (LOS), and costs in head and neck cancer (HNCA) surgery. STUDY DESIGN: Cross-sectional analysis. METHODS: Discharge data from the Nationwide Inpatient Sample for 159,301 patients who underwent ablative surgery for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm in 2001 to 2010 was analyzed using cross-tabulations and multivariate regression modeling...
July 21, 2017: Laryngoscope
https://www.readbyqxmd.com/read/28709946/frailty-and-sarcopenia-do-not-predict-adverse-events-in-an-elderly-population-undergoing-non-complex-primary-elective-surgery-for-degenerative-conditions-of-the-lumbar-spine
#17
Raphaële Charest-Morin, John Street, Honglin Zhang, Taren Roughead, Tamir Ailon, Michael Boyd, Marcel Dvorak, Brian Kwon, Scott Paquette, Nicolas Dea, Charles G Fisher, Alana M Flexman
BACKGROUND CONTEXT: Sarcopenia measured by normalized total psoas area (NTPA) has been shown to predict mortality and adverse events (AE) in numerous surgical populations. The relationship between sarcopenia and postoperative outcomes after surgery for degenerative spine disease (DSD) has not been investigated. PURPOSE: This study aimed to determine the relationships between sarcopenia, frailty and postoperative adverse events in the elderly DSD population. Secondary objectives were to describe the distribution and predictors of NTPA and to determine the relationship between sarcopenia, frailty and length of stay, discharge to a facility and in-hospital mortality...
July 11, 2017: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/28701190/a-novel-algorithm-for-the-treatment-strategy-for-advanced-epithelial-ovarian-cancer-consecutive-imaging-frailty-assessment-and-diagnostic-laparoscopy
#18
Kyung Jin Eoh, Jung Won Yoon, Jung-Yun Lee, Eun Ji Nam, Sunghoon Kim, Sang Wun Kim, Young Tae Kim
BACKGROUND: This study aimed to evaluate the perioperative outcomes and prognostic impact of the consecutive steps of imaging, frailty assessment, and diagnostic laparoscopy (DLS) in patients with advanced epithelial ovarian cancer (EOC). METHODS: Patients diagnosed with EOC during 2012-2015 were analyzed retrospectively. Surgical and survival outcomes were compared between three treatment groups: patients without high tumor dissemination (HTD) who underwent primary debulking surgery (PDS group); patients with HTD who underwent DLS (DLS group); and patients with HTD diagnosed by cytological confirmation of malignancy followed by neoadjuvant chemotherapy (NACT group)...
July 12, 2017: BMC Cancer
https://www.readbyqxmd.com/read/28693934/frailty-in-older-adults-undergoing-aortic%C3%A2-valve-replacement-the-frailty-avr-study
#19
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/28669651/frailty-in-major-oncologic-surgery-of-upper-gastrointestinal-tract-how-to-improve-postoperative-outcomes
#20
M Mazzola, C Bertoglio, M Boniardi, C Magistro, P De Martini, P Carnevali, L Morini, G Ferrari
INTRODUCTION: Certain surgical interventions, especially those involving upper GI tract remain challenging, due to high morbidity and mortality rates. The study of frailty in the surgical population has allowed the identification of those patients with a higher risk of poor postoperative outcomes. There remains a lack of evidence regarding the possibility of improving these results through a preoperative holistic management of the patients. The aim of this study is to evaluate whether preoperative treatment, in carefully selected patients, can improve the outcome following surgery...
June 23, 2017: European Journal of Surgical Oncology
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