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Geriatric preoperative assessment

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https://www.readbyqxmd.com/read/28581701/mini-nutritional-assessment-short-form-as-a-useful-method-of-predicting-poor-1-year-outcome-in-elderly-patients-undergoing-orthopedic-surgery
#1
Che-Sheng Chu, Chih-Kuang Liang, Ming-Yueh Chou, Ti Lu, Yu-Te Lin, Chin-Liang Chu
AIM: The present study aimed to determine whether the Mini-Nutritional Assessment Short-Form (MNA-SF) can predict the 1-year outcome of orthopedic fracture surgery in elderly patients. METHODS: This 1-year prospective study assessed nutrition using the MNA-SF at baseline, and postoperatively at 6 and 12 months. Repeated measures analysis of covariance was used to examine functional change over time for two MNA-SF categories. Multivariable logistic regression analysis with forward stepwise modeling was carried out to identify risk factors of functional decline, emergency department visit, hospital readmission and mortality at follow up...
June 5, 2017: Geriatrics & Gerontology International
https://www.readbyqxmd.com/read/28540113/comparison-of-3-different-perioperative-care-models-for-patients-with-hip-fractures-within-1-health-service
#2
Lillian Sarah Coventry, Austin Nguyen, Amalia Karahalios, Sasha Roshan-Zamir, Phong Tran
INTRODUCTION: Orthogeriatric care models have been introduced within many health-care facilities to improve outcomes for hip fracture patients. This study aims to evaluate differences in care between 3 models, an orthopedic model, a geriatric model, and a comanaged model. MATERIALS AND METHODS: A retrospective analysis was conducted for hip fracture patients treated at Western Health between November 2012 and March 2014. All patients aged 65 years or older were included in the analysis...
June 2017: Geriatric Orthopaedic Surgery & Rehabilitation
https://www.readbyqxmd.com/read/28530213/-the-model-of-perioperative-risk-assessment-in-elderly-patients-interim-analysis
#3
Izabela Grabowska, Lucyna Ścisło, Szymon Pietruszka, Elzbieta Walewska, Agata Paszko, Benita Siarkiewicz, Piotr Richter, Andrzej Budzyński, Antoni M Szczepanik
Demographic changes in contemporary society require implementation of proper perioperative care of elderly patients due to an increased risk of perioperative complications in this group. Preoperative assessment of health status identifies risks and enables preventive interventions, improving outcomes of surgical treatment. The Comprehensive Geriatric Assessment contains numerous diagnostic tests and consultations, which is expensive and difficult to use in everyday practice. The development of a simplified model of perioperative assessment of elderly patients will help identifying the group of patients who require further diagnostic workup...
April 21, 2017: Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego
https://www.readbyqxmd.com/read/28500499/-anesthesiological-care-of-trauma-patients-in-orthogeriatric-co-management
#4
Markus F Luger, Thomas J Luger
Elderly patients increasingly need to undergo surgery under anesthesia, especially following trauma. A timely interdisciplinary approach to the perioperative management of these patients is decisive for the long-term outcome. Orthogeriatric co-management, which includes geriatricians and anesthesiologists from an early stage, is of great benefit for geriatric patients. Patient age, comorbidities and self-sufficiency in activities of daily life are decisive for an anesthesiological assessment of the state of health and preoperative risk stratification...
May 12, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28419035/clinical-practice-guidelines-decrease-unnecessary-echocardiograms-before-hip-fracture-surgery
#5
Chris Adair, Eric Swart, Rachel Seymour, Joshua Patt, Madhav A Karunakar
BACKGROUND: Preoperative assessment of geriatric patients with a hip fracture may include transthoracic echocardiography (TTE), which increases resource utilization and cost and may delay surgery. The purpose of this study was to evaluate preoperative TTE utilization at a single institution in order to determine (1) how often TTE is ordered in accordance with clinical practice guidelines (CPGs), (2) how frequently TTE reveals cardiac disease that may alter medical or anesthesia management, and (3) whether following CPGs reduces unnecessary TTE utilization without potentially missing important disease...
April 19, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28391428/do-clinical-outcomes-correlate-with-bone-density-after-open-reduction-and-internal-fixation-of-tibial-plateau-fractures
#6
Elizabeth Gausden, Matthew R Garner, Peter D Fabricant, Stephen J Warner, Andre D Shaffer, Dean G Lorich
INTRODUCTION: The operative management of tibial plateau fractures in elderly patients has historically led to inconsistent results, and these clinical outcomes were thought to be associated with poor bone quality often in elderly patients. The goal of this study was to investigate the relationship between bone density and subjective clinical outcome scores after open reduction and internal fixation of tibial plateau fractures. MATERIALS AND METHODS: This is a retrospective cohort study from a single-surgeon conducted at an Academic, Level 1 Trauma Center...
April 8, 2017: Archives of Orthopaedic and Trauma Surgery
https://www.readbyqxmd.com/read/28383453/predictors-of-anastomotic-leak-in-elderly-patients-after-colectomy-nomogram-based-assessment-from-the-american-college-of-surgeons-national-surgical-quality-program-procedure-targeted-cohort
#7
Ahmet Rencuzogullari, Cigdem Benlice, Michael Valente, Maher A Abbas, Feza H Remzi, Emre Gorgun
BACKGROUND: Elderly patients undergoing colorectal surgery have increasingly become under scrutiny by accounting for the largest fraction of geriatric postoperative deaths and a significant proportion of all postoperative complications, including anastomotic leak. OBJECTIVE: This study aimed to determine predictors of anastomotic leak in elderly patients undergoing colectomy by creating a novel nomogram for simplistic prediction of anastomotic leak risk in a given patient...
May 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/28366577/use-of-geriatric-assessment-tools-in-selecting-therapies-in-women-aged-%C3%A2-70%C3%A2-years-with-hormone-receptor-positive-early-stage-breast-cancer-preliminary-experience-with-a-quality-improvement-initiative
#8
Jean L Wright, Arti Parekh, Yao Yao Pollock, Nancy Schoenborn, Karen L Smith, Colette Magnant, Vered Stearns
PURPOSE: To develop a multidisciplinary algorithmic approach to management of women aged ≥70 years with clinically staged T1N0 hormone receptor-positive breast cancer, including geriatric assessments predicting life expectancy and the likelihood of functional decline in the near future, in the context of a program-wide quality improvement initiative, to better select patients for therapeutic interventions. METHODS AND MATERIALS: Two geriatric assessment tools, the Combined Lee-Schonberg Index and the Vulnerable Elderly Scale, were introduced into our clinical workflow to predict long-term mortality and likelihood of functional decline...
January 29, 2017: International Journal of Radiation Oncology, Biology, Physics
https://www.readbyqxmd.com/read/28342121/can-comprehensive-imaging-analysis-with-analytic-morphomics-and-geriatric-assessment-predict-serious-complications-in-patients-undergoing-pancreatic-surgery
#9
Andrew J Benjamin, Mary M Buschmann, Andrew Schneider, Brian A Derstine, Jeffrey F Friedman, Stewart C Wang, William Dale, Kevin K Roggin
We aimed to determine whether comprehensive imaging analysis with analytic morphomics (AM) enhances or replaces geriatric assessment (GA) in risk-stratifying pancreatic surgery patients. One hundred thirty-four pancreatic surgery patients were identified from a prospective cohort. Sixty-three patients in the cohort had preoperative CT scans in addition to comprehensive geriatric assessments. CT scans were processed using AM. Associations with National Surgical Quality Improvement Program (NSQIP) serious complications were evaluated using univariate analysis and robust elastic net modeling to obtain AUROC curves by adding AM and GA measures to our previously defined clinical base risk model (age, body mass index, American Society of Anesthesiologists classification, and Charlson comorbidity index)...
March 24, 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/28277408/hospital-standards-to-promote-optimal-surgical-care-of-the-older-adult-a-report-from-the-coalition-for-quality-in-geriatric-surgery
#10
Julia R Berian, Ronnie A Rosenthal, Tracey L Baker, JoAnn Coleman, Emily Finlayson, Mark R Katlic, Sandhya A Lagoo-Deenadayalan, Victoria L Tang, Thomas N Robinson, Clifford Y Ko, Marcia M Russell
OBJECTIVE: The aim of this study was to establish high-quality, valid standards to improve surgical care of the older adult. BACKGROUND: The aging population increases demand for high-quality surgical care. Building upon prior guidelines, quality indicators, and pilot projects, the Coalition for Quality in Geriatric Surgery (CQGS) includes 58 diverse stakeholder organizations committed to improving geriatric surgery. METHODS: Using a modified RAND-UCLA Appropriateness Methodology, 44 of 58 CQGS Stakeholders twice rated validity (primary outcome) and feasibility for 308 standards, ranging from goals and decision-making, pre-operative assessment and optimization, perioperative and postoperative care, to transitions of care beyond the acute care hospital...
March 8, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28263371/association-between-preoperative-malnutrition-and-postoperative-delirium-after-hip-fracture-surgery-in-older-adults
#11
Paolo Mazzola, Libby Ward, Sara Zazzetta, Valentina Broggini, Alessandra Anzuini, Breanna Valcarcel, Justin S Brathwaite, Giulio M Pasinetti, Giuseppe Bellelli, Giorgio Annoni
OBJECTIVES: To determine whether poor nutritional status can predict postoperative delirium in elderly adults undergoing hip fracture surgery. DESIGN: Prospective observational cohort study. SETTING: Italian orthogeriatric unit. PARTICIPANTS: Individuals aged 70 and older (mean age 84.0 ± 6.6, 74.5% female) consecutively admitted for surgical repair of a proximal femur fracture between September 2012 and April 2016 (N = 415)...
March 6, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28255514/initial-preoperative-management-of-geriatric-hip-fractures
#12
REVIEW
Tochukwu C Ikpeze, Stephen Mohney, John C Elfar
Hip fractures are a common emergency among the geriatric population and often requires immediate hospitalization for proper assessment. More than 90% of the time, hip fractures are suffered by individuals older than 65 and are usually precipitated predominantly by falls. Current studies show that the average individual over 65 years falls at least once a year, and roughly 1 out of every 4 of these individuals succumb to their injuries just 12 months following surgical treatment. Moreover, timely treatment and management of these hip fractures have shown to decrease mortality by reducing cardiopulmonary and venous thromboembolic complications that often accompany hip surgeries...
March 2017: Geriatric Orthopaedic Surgery & Rehabilitation
https://www.readbyqxmd.com/read/28238301/the-impact-of-hemocoagulase-for-improvement-of-coagulation-and-reduction-of-bleeding-in-fracture-related-hip-hemiarthroplasty-geriatric-patients-a-prospective-single-blinded-randomized-controlled-study
#13
Meiguang Qiu, Xuming Zhang, Hongru Cai, Zhixian Xu, Hao Lin
BACKGROUND: Uncontrolled bleeding is associated with poor outcomes and mortality in geriatric patients undergoing hemiarthroplasty. Hemocoagulase agkistrodon is a hemocoagulative, anti-hemorrhagic enzyme complex from Deinagkistrodon acutus snake venom. This study aimed to investigate the efficacy of hemocoagulase agkistrodon on coagulation and bleeding outcomes in fracture-related hemiarthroplasty. PATIENTS AND METHODS: This was a prospective, single-blinded, randomized controlled trial carried out between October 2013 and September 2014 in 96 geriatric patients undergoing hemiarthroplasty for unilateral femoral neck fracture...
November 27, 2016: Injury
https://www.readbyqxmd.com/read/28198997/randomized-clinical-trial-of-comprehensive-geriatric-assessment-and-optimization-in-vascular-surgery
#14
RANDOMIZED CONTROLLED TRIAL
J S L Partridge, D Harari, F C Martin, J L Peacock, R Bell, A Mohammed, J K Dhesi
BACKGROUND: Increasing numbers of older patients are undergoing vascular surgery. Inadequate preoperative assessment and optimization may contribute to increased postoperative morbidity and mortality. METHODS: Patients aged at least 65 years scheduled for elective aortic aneurysm repair or lower-limb arterial surgery were enrolled in an RCT of standard preoperative assessment or preoperative comprehensive geriatric assessment and optimization. Randomization was stratified by sex and surgical site (aorta/lower limb)...
May 2017: British Journal of Surgery
https://www.readbyqxmd.com/read/28188187/electronic-rapid-fitness-assessment-a-novel-tool-for-preoperative-evaluation-of-the-geriatric-oncology-patient
#15
Armin Shahrokni, Amy Tin, Robert J Downey, Vivian Strong, Sanam Mahmoudzadeh, Manpreet K Boparai, Sincere McMillan, Andrew Vickers, Beatriz Korc-Grodzicki
Background: The American College of Surgeons and American Geriatrics Society recommend performing a geriatric assessment (GA) in the preoperative evaluation of older patients. To address this, we developed an electronic GA, the Electronic Rapid Fitness Assessment (eRFA). We reviewed the feasibility and clinical utility of the eRFA in the preoperative evaluation of geriatric patients. Methods: We performed a retrospective review of our experience using the eRFA in the preoperative assessment of geriatric patients...
February 2017: Journal of the National Comprehensive Cancer Network: JNCCN
https://www.readbyqxmd.com/read/28088377/intracapsular-hip-fractures-in-the-elderly-do-we-know-what-is-important
#16
Diana Crego-Vita, Coral Sanchez-Perez, Jose Adolfo Orellana Gomez-Rico, Celia Clemente de Arriba
BACKGROUND: Hip fractures in the elderly are a common reason for admission to the department of orthopaedic surgery, this condition asks an important part of health resources and is associated with high levels of co-morbidity and mortality. Many improvements have been introduced in the treatment of these patients, preoperative regional analgesia, intensive physical therapy, interdisciplinary care program; but still remain unresolved gaps. The aim of this study is to document the natural history of early versus delayed surgical intervention in elderly patients with hip fractures and to establish the prognostic factors of mortality and walking ability after discharge...
January 9, 2017: Injury
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
#17
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/28049616/three-decades-of-comprehensive-geriatric-assessment-evidence-coming-from-different-healthcare-settings-and-specific-clinical-conditions
#18
REVIEW
Alberto Pilotto, Alberto Cella, Andrea Pilotto, Julia Daragjati, Nicola Veronese, Clarissa Musacchio, Anna Maria Mello, Giancarlo Logroscino, Alessandro Padovani, Camilla Prete, Francesco Panza
Comprehensive geriatric assessment (CGA) is a multidisciplinary diagnostic and treatment process that identifies medical, psychosocial, and functional capabilities of older adults to develop a coordinated plan to maximize overall health with aging. Specific criteria used by CGA programs to evaluate patients include age, medical comorbidities, psychosocial problems, previous or predicted high healthcare utilization, change in living situation, and specific geriatric conditions. However, no universal criteria have been agreed upon to readily identify patients who are likely to benefit from CGA...
February 1, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/27999856/predictors-of-health-related-quality-of-life-decline-after-transcatheter-aortic-valve-replacement-in-older-patients-with-severe-aortic-stenosis
#19
A S Boureau, J N Trochu, A Rouaud, R Hureau, P Jaafar, T Manigold, V Letocart, P Guerin, G Berrut, L de Decker
BACKGROUND: Transcatheter aortic-valve implantation (TAVI) has been shown to improve survival and quality of life in patients with severe aortic stenosis. However, one-third of patients have poor outcome as death, functional decline or quality of life (QoL) decline. The aim of this study was to determine cardiac and geriatric predictors of physical and mental QoL decline 6 months after a TAVI procedure in patients aged 75 and older. METHODS: Between January 2013 and June 2014, we did a prospective and multicenter study including patients ≥ 75 years old referred for TAVI...
2017: Journal of Nutrition, Health & Aging
https://www.readbyqxmd.com/read/27896467/audit-of-geriatric-hip-fracture-care-a%C3%A2-slovenian-trauma-center-analysis
#20
Dejan Krušič, Drago Brilej, Colin Currie, Radko Komadina
BACKGROUND: The aim was to describe an audit of hip fracture patient care and outcomes in a Slovenian healthcare setting prior to the implementation of the Geriatric Fracture Center (GFC) model of care. METHODS: The Fragility Fracture Network (FFN) hip fracture audit database was used to collect data on hip fracture care in elderly patients. Epidemiological data were submitted as well as fracture type, prefracture residence and mobility prior to the fracture. The timeline of events and acute care data were also collected...
December 2016: Wiener Klinische Wochenschrift
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