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Geriatric preoperative assessment

Olubode A Olufajo, Gally Reznor, Stuart R Lipsitz, Zara R Cooper, Adil H Haider, Ali Salim, Erika L Rangel
BACKGROUND: The risk of mortality after emergency general surgery (EGS) in elderly patients is prolonged beyond initial hospitalization. Our objective was to develop a preoperative scoring tool to quantify risk of 1-year mortality. METHODS: Three hundred ninety EGS patients aged 70 years or more were analyzed. Risk factors for 1-year mortality were identified using stepwise-forward logistic multivariate regression and weights assigned using natural logarithm of odds ratios...
September 3, 2016: American Journal of Surgery
Giulio Mari, Andrea Costanzi, Elisa Galfrascoli, Andrea Rosato, Jacopo Crippa, Dario Maggioni
Laparoscopic anterior rectal resection with total mesorectal excision is related to sexual and urinary disorders. Anastomotic leak and neo-adjuvant radiation therapy are effective factors in worsening pelvic function. We report a series of 50 elderly (age 70) patients who underwent laparoscopic total mesorectal excision inquired about pre and post-operative genito-urinary function. Patients were interviewed preoperatively, 1 and 9 months post-operatively with validated questionnaires about sexual and urinary function and quality of life...
July 2016: Chirurgia
Judith H Tomlinson, Judith S L Partridge
Postoperative delirium is a common complication in the older surgical population, occurring in 10-50 % of cases. It is thought to be more common if an individual is identified as frail. Postoperative delirium is associated with poor outcome including higher mortality rates, prolonged length of hospital stay, increased care needs on discharge and longer term post-traumatic stress disorder. Guidelines from the American Geriatric Society and the National Institute for Health and Care Excellence highlight the importance of risk assessment at the time of the preoperative visit...
2016: Perioperative Medicine
Shelley R McDonald, Mitchell T Heflin
No abstract text is available yet for this article.
March 2016: Geriatric Nursing
Fan-Feng Chen, Fei-Yu Zhang, Xuan-You Zhou, Xian Shen, Zhen Yu, Cheng-Le Zhuang
PURPOSE: This study was performed to determine the association of frailty and nutritional status with postoperative complications after total gastrectomy (TG) with D2 lymphadenectomy in patients with gastric cancer. METHODS: Patients undergoing TG with D2 lymphadenectomy for gastric cancer between August 2014 and February 2016 were enrolled. Frailty was evaluated by sarcopenia which was diagnosed by a combination of third lumbar vertebra muscle index (L3 MI), handgrip strength, and 6-m usual gait speed...
September 2016: Langenbeck's Archives of Surgery
Jakub Kenig, Piotr Wałęga, Urszula Olszewska, Aleksander Konturek, Wojciech Nowak
BACKGROUND: Older patients experience a higher incidence of postoperative complications after cholecystectomy compared with younger patients. However, most studies have not considered patient frailty, particularly regarding emergency cholecystectomy. The aim of this prospective study was to evaluate outcomes in frail older patients eligible for elective and emergency cholecystectomy. METHODS: Preoperative Geriatric Assessment (GA) was performed in consecutive patients aged 65+ years, operated for biliary disease...
2016: World Journal of Emergency Surgery: WJES
Daisuke Makiura, Rei Ono, Junichiro Inoue, Miyuki Kashiwa, Taro Oshikiri, Tetsu Nakamura, Yoshihiro Kakeji, Yoshitada Sakai, Yasushi Miura
OBJECTIVES: The number of geriatric patients with esophageal cancer has been increasing. Geriatric syndromes such as sarcopenia might adversely affect postoperative recovery. The aim of this study was to evaluate the relationships between sarcopenia and postoperative complications, and the associations between sarcopenia and perioperative functional changes in patients with esophageal cancer following esophagectomy. MATERIALS AND METHODS: Participants comprised 104 patients who underwent esophagectomy from July 2011 to April 2015...
July 21, 2016: Journal of Geriatric Oncology
M G Huisman, M Kok, G H de Bock, B L van Leeuwen
The onco-geriatric population is increasing and thus more and more elderly will require surgery; an important treatment modality for many cancer types. This population's heterogeneity demands preoperative risk stratification, which has led to the introduction of Geriatric Assessment (GA) and associated screening tools in surgical oncology. Many reviews have investigated the use of GA in onco-geriatric patients. Discrepancies in outcomes between studies currently hamper the implementation of a preoperative GA in clinical practice...
June 21, 2016: European Journal of Surgical Oncology
K Singler, S Goisser, D Volkert
The prevalence of malnutrition or the risk of malnourishment is high among orthogeriatric patients and a poor nutritional status is associated with a negative outcome. A comprehensive management of preoperative and postoperative nutritional and fluid intake in these patients can help to improve the situation. The management includes identification of patients affected, a thorough assessment of the nutritional status, work-up of possible underlying causes, documentation of nutritional and fluid intake and, most importantly, procedures to improve the preoperative and postoperative nutritional situation...
August 2016: Zeitschrift Für Gerontologie und Geriatrie
Masaaki Yamamoto, Makoto Yamasaki, Ken Sugimoto, Yoshihiro Maekawa, Yasuhiro Miyazaki, Tomoki Makino, Tsuyoshi Takahashi, Yukinori Kurokawa, Kiyokazu Nakajima, Shuji Takiguchi, Hiromi Rakugi, Masaki Mori, Yuichiro Doki
BACKGROUND: The number of geriatric patients with esophageal cancer is increasing in step with the aging of the population. Geriatric patients have a higher risk of postoperative complications, including delirium that can cause a fall or impact survival. Therefore, it is very important that we evaluate risks of postoperative complications before surgery. The aim of this study was to predict postoperative delirium in elderly patients. METHODS: We retrospectively reviewed the medical records of 91 patients aged 75 years and over who underwent esophagectomy between January 2006 and December 2014...
November 2016: World Journal of Surgery
Sushila Murthy, David Lerner Hepner, Zara Cooper, Houman Javedan, Lauren Jan Gleason, John H Chi, Angela Maria Bader
The decision to pursue surgery is often complicated in older adults. A multidisciplinary, shared approach to decision-making may improve communication between patients and their providers and facilitate complex risk assessment. We describe a case of an older adult presenting for complex surgery in which the preoperative anesthesia clinic visit was used to facilitate involvement of the geriatrics service. This multidisciplinary approach allowed for re-evaluation and reiteration of risks and benefits, in-depth discussion of the patient's values and goals, and recommendations for care teams downstream in the patient's surgical pathway to ensure treatment consistent with patient goals and clinical recommendations...
July 15, 2016: A & A Case Reports
Sebastian Müller, Hatem Al-Fadel Saleh, Marcel Jakob, Nicholas A Beckmann, Bojana Savic, Daniel Rikli, Norbert Suhm
INTRODUCTION: Geriatric hip fracture patients are a highly heterogeneous collective, what distinctly aggravates the best possible treatment. Consequently, it is becoming more important to identify selection criteria that can distinguish those patients who can benefit the most from treatment in a geriatric fracture center. In our pilot study, we assessed the 2007 published Penrod score for its utility as a useful selection tool by prospectively comparing our own patient's outcome with the Penrod study...
August 2016: Archives of Orthopaedic and Trauma Surgery
M G Huisman, G Veronese, R A Audisio, G Ugolini, I Montroni, G H de Bock, B L van Leeuwen
BACKGROUND: Nutritional status (NS), though frequently affected in onco-geriatric patients, is no standard part of a geriatric assessment. The aim of this study was to analyse the association between a preoperatively impaired NS and geriatric domain impairments and adverse postoperative outcomes in onco-geriatric surgical patients. METHODS: 309 patients ≥70 years undergoing surgery for solid tumours were prospectively recruited. Nine screening tools were preoperatively administered as part of a geriatric assessment...
July 2016: European Journal of Surgical Oncology
Florence E Turrentine, Karen M Rose, John B Hanks, Breyette Lorntz, John A Owen, Valentina L Brashers, Erika E Ramsdale
BACKGROUND: Effective collaboration among healthcare providers is an essential component of high-quality patient care. Interprofessional education is foundational to ensuring that students are prepared to engage in optimal collaboration once they enter clinical practice particularly in the care of complex geriatric patients undergoing surgery. STUDY DESIGN: To enhance interprofessional education between nursing students and medical students in a clinical environment, we modeled the desired behavior and skills needed for interprofessional preoperative geriatric assessment for students, then provided an opportunity for students to practice skills in nurse/physician pairs on standardized patients...
May 2016: Nurse Education Today
Thomas J Luger, Markus F 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...
April 2016: Zeitschrift Für Gerontologie und Geriatrie
Benedicte Rønning, Torgeir Bruun Wyller, Arild Nesbakken, Eva Skovlund, Marit Slaaen Jordhøy, Arne Bakka, Siri Rostoft
OBJECTIVE: The incidence of colorectal cancer is increasing, mainly due to the aging of the population. Frailty, describing a state of increased vulnerability, is common in older patients, but frailty and high age are not necessarily contraindications to surgical treatment. However, limited data describing long-term outcomes after surgery in this patient group exist. In this clinical follow-up study, we aimed to examine long-term health-related quality of life in older surgical patients with colorectal cancer...
May 2016: Journal of Geriatric Oncology
R Gauthé, A Desseaux, L Rony, N Tarissi, F Dujardin
INTRODUCTION: In the elderly, ankle fractures are likely to cause specific complications and have a major impact on their autonomy. The goal of this multicentre study was to assess these outcomes in a geriatric population treated operatively. MATERIAL AND METHODS: This retrospective study included 477 patients with ankle fractures treated surgically between 2008 and 2014. The minimum age was 60years for women and 70 for men. Patients with a tibial pilon fracture or less than 3months' follow-up were excluded...
June 2016: Orthopaedics & Traumatology, Surgery & Research: OTSR
Masato Ogawa, Kazuhiro P Izawa, Seimi Satomi-Kobayashi, Aki Kitamura, Rei Ono, Yoshitada Sakai, Yutaka Okita
BACKGROUND: Preoperative nutritional status and physical function are important predictors of mortality and morbidity after cardiac surgery. However, the influence of nutritional status before cardiac surgery on physical function and the progress of postoperative rehabilitation requires clarification. AIMS: To determine the effect of preoperative nutritional status on preoperative physical function and progress of rehabilitation after elective cardiac surgery. METHODS: We enrolled 131 elderly patients with mean age of 73...
March 15, 2016: Aging Clinical and Experimental Research
Sunghye Kim, Anthony P Marsh, Lauren Rustowicz, Catherine Roach, Xiaoyan I Leng, Stephen B Kritchevsky, W Jack Rejeski, Leanne Groban
BACKGROUND: Specific geriatric assessment tools may complement traditional perioperative risk stratification. The aim of this study was to evaluate whether self-reported mobility is predictive of postoperative outcomes in older patients undergoing elective noncardiac surgery. METHODS: Patients aged 69 yr or older (n = 197) underwent (1) traditional risk assessments (American Society of Anesthesiologists physical status classification and Revised Cardiac Risk Index), (2) five-point frailty evaluation, (3) self-reported mobility assessment using the Mobility Assessment Tool-short form (range, 30...
April 2016: Anesthesiology
Justin G Knittel, Troy S Wildes
Geriatric patients are over-represented in hospitalizations, surgeries, and perioperative complications. Special consideration is required for this patient group in the perioperative period because of the prevalence of comorbid diseases, functional impairments, and other deficits. A comprehensive preoperative evaluation strategy is recommended to identify and address these issues. Systematic, multidomain assessments should be performed and paired with risk reduction efforts. A shared understanding of patient function and long-term health goals is also important for providing patient-centered care of the geriatric surgical patient...
March 2016: Anesthesiology Clinics
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