scholarly journals Comparing Emergent and Elective Colectomy Outcomes in Elderly Patients: A NSQIP Study

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Mostapha El Edelbi ◽  
Ibrahim Abdallah ◽  
Rola F. Jaafar ◽  
Hani Tamim ◽  
Samer Deeba ◽  
...  
Keyword(s):  
Elderly Patients ◽  
The Elderly ◽  
Open Colectomy ◽  
Morbidity And Mortality ◽  
Chronic Obstructive ◽  
Chronic Obstructive Pulmonary Disorder ◽  
Improvement Program ◽  
Outcome Differences ◽  
Elective Colectomy ◽  
Emergent Surgery

Introduction. With the increasing prevalence of colorectal cancer (CRC) worldwide, especially in the elderly, and the variability between physiological and chronological age and its impact on functional status, acute symptoms leading to emergent surgery due to colorectal malignancy may lead to increased morbidity and mortality. The aim of this study is to identify the outcome differences of elective vs. emergent open colectomy in patients above 80 years. Methods. The National Surgical Quality Improvement Program (NSQIP) database was reviewed from 2010 to 2014 for open colectomy based on CPT codes. Comparison between groups was done based on the clinical context at presentation as elective or emergent surgery. Data were analyzed using SAS. Results. Elective colectomies were performed in 8289 (70.8%) vs. emergent colectomies in 3409 (29.1%). Emergent colectomy patients had higher American Society of Anesthesiologists (ASA) preoperative classification III-IV, 1429 (42.0%) and 224 (6.6%), vs. 1238 (14.9%) and 21 (0.2%) in elective colectomy patients p < 0.0001 . Emergent colectomy patients had more comorbidities such as chronic obstructive pulmonary disorder (493 (14.5%) vs. 796 (9.6%)), congestive heart failure (206 (6.0%) vs. 310 (3.8%)), dialysis (106 (3.1%) vs. 56 (0.7%)), and acute renal failure (166 (4.9%) vs. 46 (0.6%)) p < 0.0001 , respectively. Postoperative morbidity and mortality were significantly higher in emergent colectomy (1651 (48.4%) and 872 (25.6%)) vs. elective colectomy (1859 (22.4%) and 567 (6.8%)) p < 0.0001 , respectively. Conclusion. Emergent open colectomy in elderly patients carries a higher risk of morbidity and mortality when compared to elective open colectomy with risk factors being higher ASA classification and more comorbidities.

Anaesthesia in the elderly

2017 ◽  
Author(s):  
Bernadette Veering ◽  
Chris Dodds
Keyword(s):  
Elderly Patients ◽  
Postoperative Morbidity ◽  
Medical Condition ◽  
Clinical Care ◽  
The Elderly ◽  
Individual Variability ◽  
Morbidity And Mortality ◽  
Clear Understanding ◽  
Organ Systems ◽  
Specific Organ

The elderly population continues to grow. As surgical intervention in disease processes becomes more aggressive, the anaesthetist is faced with an increasing number of elderly patients. Elderly patients should be approached with a clear understanding of ageing, how it occurs, how it affects specific organ systems, and how it may influence clinical care, when a patient is subjected to an operation. The ageing process is a multifactorial process, resulting in a decreased capacity for adaptation and producing a gradual decrease in functional reserve of many organ systems. This has significant effects on the physiological responses to surgical and pharmacological trespass faced during anaesthesia. Increasing age is associated with changes in the response to a wide variety of drugs. Changes in dose–response relationships may be as a result of changes in pharmacokinetics, pharmacodynamics, or a combination of both. One should realize that increasing age is associated with a large inter-individual variability in dose requirements. As such, it is important to carefully titrate the dose against the desired clinical effect in an older patient. Preoperative physical and mental state are the most important determinants of per- and postoperative morbidity and mortality. The number of co-morbidities increases with advanced age and as such, optimization of the medical condition is essential to reduce the morbidity and mortality.

Morbidity and Mortality of C2 Fractures in the Elderly

Neurosurgery ◽  
2011 ◽  
Vol 70 (5) ◽  
pp. 1055-1059 ◽  
Author(s):  
Yi-Ren Chen ◽  
Maxwell Boakye ◽  
Robert T. Arrigo ◽  
Paul S. A. Kalanithi ◽  
Ivan Cheng ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hospital Stay ◽  
Treatment Modality ◽  
The Elderly ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Complication Rates ◽  
Term Survival ◽  
Cord Injury

Abstract BACKGROUND: Closed C2 fractures commonly occur after falls or other trauma in the elderly and are associated with significant morbidity and mortality. Controversy exists as to best treatment practices for these patients. OBJECTIVE: To compare outcomes for elderly patients with closed C2 fractures by treatment modality. METHODS: We retrospectively reviewed 28 surgically and 28 nonsurgically treated cases of closed C2 fractures without spinal cord injury in patients aged 65 years of age or older treated at Stanford Hospital between January 2000 and July 2010. Comorbidities, fracture characteristics, and treatment details were recorded; primary outcomes were 30-day mortality and complication rates; secondary outcomes were length of hospital stay and long-term survival. RESULTS: Surgically treated patients tended to have more severe fractures with larger displacement. Charlson comorbidity scores were similar in both groups. Thirty-day mortality was 3.6% in the surgical group and 7.1% in the nonsurgical group, and the 30-day complication rates were 17.9% and 25.0%, respectively; these differences were not statistically significant. Surgical patients had significantly longer lengths of hospital stay than nonsurgical patients (11.8 days vs 4.4 days). Long-term median survival was not significantly different between groups. CONCLUSION: The 30-day mortality and complication rates in surgically and nonsurgically treated patients were comparable. Elderly patients faced relatively high morbidity and mortality regardless of treatment modality; thus, age alone does not appear to be a contraindication to surgical fixation of C2 fractures.

scholarly journals Appendicular perforation and its contributing factors

2017 ◽  
Vol 4 (6) ◽  
pp. 2007
Author(s):  
Anandaravi B. N. ◽  
Ramaswami B.
Keyword(s):  
Risk Factors ◽  
Acute Appendicitis ◽  
Elderly Patients ◽  
Perforated Appendicitis ◽  
Clinical History ◽  
The Elderly ◽  
Morbidity And Mortality ◽  
Delayed Presentation ◽  
Contributing Factors ◽  
Steroid Dependent

Background: The objective was to study of different risk factors contributing in appendicular perforation and effective management of patients by knowing risk factors.Methods: This study was conducted in the department of general surgery K. R. Hospital Mysore medical college and research institute, Mysore, Karnataka, India from January 2015 to June 2016. Patients of age above 18 years and both sexes operated for acute appendicitis were included in present study. The clinical history, clinical features, investigations, intraoperative findings, were noted and surgical procedure done and all perforated appendicitis cases were operated lower midline incision, through wash given with normal saline drain in situ. Post operatively antibiotics were given and all patients follow up done for one month.Results: Present study duration is one and half year we operated total 100 patients for acute appendicitis. In this study 55 patients were male (55%) and 45 patients were females (45%). According to our study acute appendicitis is more common in males. Appendicular perforation has noticed in 23 female patients. The incidence of perforated appendicitis is low in males 12 out of 35 as compared to females 23 out of 35. The incidence of appendicular perforation is higher in the extreme of ages. In the elderly patients it is 58.33%. Thus, according to present study findings age above (>40 years) is strongly associated with the perforated appendicitis (p<0.001 chi squared test). Delayed presentation shows 77.41% appendicular perforation and faecolith associated with 64.51%.Conclusions: The morbidity and mortality rates are higher in elderly patients, diabetics, steroid dependent and immunocompromised patients. We should be aggressive in the treatment of acute appendicitis associated with high risk factors. So once acute appendicitis is diagnosed, the expedient surgery and appropriate use of perioperative antibiotics can help in reducing the morbidity and mortality.

scholarly journals Chronic obstructive pulmonary disease in patients with coronary heart disease of elderly age groups

2020 ◽  
pp. 19-19
Author(s):  
G.P. Voinarovska ◽  
E.O. Asanov
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Elderly Patients ◽  
Old Age ◽  
Age Groups ◽  
The Elderly ◽  
Chronic Obstructive ◽  
Bronchial Obstruction ◽  
Obstructive Pulmonary Disease

Background. Among the combinations of comorbid conditions, a special role belongs to the combination of coronary heart disease (CHD) and chronic obstructive pulmonary disease (COPD). Because COPD is often associated with CHD, most authors believe that there is a direct link between COPD, progression of bronchial obstruction, and pathological conditions of the cardiovascular system, including mortality from myocardial infarction. In elderly patients, according to some researchers, the link between COPD and CHD is most pronounced. Objective. To establish the frequency of COPD in patients with CHD in older age groups. Materials and methods. The studies are based on the results of a comprehensive survey of 635 patients with CHD aged 60-89 years, who were observed for a long time of the State Institution “Chebotarev Institute of Gerontology of the National Academy of Medical Sciences of Ukraine”. Results and discussion. The share of patients with CHD in whom COPD was detected in the group of elderly people is 19.4 %. This is much more than the average population. The frequency of COPD in patients with CHD decreases significantly with further aging. The prevalence of COPD among elderly patients is much lower than among elderly patients. This can most likely be explained by the fact that a significant proportion of patients with CHD with COPD do not live to old age. The analysis revealed that in elderly patients there is bronchial obstruction of more severe stages. This is due to the fact that CHD patients with COPD who live to old age have worsening bronchial patency due to the longer duration of the disease. It has been established that the majority of patients with CHD with COPD, both elderly and senile, are male. This can be explained by the negative effects of smoking. Conclusions. The incidence of COPD in patients with CHD in the elderly is much higher than in the population. At the same time, the incidence of COPD among patients with CHD in the elderly is much lower than among the elderly. In patients of advanced age bronchial obstruction is more expressed.

525 EVERYONE NEEDS TO POOP: REDUCING CONSTIPATION IN THE ELDERLY INPATIENT POPULATION

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii8-ii13
Author(s):  
J C R G Rollo-Walker
Keyword(s):  
Elderly Patients ◽  
Nursing Staff ◽  
The Elderly ◽  
Morbidity And Mortality ◽  
Medical Review ◽  
Dependent Effect ◽  
Elderly Inpatient ◽  
Inpatient Population ◽  
Multi Disciplinary Team

Abstract Introduction Due to a variety of factors when elderly patients are admitted to hospital they can become constipated. This can impact the entire admission increasing morbidity and mortality for what is a treatable problem. The aim therefore was to assess how prevalent constipation was across the inpatient population; analyse if there were any common themes and implement interventions that might help solve these. Method Data was collected over 15 days across the department (up to 87 patients) using nursing handover sheets to review the date bowels had last been opened. Patients were classified as constipated if they had not opened their bowels for more than 3 days. On two days common themes in the constipated patients were reviewed and analysed. On average 27% of patients were constipated. The majority of these had been deemed ‘Medically Ready for Discharge’. They all had either no or only a reduced range of aperients prescribed. Stakeholders including patients, nursing staff, prescribers and Consultants were surveyed. First cycle intervention was to highlight those constipated at morning Multi-disciplinary Team (MDT) meetings to prompt medical review. Second cycle intervention: an e-prescribing bundle was designed to allow for simple prescription and for nurses to give aperients on an as required basis. A laxative prescribing guide sheet was also written to aid prescribers. Results Aim is to reduce constipation to less than 20% thereby reducing morbidity and mortality in inpatients. Highlighting patients at MDT had little effect partly as it was person dependent. Effect of prescribing bundle yet to be determined but received positively by stakeholders. Prescribing guide received positively by Consultants and junior prescribers. Conclusions Person dependent intervention was ineffective at reducing constipation highlighted by staff sickness due to Covid-19. A prescribing bundle is more system based. If used at admission hopefully will be effective and sustainable.

scholarly journals Hip Fractures in the Elderly During the COVID-19 Pandemic: A Latin-American Perspective With a Minimum 90-Day Follow-Up

2021 ◽  
Vol 12 ◽  
pp. 215145932110245
Author(s):  
Tomas Zamora ◽  
Felipe Sandoval ◽  
Hugo Demandes ◽  
Javier Serrano ◽  
Javiera Gonzalez ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Latin American ◽  
Clinical Information ◽  
The Elderly ◽  
Older Age ◽  
Morbidity And Mortality ◽  
Level Of Evidence ◽  
Fragility Hip Fracture

Introduction: Hip fracture patients have been severely affected by the COVID-19 pandemic; however, the sub acute effects of a concomitant SARS-CoV-2 infection and the outcomes in highly exposed developing countries are still unknown. Our objective is to describe the morbidity and mortality of elderly patients admitted for a hip fracture during the COVID-19 pandemic in Chile, with a minimum 90-day follow-up. Also, to elucidate predictors for mortality and to compare mortality results with the pre-pandemic era. Material and Methods: Multicentric retrospective review of patients admitted for a fragility hip fracture in 3 hospitals during the COVID-19 pandemic, and during the same time in 2019. All clinical information and images were recorded, and patients were followed for a minimum of 90-days. Morbidity and mortality were the primary outcomes. Uni/multivariable models were performed to elucidate predictors for mortality utilizing the Weibull’s regression. Results: Three hundred ninety-one cases were included. From the 2020 cohort (162 patients), 24 (15%) had a concomitant SARS-CoV-2 infection. Fourteen patients (58%) tested positive after admission. The COVID-19(+) group had a higher risk of in-hospital, 30-day, and 90-day mortality (p < 0.001). They also had a prolonged hospital stay and presented with more complications and readmissions (p < 0.05). Only COVID-19(+) status and older age were independent predictors for mortality with a HR = 6.5 (p = < 0.001) and 1.09 (p = 0.001), respectively. The 2020 cohort had twice the risk of mortality with a HR = 2.04 (p = 0.002) compared to the 2019 cohort. However, comparing only the COVID-19 (-) patients, there was no difference in mortality risk, with a HR = 1.30 (p = 0.343). Discussion: The COVID-19 pandemic has significantly affected healthcare systems and elderly patients. Conclusions: Hip fracture patients with a concomitant SARS-CoV-2 virus infection were associated with increased morbidity and mortality throughout the first 3 months. COVID-19 status and older age were significant predictors for mortality. Efforts should be directed into nosocomial infection reduction and prompt surgical management. Level of evidence: Level III

scholarly journals Contributing Factors to Hospital Readmissions

2013 ◽  
Author(s):  
Susan Amalfitano
Keyword(s):  
Elderly Patients ◽  
Hospital Readmission ◽  
Transitional Care ◽  
Hospital Readmissions ◽  
The Elderly ◽  
High Rate ◽  
Chronic Obstructive ◽  
Contributing Factors ◽  
Obstructive Pulmonary Disease ◽  
Care Of Elderly

Aims and objectives. To investigate the elderly patient’s perspective about the reasons for discharge to home being unsuccessful, resulting in rehospitalization. Background. Elderly patients have a high rate of readmission to the hospital within 30 days of discharge. Starting in October of 2013, hospitals having a high rate of readmission of patients with heart failure (HF), myocardial infarction (MI), and pneumonia (PNA) will face financial penalties. Evidence indicated that by utilizing risk prediction tools and incorporating transition interventions the risk of a hospital readmission may be reduced. Design. A qualitative, descriptive design was used. Methods. In 2013, a student investigator interviewed elderly patients over the age of 65 who were readmitted to the hospital with the diagnosis of HF, MI, PNA or chronic obstructive pulmonary disease (COPD) within 30 days of discharge. A total of six (N=6) patients and/or surrogates participated in the interviews. Data were collected using semistructured interviews and subjected to thematic content analysis. Results. Three major themes emerged: discharge readiness, communication, and education. Implications for the advanced practice registered nurse (APRN). Practicing in an APRN role provides the opportunity for the nurse to facilitate the appropriate transitional care of elderly patients placing them at less risk for hospital readmission within 30 days.

scholarly journals Clinical presentation of urolithiasis in older and younger population

2014 ◽  
Vol 86 (4) ◽  
pp. 249 ◽  
Author(s):  
Murat Dursun ◽  
Emin Ozbek ◽  
Alper Otunctemur ◽  
Suleyman Sahin ◽  
Suleyman Sami Cakir
Keyword(s):  
Heart Disease ◽  
Elderly Patients ◽  
Average Length ◽  
The Elderly ◽  
Stone Disease ◽  
Elderly Group ◽  
Ureteral Stones ◽  
Chronic Obstructive ◽  
Younger Patients ◽  
The Difference

Aim of the study: We compared stone size, localization, complaint at the time of applying, comorbidity, treatment and complications between older (60 years of age and older) and younger patients with urolithiasis (59 years of age and younger). Materials and Methods: We retrospectively reviewed the records of 950 consecutive patients who presented to our clinic and underwent surgery for urolithiasis from January 2007 to March 2012. The patients were divided into two groups: patients ≥ 60 years an patients &lt; 60 years. Results: There were 174 men and 61 women in elderly group, 528 men and 187 women in younger group. Ureteral stones were found more often in the younger group compared to elderly patients (p &lt; 0.05). Conversely, bladder stone was more frequent in the elderly group. In the elderly group comorbidities are more frequent (diabetes mellitus, hypertension, ischemic heart disease, congestive heart disease, osteoarthritis and chronic obstructive lung). Patients ≥ 60 years significantly had larger kidney and bladder stones compared the younger, but ureteral stone sizes were not statistically different between the two groups. Older patients had a higher postoperative complication rate than younger patients (16% versus 3%, p &lt; 0.05) although postoperative complications (e.g. urinary retention, cardiac dysrythmia, fever, constipation) were not serious and resolved with medical treatment. The average length of stay in hospital was longer in the elderly group, but the difference was not statistically significant. Conclusions: Elderly patients with urolithiasis usually have larger and more complex stone disease, more comorbidities and atypical presentation.

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