Characteristics and outcomes of elderly patients undergoing carotid stenting: Experience of a high‐volume interventional cardiology center

2021 ◽  
Author(s):  
Ferdinando Varbella ◽  
Enrico Cerrato ◽  
Cristina Rolfo ◽  
Giorgio Quadri ◽  
Alfonso Franzè ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Interventional Cardiology ◽  
High Volume ◽  
Carotid Stenting

scholarly journals NutriCatt Protocol Improves Body Composition and Clinical Outcomes in Elderly Patients Undergoing Colorectal Surgery in ERAS Program: A Retrospective Cohort Study

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1781
Author(s):  
Emanuele Rinninella ◽  
Alberto Biondi ◽  
Marco Cintoni ◽  
Pauline Raoul ◽  
Francesca Scialanga ◽  
...  
Keyword(s):  
Body Composition ◽  
Colorectal Surgery ◽  
Elderly Patients ◽  
Clinical Outcomes ◽  
Cell Mass ◽  
Length Of Hospital Stay ◽  
Bioelectrical Impedance ◽  
High Volume ◽  
Analysis Data ◽  
Perioperative Outcomes

Background: A poor body composition, often found in elderly patients, negatively impacts perioperative outcomes. We evaluated the effect of a perioperative nutritional protocol (NutriCatt) on body composition and clinical outcomes in a cohort of elderly patients undergoing colorectal surgery in a high-volume center adopting the ERAS program. Methods: 302 out of 332 elderly (>75 years) patients from 2015 to 2020 were identified. Patients were divided according to their adherence, into “NutriCatt + ERAS” (n = 166) or “standard ERAS” patients (n = 136). Anthropometric and bioelectrical impedance analysis data were evaluated for NutriCatt + ERAS patients. Complications, length of hospital stay (LOS), and other postoperative outcomes were compared between both groups. Results: In NutriCatt + ERAS patients, significant improvements of phase angle (pre-admission vs. admission 4.61 ± 0.79 vs. 4.84 ± 0.85; p = 0.001; pre-admission vs. discharge 4.61 ± 0.79 vs. 5.85 ± 0.73; p = 0.0002) and body cell mass (pre-admission vs. admission 22.4 ± 5.6 vs. 23.2 ± 5.7; p = 0.03; pre-admission vs. discharge 22.4 ± 5.6 vs. 23.1 ± 5.8; p = 0.02) were shown. NutriCatt + ERAS patients reported reduced LOS (p = 0.03) and severe complications (p = 0.03) compared to standard ERAS patients. A regression analysis confirmed the protective effect of the NutriCatt protocol on severe complications (OR 0.10, 95% CI 0.01–0.56; p = 0.009). Conclusions: The NutriCatt protocol improves clinical outcomes in elderly patients and should be recommended in ERAS colorectal surgery.

P119 SURGICAL OUTCOMES AFTER ESOPHAGECTOMY IN THE ELDERLY POPULATION - A SINGLE CENTER COHORT STUDY

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Söderström Henna ◽  
Ilonen Ilkka ◽  
Andersson Saana ◽  
Kauppi Juha ◽  
Räsänen Jari
Keyword(s):  
Elderly Patients ◽  
Neoadjuvant Treatment ◽  
Hybrid Approach ◽  
High Volume ◽  
Good Health ◽  
The Elderly ◽  
Pulmonary Complications ◽  
Long Term Results ◽  
High Morbidity ◽  
Survival Times

Abstract Aim To evaluate morbidity and mortality after esophagectomy among elderly patients Background & Methods Esophagectomy is associated with significant morbidity1, and with the aging population we are faced with an increasing number of elderly patients eligible for surgery. In this retrospective study we analyzed both minor and major postoperative complications (Clavidien-Dindo II-V), in-hospital and 90-day mortality, and overall survival in all carcinoma patients ≥75 yo undergoing esophagectomy for cancer between 2009 and 2018 at a high-volume center. Results 47 patients underwent esophagectomy during the 10-yr. period, 95,7% either minimally invasively or with a hybrid approach. Median age was 77, and the oldest patient 85 yo. The majority were in otherwise good health, 39 had an ASA score of 1-2, and all but one was ECOG 0. 70% had adenocarcinomas, and 70% received neoadjuvant treatment. 68,1% of the patients suffered some sort of complication. 19 patients (40,4%) had a C-D III-IV complication, 9 of which were pulmonary requiring a median of 5 days in the ICU. Only 4 patients (8,5%) had anastomotic leakage requiring an intervention, 2 were managed endoscopically, 1 early dehiscence was sutured and one required a revision and LD plasty. One patient had non-fatal gastric tube necrosis that was excised. Atrial fibrillation (34%) was the most common but easily managed issue, followed by pulmonary complications (C-D II 5pts /10,6%, C-D III-IV 10 pts / 21,3%). We had 3 re-operations for bowl herniation, and one for bleeding. Our in-hospital and 90-day mortality were 0%, in spite of the high complication rate. 63,8% were discharged home. Mean and median survival times 68,2 mo. and 47 mo., respectively. At time of follow up, 28 patients (59,6%) were still alive. Conclusion Esophagectomy comes with high morbidity, but with acceptable long term results it should be considered for elderly patients otherwise fit for surgery. Our results show that in select cases age is just a number 1. Low DE, Kuppusamy MK, Alderson D, Cecconello I, Chang AC, Darling G, Davies A, D'Journo XB, Gisbertz SS, Griffin SM, Hardwick R, Hoelscher A, et al. Benchmarking Complications Associated with Esophagectomy. Ann Surg 2017;:1.

Abstract 16: Society of Chest Pain Centers accreditation is associated with improved cardiac service line outcomes in Virginia hospitals

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Chris Ghaemmaghami
Keyword(s):  
Chest Pain ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Interventional Cardiology ◽  
High Volume ◽  
Coronary Intervention ◽  
Service Line ◽  
Mortality Ratio ◽  
Reported Data ◽  
Expected Mortality

Introduction: Hospitals in Virginia publicly report mortality outcomes on cardiac patients voluntarily. The Society of Chest Pain Centers (SCPC) is a process improvement organization that uses a standardized system of accreditation to recognize hospitals meeting specific process and organizational standards in acute cardiac care. Hypothesis: An association may exist between a hospital’s SCPC accreditation status and the reported mortality index for cardiology patients who do not undergo percutaneous or surgical coronary intervention. Methods: Self-reported data on non-interventional cardiac service line mortality for acute care hospitals in Virginia for calendar year 2009 were obtained from the Virginia Health Information website ( www.VHI.org ). Expected mortality rates were calculated by quality personnel at each hospital using standardized methodologies. Actual to expected (A:E) mortality ratios were compared between SCPC accredited an d non-accredited hospitals. Two-tailed t tests were used for comparisons. Results: Data were available from 77 acute care hospitals representing a total of 57,976 non-interventional cardiology patient cases in Virginia for 2009. 17 SCPC-accredited hospitals accounted for 19,246 cases and 60 non-accredited hospitals accounted for 38,730 cases. Using volume-weighted averages, the mean A:E mortality ratio was 0.91 at SCPC-accredited hospitals vs. 1.14 at non-accredited hospitals. (p <0.0001, 95% CI for difference in means: -0.24 to -0.22). In high-volume centers (>500 cases/yr), there was a significantly decreased A:E mortality ratio in accredited centers (n=13) vs. non-accredited ones (n=29) (0.86 vs. 1.11, p <0.0001; 95% CI for difference in means: -0.26 to -0.24). In low-volume centers (<500 cases/yr), there were higher than expected A:E mortality ratios in both the accredited (n=4) and non-accredited groups (n=31) (1.54 and 1.24, respectively). Conclusions: SCPC accreditation was associated with a lower A:E mortality ratio in Virginia hospitals. This lower mortality ratio was more prominent in hospitals having higher volumes of non-interventional cardiac cases. Smaller volume centers had higher than expected mortality ratios regardless of accreditation status.

scholarly journals One-Year Clinical Outcomes, Midterm Survival, and Predictors of Mortality After Carotid Stenting in Elderly Patients

Circulation ◽  
2009 ◽  
Vol 119 (17) ◽  
pp. 2343-2348 ◽  
Author(s):  
Paul T.L. Chiam ◽  
Gary S. Roubin ◽  
Georgia Panagopoulos ◽  
Sriram S. Iyer ◽  
Richard M. Green ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Clinical Outcomes ◽  
Carotid Stenting ◽  
Predictors Of Mortality ◽  
One Year

Interventions in the elderly: special considerations

ESC CardioMed ◽  
2018 ◽  
pp. 2980-2985
Author(s):  
Adrian Messerli ◽  
Khaled M Ziada
Keyword(s):  
Elderly Patients ◽  
Valve Replacement ◽  
Age Groups ◽  
Vascular Complications ◽  
Interventional Cardiology ◽  
The Elderly ◽  
Adverse Outcomes ◽  
St Segment Elevation ◽  
Transcatheter Aortic Valve ◽  
St Segment

The elderly population has high rates of coronary and valvular heart disease, hence the need for interventional cardiology solutions. Despite the safety of interventional procedures, older age independently predicts adverse outcomes. The elderly are more likely to have co-morbidities and suffer complications after invasive procedures. For these and other reasons, invasive therapies are disproportionately underutilized in this population. The elderly account for the majority of acute coronary syndrome-related deaths. Randomized trials and observational data confirm the favourable benefit versus risk ratio of early invasive approaches, but these strategies remain underutilized. Those presenting with ST-segment elevation are at higher risk of mechanical complications and death. Evidence supports the superiority of primary angioplasty over thrombolysis in ST-segment elevation infarction in the elderly. Although the benefit of early revascularization in elderly patients with cardiogenic has been questioned, recent analysis of larger datasets confirms that they benefit from earlier intervention like other age groups. Transcatheter aortic valve replacement (TAVR) has improved survival and quality of life of elderly patients frequently considered ineligible to undergo open valve replacement. The elderly remain at highest risk of death, stroke, and vascular complications with TAVR, but such complications remain limited and outcomes of the transcatheter approaches are better than open valve replacement or medical therapy. Concerns regarding overuse of TAVR in terminal patients have been raised, but standardized and methodical assessment of frailty and co-morbidity help in selection of patients in whom the benefit outweighs the risk.

Economic appraisal of the angioplasty procedures performed in 2004 in a high-volume diagnostic and interventional cardiology unit

2007 ◽  
Vol 8 (10) ◽  
pp. 792-798
Author(s):  
Antonio Manari ◽  
Elena Costa ◽  
Alessandro Scivales ◽  
Patrizia Ponzi ◽  
Francesca Di Stasi ◽  
...  
Keyword(s):  
Interventional Cardiology ◽  
High Volume ◽  
Economic Appraisal

P21 FEASIBILITY OF ENHANCED RECOVERY PROTOCOL AFTER ESOPHAGEAL SURGERY IN ELDERLY PATIENTS

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
C A De Pasqual ◽  
J Weindelmayer ◽  
R La Mendola ◽  
L Alberti ◽  
C Ridolfi ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Enhanced Recovery ◽  
High Volume ◽  
Young Group ◽  
Pulmonary Complications ◽  
Esophageal Surgery ◽  
Morbidity Rate ◽  
Cardiac Complications ◽  
Soft Diet ◽  
Complications Rate

Abstract Background In dedicated centres ERAS (Enhanced Recovery After Surgery) programs have been successfully applied after esophageal surgery. However, some concerns have been raised about the feasibility of these protocols in elderly patients. Methods We retrospective reviewed 72 patients submitted to Ivor-Lewis esophagectomy in our Institution, during the period 2015-2017. We divided the patients into two groups: 47 patients (65,3%) were <70 years old (Young Group, YG) while 25 patients (34,7%) were ≥70 years old (Elderly Group, EG). We compared post-operative outcomes and adherence to ERAS steps of the two groups. Results The two groups were not different in terms of overall morbidity rate (53,2% in YG vs 60,0% in EG p= 0,6) and pulmonary complications rate (70,2% in YG vs 72,0% in EG, p= 1). EG showed a higher cardiac complications rate (3,5% in YG vs 26,7% in EG, p=0,001). We did not report 90-days mortality. We did not observe differences in adherence to the following ERAS steps: pre-operative carbohydrate load administration (78,7% in YG vs 76,0% in EG, p=0,7), ward transfer on POD 0 (61,7% in YG vs 48,0% in EG, p=0,32), removal of naso-gastric tube on POD 1 (87,2% in YG vs 96,0% in EG, p=0,4), resume of liquid diet on POD 1 (55,3% in YG vs 56,0% in EG, p=1), urinary catheter removal on POD 2 (61,7% in YG vs 48,0% in EG, p=0,3), fully mobilization on POD 3 (63,8% in YG vs 52,0% in EG, p=0,4), resume of soft diet on POD 4 (72,3% in YG vs 68,0% in EG, p=0,7), discharge on POD 7 (48,9% in YG vs 40,0% in EG, p=0,6). Median day of discharge was POD 8 for both groups (p= 0,8). Conclusions In high-volume centres ERAS protocols can be safely applied to elderly patients undergoing esophagectomy.

scholarly journals Cerebral Protection in Elderly Patients during Carotid Stenting

2013 ◽  
Vol 21 (2) ◽  
pp. 159-164
Author(s):  
Manuel Nicolas Cano ◽  
Silvia Judith Fortunato de Cano ◽  
Antônio Massamitsu Kambara ◽  
Samuel Moreira ◽  
Luiz Antônio Pezzi Portela ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Carotid Stenting ◽  
Cerebral Protection

PS01.205: FEASIBILITY OF ENHANCED RECOVERY PROTOCOL AFTER ESOPHAGEAL SURGERY IN ELDERLY PATIENTS: A SINGLE CENTRE EXPERIENCE

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 107-108
Author(s):  
Carlo Alberto De Pasqual ◽  
Jacopo Weindelmayer ◽  
Simone Giacopuzzi ◽  
Luca Alberti ◽  
Roberta La Mendola ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Conflicts Of Interest ◽  
Enhanced Recovery ◽  
High Volume ◽  
Young Group ◽  
Pulmonary Complications ◽  
Morbidity Rate ◽  
Operative Outcomes ◽  
Soft Diet ◽  
Carbohydrate Load

Abstract Background The use of ERAS (Enhanced Recovery After Surgery) protocols, to reduce morbidity and accelerate recovery is spreading in general surgery. In dedicated centres these programs have been successfully applied after oesophageal surgery. However, some concerns have been raised about the feasibility of these protocols in elderly patients. Methods We retrospective reviewed 72 patients submitted to Ivor-Lewis esophagectomy in our Institution, in the period 2015–2017. We divided the patients into two groups: 47 patients (65,3%) were < 70 years old (Young Group, YG) while 25 patients (34,7%) were ≥ 70 years old (Elderly Group, EG). We compared post-operative outcomes and adherence to ERAS steps of the two groups. Results The two groups were not different in terms of overall morbidity rate (53,2% in YG vs 60,0% in EG P = 0,6) and pulmonary complications rate (70,2% in YG vs 72,0% in EG, P = 1). We did not reporte 90-days mortality. We did not observe differences in adherence to ERAS step: pre-operative carbohydrate load administration (78,7% in YG vs 76,0% in EG, P = 0,7), peri-dural catheter for analgesia placement (89,3% in YG vs 88,0% in EG, P = 1), ward transfer on POD 0 (61,7% in YG vs 48,0% in EG, P = 0,32), removal of naso-gastric tube on POD 1 (87,2% in YG vs 96,0% in EG, P = 0,4), resume of liquid diet on POD 1 (55,3% in YG vs 56,0% in EG, P = 1), urinary catheter removal on POD 2 (61,7% in YG vs 48,0% in EG, P = 0,3), fully mobilization on POD 3 (63,8% in YG vs 52,0% in EG, P = 0,4), resume of soft diet on POD 4 (72,3% in YG vs 68,0% in EG, P = 0,7), discharge on POD 7 (48,9% in YG vs 40,0% in EG, P = 0,6). Median day of discharge was POD 8 for both groups (P = 0,8). Conclusion In high-volume centres ERAS protocols can be safely applied to elderly patients undergoing esophagectomy. An experienced team is needed to achieve this results. Disclosure All authors have declared no conflicts of interest.

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