Common Perioperative Complications in Older Patients

2011 ◽  
pp. 361-376 ◽  
Author(s):  
Sandhya A. Lagoo-Deenadayalan ◽  
Mark A. Newell ◽  
Walter E. Pofahl
Keyword(s):  
Older Patients ◽  
Perioperative Complications

scholarly journals A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy

2016 ◽  
Vol 24 (1) ◽  
pp. 77-99 ◽  
Author(s):  
Lindsay Tetreault ◽  
Ahmed Ibrahim ◽  
Pierre Côté ◽  
Anoushka Singh ◽  
Michael G. Fehlings
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
Older Patients ◽  
Intervention Studies ◽  
Perioperative Complications ◽  
Patient Specific ◽  
Cochrane Central Register ◽  
Moderate Evidence ◽  
Operative Duration ◽  
Risk Patients

OBJECT Although generally safe and effective, surgery for the treatment of cervical spondylotic myelopathy (CSM) is associated with complications in 11%–38% of patients. Several predictors of postoperative complications have been proposed but few are used to detect high-risk patients. A standard approach to identifying “at-risk” patients would improve surgeons’ ability to prevent and manage these complications. The authors aimed to compare the complication rates between various surgical procedures used to treat CSM and to identify patient-specific, clinical, imaging, and surgical predictors of complications. METHODS The authors conducted a systematic review of the literature and searched MEDLINE, MEDLINE in Process, EMBASE, and Cochrane Central Register of Controlled Trials from 1948 to September 2013. Cohort studies designed to evaluate predictors of complications and intervention studies conducted to compare different surgical approaches were included. Each article was critically appraised independently by 2 reviewers, and the evidence was synthesized according to the principles outlined by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. RESULTS A total of 5472 citations were retrieved. Of those, 60 studies met the inclusion criteria and were included in the review. These studies included 36 prognostic cohort studies and 28 comparative intervention studies. High evidence suggests that older patients are at a greater risk of perioperative complications. Based on low evidence, other clinical factors such as body mass index, smoking status, duration of symptoms, and baseline severity score, are not predictive of complications. With respect to surgical factors, low to moderate evidence suggests that estimated blood loss, surgical approach, and number of levels do not affect rates of complications. A longer operative duration (moderate evidence), however, is predictive of perioperative complications and a 2-stage surgery is related to an increased risk of major complications (high evidence). In terms of surgical techniques, higher rates of neck pain were found in patients undergoing laminoplasty compared with anterior spinal fusion (moderate evidence). In addition, with respect to laminoplasty techniques, there was a lower incidence of C-5 palsy in laminoplasty with concurrent foraminotomy compared with nonforaminotomy (low evidence). CONCLUSIONS The current review suggests that older patients are at a higher risk of perioperative complications. A longer operative duration and a 2-stage surgery both reflect increased case complexity and can indirectly predict perioperative complications.

scholarly journals Curative effect and Safety in Anteromedial Osteoarthritis Patients over 80 Years Old Undergoing Oxford Unicompartmental Knee Arthroplasty (UKA) in China: A Single-Center Retrospective Study

2019 ◽  
Author(s):  
Jingbo Cheng ◽  
Mingli Feng ◽  
Guanglei Cao ◽  
Zheng Li ◽  
Shuai An ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Older Patients ◽  
Perioperative Complications ◽  
Womac Score ◽  
Younger Patients ◽  
Group 2 ◽  
Hss Score ◽  
Oxford Unicompartmental Knee Arthroplasty ◽  
Group 1

Abstract Background: Oxford Unicompartmental Knee Arthroplasty (UKA) has increased rapidly around the world, and the effectiveness and safety of a minimally invasive surgical approach for it demonstrate excellent outcome. Oxford UKA represents an interesting solution for older patients. The aim of our study is to evaluate the perioperative complications and short-term clinical outcome and analyze the safety for older patients who undergo Oxford UKA.Methods: A retrospective review was performed of all patients who underwent Oxford UKA between June 2015 and January 2018. We divided all patients into two groups (ages 60–80; age over 80). We used the HSS score and WOMAC score to evaluate the general condition of the patients’ knees. We also recorded perioperative complications and long-term complications. Result:130 patients (139 knees) between the ages of 60 and 80 (Group 1) and 65 patients (70 knees) over 80 years old (Group 2) were included in the study. The mean follow-up was 22.04 ± 11.04 and 21.76 ± 10.20 months in Group 1 and 2, respectively. At last follow-up, the patients in Group 2 showed lower function scores, but both the HSS score and the WOMAC score were significantly improved in both groups after surgery. The rate of perioperative complications and other complications in elderly patients is the same as in younger patients. Conclusion: Oxford UKA showed validity and safety for elderly patients in China. The knee joint pain symptoms of the elderly patients are relieved and the function is well restored, but the function is still poor compared with the younger patients.

Effect of Age on Clinical and Radiological Outcomes of Hallux Valgus Surgery

2021 ◽  
pp. 107110072098297
Author(s):  
Graham S. Goh ◽  
Adriel You Wei Tay ◽  
Yogen Thever ◽  
Kevin Koo
Keyword(s):  
Hallux Valgus ◽  
Older Patients ◽  
Perioperative Complications ◽  
Age Groups ◽  
Surgical Correction ◽  
Middle Aged ◽  
Level Of Evidence ◽  
Risk Of Recurrence ◽  
Valgus Angle

Background: The prevalence of hallux valgus increases with age. However, no studies have compared the effectiveness of surgical correction among different age groups. This study investigated the influence of age on clinical and radiological outcomes following hallux valgus surgery. Methods: Patients who underwent correction for hallux valgus at an academic hospital were stratified into 3 age groups: younger (<50 years), middle-aged (50-59 years), and older (≥60 years). Functional outcomes and satisfaction questionnaires were collected preoperatively and at 6 months and 2 years postoperatively. Radiological recurrence and reoperations were recorded at follow-up. There were 193 patients (93% female): 34 younger, 74 middle-aged, and 85 older. Results: The preoperative hallux valgus angle was significantly greater in older patients ( P < .001). The older group had 3 perioperative complications ( P = .144) and showed a trend toward a longer hospital stay ( P = .083). There was no difference in visual analog scale, American Orthopaedic Foot & Ankle Society score, or SF-36 among the groups at 6 months or 2 years. Using multiple regression, age was not associated with any outcome score. The satisfaction rates were 82%, 78%, and 83% in the young, middle-aged, and older groups, respectively ( P = .698). There was no difference in the number of reoperations at a mean follow-up of 9.2 ± 2.2 years ( P = .778), and no patients underwent reoperation for recurrent hallux valgus. The risk of recurrence was 5 times higher in older patients compared with younger patients (OR, 5.15; 95% CI, 1.10-24.03; P = .037). Conclusion: Age did not influence the perioperative, functional, or subjective outcomes following hallux valgus surgery. However, older patients should be counseled on the higher risk of recurrence following surgical correction. Level of Evidence: Therapeutic, level III, retrospective comparative series.

Perioperative Complication Profile of Skull Base Meningioma Resection in Older versus Younger Adult Patients

2021 ◽  
Author(s):  
Colin J. Przybylowski ◽  
Kelly A. Shaftel ◽  
Benjamin K. Hendricks ◽  
Kristina M. Chapple ◽  
Shawn M. Stevens ◽  
...  
Keyword(s):  
Functional Status ◽  
Skull Base ◽  
Older Patients ◽  
Perioperative Complications ◽  
Anterior Skull Base ◽  
Adult Patients ◽  
World Health ◽  
Younger Patients ◽  
Skull Base Meningioma ◽  
Perioperative Complication

Abstract Objectives To better understand the risk-benefit profile of skull base meningioma resection in older patients, we compared perioperative complications among older and younger patients. Design Present study is based on retrospective outcomes comparison. Setting The study was conducted at a single neurosurgery institute at a quaternary center. Participants All older (age ≥ 65 years) and younger (<65 years) adult patients treated with World Health Organization grade 1 skull base meningiomas (2008–2017). Main Outcome Measures Perioperative complications and patient functional status are the primary outcomes of this study. Results The analysis included 287 patients, 102 older and 185 younger, with a mean (standard deviation [SD]) age of 72 (5) years and 51 (9) years (p < 0.01). Older patients were more likely to have hypertension (p < 0.01) and type 2 diabetes mellitus (p = 0.01) but other patient and tumor factors did not differ (p ≥ 0.14). Postoperative medical complications were not significantly different in older versus younger patients (10.8 [11/102] vs. 4.3% [8/185]; p = 0.06) nor were postoperative surgical complications (13.7 [14/102] vs. 10.8% [20/185]; p = 0.46). Following anterior skull base meningioma resection, diabetes insipidus (DI) was more common in older versus younger patients (14 [5/37] vs. 2% [1/64]; p = 0.01). Among older patients, a decreasing preoperative Karnofsky performance status score independently predicted perioperative complications by logistic regression analysis (p = 0.02). Permanent neurologic deficits were not significantly different in older versus younger patients (12.7 [13/102] vs. 10.3% [19/185]; p = 0.52). Conclusion The overall perioperative complication profile of older and younger patients was similar after skull base meningioma resection. Older patients were more likely to experience DI after anterior skull base meningioma resection. Decreasing functional status in older patients predicted perioperative complications.

scholarly journals Patient outcomes in Anteromedial Osteoarthritis Patients over 80 Years Old Undergoing Oxford Unicompartmental Knee Arthroplasty in China

2020 ◽  
Author(s):  
Jingbo Cheng ◽  
Mingli Feng ◽  
Guanglei Cao ◽  
Zheng Li ◽  
Shuai An ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Older Patients ◽  
Perioperative Complications ◽  
Womac Score ◽  
Younger Patients ◽  
Group 3 ◽  
Hss Score ◽  
Oxford Unicompartmental Knee Arthroplasty ◽  
Group 1

Abstract Background: Oxford Unicompartmental Knee Arthroplasty (UKA) has increased rapidly around the world, and the effectiveness and safety of a minimally invasive surgical approach for it demonstrate excellent outcome. Oxford UKA represents an interesting solution for older patients. The aim of our study is to evaluate the perioperative complications and short-term clinical outcome and analyze the safety for older patients who undergo Oxford UKA.Methods: A retrospective review was performed of all patients who underwent Oxford UKA between June 2015 and January 2018. We divided all patients into three groups (ages 60–69; ages 70-79; age over 80). We used the HSS score and WOMAC score to evaluate the general condition of the patients’ knees. We also recorded perioperative complications and long-term complications.Result:60 patients (60 knees) between the ages of 60 and 69 (Group 1), 70 patients (79 knees) between the ages of 70-79 (Group 2) and 65 patients (70 knees) over 80 years old (Group 3) were included in the study. The mean follow-up was 21.34±12.04, 22.08±11.38 and 21.76 ± 10.20 months in Group 1, 2 and 3, respectively. At last follow-up, the patients in Group 3 showed lower function scores as compared to group 1 and 2 (P <0.05), but both the HSS score and the WOMAC score were significantly improved in both groups after surgery. The rate of perioperative complications and other complications in elderly patients is the same as in younger patients.Conclusion: Oxford UKA is an effective and safe treatment for osteoarthritis, even in old adult patients in China. The knee joint pain symptoms of the elderly patients are relieved and the function is improved, but the function is still poor compared with the younger patients.

Aging and Autism

2012 ◽  
Vol 17 (2) ◽  
pp. 69-75 ◽  
Author(s):  
Pamela A. Smith
Keyword(s):  
Health Care ◽  
Autism Spectrum Disorders ◽  
Patient Group ◽  
Older Patients ◽  
Geriatric Patients ◽  
Recent Literature ◽  
Communication Disorders ◽  
Autism Spectrum ◽  
Need For Support ◽  
Spectrum Disorders

In this article, I will review the available recent literature about the aging population with autism, a patient group that researchers know little about and a group that is experiencing a growing need for support from communication disorders professionals. Speech-language pathologists working with geriatric patients should become familiar with this issue, as the numbers of older patients with autism spectrum disorders is likely to increase. Our profession and our health care system must prepare to meet the challenge these patients and residents will present as they age.

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