The impact of patient age and procedure type on postoperative opioid use following ambulatory pediatric urologic procedures

Background: Chondral damage from the impact of injury may contribute to the high incidence of post-traumatic arthritis after calcaneal fractures, but this has yet to be proven. We sought to study the effect of intra-articular calcaneal fractures on chondrocyte viability and to correlate these effects with injury severity, time from injury to surgery, and patient age and co-morbidities. Methods: Irreducible osteochondral fragments from 12 patients undergoing operative treatment for intra-articular calcaneal fractures were analyzed. Control cartilage was obtained from four tissue donors who died of unrelated causes. The cartilage was assessed for chondrocyte viability through the full thickness of tissue using a Live/Dead assay followed by laser scanning confocal microscopy. Patient demographics including injury classification and severity, time from injury to surgery, and patient age were recorded. Results: Chondrocyte viability from fracture patients averaged 72.8% ± 12.9% (range 53% to 95%), which was significantly lower than the 94.8% ± 1.5% viability observed in the control specimens ( p = 0.005). Chondrocyte viability declined with higher energy injuries ( p = 0.13), time from injury to surgery ( p = 0.07), and increasing patient age ( p = 0.07). However, none of these factors reached a level of statistical significance. Conclusions: A significant decline in chondrocyte viability occurs after intra-articular fractures of the calcaneus. This may contribute to the development of post-traumatic arthritis.

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The impact of regional anesthesia on bladder cancer outcomes.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e15021 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e15021-e15021

Author(s):

Jamie RiChard ◽

Michael Lipsky ◽

Michael Whalen ◽

Piruz Motamedinia ◽

Julia Finkelstein ◽

...

Keyword(s):

Bladder Cancer ◽

Clinical Stage ◽

Cancer Recurrence ◽

Group Differences ◽

Incomplete Resection ◽

Opioid Use ◽

Cancer Outcomes ◽

The Impact ◽

Procedure Type

e15021 Background: Studies in breast and prostate surgery show reduced cancer recurrence after regional (RA) versus general anesthesia (GA). Mechanisms include RAÕs reduced post-operative opioid use and cortisol-mediated immunosuppression. RA may be used alone during transurethral resection of bladder tumors (TURBT) and in combination with GA during radical cystectomy (RC). We assess the impact of RA on short-term bladder urothelial cell carcinoma (UCC) recurrence after TURBT or RC. Methods: From 8/2001 and 6/2006 to 6/2011, 151 patients underwent RC and 488 patients underwent TURBT for bladder UCC, respectively. Those with incomplete resection on TURBT were excluded. Anesthesia included RA or GA for TURBT, and GA alone or GA + RA for RC. Multivariate logistic regression was performed to identify significant predictors of biopsy- or radiography-confirmed UCC recurrence. Results: TURBT. Of 252 patients, 211 received GA and 41 received RA during TURBT. Patient and operative characteristics were similar between groups. Recurrence was 56% at 12 months for GA and RA. Multivariate analysis revealed clinical stage to be the only predictor of UCC recurrence (HR=1.8, p<0.0001). Anesthesia had no affect on 6 or 12 month RFS, DSS or OS (see table). RC. GA was used in 114 patients and 37 patients had GA + RA at RC. There were no between group differences in patient or tumor characteristics. After follow-up of 18 months, 25.9% and 21.6% recurred in GA and GA+RA groups, respectively (p>0.05). There were no differences in RFS, DSS, or OS (see Table). Conclusions: Contrary to other malignancies, our data suggest anesthesia type at TURBT or RC does not affect bladder cancer outcomes. Anesthesia modality should be based on patient comorbidities and procedure type. [Table: see text]

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Impact of Patient Age on Procedure Type for Ulcerative Colitis

Diseases of the Colon & Rectum ◽

10.1097/dcr.0000000000000398 ◽

2015 ◽

Vol 58 (8) ◽

pp. 769-774 ◽

Cited By ~ 8

Author(s):

Jessica N. Cohan ◽

Peter Bacchetti ◽

Madhulika G. Varma ◽

Emily Finlayson

Keyword(s):

Ulcerative Colitis ◽

Patient Age ◽

Patient Âgé ◽

Procedure Type

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Prehospital Emergency Medical Services Departure Interval: Does Patient Age Matter?

Prehospital and Disaster Medicine ◽

10.1017/s1049023x16000947 ◽

2016 ◽

Vol 31 (6) ◽

pp. 608-613 ◽

Cited By ~ 1

Author(s):

Bruno Schnegg ◽

Mathieu Pasquier ◽

Pierre-Nicolas Carron ◽

Bertrand Yersin ◽

Fabrice Dami

Keyword(s):

Response Time ◽

Emergency Medical Services ◽

Time Of Day ◽

Medical Services ◽

Time Interval ◽

Patient Age ◽

Emergency Medical ◽

Patient Âgé ◽

Prehospital Emergency ◽

The Impact

AbstractIntroductionThe concept of response time with minimal interval is intimately related to the practice of emergency medicine. The factors influencing this time interval are poorly understood.ProblemIn a process of improvement of response time, the impact of the patient’s age on ambulance departure intervals was investigated.MethodThis was a 3-year observational study. Departure intervals of ambulances, according to age of patients, were analyzed and a multivariate analysis, according to time of day and suspected medical problem, was performed.ResultsA total of 44,113 missions were included, 2,417 (5.5%) in the pediatric group. Mean departure delay for the adult group was 152.9 seconds, whereas it was 149.3 seconds for the pediatric group (P =.018).ConclusionA statistically significant departure interval difference between missions for children and adults was found. The difference, however, probably was not significant from a clinical point of view (four seconds).SchneggB, PasquierM, CarronPN, YersinB, DamiF. Prehospital Emergency Medical Services departure interval: does patient age matter?Prehosp Disaster Med. 2016;31(6):608–613.

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39 Are we ageist? The impact of patient age on chemotherapy treatment decisions in advanced non-small cell lung cancer at St James's Institute of Oncology

Lung Cancer ◽

10.1016/s0169-5002(13)70039-4 ◽

2013 ◽

Vol 79 ◽

pp. S13-S14

Author(s):

J. Kelly ◽

Z. Toukan ◽

C. Mulatero

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Treatment Decisions ◽

Small Cell ◽

Chemotherapy Treatment ◽

Small Cell Lung ◽

Patient Age ◽

Patient Âgé ◽

The Impact

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The impact of patient age and comorbidities on the occurrence of “never events” in cerebrovascular surgery: an analysis of the Nationwide Inpatient Sample

Journal of Neurosurgery ◽

10.3171/2014.4.jns131253 ◽

2014 ◽

Vol 121 (3) ◽

pp. 580-586 ◽

Cited By ~ 22

Author(s):

Timothy Wen ◽

Shuhan He ◽

Frank Attenello ◽

Steven Y. Cen ◽

May Kim-Tenser ◽

...

Keyword(s):

Hospital Costs ◽

Patient Characteristics ◽

High Risk Population ◽

Health Care Administrators ◽

Patient Age ◽

Medical Comorbidities ◽

Patient Âgé ◽

Never Events ◽

Tract Infections ◽

The Impact

Object As health care administrators focus on patient safety and cost-effectiveness, methodical assessment of quality outcome measures is critical. In 2008 the Centers for Medicare and Medicaid Services (CMS) published a series of “never events” that included 11 hospital-acquired conditions (HACs) for which related costs of treatment are not reimbursed. Cerebrovascular procedures (CVPs) are complex and are often performed in patients with significant medical comorbidities. Methods This study examines the impact of patient age and medical comorbidities on the occurrence of CMS-defined HACs, as well as the effect of these factors on the length of stay (LOS) and hospitalization charges in patients undergoing common CVPs. Results The HACs occurred at a frequency of 0.49% (1.33% in the intracranial procedures and 0.33% in the carotid procedures). Falls/trauma (n = 4610, 72.3% HACs, 357 HACs per 100,000 CVPs) and catheter-associated urinary tract infections (n = 714, 11.2% HACs, 55 HACs per 100,000 CVPs) were the most common events. Age and the presence of ≥ 2 comorbidities were strong independent predictors of HACs (p < 0.0001). The occurrence of HACs negatively impacts both LOS and hospital costs. Patients with at least 1 HAC were 10 times more likely to have prolonged LOS (≥ 90th percentile) (p < 0.0001), and 8 times more likely to have high inpatient costs (≥ 90th percentile) (p < 0.0001) when adjusting for patient and hospital factors. Conclusions Improved quality protocols focused on individual patient characteristics might help to decrease the frequency of HACs in this high-risk population. These data suggest that risk adjustment according to underlying patient factors may be warranted when considering reimbursement for costs related to HACs in the setting of CVPs.

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The effect of patient age, the presence of infection and neoplastic disease on the occurrence of dehiscence laparotomy

Acta chirurgica iugoslavica ◽

10.2298/aci1104089p ◽

2011 ◽

Vol 58 (4) ◽

pp. 89-92

Author(s):

Milorad Paunovic

Keyword(s):

Prospective Study ◽

General Surgery ◽

T Test ◽

Neoplastic Disease ◽

Patient Age ◽

Younger Patients ◽

Neoplastic Diseases ◽

Abdominal Organs ◽

Patient Âgé ◽

The Impact

Background/Aim. Dehiscence after laparotomy is one of the major complications of laparotomy. Laparotomy is a partial or complete wound with disruption and evisceratio abdominal organs and require urgent reintervention. The aim of this study was to determine the impact of age, infection and neoplastic disease on the occurrence of dehiscence laparotomy. Methods. A retrospective-prospective study were included 826 patients operated at the Clinic for General Surgery in Nis in the period from January 2008 to December 2009. The effect of patient age, the presence of infection and neoplastic disease on the occurrence of dehiscence laparotomy. Results are displayed numerically and in percentages. Results. Of the total 32 patients with dehiscence laparotomy, 20 patients were male or 62.5% and 12 female patients, or 37.5%. Patients with dehiscence laparotomy were significantly younger than patients without dehiscence laparotomy (T-test t=3.237, p<0.05). The average age of respondents with dehiscence was 57.93 years, while patients without dehiscence 63.97 years. There is a statistically highly significant correlation between laparotomy dehiscence and infection (X2=62.024, p<0,01). There was a statistically significant association between dehiscence laparotomy and neoplastic diseases (X2 =42,196; p<0,01). Conclusion. With respect to age, dehiscence laparotomy is significantly more common in younger patients. Infection was significantly more frequent in patients with dehiscence laparotomy. In patients with neoplastic diseases dehiscence laparotomy is common.

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