Which preoperative screening tool should be applied to older patients undergoing elective surgery to predict short-term postoperative outcomes? Lessons from systematic reviews, meta-analyses and guidelines

8537 Background: Surgery is the treatment of choice for solid cancers. Frequent functional impairment/comorbidities in the elderly enhances the risk of treatment related complications. Inability to forecast short term outcomes after cancer surgery in elderly affects clinical practice, denying optimal treatment. No validated instrument is available to help make informed decision; a compilation of validated questionnaires (PACE) is established to preoperatively inform on the health condition of elderly cancer pts. This international multicentre study investigates how components of PACE preoperatively assessed are associated with postoperative outcomes. Methods: A prospective series of consenting elderly cancer pts (≥70 yrs) receiving elective surgery (moderate-major+) were recruited from 8 hospitals (UK, Netherlands, Italy, Japan, Belgium) (07/2003–12/2005) and assessed using PACE (Comorbidities, IADL, ADL, GDS, BFI, PS, MMS, ASA). 30day morbidity, hospital stay and mortality were recorded. Results: 448 pts [breast (48%), GI (30%), GU (16%), miscellaneous (6%)] were recruited and followed postoperatively. Observed morbidity was 36% (161 pts), mortality 4% (16 pts) and median hospital stay was 5 days (range 2 -10). All components of PACE but ASA were associated with morbidity (p<0.05) and hospital stay (p<0.05) on univariate analysis. Operative deaths were too few to look for associations. Forward stepwise logistic regression models (multivariate analysis) identified 3 components of PACE as best describing the occurrence of post-surgical morbidity: BFI (OR (upper quartile)= 2.4; 95% CI=1.2–4.9); PS (OR=1.9; 95% CI=1.1–3.4); IADL (OR=1.7; 95% CI=1.0–3.0). The same components were also selected into the model as best describing hospital stay beyond average: BFI (OR (upper quartile)=18.1; 95% CI=7.2–45.3), PS (OR=2.2; 95%=1.2–4.4) and IADL (OR=2.7; 95% CI=1.4–5.1). Of those pts exposed to all 3 factors entered into the regression models 61% experienced complications and >80% had a longer hospital stay. Conclusions: BFI, PS and IADL appear to be the most relevant prognosticators of short term surgical outcomes. A holistic appraisal of elderly pts undergoing surgery is warmly recommended when consenting the patient and during the decision making process. No significant financial relationships to disclose.

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A Comparison of the Malnutrition Universal Screening Tool (MUST) and the Mini Nutritional Assessment-Short Form (MNA-SF) Tool for Older Patients Undergoing General Surgery

Journal of Clinical Medicine ◽

10.3390/jcm10245860 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5860

Author(s):

Stamatios Kokkinakis ◽

Maria Venianaki ◽

Georgia Petra ◽

Alexandros Chrysos ◽

Emmanuel Chrysos ◽

...

Keyword(s):

General Surgery ◽

Older Patients ◽

Universal Screening ◽

Screening Tool ◽

Nutritional Assessment ◽

Short Form ◽

Mini Nutritional Assessment ◽

Postoperative Outcomes ◽

Postoperative Length ◽

Malnutrition Universal Screening Tool

The optimal malnutrition screening tool in geriatric surgery has yet to be determined. Herein, we compare two main tools in older patients undergoing general surgery operations. Older patients (>65 years old) who underwent general surgery operations between 2012 and 2017 in a tertiary centre were included. The Malnutrition Universal Screening Tool (MUST) and the Mini Nutritional Assessment Short Form (MNA-SF) were used for nutritional risk assessment. Preoperative variables as well as postoperative outcomes were recorded prospectively. Agreement between tools was determined with the weighted kappa (κ) statistic. Multiple regression analysis was used to assess the association of the screening tools with postoperative outcomes. A total of 302 patients (median age 74 years, range: 65–92) were included. A similar number of patients were classified as medium/high risk for malnutrition with the MNA-SF and MUST (26% vs. 36%, p = 0.126). Agreement between the two tools was moderate (weighted κ: 0.474; 95%CI: 0.381–0.568). In the multivariate analysis, MNA-SF was associated significantly with postoperative mortality (p = 0.038) and with postoperative length of stay (p = 0.001). MUST was associated with postoperative length of stay (p = 0.048). The MNA-SF seems to be more consistently associated with postoperative outcomes in elderly patients undergoing general surgery compared with the MUST tool.

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Management of Outpatient Elective Surgery for Arthroplasty and Sports Medicine During the COVID-19 Pandemic: A Scoping Review

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211053335 ◽

2021 ◽

Vol 9 (11) ◽

pp. 232596712110533

Author(s):

Spencer M. Comfort ◽

Yoichi Murata ◽

Lauren A. Pierpoint ◽

Marc J. Philippon

Keyword(s):

Systematic Reviews ◽

Patient Selection ◽

Scoping Review ◽

Sports Medicine ◽

Elective Surgery ◽

Outpatient Setting ◽

Innovative Technology ◽

Management Options ◽

Level Of Evidence ◽

Meta Analyses

Background: The onset of the coronavirus disease 2019 (COVID-19) pandemic has presented unforeseeable challenges to the orthopaedic community, especially arthroplasty and sports medicine subspecialities, as many surgeries were deemed nonessential and delayed. Although there is a glimpse of hope with the approval and distribution of vaccines, daily case numbers and death tolls continue to rise at the time of this review. Purpose: To summarize the available literature on the management of elective sports medicine and arthroplasty procedures in the outpatient setting to gather a consolidated source of information. Study Design: Scoping review; Level of evidence, 5. Methods: A scoping review of 3 databases (PubMed, Embase, and OVID Medline) was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. All retrospective and prospective analyses, systematic reviews and meta-analyses, expert opinions, and societal guidelines were included for review, with 29 articles meeting the inclusion criteria. Results: Guidance for resumption of elective arthroplasty and sports medicine surgery and patient selection during the COVID-19 pandemic focuses on resource availability, patient fitness, and time sensitivity of the procedure, with patient and surgical team safety as the highest priority. Telemedicine and other innovative technology can be used to continue patient care during periods of delayed surgery through monitoring disease progression and offering nonoperative management options. Conclusion: While the current societal recommendations provide guidance on safety protocols and patient prioritization, each orthopaedic practice must consider its unique situation and use evidence-based medicine when determining surgical timing and patient selection.

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Mortality in hospitalised older patients: the WHALES short-term predictive score

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2021-003258 ◽

2021 ◽

pp. bmjspcare-2021-003258

Author(s):

Zara Steinmeyer ◽

Antoine Piau ◽

Joséphine Thomazeau ◽

Samantha Huo Yung Kai ◽

Fati Nourhashemi

Keyword(s):

Older Patients ◽

Goodness Of Fit ◽

Screening Tool ◽

Area Under The Curve ◽

Predictive Score ◽

Short Term ◽

Goodness Of Fit Test ◽

Derivation Cohort ◽

Independent Variables ◽

Short Term Mortality

ObjectiveTo develop and validate the WHALES screening tool predicting short-term mortality (3 months) in older patients hospitalised in an acute geriatric unit.MethodsOlder patients transferred to an acute geriatric ward from June 2017 to December 2018 were included. The cohort was divided into two groups: derivation (n=664) and validation (n=332) cohorts. Cause for admission in emergency room, hospitalisation history within the previous year, ongoing medical conditions, cognitive impairment, frailty status, living conditions, presence of proteinuria on a urine strip or urine albumin-to-creatinine ratio and abnormalities on an ECG were collected at baseline. Multiple logistic regressions were performed to identify independent variables associated with mortality at 3 months in the derivation cohort. The prediction score was then validated in the validation cohort.ResultsFive independent variables available from medical history and clinical data were strongly predictive of short-term mortality in older adults including age, sex, living in a nursing home, unintentional weight loss and self-reported exhaustion. The screening tool was discriminative (C-statistic=0.74 (95% CI: 0.67 to 0.82)) and had a good fit (Hosmer-Lemeshow goodness-of-fit test (X2 (3)=0.55, p=0.908)). The area under the curve value for the final model was 0.74 (95% CI: 0.67 to 0.82).Conclusions and implicationsThe WHALES screening tool is a short and rapid tool predicting 3-month mortality among hospitalised older patients. Early identification of end of life may help appropriate timing and implementation of palliative care.

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Malnutrition in Older Veterans Preparing for Surgery: Prevalence Rates and Evaluation (Sensitivity/Specificity) of Screening and Assessment Tools (OR36-07-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz035.or36-07-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Kathryn Porter Starr ◽

Kenlyn Young ◽

Nancy Loyack ◽

Sandhya Lagoo-Deenadayalan ◽

Mitchell Heflin ◽

...

Keyword(s):

Older Adults ◽

High Risk ◽

Abdominal Surgery ◽

Older Patients ◽

Screening Tool ◽

Elective Surgery ◽

Assessment Tools ◽

Nutritional Risk ◽

Nutrition Screening ◽

Nrs 2002

Abstract Objectives Malnourished older adults are at high risk for poor surgical outcomes, yet screening prior to surgery is not required and rarely conducted. For older adults anticipating elective surgery, there is an opportunity to detect and correct malnutrition prior to surgery. However, there is limited evidence regarding the appropriate nutrition screening and assessment tools to use in this population and the extent of nutritional risk is unknown. The purposes of this study were (1) to assess the usefulness of a nutrition screening tool (Nutritional Risk Screening-2002; NRS-2002) and a nutrition assessment tool (Patient Generated Subjective Global Assessment; PG-SGA) by determining their sensitivity and specificity compared to the Nutrition Focused Physical Exam (NFPE) and (2) use these tools to identify the prevalence of nutritional risk and malnutrition in older, high risk Veterans preparing for elective abdominal surgery. Methods Older Veterans (N = 76) referred to the VA Perioperative Optimization of Senior Health interdisciplinary clinic that targets high risk older patients preparing for elective surgery were administered the NRS-2002, PG-SGA and the NFPE by trained RDs. A contingency table was used to determine the sensitivity and specificity of the NRS-2002 and PG-SGA compared to the NFPE. Results Study population was 64.5% white, 86% male, and 72.3 ± 5.9 years of age. Results of sensitivity testing showed 46.2% for the NRS-2002 and 100% for PG-SGA. Specificity was 100% for the NRS-2002 and 98% for the PG-SGA. The PG-SGA (35.5%) and NFPE (34%) identified very similar numbers of Veterans as being moderately or severely malnourished. Accordingly, the NRS-2002 identified only 15.8% of Veterans at nutritional risk. Conclusions The most important finding is the alarming prevalence of malnutrition in this population of Veterans, more than a third were found to be malnourished. Additionally, the NRS-2002, a screening tool often used in the clinical setting, failed to identify nutritional risk in these patients, misclassifying 46.2% of malnourished patients as nourished. These results justify further work to more effectively identify and treat pronounced nutritional risk in older patients anticipating elective abdominal surgery. Funding Sources US Department of Veterans Affairs Rehabilitation Research and Development Service Program (CDA-2/IK2 RX002348).

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Hotspots in Psychology – 2020 Edition

Zeitschrift für Psychologie ◽

10.1027/2151-2604/a000398 ◽

2020 ◽

Vol 228 (1) ◽

pp. 1-2

Author(s):

Michael Bošnjak ◽

Nadine Wedderhoff

Keyword(s):

Systematic Reviews ◽

Research Synthesis ◽

Synthesis Methods ◽

Common Denominator ◽

The Common ◽

Meta Analyses

Abstract. This editorial gives a brief introduction to the six articles included in the fourth “Hotspots in Psychology” of the Zeitschrift für Psychologie. The format is devoted to systematic reviews and meta-analyses in research-active fields that have generated a considerable number of primary studies. The common denominator is the research synthesis nature of the included articles, and not a specific psychological topic or theme that all articles have to address. Moreover, methodological advances in research synthesis methods relevant for any subfield of psychology are being addressed. Comprehensive supplemental material to the articles can be found in PsychArchives ( https://www.psycharchives.org ).

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Parâmetros e efeitos do laser não ablativo no tratamento de melasma facial

Fisioterapia Brasil ◽

10.33233/fb.v19i3.2061 ◽

2018 ◽

Vol 19 (3) ◽

pp. 342

Author(s):

Felipe Soares Macedo ◽

Marthina Santos Rosa ◽

Suélia De Siqueira Rodrigues Fleury Rosa ◽

Hellen Batista De Carvalho ◽

Luisiane De Ávila Santana

Keyword(s):

Systematic Reviews ◽

Evidence Database ◽

Meta Analyses

O uso do laser não ablativo no tratamento do melasma tem sido abordado em diversos estudos, porém, não há consenso na literatura quanto aos parâmetros e feitos de intervenções baseadas neste recurso. O objetivo deste estudo foi identificar e descrever parâmetros e efeitos do laser não ablativo no tratamento de hiperpigmentação de pele (melasma). Trata-se de uma revisão sistemática da literatura baseada no Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A busca eletrônica compreendeu as seguintes bases de dados: PubMed, Physiotherapy Evidence Database (PEDro), Science Direct e SciELO. Foram identificados inicialmente 641 documentos nas bases de dados eletrônicas, enquanto na busca manual 26 artigos foram encontrados, após leitura e análise 7 artigos foram selecionados. Foram analisados 7 artigos correspondentes as bases de dados PubMed e Science Direct, todos na língua inglesa e publicados a partir do ano de 2010. Apenas um estudo utilizou uma amostra maior que 30 indivíduos, os demais utilizaram em média 16 participantes, com predomínio do sexo feminino e classificação segundo Fitzpatrick entre III-V. O comprimento de onda variou entre 1064 nm a 1550 nm e a energia máxima não ultrapassou 4 J/cm². De acordo com as variáveis avaliadas, os protocolos testados demonstraram que o laser não ablativo foi ineficaz no tratamento de melasma facial, sobretudo após a interrupção da terapia.Palavras-chave: hiperpigmentação, laser não ablativo, fisioterapia dermato-funcional, revisão sistemática.

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