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: heart and non-cardiac surgery need a different approach?

2020 ◽  
Author(s):  
Carlo Rostagno
Keyword(s):  
Cardiac Surgery ◽  
Systematic Reviews ◽  
Older Patients ◽  
Screening Tool ◽  
Elective Surgery ◽  
Postoperative Outcomes ◽  
Preoperative Screening ◽  
Short Term ◽  
Meta Analyses

Systematic reviews and meta-analyses in cardiac surgery: rules of the road – 2

2020 ◽  
Author(s):  
Mario Gaudino ◽  
Stephen Fremes ◽  
Emilia Bagiella ◽  
Sripal Bangalore ◽  
Michelle Demetres ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Systematic Reviews ◽  
The Road ◽  
Meta Analyses

scholarly journals Pharmacological interventions for preventing post-operative atrial fibrillation in patients undergoing cardiac surgery: a network meta-analysis protocol

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e018544 ◽  
Author(s):  
Xiaoqin Wang ◽  
Liang Yao ◽  
Long Ge ◽  
Lun Li ◽  
Fuxiang Liang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Systematic Reviews ◽  
Sequential Analysis ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Trial Sequential Analysis ◽  
Pharmacological Interventions ◽  
Patient Consent ◽  
Meta Analyses

IntroductionPostoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery, and randomised clinical trials (RCTs) and systematic reviews have been conducted to compare and evaluate different pharmacological interventions for preventing POAF. This study aimed to explore the effect of different pharmacological interventions for prophylaxis against POAF after cardiac surgery using network meta-analysis (NMA).Methods and analysisA systematic search will be performed in PubMed, EMBASE and the Cochrane Library to identify RCTs, systematic reviews, meta-analyses or NMA of different pharmacological interventions for POAF. We will evaluate the risk of bias of the included RCTs according to the Cochrane Handbook V.5.1.0, and use GRADE to assess the quality of evidence. Standard pairwise meta-analysis, trial sequential analysis and Bayesian network meta-analysis will be used to compare the efficacy of different pharmacological interventions.Ethics and disseminationEthics approval and patient consent are not required as this study is a meta-analysis based on published studies. The results of this NMA and trial sequential analysis will be submitted to a peer-reviewed journal for publication.Protocol registration numberCRD42017067492.

Systematic reviews and meta-analyses in cardiac surgery: rules of the road – 1

2020 ◽  
Author(s):  
Mario Gaudino ◽  
Stephen Fremes ◽  
Emilia Bagiella ◽  
Sripal Bangalore ◽  
Michelle Demetres ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Systematic Reviews ◽  
The Road ◽  
Meta Analyses

Can preoperative assessment of cancer in the elderly (PACE) predict 30-days postoperative outcomes?

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8537-8537 ◽  
Author(s):  
R. A. Audisio ◽  
H. S. Ramesh ◽  
R. Gennari ◽  
G. Corsini ◽  
M. Maffezzini ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Regression Models ◽  
Elective Surgery ◽  
Univariate Analysis ◽  
Preoperative Assessment ◽  
The Elderly ◽  
Postoperative Outcomes ◽  
Stepwise Logistic Regression ◽  
Short Term ◽  
Surgical Morbidity

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.

Routine Preoperative Screening Computed Tomography of the Thorax for Cardiac Surgery

2021 ◽  
Author(s):  
Jai Sule ◽  
Xue Wei Chan ◽  
Hari Kumar Sampath ◽  
Hai Dong Luo ◽  
Mofassel Uddin Ahmed ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cardiac Surgery ◽  
Older Patients ◽  
Independent Risk Factor ◽  
Preoperative Screening ◽  
Operative Strategy ◽  
Postoperative Stroke ◽  
Subgroup Analyses ◽  
Ct Features

Abstract Purpose: This study aims to evaluate the role of screening computed tomography (CT) thorax in cardiac surgery by analysing presence of CT aortic calcifications in association with change of operative strategy and postoperative stroke, as well as CT features of emphysema with development of pneumonia.Methods: All patients who underwent cardiac surgery from January 2013 to October 2017 by a single surgeon were retrospectively studied. Patients who underwent screening CT thorax prior to cardiac surgery (CT group) were compared with those who did not (no CT group). Multivariate subgroup analyses were performed to determine significant association with postoperative outcomes.Results: 392 patients were included, of which 156 patients underwent preoperative screening CT thorax. Patients in the CT group were older (63.9 vs 59.0 years, p=0.001), had fewer recent myocardial infarction preoperatively (41 vs 56.4%, p=0.003) and better ejection fraction >30% (p=0.02). Operative strategy was changed in 4.3% of patients, and 4.9% suffered stroke postoperatively. Presence of CT aortic calcifications was significantly associated with change in operative strategy (OR 1.54, p=0.016) but not associated with postoperative stroke (OR 0.53, p=0.33). Age was an independent risk factor for change in operative strategy among patients with CT thorax (p=0.02). Multivariate age-adjusted analysis showed only palpable plaque to be significantly associated with change in operative strategy (p<0.001). None of the patients with CT emphysema features developed pneumonia.Conclusion: The results do not support routine use of preoperative screening CT thorax. It should only be recommended in older patients.

scholarly journals 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

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.

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

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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