scholarly journals Emergency laparotomy in the older patient: factors predictive of 12-month mortality—Salford-POPS-GS. An observational study

2020 ◽  
Vol 32 (11) ◽  
pp. 2367-2373 ◽  
Author(s):  
Arturo Vilches-Moraga ◽  
Mollie Rowley ◽  
Jenny Fox ◽  
Haroon Khan ◽  
Areej Paracha ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Observational Study ◽  
Hospital Mortality ◽  
Older Patients ◽  
Care Home ◽  
Emergency Laparotomy ◽  
Older Patient ◽  
Readmission Rates ◽  
Clinical Frailty Scale ◽  
Female Predominance

Abstract Introduction Although high rates of in-hospital mortality have been described in older patients undergoing emergency laparotomy (EL), less is known about longer-term outcomes in this population. We describe factors present at the time of hospital admission that influence 12-month survival in older patients. Methods Observational study of patients aged 75 years and over, who underwent EL at our hospital between 8th September 2014 and 30th March 2017. Results 113 patients were included. Average age was 81.9 ± 4.7 years, female predominance (60/113), 3 (2.6%) lived in a care home, 103 (91.2%) and 79 (69.1%) were independent of personal and instrumental activities of daily living (ADLs) and 8 (7.1%) had cognitive impairment. Median length of stay was 16 days ± 29.9 (0–269); in-hospital mortality 22.1% (25/113), post-operative 30-day, 90-day and 12-month mortality rates 19.5% (22), 24.8% (28) and 38.9% (44). 30-day and 12-month readmission rates 5.7% (5/88) and 40.9% (36). 12-month readmission was higher in frail patients, using the Clinical Frailty Scale (CFS) score (64% 5–8 vs 31.7% 1–4, p = 0.006). Dependency for personal ADLs (6/10 (60%) dependent vs. 38/103 (36.8%) independent, p = 0.119) and cognitive impairment (5/8 (62.5%) impaired vs. 39/105 (37.1%) no impairment, p = 0.116) showed a trend towards higher 12-month mortality. On multivariate analysis, 12-month mortality was strongly associated with CFS 5–9 (HR 5.0403 (95% CI 1.719–16.982) and ASA classes III–V (HR 2.704 95% CI 1.032–7.081). Conclusion Frailty and high ASA class predict increased mortality at 12 months after emergency laparotomy. We advocate early engagement of multi-professional teams experienced in perioperative care of older patients.

scholarly journals 156 Review of Outcomes of a Dedicated Geriatric Surgical Liaison Service

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Roisin Coary ◽  
Kathryn McCarthy ◽  
Haytham Sumrien ◽  
David Shipway
Keyword(s):  
Patient Outcome ◽  
Surgical Procedure ◽  
Older Patients ◽  
Inclusion Criteria ◽  
Inpatient Mortality ◽  
Confidential Enquiry ◽  
Readmission Rates ◽  
Clinical Frailty Scale ◽  
Icu Patients ◽  
The United Kingdom

Abstract Background In the United Kingdom, the 2010 National Confidential Enquiry into Patient Outcome and Death report ‘An Age Old Problem’ outlined significant shortcomings in the perioperative care of older people. Other than hip fractures, the care of older patients under surgical specialities is largely devoid of routine geriatrician input. In August 2018, we introduced daily geriatric reviews (GR) on the gastrointestinal surgical wards, aiming to improve length of stay (LOS) and mortality. Methods All acute general surgery admissions for patients ≥70 years were reviewed between September and October 2017 (pre-introduction) and 2018 (post-introduction), and outcomes compared. For 2018, comparisons were also made between those who had GR and those who didn’t. Results There were 173 admissions in 2017, vs 190 in 2018. In both 2017 and 2018, median age was 80, median LOS was 4 days, and clinical frailty scale (CFS) 4. Twenty-two percent (38/173) of patients had a surgical procedure in 2017, vs 33% (63/190) in 2018. Inpatient mortality was 8% (13/173) in 2017 (median CFS 6), vs 6% (11/190) in 2018 (median CFS 6). In 2018, 21% (40/190) of patients had GR: median time to review 3 days. 54% (n=22) of the patients with GR underwent a surgical procedure, 37% (n=15) were admitted to ICU, and inpatient mortality was 5% (n=2), vs 28% (n=42), 4% (n=6) and 6% (n=9) respectively for those without GR. 30 day readmission for those with GR was 12.5% (n=5), vs 18.4% (n=28) for those not seen. Conclusion While more surgical procedures were performed in 2018 (post-introduction), overall LOS remained unchanged and improved mortality was observed compared to 2017. Geriatricians are seeing more post-operative and ICU patients, and despite presumed increased complexity, both mortality and readmission rates remain low. Screening for frailty and specific inclusion criteria may improve rates of GR.

scholarly journals The impact of delirium on outcomes for older adults hospitalised with COVID-19

2020 ◽  
Vol 49 (6) ◽  
pp. 923-926 ◽  
Author(s):  
Alessandra Marengoni ◽  
Alberto Zucchelli ◽  
Giulia Grande ◽  
Laura Fratiglioni ◽  
Debora Rizzuto
Keyword(s):  
Hospital Mortality ◽  
Direct Effect ◽  
Older Patients ◽  
Total Sample ◽  
Prognostic Indicator ◽  
Multivariate Logistic Regression Model ◽  
Clinical Frailty Scale ◽  
Acute Geriatric Ward ◽  
The Central Nervous System ◽  
The Impact

Abstract Introduction Delirium is a frequent condition in hospitalized older patients and it usually has a negative prognostic value. A direct effect of SARS-COV-2 on the central nervous system (CNS) has been hypothesized. Objective To evaluate the presence of delirium in older patients admitted for a suspected diagnosis of COVID-19 and its impact on in-hospital mortality. Setting and subjects 91 patients, aged 70-years and older, admitted to an acute geriatric ward in Northern Italy from March 8th to April 17th, 2020. Methods COVID-19 cases were confirmed by reverse transcriptase-polymerase chain reaction assay for SARS-Cov-2 RNA from nasal and pharyngeal swabs. Delirium was diagnosed by two geriatricians according to the Diagnostic and Statistical Manual of Mental Disorders V (DMS V) criteria. The number of chronic diseases was calculated among a pre-defined list of 60. The pre-disease Clinical Frailty Scale (CFS) was assessed at hospital admission. Results Of the total sample, 39 patients died, 49 were discharged and 3 were transferred to ICU. Twenty-five patients (27.5%) had delirium. Seventy-two percent of patients with delirium died during hospitalization compared to 31.8% of those without delirium. In a multivariate logistic regression model adjusted for potential confounders, patients with delirium were four times more likely to die during hospital stay compared to those without delirium (OR = 3.98;95%CI = 1.05–17.28; p = 0.047). Conclusions Delirium is common in older patients with COVID-19 and strongly associated with in-hospital mortality. Regardless of causation, either due to a direct effect of SARS-COV-2 on the CNS or to a multifactorial cause, delirium should be interpreted as an alarming prognostic indicator in older people.

scholarly journals Utilisation and outcomes of allogeneic hematopoietic cell transplantation in Ontario, Canada, and New York State, USA: a population-based retrospective cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e039293
Author(s):  
Samantha Aliza Hershenfeld ◽  
John Matelski ◽  
Vicki Ling ◽  
Michael Paterson ◽  
Matthew Cheung ◽  
...  
Keyword(s):  
New York ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Cell Transplantation ◽  
Outcome Measures ◽  
Older Patients ◽  
New York State ◽  
Population Based ◽  
Readmission Rates ◽  
York State

ObjectiveAllogeneic haematopoietic cell transplantation (HCT) is a potentially curative treatment for haematologic and oncologic diseases. There is a perception that the United States of America (USA) offers greater access to expensive therapies such as HCT. Alternatively, Canada is thought to suffer from protracted wait times, but lower spending. Our objective was to compare HCT utilisation and short-term outcomes in Ontario (ON), Canada, and New York State (NY), USA.Design, setting and participantsWe conducted a population-based cohort study using administrative health data to identify all residents of ON and NY who underwent allogeneic HCT between 2012 and 2015.Primary and secondary outcome measuresThe primary outcome measures were age and sex standardised HCT utilisation rates, in-hospital mortality, hospital length of stay (LOS) and readmission rates in ON and NY. Secondary outcomes included comparing ON and NY HCT recipients with respect to demographic characteristics and patient wealth (using neighbourhood income quintile).ResultsWe identified 547 HCT procedures in ON and 1361 HCT procedures performed in NY. HCT recipients in ON were younger than NY (mean age 49.0 vs 51.6 years; p<0.001) and a lower percentage of ON recipients resided in affluent neighbourhoods compared with NY (47.2% vs 52.6%; p=0.026). Utilisation of HCT was 14.4 per 1 million population per year in ON and 26.7 per 1 million per year in NY (p<0.001). The magnitude of the ON–NY difference in utilisation was larger for older patients. In-hospital mortality, LOS and readmission rates were lower in ON than NY in both unadjusted and adjusted analyses.ConclusionsWe found significantly lower utilisation of HCT in ON compared with NY, particularly among older patients. Higher in-hospital mortality in NY relative to ON requires further study. These differences are thought provoking for patients, healthcare providers and policy-makers in both jurisdictions.

scholarly journals Older patients undergoing emergency laparotomy: observations from the National Emergency Laparotomy Audit (NELA) years 1–4

2020 ◽  
Vol 49 (4) ◽  
pp. 656-663 ◽  
Author(s):  
Rachel M Aitken ◽  
Judith S L Partridge ◽  
Charles Matthew Oliver ◽  
Dave Murray ◽  
Sarah Hare ◽  
...  
Keyword(s):  
Older Patients ◽  
Care Home ◽  
Mortality Data ◽  
Emergency Laparotomy ◽  
Data Set ◽  
Process Measures ◽  
Younger Patients ◽  
Age Cohorts ◽  
National Emergency ◽  
Over Time

Abstract Background older patients aged ≥65 years constitute the majority of the National Emergency Laparotomy Audit (NELA) population. To better understand this group and inform future service changes, this paper aims to describe patient characteristics, outcomes and process measures across age cohorts and temporally in the 4-year period (2014–2017) since NELA was established. Methods patient-level data were populated from the NELA data set years 1–4 and linked with Office of National Statistics mortality data. Descriptive data were compared between groups delineated by age, NELA year and geriatrician review. Primary outcomes were 30- and 90-day mortality, length of stay (LOS) and discharge to care-home accommodation. Results in total, 93,415 NELA patients were included in the analysis. The median age was 67 years. Patients aged ≥65 years had higher 30-day (15.3 versus 4.9%, P &lt; 0.001) and 90-day mortality (20.4 versus 7.2%, P &lt; 0.001) rates, longer LOS (median 15.2 versus 11.3 days, P &lt; 0.001) and greater likelihood of discharge to care-home accommodation compared with younger patients (6.7 versus 1.9%, P &lt; 0.001). Mortality rate reduction over time was greater in older compared with younger patients. The proportion of older NELA patients seen by a geriatrician post-operatively increased over years 1–4 (8.5 to 16.5%, P &lt; 0.001). Post-operative geriatrician review was associated with reduced mortality (30-day odds ratio [OR] 0.38, confidence interval [CI] 0.35–0.42, P &lt; 0.001; 90-day OR 0.6, CI 0.56–0.65, P &lt; 0.001). Conclusions older NELA patients have poorer post-operative outcomes. The greatest reduction in mortality rates over time were observed in the oldest cohorts. This may be due to several interventions including increased perioperative geriatrician input.

scholarly journals The Six-Item Cognitive Impairment Test Is Associated with Adverse Outcomes in Acutely Hospitalized Older Patients: A Prospective Cohort Study

2018 ◽  
Vol 8 (2) ◽  
pp. 259-267 ◽  
Author(s):  
Jacinta A. Lucke ◽  
Roos C.  van der Mast ◽  
Jelle de Gelder ◽  
Noor Heim ◽  
Bas de Groot ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Older Patients ◽  
Adverse Outcome ◽  
Independent Predictor ◽  
Hospital Length ◽  
Adverse Outcomes ◽  
Hospital Length Of Stay ◽  
Impaired Cognition

Aim: The study aim was to investigate whether cognitive impairment, measured by the Six-Item Cognitive Impairment Test (6-CIT), is an independent predictor of adverse outcomes in acutely hospitalized older patients. Methods: This was a prospective multicenter study including acutely hospitalized patients aged 70 years and older. Multivariable logistic regression was used to investigate whether impaired cognition (6-CIT ≥11 points) was an independent predictor of 90-day adverse outcome, a composite measure of functional decline and mortality. Secondary endpoints were hospital length of stay, new institutionalization, and in-hospital mortality. Results: In total, 196 (15.6%) of 1,252 included patients had a 6-CIT ≥11. Median age was 80 years (interquartile range 74–85). Patients with impaired cognition had higher rates of 90-day adverse outcome (41.7% compared to 30.3% in 1,056 not cognitively impaired patients, p = 0.009). Impaired cognition was a predictor of 90-day adverse outcome with a crude odds ratio (OR) of 1.64 (95% CI 1.13–2.39), but statistical significance was lost when fully corrected for possible confounders (OR 1.44, 95% CI 0.98–2.11). For all secondary outcomes, impaired cognition was an independent predictor. Conclusions: In the acute hospital setting, the 6-CIT is associated with 90-day adverse outcome and is an independent predictor of hospital length of stay, new institutionalization, and in-hospital mortality.

scholarly journals Changes in the in-hospital mortality and 30-day post-discharge mortality in acutely admitted older patients: retrospective observational study

2016 ◽  
Vol 45 (1) ◽  
pp. 41-47 ◽  
Author(s):  
Marjon van Rijn ◽  
Bianca M. Buurman ◽  
Janet L. Macneil Vroomen ◽  
Jacqueline J. Suijker ◽  
Gerben ter Riet ◽  
...  
Keyword(s):  
Observational Study ◽  
Hospital Mortality ◽  
Older Patients ◽  
Retrospective Observational Study ◽  
Post Discharge

Predictive value of thyroxine for prognosis in pediatric septic shock: a prospective observational study

2020 ◽  
Vol 33 (5) ◽  
pp. 653-659
Author(s):  
Jia Song ◽  
Yun Cui ◽  
Chunxia Wang ◽  
Jiaying Dou ◽  
Huijie Miao ◽  
...  
Keyword(s):  
Septic Shock ◽  
Thyroid Hormone ◽  
Observational Study ◽  
Hospital Mortality ◽  
Predictive Value ◽  
Prospective Observational Study ◽  
Threshold Value ◽  
Nonthyroidal Illness ◽  
Hormone Levels ◽  
Thyroid Hormone Levels

AbstractBackgroundThyroid hormone plays an important role in the adaptation of metabolic function to critically ill. The relationship between thyroid hormone levels and the outcomes of septic shock is still unclear. The aim of this study was to assess the predictive value of thyroid hormone for prognosis in pediatric septic shock.MethodsWe performed a prospective observational study in a pediatric intensive care unit (PICU). Patients with septic shock were enrolled from August 2017 to July 2019. Clinical and laboratory indexes were collected, and thyroid hormone levels were measured on PICU admission.ResultsNinety-three patients who fulfilled the inclusion criteria were enrolled in this study. The incidence of nonthyroidal illness syndrome (NTIS) was 87.09% (81/93) in patients with septic shock. Multivariate logistic regression analysis showed that T4 level was independently associated with in-hospital mortality in patients with septic shock (OR: 0.965, 95% CI: 0.937–0.993, p = 0.017). The area under receiver operating characteristic (ROC) curve (AUC) for T4 was 0.762 (95% CI: 0.655–0.869). The cutoff threshold value of 58.71 nmol/L for T4 offered a sensitivity of 61.54% and a specificity of 85.07%, and patients with T4 < 58.71 nmol/L showed high mortality (60.0%). Moreover, T4 levels were negatively associated with the pediatric risk of mortality III scores (PRISM III), lactate (Lac) level in septic shock children.ConclusionsNonthyroidal illness syndrome is common in pediatric septic shock. T4 is an independent predictor for in-hospital mortality, and patients with T4 < 58.71 nmol/L on PICU admission could be with a risk of hospital mortality.

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