Interventions to Mobilize Elderly Patients and Reduce Length of Hospital Stay

2018 ◽  
Vol 34 (7) ◽  
pp. 881-888 ◽  
Author(s):  
Megan J. Surkan ◽  
William Gibson
Keyword(s):  
Elderly Patients ◽  
Hospital Stay ◽  
Length Of Hospital Stay

PS01.218: MORBIDITY AND MORTALITY IN ELDERLY PATIENTS AFTER MINIMALLY INVASIVE ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 112-112
Author(s):  
Jeroen Hol ◽  
Joos Heisterkamp ◽  
Barbara Langenhoff
Keyword(s):  
Minimally Invasive ◽  
Elderly Patients ◽  
Hospital Stay ◽  
Minimally Invasive Esophagectomy ◽  
Length Of Hospital Stay ◽  
Morbidity And Mortality ◽  
Tumor Type ◽  
Invasive Esophagectomy ◽  
Group 2 ◽  
Group 1

Abstract Background Elderly patients undergoing gastrointestinal surgery are at higher risk for postoperative complications and mortality. Currently available literature on elderly patients undergoing an esophagectomy is inconclusive and dates back from the time before minimally invasive techniques were implemented. Methods Length of hospital stay, 90-day morbidity and mortality were analyzed from patients undergoing minimally invasive esophagectomy (MIE) between 2014 and 2017 in a single center. Data from patients aged 76 years or older was compared to the cohort of patients aged 71 to 75 years old. Results From a consecutive series of in total 187 patients two cohorts were retrieved: 19 patients 76 years or older (group 1) were compared to 41 patients 71 to 75 years old (group 2). Median age was 77 years (76–83) in group 1 and 72 years (71–75) in group 2 (P < 0.05). There were no significant differences in sex, Charlson comorbidity score, number of patients undergoing neoadjuvant chemoradiaton, histological tumor type, tumor stage, number of lymph nodes harvested and type of anastomosis. There were no significant differences in length of hospital stay, 90-day morbidity and mortality. The percentage of anastomotic leakage was 21.2% in group 1 and 14.6% in group 2. Mortality was 10.5% and 4.9% respectively. Conclusion No difference was seen in morbidity and mortality after MIE comparing the eldest old to younger old patients. Therefore, patient selection should not be based on calendar age alone. Disclosure All authors have declared no conflicts of interest.

scholarly journals Lumboperitoneal Shunt Surgery Under Rachianesthesia

2022 ◽  
Author(s):  
Yukihiro Goto ◽  
Shinji Nozuchi ◽  
Takuro Inoue
Keyword(s):  
Elderly Patients ◽  
Hospital Stay ◽  
General Anesthesia ◽  
Postoperative Delirium ◽  
Length Of Hospital Stay ◽  
Normal Pressure ◽  
Respiratory Complications ◽  
General Anesthesia Group ◽  
Lumboperitoneal Shunt ◽  
Hospital Stays

Abstract Purpose: In the very elderly, complications such as postoperative pneumonia or delirium, which are directly associated with longer hospitalization, are more frequent. In order to overcome these drawbacks, we switched from general anesthesia to rachianesthesia for the lumboperitoneal shunt (LPS) procedure in idiopathic normal pressure hydrocephalus (iNPH) patients. This is because iNPH suffers particularly elderly patients, and neuraxial anesthesia techniques such as rachianesthesia reportedly decrease postoperative complications in patients of very advanced age as compared with general anesthesia. Methods: We retrospectively analyzed 45 patients who underwent LPS in our institution, and divided them into two groups based on the anesthetic approach; 1) general anesthesia, 2) rachianesthesia. We analyzed these two groups with regard to postoperative delirium score and the hospital stay.Results: In the general anesthesia group, two patients had respiratory complications after the surgery. The mean postoperative delirium score using the intensive care delirium screening checklist (ICDSC) was 1.3 (1.4) and the length of hospital stay was 13.9 (4.7) days. In the rachianesthesia group, no patients had respiratory complications. The postoperative mean ICDSC was 1.3 (1.4), and the length of hospital stay was 10.8 (2.1) days. The statistical analysis showed the rachianesthesia group to have significantly shorter hospital stays.Conclusions: LPS under rachianesthesia is an alternative to performing this procedure under general anesthesia in elderly patients.

scholarly journals Efficacy of Tolvaptan in Elderly Patients with Heart Failure and Preserved Ejection Fraction

2019 ◽  
Vol 5 (2) ◽  
pp. 59-65
Author(s):  
Yoriyasu Suzuki ◽  
Akira Murata ◽  
Satoshi Tsujimoto ◽  
Yusuke Ochiumi ◽  
Tatsuya Ito
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Rest Period ◽  
Length Of Hospital Stay ◽  
Bed Rest ◽  
Preserved Ejection Fraction ◽  
Patients With Heart Failure

Abstract Background: There is no known therapy with proven efficacy for improving clinical outcomes in elderly patients with heart failure (HF) and preserved ejection fraction (HFpEF). In this study, we aimed to evaluate the efficacy of tolvaptan (TLV) in elderly HFpEF patients. Methods: This retrospective observational study involved 100 consecutive elderly HFpEF patients hospitalized at the Nagoya Heart Center, Japan. Inclusion criteria were: (1) patients aged ≥75 years; (2) first hospitalization secondary to HF; (3) received medical therapy for HF, without invasive treatment; and (4) clinical follow-up for >6 months after discharge. The primary endpoint was rehospitalization due to worsening HF, and the secondary endpoint was worsening renal function (WRF) during hospitalization and at 6 months after discharge. Sixty background-matched HFpEF patients were divided into 2 groups: with TLV therapy (TLV (+), n = 29) and without TLV therapy (TLV (–), n = 31). In the TLV (+) group, TLV therapy was continued after discharge. Clinical outcomes of these patients were evaluated. Results: Bed rest period and length of hospital stay were significantly shorter in the TLV (+) group than in the TLV (−) group. The dose of loop diuretics, mean serum creatinine levels, and incidence of WRF development were significantly lower in the TLV (+) group. Incidence of rehospitalization was also significantly lower in the TLV (+) group (log-rank test; p = 0.018). The multivariate logistic regression analysis demonstrated that TLV therapy reduces the incidence of rehospitalization in elderly patients with HFpEF. Conclusions: TLV therapy reduced the bed rest period, length of hospital stay, and rate of rehospitalization without WRF in elderly HFpEF patients, suggesting that TLV could represent an effective therapy for this group of patients.

Screening for delirium: a means to improved outcome in hospitalized elderly patients

1997 ◽  
Vol 7 (3) ◽  
pp. 235-256 ◽  
Author(s):  
Dominique L Musselman ◽  
Colleen N Hawthorne ◽  
Alan Stoudemire
Keyword(s):  
Nursing Home ◽  
Elderly Patients ◽  
Hospital Stay ◽  
Cognitive Deficits ◽  
Functional Decline ◽  
Length Of Hospital Stay ◽  
Accurate Diagnosis ◽  
Hospitalized Elderly ◽  
Hospitalized Elderly Patients ◽  
Improved Outcome

In recent years, psychiatrists have improved their accuracy and efficiency in diagnosing delirium, particularly in hospitalized elderly patients. Early and accurate diagnosis is essential as unrecognized and untreated delirium is associated with longer length of hospital stay and greater expense, accelerated functional decline, an increase in nursing home placements, persistent cognitive deficits, and elevated rates of mortality.

Impact of Glycemic Variability and Hypoglycemia on the Mortality and Length of Hospital Stay among Elderly Patients in Brazil

2020 ◽  
Vol 16 (2) ◽  
pp. 171-180 ◽  
Author(s):  
Danielle Bruginski ◽  
Dalton Bertolin Précoma ◽  
Ary Sabbag ◽  
Marcia Olandowski
Keyword(s):  
Blood Glucose ◽  
Elderly Patients ◽  
Hospital Stay ◽  
Critically Ill ◽  
Glucose Level ◽  
Length Of Hospital Stay ◽  
Glycemic Variability ◽  
Ease Of Use ◽  
Hospitalized Elderly ◽  
Enteral Diet

Background: Glycemic variability (GV) is an alternative diabetes-related parameter that has been associated with mortality and longer hospitalization periods. There is no ideal method for calculating GV. In this study, we used standard deviation and coefficient of variation due to their suitability for this sample and ease of use in daily clinical practice. Objective: This study aimed to investigate the association between GV, hypoglycemia, and the 90-day mortality and length of hospital stay (LOS) among non-critically ill hospitalized elderly patients. Methods: The medical records of 2,237 elderly patients admitted to the Zilda Arns Elderly Hospital over a 2.5-year period were reviewed. Hypoglycemia was defined as a glucose level <70 mg/dL (hypoglycemia alert value) and represented by the proportion of days in which the patient presented with this condition relative to the LOS. The Charlson comorbidity index was used to evaluate prognosis. Data were analyzed using multiple linear and logistic multivariate regression analyses. Results: Adjusted analysis of 687 patients (305 men [44.4%] and 382 women [55.6%], mean age of 77.86±9.25 years) revealed that GV was associated with a longer LOS (p=0.048). Mortality was associated with hypoglycemia (p=0.005) and mean patient-day blood glucose level (p=0.036). Variables such as age (p<0.001), Charlson score (p<0.001), enteral diet (p<0.001), and corticosteroid use (p=0.007) were also independently associated with 90-day mortality. Conclusion: Increased GV during hospitalization is independently associated with a longer LOS and hypoglycemia in non-critically ill elderly patients, while the mean patient-day blood glucose is associated with increased mortality.

scholarly journals Clinical benefits after the implementation of a multimodal perioperative protocol in elderly patients

2010 ◽  
Vol 47 (2) ◽  
pp. 178-183 ◽  
Author(s):  
José Eduardo de Aguilar-Nascimento ◽  
Alberto Bicudo Salomão ◽  
Cervantes Caporossi ◽  
Breno Nadaf Diniz
Keyword(s):  
Elderly Patients ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Perioperative Care ◽  
Length Of Hospital Stay ◽  
Intravenous Fluids ◽  
Site Infection ◽  
Preoperative Fasting ◽  
Historical Cohort ◽  
Abdominal Operations

CONTEXT: Multimodal protocol of perioperative care may enhance recovery after surgery. Based on evidence these new routines of perioperative care changed conventional prescriptions in surgery. OBJECTIVE: To evaluate the results of a multimodal protocol (ACERTO protocol) in elderly patients. METHODS: Non-randomized historical cohort study was performed at the surgical ward of a tertiary university hospital. One hundred seventeen patients aged 60 and older were submitted to elective abdominal operations under either conventional (n = 42; conventional group, January 2004-June 2005) or a fast-track perioperative protocol named ACERTO (n = 75; ACERTO group, July 2005-December 2007). Main endpoints were preoperative fasting time, postoperative day of re-feeding, volume of intravenous fluids, length of hospital stay and morbidity. RESULTS: The implantation of the ACERTO protocol was followed by a decrease in both preoperative fasting (15 [8-20] vs 4 [2-20] hours, P<0.001) and postoperative day of refeeding (1st [1st-10th] vs 0 [0-5th] PO day; P<0.01), and intravenous fluids (10.7 [2.5-57.5] vs 2.5 [0.5-82] L, P<0.001). The changing of protocols reduced the mean length of hospital stay by 4 days (6[1-43] vs 2[1-97] days; P = 0.002) and surgical site infection rate by 85.7% (19%; 8/42 vs 2.7%; 2/75, P<0.001; relative risk = 1.20; 95% confidence interval = 1.03-1.39). Per-protocol analysis showed that hospital stay in major operations diminished only in patients who completed the protocol (P<0.01). CONCLUSION: The implementation of multidisciplinary routines of the ACERTO protocol diminished both hospitalization and surgical site infection in elderly patients submitted to abdominal operations.

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