Article Review: One-year medicare costs associated with delirium in older patients undergoing major elective surgery by Gou, R., Hshieh, T., Marcantonio, E., et al. JAMA 2021

Objective: To explore chaplains’ ability to identify unmet palliative care (PC) needs in older emergency department (ED) patients. Methods: A palliative chaplain-fellow conducted a retrospective chart review evaluating 580 ED patients, age ≥80 using the Palliative Care and Rapid Emergency Screening (P-CaRES) tool. An emergency medicine physician and chaplain-fellow screened 10% of these charts to provide a clinical assessment. One year post-study, charts were re-examined to identify which patients received PC consultation (PCC) or died, providing an objective metric for comparing predicted needs with services received. Results: Within one year of ED presentation, 31% of the patient sub-sample received PCC; 17% died. Forty percent of deceased patients did not receive PCC. Of this 40%, chaplain screening for P-CaRES eligibility correctly identified 75% of the deceased as needing PCC. Conclusion: Establishing chaplain-led PC screenings as standard practice in the ED setting may improve end-of-life care for older patients.

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Aspartate aminotransferase to alanine aminotransferase ratio is associated with frailty and mortality in older patients with heart failure

Scientific Reports ◽

10.1038/s41598-021-91368-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Daichi Maeda ◽

Nobuyuki Kagiyama ◽

Kentaro Jujo ◽

Kazuya Saito ◽

Kentaro Kamiya ◽

...

Keyword(s):

Heart Failure ◽

Older Patients ◽

Early Recognition ◽

Walk Distance ◽

Failure Data ◽

Patients With Heart Failure ◽

All Cause Mortality ◽

One Year ◽

Independent Marker

AbstractFrailty is a common comorbidity associated with adverse events in patients with heart failure, and early recognition is key to improving its management. We hypothesized that the AST to ALT ratio (AAR) could be a marker of frailty in patients with heart failure. Data from the FRAGILE-HF study were analyzed. A total of 1327 patients aged ≥ 65 years hospitalized with heart failure were categorized into three groups based on their AAR at discharge: low AAR (AAR < 1.16, n = 434); middle AAR (1.16 ≤ AAR < 1.70, n = 487); high AAR (AAR ≥ 1.70, n = 406). The primary endpoint was one-year mortality. The association between AAR and physical function was also assessed. High AAR was associated with lower short physical performance battery and shorter 6-min walk distance, and these associations were independent of age and sex. Logistic regression analysis revealed that high AAR was an independent marker of physical frailty after adjustment for age, sex and body mass index. During follow-up, all-cause death occurred in 161 patients. After adjusting for confounding factors, high AAR was associated with all-cause death (low AAR vs. high AAR, hazard ratio: 1.57, 95% confidence interval, 1.02–2.42; P = 0.040). In conclusion, AAR is a marker of frailty and prognostic for all-cause mortality in older patients with heart failure.

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One-Year Follow-up of Elective Surgery Child Patients Receiving Preoperative Preparation

Journal of Pediatric Psychology ◽

10.1093/jpepsy/7.1.43 ◽

1982 ◽

Vol 7 (1) ◽

pp. 43-48 ◽

Cited By ~ 24

Author(s):

Lizette Peterson ◽

Carol Shigetomi

Keyword(s):

Elective Surgery ◽

Preoperative Preparation ◽

Child Patients ◽

One Year

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What are the Risk Factors for One-Year Mortality in Older Patients with Chronic Kidney Disease? An Analysis of the Cleveland Clinic CKD Registry

Nephron ◽

10.1159/000494298 ◽

2018 ◽

Vol 141 (2) ◽

pp. 98-104 ◽

Cited By ~ 4

Author(s):

Fahad Saeed ◽

Susana Arrigain ◽

Jesse D. Schold ◽

Joseph V. Nally Jr ◽

Sankar Dass Navaneethan

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Older Patients ◽

Cleveland Clinic ◽

One Year

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Improving outcomes in older patients undergoing elective surgery

Aging Health ◽

10.2217/ahe.12.38 ◽

2012 ◽

Vol 8 (4) ◽

pp. 329-332 ◽

Cited By ~ 1

Author(s):

Jugdeep Dhesi

Keyword(s):

Older Patients ◽

Elective Surgery

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These studies indicate that homologous blood transfusion affects the outcome of clinical diseases in both beneficial and adverse ways. Experimental situations are not suitable for randomized clinical trials - transfusions cannot be given to prevent the onset of diabetes or wound strength measured in man following receipt of homologous or autologous blood. These experimental observations indicate that the outcomes of numerous clinical diseases which have not been studied may be manipulated by the use of homologous blood or that transfusion should be avoided. Several studies indicate that changes in immune function following transfusion are permanent. The number of clinical phenomena associated with immune suppression and attributable to blood transfusion is unknown. SUMMARY Given the evidence presented here it would be foolish to suggest that transfusion of homologous blood has no immunologic consequences for the recipient. Blood transfusion is the oldest form of transplant - no one would argue that transplantation between unrelated individuals has no influience on the immune system. In organ transplantation the immunologic sequelae are permanent and there is evidence that the same is true following homologous blood transfusion. Lymphocytopenia is present one year following surgery for Crohn's disease if patients receive perioperative blood transfusion (43). Colorectal cancer patients transfused more than seven years prior to diagnosis have significantly reduced numbers of lymphocytes and lower natural killer cytotoxicity than colorectal cancer patients who have never been transfused (44). Transfusion of neonates causes suppression of lymphocyte reactivity which is still demonstrable 25 to 30 years later (45). There is evidence that transfusion at any time prior to elective surgery increases susceptibility to infectious complications (14) and otherwise healthy transfused individuals may be at increased risk of developing malignancies (46). All the longterm consequences of blood transfusion are not negative: Survival of transplants is prolonged by pretransplant transfusion and some women suffering from recurrent spontaneous abortion can deliver at term if previously transfused with their spouse's leukocytes. In the future we will be able to transfuse blood without causing immune perterbations and the consequent clinical phenomena. Studies presented here suggest that removal of donor leukocytes reduces the risk of infection and cancer recurrence. The technology has not reached the point of reducing the leukocyte number in transfused blood below 10^/unit. An alternative which is increasingly being utilized is autologous blood programs. Physicians are discovering that patients tolerate hemoglobin levels which were previously unacceptably low and many patients prefer being anemic over the risks of receiving homologous blood. Since transfusion is an identifier of high cost hospitalized patients, alternatives to routine blood use are being studied in hopes of safely reducing the costs of transfusion. REFERENCES 1. Jubert AV, Lee ET, Hersh EM, McBride CM. J Surg Res 15:399-403, 1973. 2. M 19 u4n ( s3t ) e3r4A6-M 35 , 2 W , i1n9c8h1u . rch RA, Keane RM, Shatney CH, Ernst CB, Nuidema GD. Ann Surg

Transfusion Immunology and Medicine ◽

10.1201/9781482273441-29 ◽

1995 ◽

pp. 300-300

Keyword(s):

Colorectal Cancer ◽

Blood Transfusion ◽

Cancer Patients ◽

Randomized Clinical Trials ◽

Elective Surgery ◽

Autologous Blood ◽

Homologous Blood ◽

Homologous Blood Transfusion ◽

One Year ◽

Colorectal Cancer Patients

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1628 Vaccination for Safe Surgery During The SARS-Cov-2 Pandemic: Modelling Study

British Journal of Surgery ◽

10.1093/bjs/znab258.064 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

Keyword(s):

General Population ◽

Elective Surgery ◽

Risk Difference ◽

Cancer Surgery ◽

Number Needed To Treat ◽

Worst Case ◽

Registration Data ◽

Increased Risk ◽

One Year ◽

The Impact

Abstract Introduction Compared to the general population, in the postoperative period, surgical patients are both at increased risk of SARS-CoV-2 infection and increased mortality in the event of SARS-CoV-2 infection. This study modelled the impact of preoperative vaccination of patients aged ≥70 years having elective inpatient surgery. Method The primary outcome was the number needed to treat (NNT) to prevent one death over one year following SARS-CoV-2 vaccination. Postoperative SARS-CoV-2 incidence and adjusted mortality risk difference for SARS-CoV-2 infection were estimated from the prospective GlobalSurg-CovidSurg Week study (90,146 elective surgery patients across 1,595 hospitals in 115 countries), were used to estimate lives saved by vaccination in the first 30 postoperative days. SARS-CoV-2 case and death registration data from the Office for National Statistics was used to estimate NNTs for the general population. Best and worst-case scenarios were used to describe uncertainty around estimates. Results Among patients aged ≥70 years undergoing any type of surgery, NNT was estimated to be 332 (best case: 213; worst case: 690). NNT was lower in the cancer surgery subgroup (245 [150-545]). This was more favourable than the NNT for vaccination of the general population aged ≥70 (588 [403-1032]). Globally, vaccinating elective surgery patients aged ≥70 years preoperatively was projected to save 27,356 lives in one year compared to vaccinating the same patients after surgery. Conclusions Preoperative pathways should be set up for the vaccination of patients aged ≥70. In settings with limited vaccine availability, elective cancer surgery patients should be prioritised for vaccination.

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Incidence and risk factors for severe tardive dyskinesia in older patients

The British Journal of Psychiatry ◽

10.1192/bjp.171.2.148 ◽

1997 ◽

Vol 171 (2) ◽

pp. 148-153 ◽

Cited By ~ 37

Author(s):

Michael P. Caligiuri ◽

Jonathan P. Lacro ◽

Enid Rockwell ◽

Lou Ann McAdams ◽

Dilip V. Jeste

Keyword(s):

Risk Factors ◽

Tardive Dyskinesia ◽

Movement Disorder ◽

Cumulative Incidence ◽

Older Patients ◽

Negative Symptoms ◽

Cox Regression ◽

Effective Dosage ◽

Regression Analyses ◽

One Year

BackgroundSevere tardive dyskinesia (TD) represents a serious and potentially disabling movement disorder, yet relatively little is known about the incidence of and risk factors for severeTD.MethodWe report the results of a longitudinal prospective incidence study of severeTD in 378 middle-aged and elderly neuropsychiatric patients. Psychiatric, neuropsychological, pharmacological and motor variables were obtained at intake and at regular intervals for 36 months.ResultsThe cumulative incidence of severeTD was 2.5% after one year, 12.1% after two years, and 22.9% after three years. Individual univariable Cox regression analyses were conducted to identify demographic, psychiatric, motor and pharmacological predictors of severeTD. Results indicated that higher daily doses of neuroleptics at study entry, greater cumulative amounts of prescribed neuroleptic, and greater severity of worsening negative symptoms were predictive of severeTD Conclusions These findings suggest that conventional neuroleptics may be prescribed to older patients only when necessary and at the lowest effective dosage. Additional caution is recommended in patients exhibiting negative symptoms.

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