Operative Versus Nonoperative Management of Odontoid Fracture in the Elderly: Stochastic Simulation of Morbidity and Mortality

With the global over 60-year-old population predicted to more than double over the next 35 years, caring for this aging population has become a major global healthcare challenge. In 2016 there were over 1 million deaths in >70 year olds due to lower respiratory tract infections; 13–31% of these have been reported to be caused by viruses. Since then, there has been a global COVID-19 pandemic, which has caused over 2.3 million deaths so far; increased age has been shown to be the biggest risk factor for morbidity and mortality. Thus, the burden of respiratory viral infections in the elderly is becoming an increasing unmet clinical need. Particular challenges are faced due to the interplay of a variety of factors including complex multimorbidities, decreased physiological reserve and an aging immune system. Moreover, their atypical presentation of symptoms may lead to delayed necessary care, prescription of additional drugs and prolonged hospital stay. This leads to morbidity and mortality and further nosocomial spread. Clinicians currently have limited access to sensitive detection methods. Furthermore, a lack of effective antiviral treatments means there is little incentive to diagnose and record specific non-COVID-19 viral infections. To meet this unmet clinical need, it is first essential to fully understand the burden of respiratory viruses in the elderly. Doing this through prospective screening research studies for all respiratory viruses will help guide preventative policies and clinical trials for emerging therapeutics. The implementation of multiplex point-of-care diagnostics as a mainstay in all healthcare settings will be essential to understand the burden of respiratory viruses, diagnose patients and monitor outbreaks. The further development of novel targeted vaccinations as well as anti-viral therapeutics and new ways to augment the aging immune system is now also essential. The reviews of this paper are available via the supplemental material section.

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Morbidity and Mortality of the Elderly after Early Operation for Trochanteric Fractures

Journal of the Korean Fracture Society ◽

10.12671/jkfs.2013.26.3.199 ◽

2013 ◽

Vol 26 (3) ◽

pp. 199 ◽

Cited By ~ 1

Author(s):

Se-Ang Jang ◽

Young-Ho Cho ◽

Young-Soo Byun ◽

Ki-Hong Park ◽

Hyun-Seong Yoo ◽

...

Keyword(s):

The Elderly ◽

Morbidity And Mortality ◽

Early Operation ◽

Trochanteric Fractures

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Radiographic Predictors of Delayed Carpal Tunnel Syndrome After Distal Radius Fracture in the Elderly

Hand ◽

10.1177/1558944720963876 ◽

2020 ◽

pp. 155894472096387

Author(s):

Kevin H. Kim ◽

Bryan Duell ◽

Swapna Munnangi ◽

Mitchell Long ◽

Elizabeth Morrison

Keyword(s):

Risk Factors ◽

Decision Making ◽

Carpal Tunnel Syndrome ◽

Distal Radius Fracture ◽

Carpal Tunnel ◽

Nonoperative Management ◽

Significant Risk ◽

The Elderly ◽

Control Group ◽

Tunnel Syndrome

Background Delayed-onset carpal tunnel syndrome (DCTS) can develop weeks and months after distal radius fracture (DRFx). A better understanding of the risk factors of DCTS can guide surgeon’s decision making regarding the management of DRFx and also provides another discussion point to be had with elderly patients when discussing outcomes of nonoperative management. Methods We reviewed 216 nonoperatively managed DRFx between June 2015 and January 2019 at a single level 1 trauma center and senior author’s office. We identified 26 patients who developed DCTS at a minimum of 6 weeks after DRFx, which constituted our case group. The remaining 190 patients served as the control group (non–carpal tunnel syndrome [CTS]). Differences between case and control group were evaluated through univariate and multivariate analyses. Results The prevalence of DCTS among nonoperatively managed DRFx was 12%. In univariate analysis, volar tilt (VT) and teardrop angle (TDA) were significant independent predictors of development of DCTS. Multivariate logistic regression analysis determined that the odds of developing CTS increased by 12% and 24% for each degree of decrease in VT and TDA, respectively. No other significant risk factors were identified. Conclusions Decreasing VT and TDA are the most significant risk factors associated with DCTS in nonoperatively managed DRFx. These are simple and reliable radiographic measurements that provide significant prognostic value. These parameters can be used to guide surgeon decision making regarding management of DRFx in the elderly while aiding patient expectations and outcomes following nonoperative management of DRFx.

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Anaesthesia in the elderly

10.1093/med/9780199642045.003.0086 ◽

2017 ◽

Author(s):

Bernadette Veering ◽

Chris Dodds

Keyword(s):

Elderly Patients ◽

Postoperative Morbidity ◽

Medical Condition ◽

Clinical Care ◽

The Elderly ◽

Individual Variability ◽

Morbidity And Mortality ◽

Clear Understanding ◽

Organ Systems ◽

Specific Organ

The elderly population continues to grow. As surgical intervention in disease processes becomes more aggressive, the anaesthetist is faced with an increasing number of elderly patients. Elderly patients should be approached with a clear understanding of ageing, how it occurs, how it affects specific organ systems, and how it may influence clinical care, when a patient is subjected to an operation. The ageing process is a multifactorial process, resulting in a decreased capacity for adaptation and producing a gradual decrease in functional reserve of many organ systems. This has significant effects on the physiological responses to surgical and pharmacological trespass faced during anaesthesia. Increasing age is associated with changes in the response to a wide variety of drugs. Changes in dose–response relationships may be as a result of changes in pharmacokinetics, pharmacodynamics, or a combination of both. One should realize that increasing age is associated with a large inter-individual variability in dose requirements. As such, it is important to carefully titrate the dose against the desired clinical effect in an older patient. Preoperative physical and mental state are the most important determinants of per- and postoperative morbidity and mortality. The number of co-morbidities increases with advanced age and as such, optimization of the medical condition is essential to reduce the morbidity and mortality.

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Treatment of type II odontoid fracture in the elderly

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa235 ◽

2020 ◽

Vol 2020 (8) ◽

Author(s):

Preci Hamilton ◽

Peyton Lawrence ◽

Christian Valentin Eisenring

Keyword(s):

Screw Fixation ◽

Holistic Approach ◽

The Elderly ◽

Spinal Fracture ◽

Cannulated Screw ◽

Odontoid Fracture ◽

Zenker’S Diverticulum ◽

Type Ii ◽

Odontoid Fractures ◽

Zenker's Diverticulum

Abstract Odontoid fractures constitute the commonest cervical spinal fracture in the elderly. There are varied management approaches with paucity of robust evidence to guide decision-making. We review the case of a 92-years-old man with traumatic Grauer type II B odontoid fracture treated with anterior cannulated screw fixation. Postoperatively, he was noted to have dysphagia due to a zenker’s diverticulum. Further history revealed repair of a zenker’s diverticulum ~40 years prior. Cervical spine images and video fluoroscopy demonstrated a recurrent zenker’s diverticulum. After re-excision of the recurrent zenker’s diverticulum his dysphagia resolved. This unique case describes dysphagia due to recurrent zenker’s diverticulum presenting after anterior cannulated screw fixation for type II B odontoid fracture. The dysphagia was diagnosed and treated in close collaboration with speech and language therapists and otorhinolaryngologist. This underscores the importance of holistic approach to the elderly patient with odontoid fractures.

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