The neuropathogenesis of delirium

2002 ◽  
Vol 12 (1) ◽  
pp. 62-67 ◽  
Author(s):  
Susan White
Keyword(s):  
Hospital Stay ◽  
Older Patients ◽  
Independent Predictor ◽  
Length Of Hospital Stay ◽  
Predisposing Factors ◽  
Advanced Age ◽  
Major Surgery ◽  
Common Disorder ◽  
Disturbance Of Consciousness ◽  
Short Period

Delirium is a common disorder in ill older patients, characterized by a fluctuating disturbance of consciousness and changes in cognition that develop over a short period of time. Studies have shown that delirium is an independent predictor of increased length of hospital stay, and is associated with increased dependency and mortality, as well as being distressing for patients and families. Much is known about the epidemiology of delirium, including predisposing factors such as pre-existing dementia and advanced age, and common precipitants such as infection, drugs and major surgery. In comparison, very little is known about the neuropathological mechanisms that lead to the development of delirium.

238 SERUM ALBUMIN EARLY DECREASE IS AN INDEPENDENT PREDICTOR OF MAJOR COMPLICATIONS AFTER ONCOLOGICAL ESOPHAGECTOMY; RESULTS FROM A LARGE EUROPEAN SERIES

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Ismail Labgaa ◽  
Styliani Mantziari ◽  
Michael Winiker-Seeberger ◽  
Jerôme Pasquier ◽  
Marguerite Messier ◽  
...  
Keyword(s):  
Predictive Value ◽  
Independent Predictor ◽  
Multivariable Analysis ◽  
Length Of Hospital Stay ◽  
Adverse Outcomes ◽  
Major Surgery ◽  
Roc Curve Analysis ◽  
Comprehensive Complication Index ◽  
Major Complications ◽  
Patients At Risk

Abstract   The predictive value of postoperative albuminemia decrease (ΔAlb) has been increasingly evidenced in different types of major surgery but data on esophagectomy remain scarce. This study aimed to assess the predictive value of ΔAlb for adverse short-term outcomes after oncological esophagectomy. Methods Retrospective analysis of an international multicentric cohort of patients undergoing oncological esophagectomy between 2006–2017. Patients with missing pre- and postoperative albumin values were excluded from the analysis. Primary endpoint was postoperative morbidity according to Clavien classification. Secondary endpoints were Comprehensive Complication Index (CCI) and length of hospital stay (LoS). Results A total of 1046 patients were analyzed. Major complications were reported in 363 (34.7%) patients. Albuminemia showed a rapid postoperative decrease on postoperative day 1 (POD1) (ΔAlb POD1) with a median value of 11 g/L. ROC curve analysis determined a cut-off of 11 g/L for the prediction of overall complications. Patients with ΔAlb POD1 ≥ 11 g/L showed increased overall complications (p = 0.004), major complications (p = 0.009) and CCI (p = 0.006) while LoS was comparable (p = 0.099). On multivariable analysis, ΔAlb POD1 ≥ 11 g/L was an independent predictor of overall (OR: 1.55; 95% CI 1.09–2.21; p = 0.015) and major complications (OR: 1.43; 95% CI 1.09–1.89; p = 0.009). Conclusion Oncological esophagectomy induced a rapid decrease of albuminemia. ΔAlb POD1 ≥ 11 g/L was independently associated with the occurrence of overall and major postoperative complications. ΔAlb appears as a promising biomarker to detect patients at risk of adverse outcomes after oncological esophagectomy.

Preventable hospitalizations among older patients with cognitive impairments and dementia

2018 ◽  
Vol 31 (3) ◽  
pp. 383-391 ◽  
Author(s):  
Dominik Wolf ◽  
Carolin Rhein ◽  
Katharina Geschke ◽  
Andreas Fellgiebel
Keyword(s):  
Cohort Study ◽  
Hospital Stay ◽  
Ambulatory Care ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Older Patients ◽  
Hospital Admissions ◽  
Cognitive Impairments ◽  
Length Of Hospital Stay ◽  
Complication Rates

ABSTRACTObjectives:Dementia and cognitive impairment are associated with higher rates of complications and mortality during hospitalization in older patients. Moreover, length of hospital stay and costs are increased. In this prospective cohort study, we investigated the frequency of hospitalizations caused by ambulatory care-sensitive conditions (ACSCs), for which proactive ambulatory care might prevent the need for a hospital stay, in older patients with and without cognitive impairments.Design:Prospective cohort study.Setting:Eight hospitals in Germany.Participants:A total of 1,320 patients aged 70 years and older.Measurements:The Mini-Cog test has been used to assess cognition and to categorize patients in the groups no/moderate cognitive impairments (probably no dementia) and severe cognitive impairments (probable dementia). Moreover, lengths of hospital stay and complication rates have been assessed, using a binary questionnaire (if occurred during hospital stay or not; behavioral symptoms were adapted from the Cohen-Mansfield Agitation Inventory). Data have been acquired by the nursing staff who received a special multi-day training.Results:Patients with severe cognitive impairments showed higher complication rates (including incontinence, disorientation, irritability/aggression, restlessness/anxiety, necessity of Tranquilizers and psychiatric consults, application of measures limiting freedom, and falls) and longer hospital stays (+1.4 days) than patients with no/moderate cognitive impairments. Both groups showed comparably high ACSC-caused admission rates of around 23%.Conclusions:The study indicates that about one-fourth of hospital admissions of cognitively normal and impaired older adults are caused by ACSCs, which are mostly treatable on an ambulatory basis. This implies that an improved ambulatory care might reduce the frequency of hospitalizations, which is of particular importance in cognitively impaired elderly due to increased complication rates.

Length of Hospital Stay is an Independent Predictor of Overall Survival in Patients with systemic AL Amyloidosis

2017 ◽  
Vol 17 (1) ◽  
pp. e109
Author(s):  
Ahmed Mohamed Abdel Shafì ◽  
Carol Whelan ◽  
Marianna Fontana ◽  
Cristina Quarta ◽  
Shameem Mahmood ◽  
...  
Keyword(s):  
Overall Survival ◽  
Hospital Stay ◽  
Independent Predictor ◽  
Length Of Hospital Stay ◽  
Al Amyloidosis

Goal-directed Intraoperative Fluid Administration Reduces Length of Hospital Stay after Major Surgery

2002 ◽  
Vol 97 (4) ◽  
pp. 820-826 ◽  
Author(s):  
Tong J. Gan ◽  
Andrew Soppitt ◽  
Mohamed Maroof ◽  
Habib El-Moalem ◽  
Kerri M. Robertson ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Hospital Stay ◽  
Elective Surgery ◽  
Length Of Hospital Stay ◽  
Postoperative Hospital Stay ◽  
Fluid Administration ◽  
Major Surgery ◽  
Control Group ◽  
Surgical Morbidity ◽  
Protocol Group

Background Intraoperative hypovolemia is common and is a potential cause of organ dysfunction, increased postoperative morbidity, length of hospital stay, and death. The objective of this prospective, randomized study was to assess the effect of goal-directed intraoperative fluid administration on length of postoperative hospital stay. Methods One hundred patients who were to undergo major elective surgery with an anticipated blood loss greater than 500 ml were randomly assigned to a control group (n = 50) that received standard intraoperative care or to a protocol group (n = 50) that, in addition, received intraoperative plasma volume expansion guided by the esophageal Doppler monitor to maintain maximal stroke volume. Length of postoperative hospital stay and postoperative surgical morbidity were assessed. Results Groups were similar with respect to demographics, surgical procedures, and baseline hemodynamic variables. The protocol group had a significantly higher stroke volume and cardiac output at the end of surgery compared with the control group. Patients in the protocol group had a shorter duration of hospital stay compared with the control group: 5 +/- 3 versus 7 +/- 3 days (mean +/- SD), with a median of 6 versus 7 days, respectively ( = 0.03). These patients also tolerated oral intake of solid food earlier than the control group: 3 +/- 0.5 versus 4.7 +/- 0.5 days (mean +/- SD), with a median of 3 versus 5 days, respectively ( = 0.01). Conclusions Goal-directed intraoperative fluid administration results in earlier return to bowel function, lower incidence of postoperative nausea and vomiting, and decrease in length of postoperative hospital stay.

scholarly journals Severe aortic stenosis in octogenarian: is surgical aortic valve replacement a good option?

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
R Menezes Fernandes ◽  
HA Costa ◽  
JS Bispo ◽  
TF Mota ◽  
D Bento ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Older Patients ◽  
Independent Predictor ◽  
Advanced Age ◽  
Surgical Aortic Valve Replacement ◽  
Predictors Of Mortality

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Aortic stenosis (AS) is the most prevalent valvular heart disease among the elderly, reaching 8,1% in 85 years-old patients. Symptomatic severe AS entails a high risk of morbidity and mortality without valve replacement, and increasing age is associated with higher surgical risk. Purpose To determine the prognostic impact of advanced age in patients with severe AS referred to surgical valve replacement. Methods We conducted a retrospective study encompassing patients referred to surgical aortic valve replacement due to severe AS, from January 2016 to December 2018. Clinical characteristics, diagnostic studies and follow-up were analysed. Patients were divided in two groups according to the age: <80 and ≥80 years old. Independent predictors of mortality and/or re-hospitalization were identified through a binary logistic regression analysis, considering p = 0,05. Results A total of 222 patients were included, with a 64,4% male predominance and a median age of 75 years old. 27,5% had concomitant surgical coronary artery disease and 87,4% waited in an out-patient setting. Median delay until surgery was 87 days and median follow-up after surgical referral was 517 days. 59 patients (26,8%) had ≥ 80 years old. Male gender (69,6% vs 50,8%; p = 0,01), smoking habits (14,3% vs 1,7%; p = 0,024), higher glomerular filtration rate (75,5 vs 63,2 ml/min; p = 0,001) and lower Euroscore II values (2,89% vs 4,64%; p = 0,003) were more common in younger patients. Global mortality rate (27,1% vs 15,5%; p = 0,05) and the composite of mortality or re-hospitalization (52,5% vs 36,6%; p = 0,034) were more frequent in older patients. Despite re-hospitalizations were also more common (37,3% vs 29,2%), they did not reach statistical significance (p = 0,252). After multivariate analysis, advanced age was not an independent predictor of mortality and/or re-hospitalization. In this population, only the presence of extracardiac arteriopathy (p = 0,007; p = 0,006) and pulmonary hypertension (p = 0,004; p = 0,002) were both independent predictors of mortality and the composite of mortality or re-hospitalization. Conclusion Older patients with AS have higher mortality, but advanced age was not an independent predictor of mortality and/or re-hospitalization. The decision to perform aortic valve replacement should be discussed in the Heart Team, considering patient’s comorbidities and performing a comprehensive geriatric evaluation, not just focusing on age itself.

Perioperative dialogue on postoperative recovery measured by the use of pain medication, psychopharmaceutical agents and length of hospital stay

2018 ◽  
Vol 38 (4) ◽  
pp. 212-219
Author(s):  
Christine Leo Swenne ◽  
Louise Hjelte ◽  
Emma Härdne ◽  
Carin Friberg ◽  
Erebouni Arakelian
Keyword(s):  
Hospital Stay ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Length Of Hospital Stay ◽  
Pain Medication ◽  
Postoperative Recovery ◽  
Major Surgery ◽  
Control Group ◽  
Medication Consumption ◽  
Experienced Pain ◽  
Before And After

The effects of perioperative dialogue have been studied using qualitative methods, describing patient satisfaction with their care. However, they have not been studied in patients with peritoneal carcinomatosis who undergo major surgery, nor with quantitative variables. The aim was to study the use of pain medication and length of hospital stay following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients who received, versus those who did not receive, perioperative dialogue. The study had a quantitative, retrospective and comparative design including 89 audits. Of these, 37 patients received perioperative dialogues, and 52 patients did not (the control group). The result showed that by postoperative day six, patients who received a perioperative dialogue experienced pain less frequently than patients in the control group. However, no differences between the groups were noted with regard to pain medication consumption and length of hospital stay. To ease their worries, all patients in both groups used benzodiazepines. The perioperative dialogue may be studied quantitatively, but it must involve the patient, who is an equal partner in the dialogue. Structured validated self-reporting measures may be used systematically before and after surgery in order to evaluate the perioperative dialogue using quantitative measures.

Hyperglycemia treatment is associated with longer length of hospital stay in colorectal cancer surgery patients

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6133-6133
Author(s):  
J. M. Geraci ◽  
N. Busaidy ◽  
J. Wang ◽  
T. P. Lam ◽  
J. M. Skibber ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Logistic Regression ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Hospital Length Of Stay ◽  
Major Surgery ◽  
Cancer Center ◽  
Diabetes Diagnosis ◽  
Colorectal Cancer Surgery ◽  
Study Population

6133 Background: Diabetes mellitus (DM) is associated with longer hospital stays in some medical and surgical inpatient populations. Aggressive control of blood sugar may prevent complications and decrease hospital length of stay (LOS). Methods: We conducted a retrospective study of 519 patients at UT MD Anderson Cancer Center (UTMDACC) who had major surgery for colon or rectal cancer in calendar years 2000–2003. Patient data extracted from the UTMDACC Institutional Database included demographics, admission and discharge dates and diagnoses, surgical procedures, and diabetes medication use during the hospitalization. Known DM was defined as present if the patient had a diabetes diagnosis prior to or at admission; hyperglycemia treatment was defined as receipt of a medication for diabetes (insulin or oral medication) during the index hospitalization. Chi-square and t tests were performed to assess associations between patient characteristics and long LOS, and multiple logistic regression was used to identify independent predictors of hospital LOS at or greater than the 75th percentile for the study population (long LOS). Results: The mean age of the study population was 60.4 years (median 61, range 18–91). Known DM was present in 10.4% of cases; the same percentage received hyperglycemia treatment during their hospital stay, although not all were known diabetics. Mean LOS was 8.9 days; median 7 days and the 75th percentile 9 days. 50% of patients treated for hyperglycemia had long LOS (27 of 54 cases, p< 0.0005). In a logistic regression model controlling for patient demographic and clinical characteristics and the occurrence of post-operative complications, hyperglycemia treatment was an independent predictor of long LOS (odds ratio 4.1, 95% confidence interval 1.6, 10.3). Conclusions: Hyperglycemia treatment is associated with longer LOS in patients undergoing surgery for colon or rectal cancer at UTMDACC. Further studies should determine whether patients at risk for long LOS can be identified prospectively such that they might benefit from an intervention to reduce their LOS. [Table: see text]

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