The Impact of Age on Perioperative Complications after Extremity Reconstruction with the Free Gracilis Flap: A Retrospective Cohort Study Involving 153 Patients

2019 ◽  
Vol 35 (06) ◽  
pp. 395-410 ◽  
Author(s):  
Laurenz Weitgasser ◽  
Amro Amr ◽  
Michaela Hladik ◽  
Gottfried Wechselberger ◽  
Adrien Daigeler ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Medical Condition ◽  
Perioperative Complications ◽  
Gracilis Muscle ◽  
Assessment Tools ◽  
Medical Complications ◽  
Muscle Flaps ◽  
Asa Score ◽  
Age Related ◽  
The Impact

Background The need for plastic and reconstructive surgery on elderly patients has been on the rise due to an increase in life expectancy in the past decades. Therefore, a study was conducted on young and elderly patients following microsurgical extremity reconstructions with free gracilis muscle flaps with the primary aim to investigate the influence of age and the American Society of Anesthesiologists (ASA) score on the general outcome, as well as surgical and medical complications. Methods A retrospective analysis of 153 patients receiving free gracilis muscle flaps for extremity reconstructions between November 2009 and January 2018 was performed at two partner institutions specialized in microsurgical reconstructions. A logistic regression analysis was performed to correlate age and the ASA score with postoperative complication probability. Patients younger than 70 years were directly compared with elderly patients with respect to age, gender, ASA score, preexisting comorbidities, localization, and postoperative medical and surgical complications. Results Age turned out to be not significantly associated with major flap complications (p = 0.925) but with higher ASA scores (p = 0.016). However, an age-related significant increase in minor flap complications could be observed in the elderly (p = 0.008). A significant correlation between minor medical complications and age could be observed (p = 0.001) in contrast to ASA score (p = 0.912). Conclusion An increased minor flap, as well as minor and major medical complications, must be expected in extremity reconstructions with free gracilis flaps in elderly patients. Higher ASA scores correlate with a higher incidence of major flap complications. Septuagenarians are more prone to develop perioperative major medical complications than patients younger than 70 years. Age and general medical condition, coupled with the performance of each patient, should be thoroughly assessed individually to facilitate a tailored reconstructive approach using risk assessment tools and established scoring systems.

scholarly journals Survival Analysis in Elderly Patients with Glioblastomas: The Influence of Clinical Status, Tumor and Surgical Features

2018 ◽  
Vol 37 (04) ◽  
pp. 297-303
Author(s):  
Ulysses Sousa ◽  
Matheus Oliveira ◽  
Lindolfo Heringer ◽  
Ricardo Botelho ◽  
José Rotta
Keyword(s):  
Survival Analysis ◽  
Elderly Patients ◽  
Poor Prognosis ◽  
Perioperative Complications ◽  
Clinical Status ◽  
Tumor Location ◽  
Malignant Neoplasms ◽  
Women Patients ◽  
The Impact

Introduction Glioblastomas are malignant neoplasms, notorious for their poor prognosis. We have conducted a survival analysis in a sample of elderly patients with glioblastomas. Methods The sample of the present study consisted of elderly patients consecutively admitted from January 2014 to January 2016 (24 months) at the Hospital do Servidor Público Estadual de São Paulo. We have evaluated the impact of age, Karnofsky scale (KS) score, tumor location, and occurrence of perioperative complications. Results A total of 42 patients were analyzed. Of these, 23 (54.7%) were men, and 19 (45.3%) were women. Patients > 60 years old, with low KS score, deep-seated tumors, and those with perioperative complications had worst outcomes. Discussion and conclusion Surgery, perioperative chemotherapy and radiotherapy add survival time and quality of life to these patients. In patients with low KS score, isolated radiotherapy and/or chemotherapy might be adequate. Decreasing perioperative complications is essential to adequately deliver adjuvant therapy in elderly patients.

scholarly journals The impact of age on outcome after surgery for colorectal adenocarcinoma

2011 ◽  
Vol 93 (6) ◽  
pp. 445-450 ◽  
Author(s):  
AL Widdison ◽  
S Wienand Barnett ◽  
N Betambeau
Keyword(s):  
Older Patients ◽  
Operative Mortality ◽  
Relative Proportion ◽  
The Elderly ◽  
Medical Complications ◽  
Related Factors ◽  
Percentage Points ◽  
Age Related ◽  
Co Morbidity ◽  
The Impact

INTRODUCTION The incidence of colorectal cancer (CRC) increases with age. The aim of this study was to investigate the impact of age and age-related factors on post-operative mortality and survival following CRC resections. METHODS A prospectively collected database of 459 CRC resections was analysed. RESULTS The mean age of the patients was 70 years (range: 25–95 years) and 54% were male. The relative proportion of female patients increased with age so that for patients aged over 77 more women were treated than men. The probability of undergoing an emergency resection (25%) did not change with age. In older patients the proportion of rectal cancers resected decreased and the proportion of hemicolectomies and Hartmann's operations performed increased. The 30-day mortality rate was 4% after elective and 11% after emergency resections. Most deaths were caused by medical complications, reflecting increased co-morbidity in the elderly. Post-operative mortality was 1% in patients under the age of 59. This increased by 3 percentage points every 10 years after elective resections and by 8 percentage points every 10 years after emergency resections. CRC-specific survival was independent of age whereas overall survival decreased so the likelihood of dying from CRC decreased with age: at age 50 half the deaths were from CRC, at age 70 a third and at age 80 a quarter. CONCLUSIONS CRC stage and the probability of presenting as an emergency did not change with age but older patients were more likely to be female and have colon cancer. Post-operative mortality progressively increased with age. Most deaths were caused by medical complications, reflecting increased co-morbidity. Older patients were less likely to die from CRC.

Perioperative Complications in Patients with Rheumatoid Arthritis Following Primary Total Knee Arthroplasty: An Analysis of 102,898 Patients

2019 ◽  
Vol 32 (11) ◽  
pp. 1075-1080 ◽  
Author(s):  
Ajit M. Vakharia ◽  
Wayne B. Cohen-Levy ◽  
Rushabh M. Vakharia ◽  
Nipun Sodhi ◽  
Michael A. Mont ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Perioperative Complications ◽  
Medical Complications ◽  
Readmission Rates ◽  
Episode Of Care ◽  
Total Knee ◽  
The Impact ◽  
Care Costs

AbstractThere are conflicting results regarding the impact of rheumatoid arthritis (RA) on total knee arthroplasty (TKA) outcomes. Therefore, the purpose of this study was to compare outcomes of patients with and without RA undergoing primary TKA. Specifically, we assessed (1) 90-day medical complications, (2) 90-day readmission rates, (3) short-term implant-related complications, (4) 1-year mortality, and (5) total global 90-day episode-of-care costs. The authors of the study hypothesize that RA would increase the rate of medical- and implant-related complications, readmission rates, and costs. A retrospective level of evidence III study was conducted using the Medicare standard analytical files from the PearlDiver database. Patients were queried using the International Classification of Disease, ninth revision codes. Patients with RA were randomly matched 1:1 to controls according to age, gender, and Charlson's comorbidity index. Two mutually exclusive cohorts were formed. Medical- and implant-related complications, readmission rates, and costs were analyzed and compared between the cohorts. Statistical analysis using logistic regression was performed calculating odds ratios (OR), 95% confidence intervals (95% CI), and their respective p-values. The query returned 102,898 patients with (n = 51,449) and without (n = 51,449) RA undergoing primary TKA within the Medicare database from 2005 to 2014. Patients with RA had greater odds of medical complications (OR: 2.08, 95% CI: 1.98–2.20, p < 0.001), implant complications (OR: 1.30, 95% CI: 1.24–1.36, p < 0.001), 1-year mortality (OR: 1.35, 95% CI: 0.68–2.70, p = 0.39), total 90-day episode-of-care costs ($16,605 vs. 15,716.53; p < 0.001), and 90-day readmission rates were similar between cohorts (OR: 1.08, 95% CI: 1.05–1.12, p < 0.001). RA increases postoperative complications and costs following primary TKA within Medicare patients. Comprehensive preoperative optimization for patients with a diagnosis of RA may mitigate perioperative complications, thus improving patient outcomes, and ultimately reducing episode-of-care costs.

Polypill therapy and frailty in elderly: Time to stop treating everything

2021 ◽  
Vol 12 (4) ◽  
pp. 39-42
Author(s):  
Sunil Kumar ◽  
Parth Godhiwala ◽  
Amrutha Garikapati ◽  
Shraddha Jain
Keyword(s):  
Observational Study ◽  
Elderly Patients ◽  
Prospective Observational Study ◽  
Related Condition ◽  
Medicine Department ◽  
Risk Of Death ◽  
Age Related ◽  
One Year ◽  
The Impact

Background: Frailty is a reversible age-related condition of increased vulnerability and risk of death or unplanned hospitalization. Frailty and polypill therapy are common in elderly, although little is known about the impact, they may have on each other. Aims and Objective: The study was a prospective observational study, designed with an aim to observe the six-month and one-year outcomes of elderly patients on polypill therapy. Material and Methods: Three hundred forty-two patients aged more than 60 years on polypill treatment were enrolled in this study, which were on regular follow up in our rural hospital at geriatric units of medicine department. Results: At the end of one year, 38.1% were in severe frailty (FIRE >0.7) category, out of which death happened at the end of one year were 41.6%. 47.6% required repeated hospitalisations that were on polypill therapy. Conclusions: A reduction of polypill therapy could be a cautious strategy to prevent and manage frailty. Further research is needed to confirm the possible benefits of reducing polypill in the development, reversion or delay of frailty.

scholarly journals The Psoas Muscle Index is Associated with Prognosis in Elderly Patients Undergoing Cardiovascular Surgery

2021 ◽  
Vol 11 (5) ◽  
Author(s):  
Yudai Iwasaki ◽  
Junji Shiotsuka ◽  
Alan Kawarai Lefor ◽  
Masamitsu Sanui
Keyword(s):  
Elderly Patients ◽  
Predictive Value ◽  
Cardiovascular Surgery ◽  
Medical Center ◽  
Psoas Muscle ◽  
Assessment Tools ◽  
Control Group ◽  
Case Group ◽  
Poor Outcomes ◽  
The Impact

Background: Sarcopenia is associated with poor outcomes in elderly patients. However, current surgical risk assessment tools for cardiovascular surgery do not include the impact of sarcopenia. Objectives: This study aimed to assess whether the psoas muscle index, a numerical score used to assess sarcopenia, is associated with outcomes in elderly patients undergoing cardiovascular surgery. Methods: This nested case-control study evaluated patients aged ≥ 75 years who underwent elective cardiovascular surgery and were admitted to the intensive care unit at Jichi Medical University, Saitama Medical Center between January 1, 2016 and March 31, 2017. The case group (poor outcomes) included patients who either died or were transferred to a rehabilitation facility postoperatively. The control group (good outcomes) included patients who were discharged postoperatively. Clinical factors likely to affect patient outcomes were assessed, and the characteristics of the two outcome groups were compared using logistic regression analysis. Results: In total, 183 patients were evaluated; among them, 137 and 46 patients were categorized to the good and poor outcome groups, respectively. The psoas muscle index was significantly associated with outcome (odds ratio: 0.25; 95% confidence interval: 0.14 – 0.43; P < 0.001). A psoas muscle index cut-off of 3.24 had a specificity, sensitivity, positive predictive value, and negative predictive value of 0.86, 0.63, 0.58, and 0.87, respectively, for predicting worse outcome at discharge. Conclusions: The psoas muscle index was strongly associated with discharge to home in patients aged ≥ 75 years who underwent elective cardiovascular surgery. This finding suggests that the psoas muscle index might be useful in identifying the eligibility of older patients for cardiovascular surgery.

Empowering Women Entrepreneurs Through Microfinance - A Case of Rural Bangladesh

2017 ◽  
Vol 3 (2) ◽  
pp. 7
Author(s):  
Saida Parvin
Keyword(s):  
Women's Empowerment ◽  
Assessment Tools ◽  
Women’S Empowerment ◽  
Case Study Method ◽  
Policy Makers ◽  
Theoretical Contribution ◽  
Donor Agencies ◽  
Definition Of ◽  
The Impact

Women’s empowerment has been at the centre of research focus for many decades. Extant literature examined the process, outcome and various challenges. Some claimed substantial success, while others contradicted with evidence of failure. But the success remains a matter of debate due to lack of empirical evidence of actual empowerment of women around the world. The current study aimed to address this gap by taking a case study method. The study critically evaluates 20 cases carefully sampled to include representatives from the entire country of Bangladesh. The study demonstrates popular beliefs about microfinance often misguide even the borrowers and they start living in a fabricated feeling of empowerment, facing real challenges to achieve true empowerment in their lives. The impact of this finding is twofold; firstly there is a theoretical contribution, where the definition of women’s empowerment is proposed to be revisited considering findings from these cases. And lastly, the policy makers at governmental and non-governmental organisations, and multinational donor agencies need to revise their assessment tools for funding.

Stress, anxiety, depression and burnout in frontline health care workers during COVID-19 pandemic: a brief systematic review and new data from Russia

2021 ◽  
Author(s):  
Ekaterina Mosolova ◽  
Dmitry Sosin ◽  
Sergey Mosolov
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Female Gender ◽  
Assessment Tools ◽  
Care Workers ◽  
Younger Age ◽  
Wide Range ◽  
Associated Risk Factors ◽  
Anxiety Depression ◽  
The Impact

During the COVID-19 pandemic, healthcare workers (HCWs) have been subject to increased workload while also exposed to many psychosocial stressors. In a systematic review we analyze the impact that the pandemic has had on HCWs mental state and associated risk factors. Most studies reported high levels of depression and anxiety among HCWs worldwide, however, due to a wide range of assessment tools, cut-off scores, and number of frontline participants in the studies, results were difficult to compare. Our study is based on two online surveys of 2195 HCWs from different regions of Russia during spring and autumn epidemic outbreaks revealed the rates of anxiety, stress, depression, emotional exhaustion and depersonalization and perceived stress as 32.3%, 31.1%, 45.5%, 74.2%, 37.7% ,67.8%, respectively. Moreover, 2.4% of HCWs reported suicidal thoughts. The most common risk factors include: female gender, nurse as an occupation, younger age, working for over 6 months, chronic diseases, smoking, high working demands, lack of personal protective equipment, low salary, lack of social support, isolation from families, the fear of relatives getting infected. These results demonstrate the need for urgent supportive programs for HCWs fighting COVID-19 that fall into higher risk factors groups.

Perioperative outcomes associated with thoracolumbar 3-column osteotomies for adult spinal deformity patients with rheumatoid arthritis

2019 ◽  
Vol 30 (6) ◽  
pp. 822-832
Author(s):  
Cecilia L. Dalle Ore ◽  
Christopher P. Ames ◽  
Vedat Deviren ◽  
Darryl Lau
Keyword(s):  
Rheumatoid Arthritis ◽  
Spinal Deformity ◽  
Perioperative Complications ◽  
Adult Spinal Deformity ◽  
Vena Cava ◽  
Deformity Correction ◽  
Perioperative Outcomes ◽  
Medical Complications ◽  
Filter Placement ◽  
Estimated Blood Loss

OBJECTIVESpinal deformity causing spinal imbalance is directly correlated to pain and disability. Prior studies suggest adult spinal deformity (ASD) patients with rheumatoid arthritis (RA) have more complex deformities and are at higher risk for complications. In this study the authors compared outcomes of ASD patients with RA following thoracolumbar 3-column osteotomies to outcomes of a matched control cohort.METHODSAll patients with RA who underwent 3-column osteotomy for thoracolumbar deformity correction performed by the senior author from 2006 to 2016 were identified retrospectively. A cohort of patients without RA who underwent 3-column osteotomies for deformity correction was matched based on multiple clinical factors. Data regarding demographics and surgical approach, along with endpoints including perioperative outcomes, reoperations, and incidence of proximal junctional kyphosis (PJK) were reviewed. Univariate analyses were used to compare patients with RA to matched controls.RESULTSEighteen ASD patients with RA were identified, and a matched cohort of 217 patients was generated. With regard to patients with RA, 11.1% were male and the mean age was 68.1 years. Vertebral column resection (VCR) was performed in 22.2% and pedicle subtraction osteotomy (PSO) in 77.8% of patients. Mean case length was 324.4 minutes and estimated blood loss (EBL) was 2053.6 ml. Complications were observed in 38.9% of patients with RA and 29.0% of patients without RA (p = 0.380), with a trend toward increased medical complications (38.9% vs 21.2%, p = 0.084). Patients with RA had a significantly higher incidence of deep vein thrombosis (DVT)/pulmonary embolism (PE) (11.1% vs 1.8%, p = 0.017) and wound infections (16.7% vs 5.1%, p = 0.046). PJK occurred in 16.7% of patients with RA, and 33.3% of RA patients underwent reoperation. Incidence rates of PJK and reoperation in matched controls were 12.9% and 25.3%, respectively (p = 0.373, p = 0.458). At follow-up, mean sagittal vertical axis (SVA) was 6.1 cm in patients with RA and 4.5 cm in matched controls (p = 0.206).CONCLUSIONSFindings from this study suggest that RA patients experience a higher incidence of medical complications, specifically DVT/PE. Preoperative lower-extremity ultrasounds, inferior vena cava (IVC) filter placement, and/or early initiation of DVT prophylaxis in RA patients may be indicated. Perioperative complications, morbidity, and long-term outcomes are otherwise similar to non-RA patients.

Sign in / Sign up

Export Citation Format

Share Document