scholarly journals SP3.1.2 The influence of frailty on outcomes for older adults admitted to hospital with benign biliary and pancreatic disease

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Michael Thomas ◽  
Minas Baltatzis ◽  
Angeline Price ◽  
Lyndsay Pearce ◽  
Jenny Fox ◽  
...  
Keyword(s):  
Daily Living ◽  
Acute Cholangitis ◽  
Pancreatic Disease ◽  
Biliary Disease ◽  
Clinical Frailty Scale ◽  
Care Level ◽  
Duration Of Hospital Stay ◽  
Common Diagnosis ◽  
Endoscopic Cholangiopancreatography ◽  
Observational Cohort

Abstract Aims To study the prevalence and complications of biliary disease with increasing age. We describe the prevalence of frailty in older patients hospitalised with benign biliary and pancreatic disease and establish its association with mortality and duration of hospital stay. Methods Prospective observational cohort study of patients aged 75 years and over admitted with acute biliary disease between 17/09/2014 and 20/03/2017. Clinical Frailty Scale (CFS) score was recorded on admission. Results 200 patients with a median age of 82 (75-99), 60% females, 154 (77%) were independent for personal and 99 (49.5%) for instrumental activities of daily living. Acute cholecystitis was the most common diagnosis (43%), acute cholangitis (36%) and acute pancreatitis (21%). 99 patients were non-frail (NF = CFS 1-4) and 101 were frail (F= CFS ≥5). 104 patients received medical treatment only. Surgery was more common in non-frail (F 2% vs. NF 11%), percutaneous drainage more frequently carried out in frail patients (15% vs. NF 5%) and endoscopic cholangiopancreatography (ERCP) was similar in both groups (F 32%vs. NF 31%). Frailty was associated with worse clinical outcomes. F vs. NF: functional deconditioning (34% vs. 11%), increased care level (19% vs 3%), length of stay (12 vs. 7 days), 90-day (8% vs. 3%) and 1 year-mortality (48% vs. 24%). Conclusions : Higher frailty scoring is associated with increased mortality in acute biliary disease. Individuals living with frailty were less likely to undergo surgical treatment, spent longer in hospital and were less likely to remain alive at 12 months after hospital discharge.

513 THE INFLUENCE OF FRAILTY ON OUTCOMES FOR OLDER ADULTS ADMITTED TO HOSPITAL WITH BENIGN BILIARY AND PANCREATIC DISEASE

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii14-ii18
Author(s):  
M Thomas ◽  
M Baltatzis ◽  
A Price ◽  
L Pearce ◽  
J Fox ◽  
...  
Keyword(s):  
Older Adults ◽  
Acute Cholangitis ◽  
Pancreatic Disease ◽  
Biliary Disease ◽  
Clinical Frailty Scale ◽  
Care Level ◽  
Frail Patients ◽  
Common Diagnosis ◽  
Endoscopic Cholangiopancreatography ◽  
Observational Cohort

Abstract Introduction The prevalence and complications of biliary disease increase with age. We describe the prevalence of frailty in older patients hospitalised with benign biliary and pancreatic disease and establish its association with mortality and duration of hospital stay. Methods Prospective observational cohort study of patients aged 75 years and over admitted with a diagnosis of acute biliary disease to a surgical hospital unit between 17/09/2014 and 20/03/2017. Clinical Frailty Scale (CFS) score was recorded on admission. Results We included 200 patients with a median age of 82 (75–99), 60% females, 89% lived in their homes, 154 (77%) were independent for personal and 99 (49.5%) for instrumental ADLs, 95% mobilised independently, 17.5% had memory impairment and 8% low mood. Acute cholecystitis was the most common diagnosis (43%) followed by acute cholangitis (36%) and acute pancreatitis (21%). 99 patients were non-frail (NF = CFS 1–4) and 101 were frail (F = CFS ≥5). 104 patients received medical treatment only. Surgery was more common in non-frail (F 2% vs. NF 11%), percutaneous drainage more frequently carried out in frail patients (15% vs. NF 5%) and endoscopic cholangiopancreatography (ERCP) was similar in both groups (F 32%vs. NF 31%). Frailty was associated with worse clinical outcomes in F vs. NF: functional deconditioning (34% vs. 11%), increased care level (19% vs 3%), length of stay (12 vs. 7 days), 90-day (8% vs. 3%) and 1 year-mortality (48% vs. 24%). Conclusion Half of patients in our cohort of older adults hospitalised with acute biliary disease were frail. Higher scores of frailty are associated with increased mortality. Compared with non-frail patients, individuals living with frailty were less likely to undergo surgical treatment, spent longer in hospital and were less likely to remain alive at 12 months after hospital discharge.

scholarly journals Bilobular pancreas: another variant of the divided pancreas?

2006 ◽  
Vol 63 (10) ◽  
pp. 902-904 ◽  
Author(s):  
Dragana Zivanovic ◽  
Vojislav Perisic
Keyword(s):  
Acute Pancreatitis ◽  
Pancreatic Disease ◽  
Recurrent Pancreatitis ◽  
Adequate Diet ◽  
Dorsal Pancreas ◽  
Full Control ◽  
Endoscopic Cholangiopancreatography ◽  
Key Factor ◽  
Ventral And Dorsal Pancreas ◽  
Possible Cause

Background. Pancreas divisum is the most common anomaly of the pancreas. This anomaly has been known as a possible cause of recurrent pancreatitis. Case report. We performed computerized tomography (CT) of the abdomen in 5 children in whom a divided pancreas was confirmed using endoscopic cholangiopancreatography. In a girl, who had three episodes of severe acute pancreatitis, a CT examination confirmed a completely divided embryonal dorsal and ventral primordium. We named this variant of the divided pancreas the "bilobular pancreas". Contrary to the remaining 4 children in whom the control of the number and severity of attacks, as well as the control of pancreatic pain were achieved by pharmacotherapeutics and an adequate diet, in the reported patient sphincteroplasty of the papilla duodeni minor resulted in a full control of the disease. Conclusion. The paper discussed the possibility that the variant of the divided pancreas, with anatomically completely separated ventral and dorsal pancreas and their ductal systems, is the key factor that determines the severity of pancreatic disease and an indication for sphincteroplasty of the papilla duodeni minor as the major therapeutic method.

scholarly journals Frailty and Exercise Training: How to Provide Best Care after Cardiac Surgery or Intervention for Elder Patients with Valvular Heart Disease

2018 ◽  
Vol 2018 ◽  
pp. 1-36 ◽  
Author(s):  
Egle Tamuleviciute-Prasciene ◽  
Kristina Drulyte ◽  
Greta Jurenaite ◽  
Raimondas Kubilius ◽  
Birna Bjarnason-Wehrens
Keyword(s):  
Heart Disease ◽  
Exercise Training ◽  
Muscle Mass ◽  
Valvular Heart Disease ◽  
Daily Living ◽  
Frailty Index ◽  
Psychosocial Health ◽  
Clinical Frailty Scale ◽  
Frailty Assessment ◽  
Elder Patients

The aim of this literature review was to evaluate existing evidence on exercise-based cardiac rehabilitation (CR) as a treatment option for elderly frail patients with valvular heart disease (VHD). Pubmed database was searched for articles between 1980 and January 2018. From 2623 articles screened, 61 on frailty and VHD and 12 on exercise-based training for patients with VHD were included in the analysis. We studied and described frailty assessment in this patient population. Studies reporting results of exercise training in patients after surgical/interventional VHD treatment were analyzed regarding contents and outcomes. The tools for frailty assessment included fried phenotype frailty index and its modifications, multidimensional geriatric assessment, clinical frailty scale, 5-meter walking test, serum albumin levels, and Katz index of activities of daily living. Frailty assessment in CR settings should be based on functional, objective tests and should have similar components as tools for risk assessment (mobility, muscle mass and strength, independence in daily living, cognitive functions, nutrition, and anxiety and depression evaluation). Participating in comprehensive exercise-based CR could improve short- and long-term outcomes (better quality of life, physical and functional capacity) in frail VHD patients. Such CR program should be led by cardiologist, and its content should include (1) exercise training (endurance and strength training to improve muscle mass, strength, balance, and coordination), (2) nutrition counseling, (3) occupational therapy (to improve independency and cognitive function), (4) psychological counseling to ensure psychosocial health, and (5) social worker counseling (to improve independency). Comprehensive CR could help to prevent, restore, and reduce the severity of frailty as well as to improve outcomes for frail VHD patients after surgery or intervention.

scholarly journals DOES AGE INFLUENCE IN ENDOSCOPIC THERAPEUTIC SUCCESS ON THE BILIARY TRACT?

2021 ◽  
Vol 34 (3) ◽  
Author(s):  
Luciano HYBNER ◽  
Fernando Issamu TABUSHI ◽  
Luis Martins COLLAÇO ◽  
Érika Gomes DA ROSA ◽  
Bruno de Faria Melquíades DA ROCHA ◽  
...  
Keyword(s):  
Adverse Events ◽  
Biliary Tract ◽  
Acute Cholangitis ◽  
Young Patients ◽  
Therapeutic Success ◽  
Adequate Treatment ◽  
Number Of Patients ◽  
Endoscopic Cholangiopancreatography ◽  
Group 2 ◽  
Group 1

ABSTRACT Background: Retrograde endoscopic cholangiopancreatography (ERCP) effectively treats biliary and pancreatic disorders. Its indications are limited and precise, since its misuse delays adequate treatment, increases costs and to patient´s adverse events. Aim: To compare clinical, radiological and exploratory characteristics in relation to therapeutic success in patients undergoing ERCP in relation to age. Method: 421 patients who underwent the method were retrospectively studied; those who were not able to access the duodenal papilla were excluded. The patients were divided into two age groups: <60 years (group 1) and >60 years (group 2), and the variables of gender, examination indications, radiological findings, therapeutic success, diagnosis and the occurrence of immediate adverse events were analyzed. Results: 177 patients were allocated to group 1 and 235 to group 2. The main indication found in both groups was choledocholithiasis. In group 2, the number of cases of acute cholangitis (p=0.001), biliary stenosis (p=0.002) and papilla cancer (p=0.046) was higher. In this group, urgent indication for ERCP was higher (p=0.042), as well as the diagnosis of biliary tract dilatation (p<0.001). The placement of prostheses was the most common procedure performed in both groups, but the greatest number of patients in absolute quantity occurred in group 2. In group 1, the success in catheterization and the chance of achieving clearing of the biliary tract was significantly higher in compared to group 2 (p=0.016, OR=2.1). Conclusion: The success of catheterization and complete clearance of the bile duct was significantly higher in the group of young patients.

scholarly journals Inter-Rater Reliability of the Retrospectively Assigned Clinical Frailty Scale Score in a Geriatric Outreach Population

2018 ◽  
Vol 21 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Jasmine Davies ◽  
Jennifer Whitlock ◽  
Iris Gutmanis ◽  
Sheri-Lynn Kane
Keyword(s):  
Scale Score ◽  
Daily Living ◽  
Chart Review ◽  
Tertiary Care ◽  
Clinical Syndrome ◽  
Clinical Frailty Scale ◽  
Rater Reliability ◽  
Outreach Service ◽  
Increased Risk ◽  
Nurse Clinician

BackgroundFrailty, a common clinical syndrome in older adults associated with increased risk of poor health outcomes, has been retrospectively calculated in previous publications; however, the reliability of retrospectively assigned frailty scores has not been established. The aim of this study was to see if frailty scores, based on chart review data, agreed with clinician-determined scores based on a comprehensive geriatric assessment.MethodsPer standard practice, all patients seen by one nurse clinician (JW) from the Southwestern Ontario Regional Geriatric Program, a tertiary care-based outreach service, between August 15, 2013 and December 31, 2015 received a comprehensive geriatric assessment which included the assignment of an interview-based Clinical Frailty Scale score (CFS-I). Subsequently, a medical student researcher (JD), blinded to the CFS-I, assigned each consenting patient a frailty score based on chart review data (CFS-C). The inter-rater reliability of the CFS-I and CFS-C was then determined.ResultsOf the 41 consented patients, 39 had both a CFS-I and CFSC score. The median CFS score was 6, indicating patients were moderately frail and required assistance for some basic activities of daily living. Cohen’s kappa coefficient was 0.64, indicating substantial agreement.ConclusionCFS scores can be reliably assigned retrospectively, thereby strengthening the utility of this measure.

The Clinical Frailty Scale predicts adverse outcome in older people admitted to a UK major trauma centre

2020 ◽  
Author(s):  
Frances Rickard ◽  
Sarah Ibitoye ◽  
Helen Deakin ◽  
Benjamin Walton ◽  
Julian Thompson ◽  
...  
Keyword(s):  
Older People ◽  
Hospital Stay ◽  
Major Trauma ◽  
Length Of Hospital Stay ◽  
Post Injury ◽  
Clinical Frailty Scale ◽  
Care Level ◽  
Trauma Population ◽  
Major Trauma Centre ◽  
Severity Scores

Abstract Background Frailty assessment using the Clinical Frailty Scale (CFS) has been mandated for older people admitted to English major trauma centres (MTC) since April 2019. Little evidence is available as to CFS-associated outcomes in the trauma population. Objective To investigate post-injury outcomes stratified by the CFS. Methods A single centre prospective observational cohort study was undertaken. CFS was prospectively assigned to patients ≥ 65 years old admitted to the MTC over a 5-month period. Primary outcome was 30-day post-injury mortality. Secondary outcomes were length of hospital stay, complications and discharge level of care. Results In 300 patients median age was 82; 146 (47%) were frail (CFS 5–9) and 28 (9.3%) severely frail (CFS 7–9). Frail patients had lower injury severity scores (median 9 vs 16) but greater 30-day mortality (CFS 5–6 odds ratio (OR) 5.68; P &lt; 0.01; CFS 7–9 OR 10.38; P &lt; 0.01). Frailty was associated with delirium (29.5% vs 17.5%; P = 0.02), but not complication rate (50.7% vs 41.6%; P = 0.20) or length of hospital stay (13 vs 11 days; P = 0.35). Mild to moderate frailty was associated with increased care level at discharge (OR 2.31; P &lt; 0.01). Conclusions Frailty is an independent predictor of 30-day mortality, inpatient delirium and increased care level at discharge in older people experiencing trauma. CFS can therefore be used to identify those at risk of poor outcome who may benefit from comprehensive geriatric review, validating its inclusion in the 2019 best practice tariff for major trauma.

scholarly journals DIAGNOSTICCRITERIAANDMANAGMENTOF ACUTE CHOLANGITIS AND BILIARY SEPSIS: THE MODERN VIEW ON THE PROBLEM

2019 ◽  
Vol 21 (1) ◽  
pp. 40-43
Author(s):  
A Yu Korolkov ◽  
D N Popov ◽  
M A Kitaeva ◽  
A O Tantsev
Keyword(s):  
Hospital Stay ◽  
Diagnostic Criteria ◽  
Economic Efficiency ◽  
Biliary Obstruction ◽  
Acute Cholangitis ◽  
Treatment Results ◽  
Inflammation Response ◽  
Improve Treatment ◽  
Duration Of Hospital Stay ◽  
Biliary Sepsis

Theproblemofcholangitisandbiliarysepsisbecomemoreandmoreactual.Developingdiagnosticcriteriaforpatientswithinflammationofbiliarytractisoneofunsolvedquestionsofbiliarysurgery. Accordingtonewclassificationofgeneralizedformofinfections (Sepsis 3) it’sadvisabletoclassifiedpatients with biliary obstruction to three groups: mechanical jaundice, acute cholangitis and biliary sepsis with defying appropriate diagnostic criteria for each of them.Theaimofourworkistoimprovetreatmentresultsforpatientswithhyperbilirubinemia, biliary hypertension and system inflammation response syndrome (SIRS) by dividing them on groups and determining diagnostic criteria for each of them. Intheperiodfrom 2014 to 2018 wehavetreated 208 patientswithbiliaryobstruction. Accordingtodevelopeddiagnosticcriteriaallpatients was divided on three groups: mechanical jaundice, acute cholangitis and biliary sepsis.Afterthetreatmentthenextvalueswereanalyzed: timefromadmissiontohospitaltooperation, thetimeofoperation, thefrequencyofpostoperativecomplications, mortality, the duration of hospital stay, economic efficiency.Toassesstheeffectivesofdevelopedcriteriacomparativeanalysiswithretrospectivegroup, whichcontained 182 patients with hyperbilirubinemia, biliary hypertension and SIRS treated in a period from 2010 to 2014, was performed. Accordingtoobtainedresultswecanconcludethatdividingpatientswithhyperbilirubinemia, biliary hypertension and SIRS on groups and developeddiagnosticcriteria, routing and manage tactics let us to improve treatment results in this category of patients, about what we can judge by such figures as timefromadmissiontohospitaltooperation, thefrequencyofpostoperativecomplications, mortality, the duration of hospital stay, economic efficiency.

scholarly journals Gallstone Disease Complicated by Choledocholithiasis: Modern Aspects of Diagnostics

2021 ◽  
Vol 6 (2) ◽  
pp. 66-70
Author(s):  
V. B. Borysenko ◽  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Clinical Laboratory ◽  
Gallstone Disease ◽  
Acute Cholangitis ◽  
Magnetic Resonance Tomography ◽  
Endoscopic Retrograde ◽  
Diagnostic Measures ◽  
Endoscopic Cholangiopancreatography

Choledocholithiasis is an urgent problem of modern hepatobiliary surgery and accounts for 60% of all obstructive jaundice. Stones of the common bile duct cause cholestasis and mechanical jaundice syndrome and in case of untimely diagnostics lead to the development of such severe complications as acute cholangitis and biliary sepsis. The criteria for determining the sequence, stages and volume of diagnostic measures with choledocholithiasis have not been determined by now. The purpose of the study. Optimization of the instrumental stage of the diagnostics of patients with choledocholithiasis. Materials and methods. 56 patients with choledocholithiasis were studied. The diagnostic program was expanded due to the instrumental stage using ultrasound, duodenopapiloscopy, endoscopic retrograde cholangiopancreatography and magnetic resonance tomography. The criterion for the patients selection was the syndrome of distal choledochal patency violation and the presence of stones in it according to echosonography and endoscopic cholangiopancreatography. Results and discussion. At sonography bilious hypertension was established in all 72 (100%) patients. Mechanical jaundice was present in 54 (96.4%) patients. Hepatic dysfunction with 84±9.6 mmol/l hyperbilirubinemia and an increase in AST and ALT levels to 1.2±0.9 mmol/l and 1.5±1.1 mmol/l, were verified respectively. At endoscopic retrograde cholangiopancreatography choledocholithiasis was found in 54 (96.4%) patients. Single stones were present in 18 (32.1%) and multiple – in 38 (67.9%) patients. In 52 (92.9%) cases, stones up to 1.5 cm in diameter were removed with a Dormia basket at one time or after mechanical lithotripsy. In 4 (7.1%) patients stones from 1.7 to 2.0 cm could not be removed endoscopically. Choledoch stenting was performed in 12 (21.4%) patients. One-stage transpapillary treatment was carried out in 38 (67.9%) patients, two and three stage treatment – in 14 (25%) cases, and «open» choledocholithotomy – in 4 (7.1%) cases. Conclusion. The program of choledocholithiasis diagnostics with the gradual use of clinical, laboratory, radiological and endoscopic data allows carrying out correct detailing of the cause, level, degree of common bile duct obstruction and the complicated course of the disease in 100% of cases

Frailty and associated prognosis among older emergency department patients with suspected infection: A prospective, observational cohort study

CJEM ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. 687-691 ◽  
Author(s):  
Shannon M. Fernando ◽  
Kevin H. Guo ◽  
Matthew Lukasik ◽  
Bram Rochwerg ◽  
Deborah J. Cook ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Tertiary Care ◽  
Clinical Frailty Scale ◽  
Suspected Infection ◽  
Prognostic Accuracy ◽  
Failure Assessment ◽  
Observational Cohort ◽  
Emergency Department Patients ◽  
Multicenter Prospective Cohort Study

ABSTRACTBackgroundPrognosis and disposition among older emergency department (ED) patients with suspected infection remains challenging. Frailty is increasingly recognized as a predictor of poor prognosis among critically ill patients; however, its association with clinical outcomes among older ED patients with suspected infection is unknown.MethodsWe conducted a multicenter prospective cohort study at two tertiary care EDs. We included older ED patients (≥75 years) with suspected infection. Frailty at baseline (before index illness) was explicitly measured for all patients by the treating physicians using the Clinical Frailty Scale (CFS). We defined frailty as a CFS 5–8. The primary outcome was 30-day mortality. We used multivariable logistic regression to adjust for known confounders. We also compared the prognostic accuracy of frailty with the Systemic Inflammatory Response Syndrome (SIRS) and Quick Sequential Organ Failure Assessment (qSOFA) criteria.ResultsWe enrolled 203 patients, of whom 117 (57.6%) were frail. Frail patients were more likely to develop septic shock (adjusted odds ratio [aOR], 1.83; 95% confidence interval [CI], 1.08–2.51) and more likely to die within 30 days of ED presentation (aOR 2.05; 95% CI, 1.02–5.24). Sensitivity for mortality was highest among the CFS (73.1%; 95% CI, 52.2–88.4), compared with SIRS ≥ 2 (65.4%; 95% CI, 44.3–82.8) or qSOFA ≥ 2 (38.4; 95% CI, 20.2–59.4).ConclusionsFrailty is a highly prevalent prognostic factor that can be used to risk-stratify older ED patients with suspected infection. ED clinicians should consider screening for frailty to optimize disposition in this population.

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