scholarly journals P-OGC96 Oesophagectomy with Enhanced Recovery for Adenocarcinoma in the Elderly

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Mina Adam ◽  
Christopher Hadjittofi ◽  
Bhaskar Kumar
Keyword(s):  
Complication Rate ◽  
Disease Burden ◽  
Enhanced Recovery ◽  
The Elderly ◽  
Postoperative Outcomes ◽  
Oesophageal Adenocarcinoma ◽  
Ageing Population ◽  
Need For Treatment ◽  
Significant Difference ◽  
Eras Protocol

Abstract Background The incidence of oesophageal adenocarcinoma is rising rapidly in high-income countries. Combined with an ageing population, it is expected that the need for treatment, including surgery, will increase in the next decade. Oesophagectomy in patients ≥70 years old has been associated with a higher risk of complications. The aim of our study is to compare the outcomes of patients ≥70 vs < 70 years old, who underwent oesophagectomy for adenocarcinoma with an enhanced recovery (ERAS) protocol. Methods A single-centre retrospective study was performed. Eligible cases were divided into the <70 and the ≥70 groups for comparison of baseline variables, postoperative outcomes, and overall survival. Results From January 2014 through September 2020, oesophagectomy with ERAS was performed for 230 patients with adenocarcinoma. Most (85%) patients were male. The median age was 70 years. The overall 90-day complication rate was 69.6%. The anastomotic leak rate was 16.1%. The 30- and 90-day mortality rates were 0 and 3.0% respectively. Median length of stay (LoS) was 7.0 days (IQR=5.0) and the readmission rate was 18.7%. The overall complication rate was higher in the ≥70 vs the <70 group (75.6% vs 63.1%; p = 0.038). There was no significant difference in major complications, anastomotic leakage, mortality, LoS, or readmission (p > 0.05) between the groups. Estimated mean survival was lower in the ≥70 vs the <70 group (45.6 vs 57.9 months; p = 0.045). Conclusions Elderly patients with oesophageal adenocarcinoma can undergo oesophagectomy with ERAS, achieving similar postoperative outcomes to younger patients. In an era of an ageing population with an increasing disease burden, these findings are encouraging.

scholarly journals Endonasal endoscopic pituitary surgery in the elderly

2018 ◽  
Vol 128 (2) ◽  
pp. 429-436 ◽  
Author(s):  
Peter J. Wilson ◽  
Sacit B. Omay ◽  
Ashutosh Kacker ◽  
Vijay K. Anand ◽  
Theodore H. Schwartz
Keyword(s):  
Elderly Patients ◽  
Complication Rate ◽  
Pituitary Adenomas ◽  
Statistical Tests ◽  
The Elderly ◽  
Medical Complications ◽  
Tumor Diameter ◽  
Complication Rates ◽  
Pseudoaneurysm Formation ◽  
Significant Difference

OBJECTIVEPituitary adenomas are benign, slow-growing tumors that cause symptoms either through mass effect or hormone overproduction. The decision to operate on a healthy young person is relatively straightforward. In the elderly population, however, the risks of complications may increase, rendering the decision more complex. Few studies have documented the risks of surgery using the endonasal endoscopic approach in a large number of elderly patients. The purpose of this study was to audit a single center's data regarding outcomes of purely endoscopic endonasal transsphenoidal resection of pituitary adenomas in elderly patients and to compare them to the current literature.METHODSA retrospective review of a prospectively acquired database of all endonasal endoscopic surgeries done by the senior authors was queried for patients aged 60–69 years and for those aged 70 years or older. Demographic and radiographic preoperative data were reviewed. Outcomes with respect to extent of resection and complications were examined and compared with appropriate statistical tests.RESULTSA total of 135 patents were identified (81 aged 60–69 years and 54 aged 70 years or older [70+]). The average tumor diameter was slightly larger for the patients in the 70+ age group (mean [SD] 25.7 ± 9.2 mm) than for patients aged 60–69 years (23.1 ± 9.8 mm, p = 0.056). There was no significant difference in intraoperative blood loss (p > 0.99), length of stay (p = 0.22), or duration of follow-up (p = 0.21) between the 2 groups. There was a 7.4% complication rate in patients aged 60–69 years (3 nasal and 3 medical complications) and an 18.5% complication rate in patients older than 70 years (4 cranial, 3 nasal, 1 visual, and 2 medical complications; p = 0.05 overall and 0.013 for cranial complications). Cranial complications in the 70+ age category included 2 postoperative hematomas, 1 pseudoaneurysm formation, and 1 case of symptomatic subdural hygromas.CONCLUSIONSEndonasal endoscopic surgery in elderly patients is safe, but there is a graded increase in complication rates with increasing age. The decision to operate on an asymptomatic or mildly symptomatic patient in these age groups should take this increasing complication rate into account. The use of a lumbar drain or lumbar punctures should be weighed against the risk of subdural hematoma in patients with preexisting atrophy.

scholarly journals Evaluation of an enhanced recovery protocol on patients having radical cystectomy for bladder cancer

2018 ◽  
Vol 12 (12) ◽  
Author(s):  
Bonnie Liu ◽  
Trustin Domes ◽  
Kunal Jana
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Enhanced Recovery ◽  
Effective Means ◽  
Control Group ◽  
Complication Rates ◽  
Readmission Rates ◽  
Significant Difference ◽  
And Gender ◽  
Eras Protocol

Introduction: Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care protocols that are designed to shorten recovery time and reduce complication rates.1,2 An ERAS protocol was implemented in the Saskatoon Health region for radical cystectomy patients in 2013. This study evaluates the safety and efficacy of the protocol for patients having radical cystectomy for bladder cancer. Methods: Length of stay (LOS), early in-hospital complication rates, 30-day readmission rates, age, and gender were collected for patients seen for bladder cancer requiring radical cystectomy in Saskatoon between January 2007 and December 2016. Of these patients, 176 were pre-ERAS implementation (control group) and 84 were post-ERAS implementation (experimental group). The data from each variable was compared between the groups using a Z-test. Results: There was no significant difference in age or gender of patients between the groups. Average LOS pre-ERAS was 14.25±14.57 days, which is significantly longer than the post-ERAS average of 10.91±8.56 days (p=0.043). There was no significant difference in 30-day readmission rate (19.87% pre-ERAS vs. 19.05% post-ERAS; p=0.873) or complication rate (51.7% pre-ERAS vs. 46.4% post-ERAS; p=0.425). Conclusions: The implementation of an ERAS protocol for radical cystectomy reduces LOS, with no effect on early complication rates or 30-day readmission rates. This indicates that the protocol is safe for patients when compared to previous practices and is an effective means of reducing LOS.

Thirty-Day Mortality and Survival in Elderly Patients Undergoing Neurosurgery

Neurosurgery ◽  
2019 ◽  
Vol 84 (5) ◽  
pp. E270-E271
Author(s):  
Emily Rose Bligh ◽  
Yahia Al-Tamimi ◽  
Priyank Sinha ◽  
Daisy Smith
Keyword(s):  
Logistic Regression ◽  
Elderly Patients ◽  
Current Model ◽  
Frailty Index ◽  
The Elderly ◽  
Ageing Population ◽  
Predictors Of Mortality ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract INTRODUCTION With an ageing population and advances in neuroanaesthesia and critical care, there is an increasing subgroup of patients greater than 70 yr of age presenting to neurosurgical departments and undergoing surgery. We are now moving towards the idea of a frailty index. The aim of the current study is to investigate 30-d mortality and survival in this cohort following emergency and elective neurosurgery. METHODS Retrospective cohort study. All patients aged 70 yr and above, who had undergone a neurosurgical procedure from April 2015 to April 2017 were identified. Online patient electronic records were retrieved to gather information related to procedure type, co-morbidities, days in hospital, discharge destination, complications and mortality. Logistic regression analysis was used to identify predictors of mortality. RESULTS A total of 798 patients in total of whom 623 were <80 yr (group A) and 175 were >80 yr (group B). Male : Female = 3 : 1. Mean age of the study was 76 yr. There were 390 elective and 408 emergency admissions. Overall 30-d mortality = 5.6% (8% in group B). Overall survival was 86.5% in group A and 79.4% in group B. There was a significant difference in 30-d mortality between elective (0.8%) and emergency (10.3%) patients. About 84.5% of patients were discharged back to their usual place of residence in group A but this figure was 68.9% for group B. Logistic regression found emergency surgery (P > .001) and degenerative spine diagnosis to be independent predictors of mortality (P = .05). CONCLUSION The current model for accepting elderly patients is associated with a good overall outcome. The elderly should not be refused neurosurgery on their age per se. We have applied fairly strict and stringent criteria particularly in SAH and TBI.

scholarly journals Examining the effectiveness of a holistic nutrition programme among community-dwelling elderly in Singapore

2019 ◽  
Vol 29 (1) ◽  
pp. 10-18
Author(s):  
James Chong Boi Lee ◽  
Caroline Robert ◽  
Nurhazimah Binte Naharudin ◽  
Mojisola Erdt ◽  
Harsha Vijayakumar ◽  
...  
Keyword(s):  
Intervention Group ◽  
The Elderly ◽  
Perceived Competence ◽  
Community Dwelling ◽  
Control Group ◽  
Ageing Population ◽  
Nutritional Knowledge ◽  
Perceived Satisfaction ◽  
Significant Difference ◽  
Nutrition Programme

Background: Singapore faces challenges in providing efficient health-care services for the ageing population. Objectives: We evaluated the effectiveness of a novel holistic nutrition programme among the elderly who were staying in several senior activity centres in Singapore. Methods: A total of 83 elderly participants (>55 years old) took part in a mixed-methods experimental study. Participants were assigned to the control group (CG), the intervention group without health talks (IGH–) or the intervention group with health talks (IGH+). Demographics, perceived satisfaction score of the administered programme and pre–post measurement on nutritional knowledge and perceived competence were measured. Subsequently, in-depth interviews were also carried out with some participants. Results: One-way analysis of variance revealed significantly higher scores for the IGH– and IGH+ groups compared to the CG in terms of perceived satisfaction of the programme ( p=0.009 and p=0.005, respectively). There was also a significant difference in terms of the change in nutritional knowledge before and after the programme between the IGH– and IGH+ groups ( p=0.002) but not for perceived competence ( p=0.26). Several determinants of dietary behaviours in the elderly such as living arrangements, attitudes and finances were identified from thematic analyses of the interviews. Conclusions: The findings from the study demonstrate the effectiveness of an holistic programme in effecting changes in nutritional knowledge but not perceived competence.

Enhanced Recovery after Surgery for Radical Cystectomy Decreases Postoperative Complications at Different Times

2021 ◽  
pp. 1-9
Author(s):  
François Lannes ◽  
Jochen Walz ◽  
Thomas Maubon ◽  
Stanislas Rybikowski ◽  
Sami Fakhfakh ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Length Of Stay ◽  
Radical Cystectomy ◽  
Positive Impact ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Fast Recovery ◽  
Significant Difference ◽  
Eras Protocol ◽  
Over Time

<b><i>Introduction:</i></b> This study aimed to assess whether enhanced recovery after surgery (ERAS) improves, at different time points, postoperative complications in patients undergoing radical cystectomy. <b><i>Methods:</i></b> We performed a retrospective monocentric study using prospectively maintained databases including all patients treated by radical cystectomy between January 2015 and July 2019. An ERAS protocol was applied in all patients from February 2018. We analyzed and compared between non-ERAS and ERAS groups early and 90-day postoperative complications and 90-day readmission. ERAS was analyzed to know its implication in fast recovery improvement over time. <b><i>Results:</i></b> A total of 150 patients underwent radical cystectomy, 74 without ERAS and 76 with ERAS protocol. ERAS decreased significantly early (<i>p</i> = 0.039) and 90-day (0.012) postoperative complications. In multivariate analysis, ERAS was an independent factor associated with less early (OR: 0.48, 95% CI: 0.25–0.96; <i>p</i> = 0.37) and 90-day (OR: 0.31, 95% CI: 0.14–0.68; <i>p</i> = 0.004) postoperative complications. There was no significant difference between groups for 90-day readmission (<i>p</i> = 0.349). Mean length of stay did not differ significantly between ERAS and non-ERAS groups (12.7 ± 6.2 and 13.1 ± 5.7 days, respectively; <i>p</i> = 0.743). <b><i>Discussion/Conclusion:</i></b> Our study shows that ERAS has an early positive impact that lasts over time on postoperative complications. ERAS implementation has decreased early and 90-day postoperative complications without increasing 90-day readmission. In our cohort, length of stay was not improved with ERAS protocol.

scholarly journals Enhanced recovery after surgery (ERAS) protocol in Oblique lumbar interbody fusion(OLIF): a case-controlled study

2020 ◽  
Author(s):  
Renjie Li ◽  
Xiaofeng Shao ◽  
Weimin Jiang
Keyword(s):  
Postoperative Complications ◽  
Interbody Fusion ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Controlled Study ◽  
Lumbar Interbody Fusion ◽  
Financial Costs ◽  
Significant Difference ◽  
Oblique Lumbar Interbody Fusion ◽  
Eras Protocol

Abstract Background Enhanced recovery after surgery (ERAS) attempts to decrease the surgical stress response to minimize postoperative complications and improve functional rehabilitation after major surgery, but it have not been widely utilized in spinal surgery. This study is to evaluate the implementation of an ERAS pathway for patients undergoing oblique lumbar interbody fusion (OLIF) surgery.Methods This was a retrospective cohort study of patient who underwent OLIF in 2018 prior to ERAS (“pre-ERAS” ,n=23) and in 2019 after ERAS was instituted (“ERAS”, n=24). Major outcomes were collected included demographics, length of hospital stay, financial cost, postoperative complications, off-bed time and perioperative factors. Visual Analogue Scale (VAS) was used to evaluate the pain. The ERAS pathway and compliance with pathway elements were also recorded.Results After ERAS implementation, we found no significant differences in the baseline characteristics between the two groups. In our study, the mean stay in the hospital was significantly lower (p= 0.033) in the ERAS group (15.3±3.9 days) compared to the standard pathway group (13.0±3.1 days). In comparison to the standard group, we also found a variation between the financial costs of surgery and hospitalization [(16446.5±4353.3)vs(14237.7±2784.9) USD, P < 0.05]. The ERAS group manifested a lower blood loss compared with the pre-ERAS group with statistical significance [(68.3±57.1)vs(119.3±104.8) ml, P < 0.05]. There was no significant difference in operative time, complications, and 30-d readmission rates ( P > 0.05 ). Pain scores between the two groups showed a significant difference during the 3th hour and 6th hour (P < 0.05).Conclusion Institution of an ERAS protocol appears to accelerate functional recovery and reduce length of stay, financial costs and decreased pain.

scholarly journals An Attempt of an Enhanced Recovery After Surgery (ERAS) Protocol in Oblique Lumbar Interbody Fusion(OLIF)

2020 ◽  
Author(s):  
Renjie Li ◽  
Xiaofeng Shao ◽  
Weimin Jiang
Keyword(s):  
Postoperative Complications ◽  
Interbody Fusion ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Standard Group ◽  
Lumbar Interbody Fusion ◽  
Financial Costs ◽  
Significant Difference ◽  
Oblique Lumbar Interbody Fusion ◽  
Eras Protocol

Abstract Background Enhanced recovery after surgery (ERAS) attempts to decrease the surgical stress response to minimize postoperative complications and improve functional rehabilitation after major surgery, but it have not been widely utilized in spinal surgery. This study is to evaluate the implementation of an ERAS pathway for patients undergoing oblique lumbar interbody fusion (OLIF) surgery.Methods This was a retrospective cohort study of patient who underwent OLIF in 2018 prior to ERAS (“pre-ERAS” ,n=23) and in 2019 after ERAS was instituted (“ERAS”, n=24). Major outcomes were collected included demographics, length of hospital stay, financial cost, postoperative complications, off-bed time and perioperative factors. Visual Analogue Scale (VAS) was used to evaluate the pain. The ERAS pathway and compliance with pathway elements were also recorded.Results After ERAS implementation, we found no significant differences in the baseline characteristics between the two groups. In our study, the mean stay in the hospital was significantly lower (p= 0.033) in the ERAS group (15.3±3.9 days) compared to the standard pathway group (13.0±3.1 days). In comparison to the standard group, we also found a variation between the financial costs of surgery and hospitalization [(116312.1±30787.4)vs(100691.2±19695.1) yuan, P < 0.05]. The ERAS group manifested a lower blood loss compared with the pre-ERAS group with statistical significance [(68.3±57.1)vs(119.3±104.8) ml, P < 0.05]. There was no significant difference in operative time, complications, and 30-d readmission rates ( P > 0.05 ). Pain scores between the two groups showed a significant difference during the 3th hour and 6th hour (P < 0.05).Conclusion Institution of an ERAS protocol appears to accelerate functional recovery and reduce length of stay, financial costs and decreased pain.

Reduction in opioid use and postoperative pain scores after elective laparotomy with implementation of enhanced recovery after surgery protocol on a gynecologic oncology service

2019 ◽  
Vol 29 (5) ◽  
pp. 935-943 ◽  
Author(s):  
Amanda Rae Schwartz ◽  
Stephanie Lim ◽  
Gloria Broadwater ◽  
Lauren Cobb ◽  
Fidel Valea ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Oral Morphine ◽  
Gynecologic Surgery ◽  
Complication Rates ◽  
Opioid Use ◽  
Pain Scores ◽  
Significant Difference ◽  
Eras Protocol

ObjectiveEnhanced Recovery After Surgery (ERAS) protocols are designed to mitigate the physiologic stress response created by surgery, to decrease the time to resumption of daily activities, and to improve overall recovery. This study aims to investigate postoperative recovery outcomes following gynecologic surgery before and after implementation of an ERAS protocol.MethodsA retrospective chart review was performed of patients undergoing elective laparotomy at a major academic center following implementation of an ERAS protocol (11/4/2014–7/27/2016) with comparison to a historical cohort (6/23/2013–9/30/2014). The primary outcome was length of hospital stay. Secondary outcomes included surgical variables, time to recovery of baseline function, opioid usage, pain scores, and complication rates. Statistical analyses were performed using Wilcoxon rank sum, Fisher’s exact, and chi squared tests.ResultsOne hundred and thirty-three women on the ERAS protocol who underwent elective laparotomy were compared with 121 historical controls. There was no difference in length of stay between cohorts (median 4 days; P = 0.71). ERAS participants had lower intraoperative (45 vs 75 oral morphine equivalents; P < 0.0001) and postoperative (45 vs 154 oral morphine equivalents; P < 0.0001) opioid use. ERAS patients reported lower maximum pain scores in the post-anesthesia care unit (three vs six; P < 0.0001) and on postoperative day 1 (four vs six; P = 0.002). There was no statistically significant difference in complication or readmission rates.ConclusionsERAS protocol implementation was associated with decreased intraoperative and postoperative opioid use and improved pain scores without significant changes in length of stay or complication rates.

Fast-Track Pancreaticoduodenectomy in the Elderly

2017 ◽  
Vol 83 (3) ◽  
pp. 239-249 ◽  
Author(s):  
Efstratios Zouros ◽  
Theodoros Liakakos ◽  
Anastasios Machairas ◽  
Paulos Patapis ◽  
Helen Tzerbinis ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Elderly Patients ◽  
Fast Track ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
The Elderly ◽  
Readmission Rates ◽  
Eras Protocol ◽  
Complex Surgery ◽  
Program Data

It remains uncertain whether enhanced recovery after surgery (ERAS) protocols can be safely implemented for elderly patients, especially after highly complex surgery such as pancreaticoduodenectomy (PD). The present study was designed to assess the feasibility and safety of an ERAS protocol in elderly patients undergoing PD. Starting January 2010 to February 2015, we prospectively collected data from 85 consecutive patients who underwent PD with a fast-track program. Data of patients older and younger than 70 years were compared. Endpoints were morbidity, mortality, readmissions, length of stay, and compliance with ERAS elements. Forty-five patients were less than 70 years old and 40 patients were 70 years of age or older. Both mortality (4.4% vs 5%; P = 1.000) and overall morbidity (33.3% vs 37.5%; P = 0.821) did not differ significantly between the groups. Rates of intervention and relaparotomy were similar in both groups. Length of stay (10 vs 11.8 days; P = 0.099) did not differ significantly between the groups, nor did the readmission rates (6.7% vs 5.0%; P = 0.272). There were no differences in compliance with ERAS elements between groups. An ERAS program seems feasible and can be safely implemented for elderly patients undergoing PD.

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