scholarly journals NCOG-21. PREDICTORS OF SURVIVAL IN ELDERLY PATIENTS UNDERGOING SURGERY FOR GBM

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi156-vi156
Author(s):  
Mathew Voisin ◽  
Sanskriti Sasikumar ◽  
Gelareh Zadeh
Keyword(s):  
Elderly Patients ◽  
Postoperative Complication ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Advanced Age ◽  
Discharge Destination ◽  
Newly Diagnosed ◽  
Clinical Predictors ◽  
Medical Comorbidities ◽  
Lengths Of Stay

Abstract BACKGROUND An increasing number of elderly patients are being diagnosed with GBM and undergoing surgery. These patients often present with multiple medical comorbidities and have significantly worse outcomes compared to adult patients. The goal of this study was to determine clinical predictors of survival in elderly patients undergoing surgery for GBM. METHODS A retrospective chart review of all consecutive patients 65 years of age and older that underwent surgery for newly diagnosed GBM from 2005-2018 was performed. A total of 150 patients were included, and subdivided into two age categories; 65-74 and 75 or older. RESULTS Advanced age and medical comorbidities were not associated with decreased survival (p = 0.07 and p = 0.09, respectively). Postoperative complication was associated with worse survival for all patients (HR = 2.34, p = 0.01) and occurred in patients with longer lengths of stay (p < 0.0001) and discharge destination other than home (p = 0.001). CONCLUSIONS The presence of medical comorbidities and advanced age are not reasons to exclude patients with GBM from surgical consideration. Postoperative complication is the most significant predictor of survival in elderly patients and can be avoided by a short length of stay and discharge home.

scholarly journals P.163 Predictors of survival in elderly patients undergoing surgery for GBM

2021 ◽  
Vol 48 (s3) ◽  
pp. S66-S67
Author(s):  
MR Voisin ◽  
S Sasikumar ◽  
G Zadeh
Keyword(s):  
Elderly Patients ◽  
Postoperative Complication ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Advanced Age ◽  
Discharge Destination ◽  
Newly Diagnosed ◽  
Clinical Predictors ◽  
Medical Comorbidities ◽  
Lengths Of Stay

Background: An increasing number of elderly patients are being diagnosed with GBM and undergoing surgery. These patients often present with multiple medical comorbidities and have significantly worse outcomes compared to adult patients. The goal of this study was to determine clinical predictors of survival in elderly patients undergoing surgery for GBM. Methods: A retrospective chart review of all consecutive patients 65 years of age and older that underwent surgery for newly diagnosed GBM from 2005-2018 was performed. A total of 150 patients were included, and subdivided into two age categories; 65-74 and 75 or older. Results: Advanced age and medical comorbidities were not associated with decreased survival (p = 0.07 and p = 0.09, respectively). Postoperative complication was associated with worse survival for all patients (HR = 2.34, p = 0.01) and occurred in patients with longer lengths of stay (p < 0.0001) and discharge destination other than home (p = 0.001). Conclusions: The presence of medical comorbidities and advanced age are not reasons to exclude patients with GBM from surgical consideration. Postoperative complication is the most significant predictor of survival in elderly patients and can be avoided by a short length of stay and discharge home.

scholarly journals Predictors of survival in elderly patients undergoing surgery for GBM

2021 ◽  
Author(s):  
Mathew R Voisin ◽  
Sanskriti Sasikumar ◽  
Gelareh Zadeh
Keyword(s):  
Brain Tumor ◽  
Postoperative Complications ◽  
Elderly Patients ◽  
Patient Characteristics ◽  
Newly Diagnosed ◽  
Clinical Predictors ◽  
Medical Comorbidities ◽  
Lengths Of Stay ◽  
Age Of Diagnosis ◽  
Age Category

Abstract Background GBM has a median age of diagnosis of 64 years old and the incidence increases with age. An increasing number of elderly patients are being diagnosed with GBM and undergoing surgery. These patients often present with multiple medical comorbidities and have significantly worse outcomes compared to adult patients. The goal of this study was to determine clinical predictors of survival in elderly patients undergoing surgery for GBM. Methods Our brain tumor database was reviewed for all patients 65 years of age and older that underwent surgery for newly diagnosed GBM over a 14-year period from 2005 to 2018. Patient characteristics, comorbidities, complications, and treatment were collected. A total of 150 patients were included, and subdivided into two age categories; 65-74 years old and 75 years or older. Results The median OS for all patients was 9.4 months. Neither the presence nor number of medical comorbidities were associated with decreased survival (p = 0.9 and p = 0.1, respectively). Postoperative complications were associated with worse survival for all patients (HR = 2.34, p = 0.01) and occurred in patients in the older age category and patients with longer lengths of stay (p &lt; 0.0001). Conclusions The presence of medical comorbidities is not a reason to exclude patients with GBM from surgical consideration. Excluding EOR and adjuvant treatment, postoperative complication is the most significant predictor of survival in elderly patients. Postoperative complications are associated with a longer LOS and are more common in patients 75 years of age and older.

Abstract P305: Post-Stroke Aphasia as a Predictor of 30-Day Readmission Associated With Infection: A Retrospective Chart Review

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Emma M Loebel ◽  
Mary Rojas ◽  
Connor Mensching ◽  
Danielle Wheelwright ◽  
Laura K Stein
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Mount Sinai Hospital ◽  
Index Admission ◽  
Negative Consequences ◽  
Medical Comorbidities ◽  
Post Stroke ◽  
Increased Risk ◽  
Adjusted Model ◽  
The Impact

Introduction: Studies have demonstrated that aphasia may negatively impact morbidity and mortality among ischemic stroke (IS) patients. However, the association between post-stroke aphasia and readmission with infection (RI) is poorly understood. We sought to assess the impact of aphasia on post-stroke RI. We hypothesized that aphasic patients are at increased risk of infection in the 30-day post-stroke period. Methods: We performed retrospective chart review of the Mount Sinai Hospital IS patients with 30-day all cause readmission from January 2016 - December 2019. All variables were abstracted from the index admission (IA) electronic medical records except for aspects related to the readmission (RA). Aphasia was present if a neurologist diagnosed the patient with acquired language dysfunction during IA. We performed chi square and logistic regression analyses to compare readmitted patients with and without aphasia at IA. Our fully adjusted model controlled for age, sex, medical comorbidities, NIHSS ≥ 8, IA LOS > 7, IA infection, discharge to facility. We completed all analyses with SPSS. Results: During IA, 36% (n=42) were diagnosed with aphasia. At IA, there were no significant differences in age (dichotomized at 65), sex, or medical comorbidities between aphasic and non-aphasic cohorts. However, more aphasic patients had admission NIHSS ≥ 8 (89% vs 35%, p<0.0001), LOS > 7 (76% vs 42%, p=0.0004), discharge to facility (79% vs 49%, p=0.0016), and RI (52% vs 19%, p=0.002). The presence of aphasia predicted RI in both unadjusted (OR=4.6, p<0.001) and adjusted (OR= 3.3, p=0.014) multivariate analyses. The Kappa inter-reliability ranged from 0.7-1.0 for the key variables included in our adjusted model. Conclusions: The adjusted odds of 30-day readmission with infection were significantly greater in those with diagnosis of aphasia at the time of index admission compared to those without. Our study provides preliminary evidence that the presence of aphasia may have negative consequences on a patient’s health beyond the language disturbance. Further study is needed to better understand the reasons and risk reduction strategies in this vulnerable population.

scholarly journals P047: Emergency department practice patterns of UTI investigation among the delirious elderly: a retrospective chart review

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S81-S81
Author(s):  
R. Pinnell ◽  
P. Joo
Keyword(s):  
Emergency Department ◽  
Elderly Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Urinary Symptoms ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Indwelling Catheter ◽  
Exact Test

Introduction: Delirium is a common emergency department (ED) presentation in elderly patients. Urinary tract infection (UTI) investigation and treatment are often initiated in delirious patients in the absence of specific urinary symptoms, despite a paucity of evidence to support this practice. The purpose of this study is to describe the prevalence of UTI investigation, diagnosis and treatment in delirious elderly patients in the ED. Methods: We performed a retrospective chart review of elderly patients presenting to the ED at The Ottawa Hospital between January 15-July 30, 2018 with a chief complaint of confusion or similar. Exclusion criteria were pre-existing and current UTI diagnosis, Glasgow Coma Scale <13, current indwelling catheter or nephrostomy tube, transfers between hospitals, and leaving without being seen. The primary outcome was the proportion of patients for whom urine tests (urinalysis or culture) or antibiotic treatment were ordered. Secondary outcomes were associations between patient characteristics, rates of UTI investigation, and patient outcomes. Descriptive values were reported as proportions with exact binomial confidence intervals for categorical variables and means with standard deviations for continuous variables. Comparisons were conducted with Fischer's exact test for categorical variables and t-tests for continuous variables. Results: After analysis of 1039 encounters with 961 distinct patients, 499 encounters were included. Urine tests were conducted in 324 patients (64.9% [60.6-69.1]) and antibiotics were prescribed to 176 (35.2% [31.1-39.6]). Overall 57 patients (11.4% [8.8-14.5]) were diagnosed with UTI, of which only 12 (21.1% [11.4-33.9]) had any specific urinary symptom. For those patients who had no urinary symptoms or other obvious indication for antibiotics (n = 342), 199 (58.2% [52.8-63.5]) received urine tests and 62 (18.1% [14.2-22.6]) received antibiotics. Patients who received urine tests were older (82.4 ± 8.8 vs. 78.3 ± 8.4 years, p < 0.001) but did not differ in sex distribution from those than those who did not. Additionally, patients who received antibiotics were more likely to be admitted (OR = 2.6 [1.48-4.73]) and had higher mortality at 30 days (OR = 4.2 [1.35-12.91]) and 6 months (OR = 3.2 [1.33-7.84]) than those who did not. Conclusion: Delirious patient without urinary symptoms in the ED were frequently investigated and treated for UTI despite a lack of evidence regarding whether this practice is beneficial.

scholarly journals Current Practices of Adjunctive Therapy for Pertussis at Six Canadian Tertiary Care Pediatric Hospitals

1998 ◽  
Vol 9 (2) ◽  
pp. 83-86
Author(s):  
Christopher T Naugler ◽  
Scott A Halperin
Keyword(s):  
Adjunctive Therapy ◽  
Chart Review ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Exclusion Criterion ◽  
Recommended Dosage ◽  
Lengths Of Stay ◽  
Pediatric Hospitals ◽  
National Perspective ◽  
Reactive Airways

OBJECTIVE: To document initial investigations and treatment used in the management of children hospitalized with pertussis.DESIGN: Retrospective chart review encompassing admissions from January 1, 1991 to June 1, 1995.SETTING: Six Canadian pediatric hospitals representing about 39% of the pediatric tertiary care beds in Canada.PATIENTS: Four hundred and forty children who met the inclusion criterion of a primary admitting diagnosis of pertussis and who did not meet the exclusion criterion of nosocomially acquired pertussis or a prior admission for pertussis during the study period.MAIN RESULTS: Most patients had cultures positive forBordetella pertussis, although the proportion of positive tests varied widely among hospitals. Erythromycin was the most commonly used medication; however, only 47% of children received the recommended dosage. Salbutamol and corticosteroids were used most often in patients with reactive airways disease. Younger children and those with reactive airways disease had longer lengths of stay in hospital.CONCLUSIONS: Pertussis treatment varied widely among the six hospitals studied, and was often not consistent with current Canadian recommendations. The results will allow practitioners to place their practices in a national perspective and provide a baseline for further studies.

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