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.

Is Gastrectomy Safe in the Elderly? A Single Institution Review

2011 ◽  
Vol 77 (4) ◽  
pp. 488-492 ◽  
Author(s):  
Eric S. Hager ◽  
Hamid Abdollahi ◽  
Albert G. Crawford ◽  
Neil Moudgill ◽  
Ernest L. Rosato ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hospital Mortality ◽  
Gastric Resection ◽  
Tertiary Care ◽  
The Elderly ◽  
The United States ◽  
Mortality Rates ◽  
Significant Difference ◽  
Group A ◽  
Group B

The population of the United States is aging. Studies within the last several years have demonstrated that major abdominal operations in elderly patients can be done safely, but with increased rates of complications. We set out to determine the rates of morbidity and mortality in elderly patients undergoing gastric resection at a tertiary care university hospital. A retrospective analysis was performed of 157 consecutive gastric resections between January 1998 and July 2007. Group A (n = 99) consisted of patients < 75-years-old at surgery, whereas group B (n = 58) included patients who were ≥ 75 years of age at time of surgery. These two groups had their clinical and demographic data analyzed. Postoperative length of hospital stay, perioperative major morbidity, and in-hospital mortality were analyzed using analysis of variance, χ2, and multivariate analyses. The average age of patients in group A was 57 years, compared with 81 years in group B. We found no significant difference in the percentage of gastric resections for malignancy (group A, 49% vs group B, 62%) or emergency surgery (group A, 10% vs group B, 10%) between age groups. There was a significant increase in length of stay in the older patients (11.7 days vs 17.6 days; P = 0.032), as well as major complications (11.1% in group A vs 27.6% in group B; P = 0.008). The in-hospital mortality rates approached significance (group A, 4% vs group B, 12%; P = 0.057). Gastric resection in elderly patients carries with it longer hospital stays, higher risk of complications, and in-hospital mortality rates despite similarity in patient disease. This information is imperative to convey to the elderly patients in the preoperative period before gastric resection.

The Short- and Long-Term Outcomes of Pancreatic Resection for Pancreatic Adenocarcinoma in Patients Older Than 75 Years

2016 ◽  
Vol 101 (11-12) ◽  
pp. 554-561
Author(s):  
Toru Aoyama ◽  
Masaaki Murakawa ◽  
Yosuke Atsumi ◽  
Keisuke Kazama ◽  
Manabu Shiozawa ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Pancreatic Adenocarcinoma ◽  
Pancreatic Resection ◽  
The Elderly ◽  
Surgical Mortality ◽  
Long Term Outcomes ◽  
Group A ◽  
Short And Long Term ◽  
Group B

The short- and long-term outcomes of pancreatic resection for pancreatic adenocarcinoma have not been fully evaluated in elderly patients. This retrospective study selected patients who underwent curative surgery for pancreatic cancer at our institution. Patients were categorized into 2 groups: nonelderly patients (age &lt; 75 years; group A) and elderly patients (age ≥ 75 years; group B). The surgical morbidity, surgical mortality, overall survival (OS), and recurrence-free survival (RFS) rates in the 2 groups were compared. A total of 221 patients were evaluated in the study. The overall complication rates were 44.8% in group A and 52.6% in group B. Surgical mortality was observed in 2 patients due to an abdominal abscess and cardiovascular disease in group A (1.1%) and in 1 patient due to postoperative bleeding in group B (2.6%). There were no significant differences (P = 0.379 and P = 0.456, respectively). Furthermore, the 5-year OS and RFS rates were similar between the elderly patients and nonelderly patients (18.55 versus 20.2%, P = 0.946 and 13.1% versus 16.0%, P = 0.829, respectively). The short-term outcomes and long-term survival after pancreatic resection for pancreatic adenocarcinoma were almost equal in the elderly and the nonelderly patients in this study. Therefore, it is unnecessary to avoid pancreatic resection for pancreatic adenocarcinoma in elderly patients simply because of their age.

scholarly journals Effect of Pilates exercise on the level of fatigue, cognition and knee proprioception in the elderly population of 60-80 years

2021 ◽  
Vol 9 (2) ◽  
pp. 3774-3779
Author(s):  
Shradha Santosh Shah ◽  
◽  
Sandhya Wasnik ◽  
Keyword(s):  
Elderly Population ◽  
The Elderly ◽  
Exercise Group ◽  
Control Group ◽  
Significant Difference ◽  
Strengthening Exercises ◽  
Group A ◽  
Randomized Control ◽  
Group B ◽  
Experimental Group

Aim: To evaluate the effect of Pilates exercise on the level of fatigue, cognition and knee proprioception in elderly population (60-80 years). Study design: experimental study; randomized control trial. Method: 40 subjects both male and female of age ranging from 60-80 years (66.578 ± 4.857 in group A and 69.4 ± 5.442 in group B) were assigned in to two groups. The objective of the study was explained, and the subjects were screened based on the inclusion and exclusion criteria. Pre-interventional and post-interventional data analysis was done for FSS, 6MWT, MoCA and KJPS error angle. Group A (Experimental group) received Pilates exercise. Group B (control group) received aerobic and strengthening exercises. Both the groups underwent exercises 3 times a week on alternate days for 6 weeks. Duration of exercise for both groups was 45-60 minutes. Results: Both the groups showed clinically and statistically significant improvement in FSS (p<0.0001 in both groups) 6MWT (p<0.0001 in both groups), MoCA (p<0.001 in both groups) and KJPS scores (p<0.0002 in group A and p<0.0001 in group B) at the end of 6 weeks of treatment. There was no significant difference between the groups for FSS (p=0.7226), 6MWT (p=0.813), MoCA (p=0.416) and KJPS (p=0.6213). Conclusion: A significant improvement were observed in both the groups; which concluded that both the groups are equally effective in improvement of FSS, 6MWT, MoCA and KJPS scores. KEY WORDS: Pilates exercise, elderly population, fatigue, cognition, knee proprioception.

Safety and feasibility of laparoscopic surgery for colorectal cancer in elderly patients (YSURG1401 study).

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 725-725
Author(s):  
Yosuke Atsumi ◽  
Masakatsu Numata ◽  
Toru Aoyama ◽  
Tsutomu Hayashi ◽  
Naoto Yamamoto ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Laparoscopic Surgery ◽  
Elderly Patients ◽  
Surgical Outcomes ◽  
Operation Time ◽  
University Hospital ◽  
Age Group ◽  
Significant Difference ◽  
Group A ◽  
Group B

725 Background: The safety and feasibility of laparoscopic surgery (LAP) for colorectal cancer has not yet been fully evaluated in elderly patients. The aim of this study was to compare the short term surgical outcomes of LAP and evaluate the safety and feasibility of LAP in colorectal cancer patients aged > 75 years. Methods: This retrospective study enrolled consecutive patients who underwent laparoscopic surgery for colorectal cancer between April 2013 and March 2014 at Yokohama City University Hospital and its related general hospitals. The patients were categorized into two groups: elderly patients (≧75 years of age: group A) and non-elderly patients ( < 75 years of age: group B). Surgical outcomes and postoperative complications were compared between the two groups. The severity of complications was evaluated using the Clavien–Dindo classification. Results: A total of 237 patients were evaluated in the present study. Eighty-four patients were classified into group A, and 153 into group B. Preoperative clinicopathological outcomes demonstrated no significant differences except for the ASA score. When comparing the surgical outcomes between group A and group B, the rate of conversion to open procedure (3.6 % vs 5.2 %, P = 0.751), median operation time (232 min vs 232 min, P = 0.318), median blood loss (20 ml vs 12 ml, P = 0.353). There was no significant difference in the surgical outcomes. Although the incidence of Japanese D3 dissection was significantly lower in Group A (56 % vs 69.3 %, P = 0.047), the incidences of postoperative surgical complications of grade ≧ Ⅱ were similar between two groups (15.5 % vs 11.8 %, p = 0.427). The length of postoperative hospital stay was also similar (10days vs 10days, p = 0.347). Conclusions: The present study suggested that laparoscopic surgery for colorectal cancer is safe and feasible, regardless of the age of the patient, especially for elderly patients who may be candidates for colorectal cancer surgery.

Safety and feasibility of S-1 adjuvant chemotherapy for pancreatic cancer in elderly patients.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 486-486
Author(s):  
Masaaki Murakawa ◽  
Toru Aoyama ◽  
Yusuke Katayama ◽  
Masahiro Asari ◽  
Sho Sawazaki ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Adjuvant Chemotherapy ◽  
Elderly Patients ◽  
Continuation Rate ◽  
Significant Difference ◽  
Hospital Patients ◽  
Group A ◽  
Grade 3 ◽  
Group B ◽  
D2 Surgery

486 Background: The safety and feasibility of starting S-1 adjuvant chemotherapy for pancreatic cancer has not been evaluated in elderly patients. Methods: The patients who underwent curative D2 surgery for pancreatic cancer were selected to this retrospective study. The patients were diagnosed within stage I to III disease, and received adjuvant S-1 at our hospital. Patients were categorized into two groups; non-elderly patients (age<70 years: group A) and elderly patients (age≥70 years: group B). The toxicity and drug continuation rates in the two groups were compared. Results: Total 40 patients were evaluated in this study. There were no grade 3 and 4 toxicities. The incidences of grade 2 hematological toxicities were 0% in group A and 11% in group B. The incidences of grade 2 non-hematological toxicities were 50% in group A and 27.8% in group B. The differences in both groups were not significant. The continuation rate at 6 months was 55.7% in group A and 72.7% in group B, and there was also no significant difference in the groups. Conclusions: These results suggest that S-1 adjuvant chemotherapy for pancreatic cancer is safe and feasible, regardless of the age of the patient; especially in elderly patients.

The short- and long-term outcomes of pancreatic resection for pancreatic adenocarcinoma in patients older than 75 years.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 470-470
Author(s):  
Keisuke Kazama ◽  
Toru Aoyama ◽  
Yosuke Atsumi ◽  
Masaaki Murakawa ◽  
Manabu Shiozawa ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Pancreatic Adenocarcinoma ◽  
Pancreatic Resection ◽  
The Elderly ◽  
Complication Rates ◽  
Long Term Outcomes ◽  
Group A ◽  
Short And Long Term ◽  
Group B

470 Background: The short- and long-term outcomes of pancreatic resection for pancreatic adenocarcinoma have not been evaluated in elderly patients. Methods: This retrospective study selected patients who underwent curative surgery for pancreatic cancer at our institution. Patients were categorized into two groups; non-elderly patients(age <75 years: group A) and non-elderly patients (age ≥75 years: group B). The surgical morbidity, motality, overall survival (OS), and recurrence-free survival (RFS) rates in the two groups were compared. Results: A total of 221 patients were evaluated in the study. The overall complication rates are 44.8% in Group A and 52.6% in Group B. Surgical mortality was observed in 2 patients due to an abdominal abcess and cardiovascular disease in Group A (1.1%) and in 1 patient due to postoperative bleeding in Group B (2.6%). There were no significant differences (p=0.379 and p=0.456, respectively). Furthermore, the 5-year OS and RFS rates were similar between the elderly patients and non-elderly patients (18.55% vs. 20.2%, p=0.946 and 13.1% vs. 16.0%, p=0.829 respectively). Conclusions: The short-term outcomes and long-term outcomes survival after pancreatic resection for pancreatic adenocarcinoma were almost equal in the elderly and the non-elderly patients in this study. Therefore, it is unnecessary to avoid pancreatic resection for pancreatic adenocarcinoma in elderly patients simply because of their age.

scholarly journals Common Bile Duct Exploration in an Elderly Asian Population

2015 ◽  
Vol 100 (2) ◽  
pp. 261-267 ◽  
Author(s):  
Vishal G. Shelat ◽  
Vincent J. M. Chia ◽  
JeeKeem Low
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Elderly Patients ◽  
Laparoscopic Approach ◽  
Asian Population ◽  
Laparoscopic Group ◽  
The Elderly ◽  
Common Bile Duct Exploration ◽  
Group A ◽  
Group B

Common bile duct exploration (CBDE) is an accepted treatment for choledocholithiasis. This procedure is not well studied in the elderly population. Here we evaluate the results of CBDE in elderly patients (&gt;70 years) and compare the open (group A) with the laparoscopic group (group B). A retrospective review was performed of elderly patients with proven common bile duct (CBD) stones who underwent CBDE from January 2005 to December 2009. There were 55 patients in group A and 33 patients in group B. Mean age was 77.6 years (70–91 years). Both groups had similar demographics, liver function tests, and stone size—12 mm (range, 5–28 mm). Patients who had empyema (n = 9), acute cholecystitis (n = 15), and those who had had emergency surgery (n = 28) were more likely to be in group A (P &lt; 0.05). The mean length of stay for group A was 11.7 ± 7.3 days; for group B, 5.2 ± 6.3 days; the complication rate was higher in group A (group A, 38.2%; group B, 8.5%; P = 0.072). The overall complication and mortality rate was 29.5% and 3.4%, respectively. CBDE can be performed safely in the elderly with accepted morbidity and mortality. The laparoscopic approach is feasible and safe in elective setting even in the elderly.

scholarly journals Close association of severe hyponatremia with exaggerated release of arginine vasopressin in elderly subjects with secondary adrenal insufficiency

2003 ◽  
Vol 148 (2) ◽  
pp. 221-226 ◽  
Author(s):  
T Yatagai ◽  
I Kusaka ◽  
T Nakamura ◽  
S Nagasaka ◽  
K Honda ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Adrenal Insufficiency ◽  
Plasma Osmolality ◽  
The Elderly ◽  
Elderly Group ◽  
Elderly Subjects ◽  
Secondary Adrenal Insufficiency ◽  
Water Excretion ◽  
Group A ◽  
Group B

OBJECTIVE: Hyponatremia occurs not infrequently in hypopituitarism. Arginine vasopressin (AVP)-induced impaired water excretion is found in patients with hypopituitarism and experimental models of glucocorticoid deficiency. DESIGN: The present study was undertaken to determine whether augmented release of AVP is involved in the development of hyponatremia in elderly subjects with secondary adrenal insufficiency. METHODS: Forty patients with ACTH-deficient, secondary adrenal insufficiency were examined. They were divided into three groups according to the age at which diagnosis was ascertained (group A <20 Years, group B 20-64 Years, and group C>or=65 Years). RESULTS: Hyponatremia was more manifest in the elderly group than in the other two groups, serum sodium (Na) levels being 124.7 mmol/l in the elderly group, a value significantly less than 141.5 and 133.5 mmol/l in groups A and B. Plasma AVP levels seemed likely to be high compared with the respective hypo-osmolality in plasma in the elderly group, as plasma AVP levels were 1.7 pmol/l despite a mean plasma osmolality of 259 mmol/kg. Such an alteration was less clear in group B and was not found in group A. Therefore, elevation of plasma AVP was apparent in the elderly patients. Hydrocortisone replacement promptly normalized serum Na levels from 125 to 142 mmol/l (P<0.01) and reduced plasma AVP levels from 1.7 to 0.9 pmol/l (P<0.05), which were comparable to the respective plasma osmolality in the elderly patients. CONCLUSION: These results indicate that non-suppressible release of AVP is crucially involved in the impaired water excretion and hyponatremia seen in elderly patients with secondary adrenal insufficiency compared with the younger patients, and that exaggerated release of AVP becomes manifest as the subjects grow older.

Impact of Karnovsky performance status (KPS) on outcome of elderly patients (pts) with glioblastoma (GBM) and activity of temozolomide (TMZ) as first line therapy: Retrospective analysis of a cohort

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 1515-1515 ◽  
Author(s):  
O. Chinot ◽  
M. Barrie ◽  
B. Calissi ◽  
S. Fuentes ◽  
P. Metellus ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Tumour Progression ◽  
Therapeutic Option ◽  
Performance Status ◽  
The Elderly ◽  
Best Supportive Care ◽  
First Line ◽  
First Line Therapy ◽  
Group A ◽  
Group B

1515 Background: Due to increasing incidence of GBM in the elderly, prognostic factors and therapeutic strategies need to be considered in this population. Recently radiotherapy has shown survival improvement in patients with KPS ≥ 70 (ANOCEF, EANO 2005), while chemotherapy with TMZ may be considered as a therapeutic option (Chinot at al, Cancer 2003). Methods: We analyzed retrospectively all pts above 70 years old with GBM, who were referred to our institution from May 1998 to October 2004; all responses to TMZ were reviewed. Results: We identified 136 pts registered. Median age was 74 (range 70–87), and 43% had a KPS < 70. Surgery consisted of stereotactic biopsy (SB), 29% ; partial surgery (PS), 12%; and gross total removal (GTR), 29% of pts. Diagnosis was strongly suggested by neuroradiology in 30% of cases. Treatment consisted of TMZ (5 days standard schedule) (group A) as first-line treatment in 89 pts (65%), radiotherapy and/or nitroso-urea based regimens in 40 pts (30%) (group B) and best supportive care in 7 (5%) pts. For the all cohort, median of overall survival (OS) was 7 months (m), strongly impacted by KPS (3.9 vs 8.7 m, p<0.0001 for KPS < 70 and ≥70 respectively) and age (8.2 vs 6.0 m, p<0.007 for age < 75 years vs. ≥ 75). OS was 6.6, 7.3, and 8.4 mos in the case of SB, PS, and GTR respectively and was 5.2 for neuroradiologic diagnosis. In group A, median time to tumour progression (TTP) and OS were 4.7 & 7.3 m. KPS impacted TTP (2.9 vs. 5.1 m, p=0.0002) and OS (4.9 vs. 8.7 m, p<0.0001) for KPS < and ≥ 70 respectively. Response rates (RR) were for 71 pts evaluable 28%; SD 35%; PD 37% associated with an OS of 11.7, 7 and 3.2 m respectively. RR was 34% for histologically proven GBM, vs 22% in cases of neuroradiologic diagnosis. In group B, TTP and OS were 4.3 & 6.7 m respectively. Conclusions: KPS appeared to have a major impact on outcomes in elderly patients with GBM. Future trials designs should take this impact into consideration. TMZ appeared to be effective in elderly patients with newly diagnosed GBM. This alternative approach is currently being tested against RT alone in international trials. Impact of MGMT status in the TMZ population will be presented. No significant financial relationships to disclose.

scholarly journals Stroke outcome after domiciliary use of opioids in the peri-stroke period

2015 ◽  
Vol 06 (04) ◽  
pp. 558-562 ◽  
Author(s):  
Shivani Juneja ◽  
Kanchan Gupta ◽  
Monika Singla ◽  
Gagandeep Singh ◽  
Sandeep Kaushal
Keyword(s):  
Rural Areas ◽  
Economic Status ◽  
The Elderly ◽  
Northern Region ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Significant Difference ◽  
Opioid Administration ◽  
Group A ◽  
Group B

ABSTRACT Background: Stroke affects large number of people worldwide resulting in disability. The people in the northern region of India follow some domiciliary practices, which include administration of opioids at the onset of stroke to retard its progression. Aim: To study the effect of opioids on the outcome and severity of stroke when used as domiciliary treatment in peri-stroke period. Materials and Methods: A prospective, observational study on stroke patients was carried out in Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India from March 2012 to March 2013. Data were collected in a semi-structured proforma. The variables which were studied included socio-demographic characteristics such as age, gender, religion, socio-economic status, and place of inhabitation. The time of opioid administration, approximate amount administered, frequency of administration, duration of hospital stay, risk factors and co-morbid conditions were also studied. The stroke severity was analyzed by comparing National Institutes of Health Stroke Scale (NIHSS) score and outcome by comparing Modified Rankin Scale (MRS) score in both the groups at the time of admission and at the time of discharge. Results: Out of n = 100 recruited patients, n = 44 (Group A) reported opioid intake in the peri-stroke period and n = 56 (Group B) did not. Proportions of patients from rural areas were 61.4% in Group A and 37.5% in Group B. Mean age in groups A and B was 63 ± 9.15 and 59.8 ± 13.87 years, respectively; in these groups male proportions were 70.5% and 60.7%, respectively. At admission, mean NIHSS scores in Groups A and B were 10.0 ± 4.48 and 10.8 ± 4.51, respectively; on discharge, these scores were 6.3 ± 3.83 and 7.7 ± 3.79, respectively. At admission, mean MRS scores in Groups A and B were 3.7 ± 1.14 and 3.8 ± 1.32, respectively; upon discharge, these scores were 2.8 ± 1.18, 3.1 ± 1.23 respectively. Conclusion: In this cohort, we found that the domiciliary practice of opioids administration in the peri-stroke period is more common among the elderly and in the rural areas. There was no statistically significant difference in the mean NIHSS and MRS scores at admission as well as discharge implying that the opioid administration did not improve outcome or decrease the severity of the stroke. Our findings are robust enough to propose a larger sample size and follow-up in future studies to definitively ascertain the effect of opioids as pretreatment in stroke patients.

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