scholarly journals Real-world evaluation of the impact of radiotherapy and chemotherapy in elderly patients with glioblastoma based on age and performance status

2020 ◽  
Author(s):  
Karine A Al Feghali ◽  
Samantha M Buszek ◽  
Hesham Elhalawani ◽  
Neil Chevli ◽  
Pamela K Allen ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Treatment Effects ◽  
Cox Regression ◽  
Performance Status ◽  
Age Groups ◽  
Community Treatment ◽  
Subtotal Resection ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Abstract Background This retrospective study investigated the impact of, in addition to age, the management and outcomes of elderly patients with glioblastoma (GBM). Methods The National Cancer Database was queried between 2004 and 2015 for GBM patients age 60 years and older. Three age groups were created: 60 to 69, 70 to 79, and 80 years and older, and 4 age/KPS groups: “age ≥ 60/ KPS < 70” (group 1), “age 60 to 69/KPS ≥ 70” (group 2), “age 70 to 79/KPS ≥ 70” (group 3), and “age ≥ 80/KPS ≥ 70” (group 4). Multivariable (MVA) modeling with Cox regression determined predictors of survival (OS), and estimated average treatment effects analysis was performed. Results A total of 48 540 patients with a median age of 70 years (range, 60-90 years) at diagnosis, and a median follow-up of 6.8 months (range, 0-151 months) were included. Median survival was 5.0, 15.2, 9.6, and 6.8 months in groups 1, 2, 3, and 4, respectively (P < .001). On treatment effects analysis, all groups survived longer with combined chemotherapy (ChT) and radiation therapy (RT), except group 1, which survived longer with ChT alone (P < .001). RT alone was associated with the worst OS in all groups (P < .01). Across all groups, predictors of worse OS on MVA were older age, lower KPS, White, higher comorbidity score, worse socioeconomic status, community treatment, tumor multifocality, subtotal resection, and no adjuvant treatment (all P < .01). Conclusions In elderly patients with newly diagnosed GBM, those with good KPS fared best with combined ChT and RT across all age groups. Performance status is a key prognostic factor that should be considered for management decisions in these patients.

scholarly journals How safe are elective craniotomies in elderly patients in neurosurgery today? A prospective cohort study of 1452 consecutive cases

2020 ◽  
pp. 1-9
Author(s):  
Ralph T. Schär ◽  
Shpend Tashi ◽  
Mattia Branca ◽  
Nicole Söll ◽  
Debora Cipriani ◽  
...  
Keyword(s):  
Cohort Study ◽  
Blood Loss ◽  
Elderly Patients ◽  
Age Groups ◽  
Head Ct ◽  
Estimated Blood Loss ◽  
Group 3 ◽  
Group 2 ◽  
The Impact ◽  
Group 1

OBJECTIVEWith global aging, elective craniotomies are increasingly being performed in elderly patients. There is a paucity of prospective studies evaluating the impact of these procedures on the geriatric population. The goal of this study was to assess the safety of elective craniotomies for elderly patients in modern neurosurgery.METHODSFor this cohort study, adult patients, who underwent elective craniotomies between November 1, 2011, and October 31, 2018, were allocated to 3 age groups (group 1, < 65 years [n = 1008], group 2, ≥ 65 to < 75 [n = 315], and group 3, ≥ 75 [n = 129]). Primary outcome was the 30-day mortality after craniotomy. Secondary outcomes included rate of delayed extubation (> 1 hour), need for emergency head CT scan and reoperation within 48 hours after surgery, length of postoperative intensive or intermediate care unit stay, hospital length of stay (LOS), and rate of discharge to home. Adjustment for American Society of Anesthesiologists Physical Status (ASA PS) class, estimated blood loss, and duration of surgery were analyzed as a comparison using multiple logistic regression. For significant differences a post hoc analysis was performed.RESULTSIn total, 1452 patients (mean age 55.4 ± 14.7 years) were included. The overall mortality rate was 0.55% (n = 8), with no significant differences between groups (group 1: 0.5% [95% binominal CI 0.2%, 1.2%]; group 2: 0.3% [95% binominal CI 0.0%, 1.7%]; group 3: 1.6% [95% binominal CI 0.2%, 5.5%]). Deceased patients had a significantly higher ASA PS class (2.88 ± 0.35 vs 2.42 ± 0.62; difference 0.46 [95% CI 0.03, 0.89]; p = 0.036) and increased estimated blood loss (1444 ± 1973 ml vs 436 ± 545 ml [95% CI 618, 1398]; p <0.001). Significant differences were found in the rate of postoperative head CT scans (group 1: 6.65% [n = 67], group 2: 7.30% [n = 23], group 3: 15.50% [n = 20]; p = 0.006), LOS (group 1: median 5 days [IQR 4; 7 days], group 2: 5 days [IQR 4; 7 days], and group 3: 7 days [5; 9 days]; p = 0.001), and rate of discharge to home (group 1: 79.0% [n = 796], group 2: 72.0% [n = 227], and group 3: 44.2% [n = 57]; p < 0.001).CONCLUSIONSMortality following elective craniotomy was low in all age groups. Today, elective craniotomy for well-selected patients is safe, and for elderly patients, too. Elderly patients are more dependent on discharge to other hospitals and postacute care facilities after elective craniotomy.Clinical trial registration no.: NCT01987648 (clinicaltrials.gov).

scholarly journals Geriatric Proximal Femur Fractures During the Covid-19 Pandemic - Fewer Cases, But More Comorbidities

2021 ◽  
Vol 12 ◽  
pp. 215145932110096
Author(s):  
Christina Polan ◽  
Heinz-Lothar Meyer ◽  
Manuel Burggraf ◽  
Monika Herten ◽  
Paula Beck ◽  
...  
Keyword(s):  
Nursing Home ◽  
Elderly Patients ◽  
Proximal Femur ◽  
Minor Trauma ◽  
Proximal Femur Fractures ◽  
Femur Fractures ◽  
Number Of Patients ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Background: The COVID-19 pandemic is challenging healthcare systems worldwide. This study examines geriatric patients with proximal femur fractures during the COVID-19 pandemic, shifts in secondary disease profile, the impact of the pandemic on hospitalization and further treatment. Methods: In a retrospective monocentric study, geriatric proximal femur fractures treated in the first six months of 2020 were analyzed and compared with the same period of 2019. Pre-traumatic status (living in a care home, under supervision of a legal guardian), type of trauma, accident mechanism, geriatric risk factors, associated comorbidities, time between hospitalization and surgery, inpatient time and post-operative further treatment of 2 groups of patients, aged 65-80 years (Group 1) and 80+ years (Group 2) were investigated. Results: The total number of patients decreased (70 in 2019 vs. 58 in 2020), mostly in Group 1 (25 vs. 16) while the numbers in Group 2 remained almost constant (45 vs. 42). The percentage of patients with pre-existing neurological conditions rose in 2020. This corresponded to an increase in patients under legal supervision (29.3%) and receiving pre-traumatic care in a nursing home (14.7%). Fractures were mostly caused by minor trauma in a home environment. In 2020, total number of inpatient days for Group 2 was lower compared to Group 1 (p = 0.008). Further care differed between the years: fewer Group 1 patients were discharged to geriatric therapy (69.6% vs. 25.0%), whereas in Group 2 the number of patients discharged to a nursing home increased. Conclusions: Falling by elderly patients is correlated to geriatric comorbidities, consequently there was no change in the case numbers in this age group. Strategic measures to avoid COVID-19 infection in hospital setting could include reducing the length of hospital stays by transferring elderly patients to a nursing home as soon as possible and discharging independent, mobile patients to return home.

Outcome of Patients Aged ≥60 After Allogeneic Hematopoietec Cell Transplantation: Age Has No Impact on Survival

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3540-3540 ◽  
Author(s):  
Birgit Federmann ◽  
Christoph Faul ◽  
Wichard Vogel ◽  
Lothar Kanz ◽  
Wolfgang A. Bethge
Keyword(s):  
High Risk ◽  
Cell Transplantation ◽  
Acute Gvhd ◽  
Performance Status ◽  
Chronic Gvhd ◽  
Allogeneic Hct ◽  
Kaplan Meier ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Abstract Abstract 3540 Historically, allogeneic hematopoietic cell transplantation (HCT) has been offered only to patients with good performance status and below the age of 60. However, the peak incidence of most hematologic malignancies is above 60 years of age. The introduction of reduced intensity conditioning (RIC) regimens enabled successful allogeneic HCT in patients with considerable comorbidities and older than 60 years. The impact of age on outcome of allogeneic HCT in patients ≥60 years has not been evaluated extensively. We retrospectively analyzed 109 consecutive patients (f=43, m=66) aged≥60 who received allogeneic HCT 2000–2010 at our institution. Median age of the patients was 65 years (range, 60–76). Patients were grouped in two cohorts depending on age: group 1 aged 60–65 years (n=60, median age=63) and group 2 aged 66–76 years (n=49, median age=68). Diagnoses were acute leukemia (AML n=65, ALL n=1), myelodysplastic syndrome (n=14), osteomyelofibrosis (n=7), non-Hodgkin lymphoma (n=9), multiple myeloma (n=8), aplastic anemia (n=1), chronic myeloid leukemia (n=2) and chronic lymphatic leukemia (n=2). At time of HCT, 41 of the patients were in complete remission (CR), 68 in partial remission (PR) (group 1: CR 21, PR 39; group 2: CR 20, PR 29) and 18 patients had a preceding HCT, 14 in group 1. Conditioning regimens were grouped in high (TBI/Bu+Cy, n=5, all group 1), intermediate (FLAMSA, Flu/Mel/BCNU, n=28, group 1=11, group 2=17), low (FLU+alkylans, n=48, group 1=32, group 2=16) and minimal (2GyTBI/Flu, n=28, group 1=12, group 2=16) intensity. Intermediate intensity conditioning was particularly used for high risk patients in PR (25/28). 22 patients were transplanted from matched related (MRD), 46 from matched unrelated (MUD) and 41 from mismatched unrelated donors (MMUD). Kaplan-Meier-estimated 3-year overall survival (OS) was 45% for all patients, 32% for group 1 and 62%, for group 2, respectively (p=0.02), with more patients with high risk constellation in group 1. 3-year OS for patients transplanted with MUD was 57%, with MMUD 46% vs. with MRD 0% (p=0.01). Non-relapse-mortality was 28% for all patients, 40% in group 1 and 12% in group 2, probably due to the higher intensity in conditioning in group 1. The outcomes with intermediate, low and minimal intensity conditioning were comparable, while all patients after high intensity conditioning died. Table 1 describes Kaplan-Meier estimated 3-year-OS and statistical univariate analysis by log-rank test in the different subgroups. Table 1. 3-year OS (in%) All Group 1 Age 60–65 Group 2 Age 66–76 Remission CR 52 p=0.25 31 p=0.76 77 p=0.15 PR 40 32 50 Conditioning high 0 p=0.5 0 p=0.08 – p=0.38 intermediate 52 50 53 low 48 43 57 minimal 45 17 67 Donor MRD 0 p=0.01 0 p=0.06 73 p=0.45 MUD 57 53 65 MMUD 46 40 33 GVHD acute no 18 p=0.003 13 p=0.008 33 p=0.27 ≥II 43 53 58 chronic no 39 p=0.25 36 p=0.70 52 p=0.08 limited 52 30 100 extensive 50 30 67 In group 1 the outcome of minimal conditioning was inferior compared to intermediate and low conditioning while patients in group 2 had a better outcome with minimal vs. low and intermediate conditioning. Incidences of acute GVHD ≥II, limited and extensive chronic GVHD (cGVHD) were 10%, 28% and 13%, respectively. In group 1, acute GVHD ≥II occurred in 13% and cGVHD in 35%, in group 2 in 5% and 41% of the patients, respectively. Acute GVHD ≥II was associated with inferior outcome (3-year OS of 18% vs. 43%, p=0.003) while cGVHD had a positive impact on OS. In group 2 patients with limited cGVHD showed better 3-year OS than patients without cGVHD (67% vs. 52%, p=0.12). Age alone had no major impact on outcome of allogeneic HCT. Patients aged ≥60 seemed to benefit from the use of MUD rather than an older MRD. Chronic GVHD had a positive influence on survival. Our data indicate that the regimen used should be tailored to disease risk and patient performance status. Disclosures: No relevant conflicts of interest to declare.

Gamma Knife Stereotactic Radiosurgery for Patients with Glioblastoma Multiforme

Neurosurgery ◽  
2002 ◽  
Vol 50 (1) ◽  
pp. 41-47 ◽  
Author(s):  
Emmanuel C. Nwokedi ◽  
Steven J. DiBiase ◽  
Salma Jabbour ◽  
Joseph Herman ◽  
Pradip Amin ◽  
...  
Keyword(s):  
Overall Survival ◽  
Regression Analysis ◽  
Glioblastoma Multiforme ◽  
Stereotactic Radiosurgery ◽  
Cox Regression ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Cox Regression Analysis ◽  
Group 2 ◽  
Group 1

ABSTRACT OBJECTIVE Stereotactic radiosurgery (SRS) has become an effective therapeutic modality for the treatment of patients with glioblastoma multiforme (GBM). This retrospective review evaluates the impact of SRS delivered on a gamma knife (GK) unit as an adjuvant therapy in the management of patients with GBM. METHODS Between August 1993 and December 1998, 82 patients with pathologically confirmed GBM received external beam radiotherapy (EBRT) at the University of Maryland Medical Center. Of these 82 patients, 64 with a minimum follow-up duration of at least 1 month are the focus of this analysis. Of the 64 assessable patients, 33 patients were treated with EBRT alone (Group 1), and 31 patients received both EBRT plus a GK-SRS boost (Group 2). GK-SRS was administered to most patients within 6 weeks of the completion of EBRT. The median EBRT dose was 59.7 Gy (range, 28–70.2 Gy), and the median GK-SRS dose to the prescription volume was 17.1 Gy (range, 10–28 Gy). The median age of the study population was 50.4 years, and the median pretreatment Karnofsky performance status was 80. Patient-, tumor-, and treatment-related variables were analyzed by Cox regression analysis, and survival curves were generated by the Kaplan-Meier product limit. RESULTS Median overall survival for the entire cohort was 16 months, and the actuarial survival rate at 1, 2, and 3 years were 67, 40, and 26%, respectively. When comparing age, Karnofsky performance status, extent of resection, and tumor volume, no statistical differences where discovered between Group 1 versus Group 2. When comparing the overall survival of Group 1 versus Group 2, the median survival was 13 months versus 25 months, respectively (P = 0.034). Age, Karnofsky performance status, and the addition of GK-SRS were all found to be significant predictors of overall survival via Cox regression analysis. No acute Grade 3 or Grade 4 toxicity was encountered. CONCLUSION The addition of a GK-SRS boost in conjunction with surgery and EBRT significantly improved the overall survival time in this retrospective series of patients with GBM. A prospective, randomized validation of the benefit of SRS awaits the results of the recently completed Radiation Therapy Oncology Group's trial RTOG 93-05.

Introduction of Combined Chemotherapies Plus Rituximab (R) Has Improved Outcome of Previously Untreated and Relapsed Follicular Lymphoma (FL) Patients (pts).

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4703-4703
Author(s):  
Stefano Sacchi ◽  
Samantha Pozzi ◽  
Luigi Marcheselli ◽  
Alessia Bari ◽  
Stefano Luminari ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Cox Regression ◽  
Clinical Stage ◽  
Cox Regression Analysis ◽  
Prognostic Features ◽  
Significant Difference ◽  
The Difference ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Abstract Some data suggest that there are been no improvement in survival of FL Pts in the last three decades of the 20th century. However that review ended in 1992, before the introduction of R treatment. Most recently reported data, show that evolving chemotherapies, including the incorporation of R has led to outcome improvement. Between 1994 and 2004, 344 Pts with FL were enrolled in different GISL Trials. For the purpose of this study we considered 270 Pts with similar characteristics enrolled in trials including or not R. The first group accounts for 176 naive Pts treated with Antracycline plus Fludarabine containing regimens (Cohort #1: 125 Pts) or plus R (Cohort #2: 51Pts). The second group accounts for 99 relapsed Pts treated with Antracycline plus Fludarabine containing regimens (Cohort #3: 40 Pts) or plus R (Cohort #4: 59 Pts). To evaluate the impact of the incorporation of R in front line and salvage therapies we assessed the patients OS, FFS, TTF, SAR in these different Cohorts of Pts. Descriptive analysis of prognostic features showed differences in the distribution among groups. To compensate for these variations we also performed Cox regression analysis. Previously Untreated patients. Regarding group #1 and #2 that enrolled Pts with clinical stage IIB, III and IV, FFS and OS according to treatment did not show any statistical differences. The univariate analysis of baseline clinical features showed an impact on OS and FFS for clinical stage, LDH level, involvement of more than 4 nodal sites and presence of extranodal involvement. The prevalence of this characteristics were higher in group #2 than group #1. Thus the FFS from group #2 vs. group #1 was adjusted for variation in prognostic features by Cox regression analysis, that shows a failure Hazard Radio reduction (HR) of 40 % in Pts who received R. Because of difference in follow up (FU) (49 months in Cohort #1 vs 21 months in Cohort #2), to evaluate differences in OS we utilized exact Log Rank test for unequal FU. So far, a trend exists for better OS in R treated patients, although the difference is not statistically significant. Relapsed Patients. Clinical characteristics were similar in the two Cohorts of pts. TTF was better in R treated Pts and the difference was statistically significant (66% vs. 53% at 3 yrs, p=0.023) The analysis of SAR demonstrated a better result for R Cohort with a statistically significant difference (88% vs. 68% at 3 yrs, p=0.022). OS according to treatment protocol, showed advantage for patients in R Cohort and the difference was statistically significant (92% vs. 70% at 5 yrs, p=0.004). Conclusion. In naïve patients our retrospective analysis showed a reduction of HR for FFS and a trend toward better OS in R treated Pts. In relapsed Pts all outcome parameters as OS, TTF and SAR had significant improvement in the Cohort treated with R. Although any conclusions between nonrandomized groups maybe subject to differences in observed and unobserved prognostic features, we believe that improvement have occurred in the management of FL Pts with the introduction of combined chemotherapy with R.

scholarly journals AN INVESTIGATION OF THE SURGICAL ANATOMY OF THE PEDIATRIC ILIOTIBIAL BAND

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0010
Author(s):  
Philip L. Wilson ◽  
Henry B. Ellis ◽  
Connor G. Richmond ◽  
Meagan J. Sabatino ◽  
Charles W. Wyatt ◽  
...  
Keyword(s):  
Surface Area ◽  
Age Groups ◽  
Surgical Anatomy ◽  
Iliotibial Band ◽  
Anatomical Landmarks ◽  
Significant Difference ◽  
Group 2 ◽  
The Impact ◽  
Gerdy’S Tubercle ◽  
Group 1

Background: Previous work on adult specimens have demonstrated some differential thickness of the iliotibial band (ITB) tissue in different areas. The purpose of this study was twofold: 1) to quantitatively and qualitatively describe the relevant surgical anatomy of the ITB, at the level of the knee, in pediatric cadaveric specimens in which either an iliotibial band tenodesis or extraphyseal reconstruction would be considered, and 2) to provide recommendations that allow the surgeon to obtain the ideal graft in terms of tissue width and location on the larger ITB structure. Methods: Pediatric cadaveric specimens (n=24) were dissected by a group of fellowship trained pediatric orthopaedic surgeons. Digital photography of each specimen was obtained prior to collecting quantitative data of the ITB and its three main divisions using digital calipers and a coordinated measurement device (Hexagon Romer Absolute V3 CMM). Measurements included thickness, surface area, length, and width of each branch; surface area and length of each insertion; and distance of insertion in relation to other pertinent anatomical landmarks. Specimens were grouped into four age groups (Group 1: 2 year olds, Group 2: 3 and 4 year olds, Group 3: 5-7 year olds, and Group 4: 9-11 year olds). The four age groups were compared utilizing ANOVA and nonparametric Kruskal-Wallis tests with post-hoc analysis using the Tukey method. In order to correlate measurements and age, a Spearman’s correlation was used. Results: All specimens (mean age 4.7 years; range 2-11) contained a visible ITB with a direct primary arm to Gerdy’s tubercle. Sixteen specimens (66.6%) had a visible trifurcation point, in which the aggregate of ITB fibers diverge into three distinct branches: a direct arm, the iliopatellar branch, and the iliotendinous branch (Figure 1). Fibers from the central third of the iliotibial band, as described as the primary site for harvest, do not terminate on Gerdy’s tubercle, but diverge to the patella, patellar tendon and a portion of Gerdy’s tubercle. The length from the trifurcation point to the insertion of the direct arm at Gerdy’s tubercle increased with each age group (21.3 mm, 29.9 mm, 31.5 mm, and 41.8 mm, respectively) with a significant difference seen between Group 1 and 4 (p<0.01) and Group 2 and 4 (p=0.03), indicating migration of this point with longitudinal growth. The mean thicknesses of the direct arm (0.55 mm), the iliopatellar branch (0.74 mm), and iliotendinous branch (0.42 mm) were not statistically different between age groups. Length, width, and surface area were also not statistically different between age groups. Conclusion: The ITB is a consistent, well-defined structure in pediatric specimens. While some longitudinal changes in the ITB and its insertions were seen with increasing age, the thickness and width of the direct arm of the ITB, typically harvested for extra-physeal ACL reconstruction, does not appear to differ between age groups and does not represent the thickest distal branch of the ITB. The location of ITB harvest may influence the impact that the extra-articular “capsular tightening” has on joint mechanics, including altering the compression across the joint, and/or the impact on the Pivot-Shift/rational laxity of the knee undergoing ITB reconstructions. Further study of the graft location/harvest and its impact on knee biomechanics is warranted. [Figure: see text]

scholarly journals Comparison of Risk Factors for Postoperative Complications Across Age Groups in Patients Undergoing ORIF of the Ankle

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0029
Author(s):  
Haley McKissack ◽  
Matthew Anderson ◽  
John T. Wilson ◽  
Leonardo V. M. Moraes ◽  
Gean C. Viner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Elderly Patients ◽  
Illicit Drugs ◽  
Age Groups ◽  
Wound Dehiscence ◽  
Implant Failure ◽  
Increased Risk ◽  
Group 2 ◽  
Group 1

Category: Ankle, Trauma Introduction/Purpose: Ankle fractures are commonly-seen orthopaedic injuries across all age groups, and often warrant operative management. Postoperative complications are particularly common among elderly patients, and can lead to a progressive culmination of negative outcomes. Although several studies have focused on the risk factors for and prevention of such complications in elderly patients, a paucity of literature exists addressing risk of postoperative complications in younger patient populations. The purpose of this study was to compare the incidence of and risk factors for various postoperative complications between younger and older patient populations. Methods: Patients who underwent open reduction and internal fixation for an ankle fracture at a single institution between the years 2008 and 2018 were retrospectively identified based on seven different Current Procedural Terminology (CPT) codes: 27829, 27784, 27822, 27814, 27769, 27792, and 27766. Patient charts were reviewed for demographic data and comorbid conditions. Patients with open fractures, pilon fractures, and polytraumatic injuries were excluded. The sample was stratified into two cohorts based on age in years: 18-49 (group 1), and 50 and older (group 2). Incidence of various postoperative complications—including infection, wound dehiscence, sepsis, DVT, implant failure, revision surgery, and non-union— was compared between groups. Secondary analysis was conducted to compare risk factors for these complications between ages 18- 49 and older than 50. Results: 881 patients were included. A significantly greater number of patients in group 2 experienced wound dehiscence (p = 0.033) and nonunion (p<0.001) postoperatively in comparison to those in group 1. Risk of infection was significantly increased among patients with hypertension, CHF, and CKD compared to patients without these comorbidities in both group 1 and group 2. Risk of wound dehiscence was significantly increased among patients using tobacco and illicit drugs in group 1 (RR=3.39, p=0.0223 and RR=3.07, p=0.0201 respectively), but not in group 2 (RR = 1.12, p = 0.8021 and RR = 1.77, p = 0.4203 respectively). Risk of implant failure was significantly increased among tobacco users in group 2 (RR=3.82, p = 0.0005), but not in group 1 (RR = 0.75, p=0.4709). Conclusion: Patients age 50 and older may be at significantly increased risk for postoperative wound dehiscence and nonunion in comparison to patients who are younger than 50. Additionally, younger patients who use tobacco and illicit drugs may be at increased risk of wound dehiscence, while tobacco use among patients 50 years and older may increase risk of implant failure. Understanding the risk factors associated with negative outcomes may help physicians to optimize individual patient care based on existing comorbidities and age.

Intermittent hypoxia and respiratory patterns during sleep of preterm infants aged 3 to 18 months residing at high altitude

SLEEP ◽  
2021 ◽  
Author(s):  
Elida Duenas-Meza ◽  
María Isabel Escamilla-Gil ◽  
María Angelica Bazurto-Zapata ◽  
Elizabeth Caparo ◽  
Miguel Suarez Cuartas ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
High Altitude ◽  
Preterm Infants ◽  
Intermittent Hypoxia ◽  
Age Groups ◽  
Apnea Hypopnea Index ◽  
Group 3 ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Abstract Study Objectives The aim of this study was to determine the impact of apneas on oxygen saturation and the presence of intermittent hypoxia, during sleep of preterm infants (PTIs) born at high altitudes and compare with full-term infants (FTIs) at the same altitude. Methods PTIs and FTIs from 3 to 18 months were included. They were divided into three age groups: 3–4 months (Group 1); 6–7 months (Group 2), and 10–18 months (Group 3). Polysomnography parameters and oxygenation indices were evaluated. Intermittent hypoxia was defined as brief, repetitive cycles of decreased oxygen saturation. Kruskal-Wallis test for multiple comparisons, t-test or Mann–Whitney U-test were used. Results 127 PTI and 175 FTI were included. Total apnea-hypopnea index (AHI) was higher in PTI that FTI in all age groups (Group 1: 33.5/h vs. 12.8/h, p = 0.042; Group 2: 27.0/h vs. 7.4/h, p &lt; 0.001; and Group 3: 11.6/h vs. 3.1/h, p &lt; 0.001). In Group 3, central-AHI (8.0/h vs. 2.3/h, p &lt; 0.001) and obstructive-AHI (1.8/h vs. 0.6/h, p &lt; 0.008) were higher in PTI than FTI. T90 (7.0% vs. 0.5, p &lt; 0.001), oxygen desaturation index (39.8/h vs. 11.3, p &lt; 0.001) were higher in PTI than FTI, nadir SpO2 (70.0% vs. 80.0, p&lt;0.001) was lower in PTI. Conclusion At high altitude, compared to FTI, PTI have a higher rate of respiratory events, greater desaturation, and a delayed resolution of these conditions, suggesting the persistence of intermittent hypoxia during the first 18 months of life. This indicates the need for follow-up of these infants for timely diagnosis and treatment of respiratory disturbances during sleep.

scholarly journals Excess mortality and undertreatment in elderly lung cancer patients: treatment nihilism in the modern era?

2021 ◽  
pp. 00393-2020
Author(s):  
Jonathan Pham ◽  
Matthew Conron ◽  
Gavin Wright ◽  
Paul Mitchell ◽  
David Ball ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Elderly Patients ◽  
Mortality Risk ◽  
Excess Mortality ◽  
Cox Regression ◽  
Performance Status ◽  
Age Groups ◽  
Disease Stage ◽  
Cancer Treatments ◽  
Significant Difference

BackgroundTreatment of elderly patients with lung cancer is significantly hindered by concerns about treatment tolerability, toxicity and limited clinical trial data in the elderly – potentially giving rise to treatment nihilism amongst clinicians. This study aims to describe survival in elderly patients with lung cancer and explore potential causes for excess mortality.MethodsPatients diagnosed with lung cancer in the Victorian Lung Cancer Registry between 2011–2018 were analysed (n=3481). Patients were age-categorised and compared using Cox-regression modelling to determine mortality risk, after adjusting for confounding. Probability of being offered cancer treatments was also determined, further stratified by disease stage.ResultsThe eldest patients (≥80 years old) had significantly shorter median survival compared to younger age groups (<60: 2.0 years; 60–69: 1.5 years; 70–79: 1.6 years; ≥80: 1.0 years; p<0.001). Amongst those diagnosed with stage 1 or 2 lung cancer, there was no significant difference in adjusted-mortality between age groups. However, in those diagnosed with stage 3 or 4 disease, the eldest patients had an increased adjusted-mortality risk of 28% compared to patients younger than 60 years (p=0.005), associated with markedly reduced probability of cancer treatment, after controlling for sex, performance status, comorbidities and histology type (OR 0.24, compared to <60 years old strata, p<0.001).ConclusionCompared to younger patients, older patients with advanced-stage lung cancer have a disproportionately higher risk of mortality and lower likelihood of receiving cancer treatments, even when performance status and comorbidity are equivalent. These healthcare inequities could be indicative of widespread treatment nihilism towards elderly patients.

scholarly journals Vyresnio amžiaus žmonių apendicito ypatumai

2003 ◽  
Vol 1 (1) ◽  
pp. 0-0
Author(s):  
Donatas Venskutonis ◽  
Virmantas Daubaras ◽  
Juozas Kutkevičius ◽  
Jelena Kornej
Keyword(s):  
Postoperative Complications ◽  
Acute Appendicitis ◽  
Elderly Patients ◽  
Age Groups ◽  
Perforated Appendicitis ◽  
The Mean ◽  
Group 2 ◽  
Medical Histories ◽  
Complications And Mortality ◽  
Group 1

Donatas Venskutonis1, Virmantas Daubaras1, Juozas Kutkevičius1, Jelena Kornej21 Kauno medicinos universiteto Bendrosios chirurgijos klinika, 2-oji Kauno klinikinė ligoninė2 Kauno medicinos universitetas Įvadas / tikslas Apendicitas yra viena iš dažniausių ūminių chirurginių pilvo ligų. Per gyvenimą ūminiu apendicitu suserga apie 7 % visos populiacijos. Literatūros duomenimis, ūminis apendicitas sudaro apie 5 % visų ūminių pilvo ligų vyresnio amžiaus grupėje. Šio darbo tikslas – išanalizuoti KMU Bendrosios chirurgijos klinikoje (II KKL) 1991–2000 metais gydytų vyresnio amžiaus žmonių apendicito formas, diagnostinio laikotarpio trukmę, bendrą gulėjimo stacionare laiką, komplikacijų ir baigčių aspektus, šiuos duomenis palyginti su jaunesnių kaip 65 metų ūminiu apendicitu sergančių ligonių grupe. Metodai Tyrimo metu retrospektyviai buvo išanalizuotos 1991–2000 m. gydytų nuo įvairių ūminio apendicito formų asmenų ligos istorijos, siekiant įvertinti ligos trukmę, diagnostinio laikotarpio trukmę, ligos formą, gulėjimo stacionare trukmę, komplikacijas, mirštamumą ir palyginti šiuos duomenis dviejų amžiaus grupių: iki 65 metų ir daugiau kaip 65 metų. Tiriant istorijas buvo kreipiamas dėmesys į diagnostinio laikotarpio trukmę iki operacijos, operacijos metu nustatytą apendicito formą, stacionarinio gydymo trukmę, buvusias komplikacijas ir baigtį. Rezultatai 1991–2000 m. nuo įvairių ūminio apendicito formų iš viso buvo gydyti 2378 ligoniai: pirmoje grupėje (iki 65 m.) buvo 2220 ligonių (92,51 %), antroje – 158 ligoniai (7,49 %). Pirmos grupės operuota 2130 ligonių (95,94 %), antros – 145 ligoniai (91,7 %). Vertinant apendicito formas, antroje amžiaus grupėje buvo gerokai daugiau gangreninių perforacinių nei pirmoje grupėje (p = 0,0014), o šioje – daugiau flegmoninių (p < 0,0010). Pirmos grupės ligoniai iki operacijos ligoninėje gulėjo 2,3 val., antros – 4,11 val. (p < 0,05). Bendras gulėjimo laikas pirmos grupės ligonių buvo 6,77 paros, antros – 11,14 paros (p < 0,05).Pooperacinių komplikacijų pirmoje grupėje buvo 151 (7,1 %), antroje – 31 (21,3 %), (p = 0,0151). Mirštamumas antroje grupėje sudarė 3,4 %, pirmoje grupėje mirusių nebuvo. Išvados Vyresnio amžiaus žmonės serga sunkesnėmis apendicito formomis, jų ikioperacinis ir bendras gulėjimo laikas yra ilgesnis (skirtumas statistiškai patikimas), pooperacinės komplikacijos sunkesnės ir dažnesnės (skirtumas statistiškai patikimas), visi mirusieji buvo vyresnio amžiaus žmonės, sirgę sunkiomis perforacinio apendicito formomis. Prasminiai žodžiai: apendicitas, vyresnio amžiaus ligoniai. Appendicitis - peculiarities in elderly patients Donatas Venskutonis1, Virmantas Daubaras1, Juozas Kutkevičius1, Jelena Kornej2 Background / objective Appendicitis is one of the most prevailing acute surgical abdominal diseases. According to literature data, acute appendicitis makes 5% of all acute diseases among elderly patients. The aim is to analyse the forms of appendicitis among elderly patients treated in KMU General Surgery Clinic (II KKL) in 1991–2000, as well as the duration of the diagnostic period, general duration of patients’ stay in hospital, the aspects of complications and mortality as compared to those in patients under 65 years of age. Methods Medical histories of the patients treated for acute appendicitis in 1991–2000 were analysed retrospectively. The patients were divided into two age groups: group 1 – under 65 years of age; group 2 – older than 65. The following criteria were evaluated: form of the disease, duration of diagnostic period; duration of stay in hospital; complications, mortality. These data were compared in both age groups. Results In 1991–2000, a total of 2378 patients were treated for various forms of acute appendicitis. There were 2220 patients (91.1%) in group 1 and 158 (7.49%) in group 2. In group 1, 2130 patients (95.94%) and in group 2, 145 (91.7%) were operated on. In group 2 there were more gangrenous perforated acute appendicitis forms than in group 1 (p = 0.0014) and in group 1 there were more phlegmonic forms of appendicitis (p < 0.001). As to the time of stay in hospital before operation, in group 1 it was 2.3 h and in group 2 4.11 h (p < 0.05). The mean stay in hospital in group 1 was 6.77 days and in group 2 11.14 days (p < 0.05). The number of postoperative complications was 151 (7.1%) in group 1 and 31 (21.3 %) in group 2 (p = 0.0151). Mortality in group 2 was 3.4%, while in group 1 nobody died. Conclusions Elderly people fall ill with more grave forms of appendicitis; their stay in hospital before the operation and total stay in hospital is longer, the postoperative complications are more severe and more fequent; the differences are statistically reliable; all lethal cases were elderly patients ill with severe forms of perforated appendicitis. Keywords: appendicitis, elderly patients.

Sign in / Sign up

Export Citation Format

Share Document