Outcomes Following Transsphenoidal Pituitary Surgery in the Elderly: A Retrospective Single-Center Review

2018 ◽  
Vol 16 (3) ◽  
pp. 302-309 ◽  
Author(s):  
Zoe Memel ◽  
Kelsi Chesney ◽  
Dhiraj J Pangal ◽  
Phillip A Bonney ◽  
John D Carmichael ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Surgical Complications ◽  
Vision Loss ◽  
Retrospective Chart Review ◽  
Pituitary Surgery ◽  
The Elderly ◽  
Altered Mental Status ◽  
Safety Outcomes ◽  
Transsphenoidal Pituitary Surgery ◽  
Postoperative Hyponatremia

Abstract BACKGROUND Transsphenoidal surgery (TSS) for pituitary adenomas (PAs) is performed on elderly patients with increasing frequency. More research is necessary to assess the risk factors that are associated with TSS in an aging population. OBJECTIVE To perform a retrospective study on postoperative safety outcomes following TSS in the elderly population stratified by decade of life. METHODS A retrospective chart review of the USC Pituitary Database was conducted to identify patients ≥70 yr, who underwent TSS for PAs between 1995 and 2017. Surgical outcomes were analyzed in elderly (≥70 yr) vs nonelderly (<70 yr) patients. Elderly patients were additionally stratified according to age 70 to 79 vs ≥80 yr. RESULTS The cohorts included 115 elderly patients (70-79 yr: 94 patients; ≥80 yr: 21 patients) and 770 nonelderly patients. Elderly patients presented with more vision loss (62% vs 38%, P < .0001), dizziness (17% vs 6%, P = .0001) and altered mental status (7.3% vs 3%, P = .0451). Overall rates of surgical, medical, and endocrine complications were similar; however, elderly patients had significantly higher rates of postoperative hyponatremia (9.3% vs 4.7%, P = .0401) and lower rates of transient diabetes insipidus (0.9% vs 7.9%, P = .0038). Patients ≥ 80 yr had significantly more surgical complications (26.3%) compared to the 70 to 79 group (7.87%; P = .021) and <70 group (12.5%; P = .04). CONCLUSION Patients >70 yr are appropriate surgical candidates for TSS given the similar safety outcomes as younger patients. Given the higher propensity for surgical complications; however, a higher level of operative selectivity should be maintained in octogenarian patients.

scholarly journals Thyroid Surgery in the Elderly: A Comparative Experience of 400 Patients From an Italian University Hospital

2014 ◽  
Vol 99 (5) ◽  
pp. 523-527 ◽  
Author(s):  
Silvestro Canonico ◽  
Gianluca Pellino ◽  
Domenico Pameggiani ◽  
Guido Sciaudone ◽  
Giuseppe Candilio ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Life Expectancy ◽  
Elderly Patients ◽  
Thyroid Surgery ◽  
Surgical Complications ◽  
The Elderly ◽  
University Hospital ◽  
Younger Patients ◽  
Surgery In The Elderly ◽  
Malignant Lesions

Abstract The aim of this study was to compare disease features and surgical complications of patients undergoing surgery under or over 65 years of age. We performed a retrospective review of patients undergoing thyroidectomy or lobectomy from January 1990 through January 2012 in our Institution. Patients aged over 65 years of age were compared with younger patients on a 1:1 ratio. A total of 2012 patients were operated on during the study period. Two-hundred patients aged > 65 years were compared with 200 patients < 65 years old. In this series, no significant differences were observed concerning surgical complications between groups. At multivariate analysis, masses causing compression, extended approaches and malignant lesions were significant predictors of complications, irrespective of age. Due to longer life expectancy, elderly patients are being operated on more frequently. Safety of thyroid surgery in this population is still debated. We observed no difference in surgical outcomes between elderly and younger patients; however, some features of the diseases impair survival in the former. Age did not increase likeliness of worse outcomes in patients receiving thyroid surgery.

Surgical complications after endoscopic transsphenoidal pituitary surgery

2009 ◽  
Vol 16 (6) ◽  
pp. 786-789 ◽  
Author(s):  
Patra Charalampaki ◽  
Ali Ayyad ◽  
Ralf Alfons Kockro ◽  
Axel Perneczky
Keyword(s):  
Surgical Complications ◽  
Pituitary Surgery ◽  
Transsphenoidal Pituitary Surgery

A Psychological Approach to Attitudes toward Blind Persons

1987 ◽  
Vol 81 (7) ◽  
pp. 323-325 ◽  
Author(s):  
R. Vickers
Keyword(s):  
Elderly Patient ◽  
Elderly Patients ◽  
Visually Impaired ◽  
Vision Loss ◽  
Well Being ◽  
The Elderly ◽  
Self Esteem ◽  
Psychological Approach ◽  
Blind Persons ◽  
Visually Impaired Persons

In a paper prepared for presentation at Goldwater Memorial Hospital in the spring of 1986, the author discusses vision loss in elderly patients. The paper further addresses the effects of stereotyping on treatment for elderly visually impaired persons and stresses self-esteem and responsibility as two integral factors in the emotional and physical well-being of the elderly patient.

Transsphenoidal pituitary surgery in the elderly is safe and effective

2013 ◽  
Vol 28 (5) ◽  
pp. 616-621 ◽  
Author(s):  
Erlick A. C. Pereira ◽  
Puneet Plaha ◽  
Aswin Chari ◽  
Menaka Paranathala ◽  
Nicholas Haslam ◽  
...  
Keyword(s):  
Pituitary Surgery ◽  
The Elderly ◽  
Transsphenoidal Pituitary Surgery ◽  
Surgery In The Elderly

Evaluating Prescribing Practices of Apixaban in the Elderly

2019 ◽  
Vol 34 (8) ◽  
pp. 514-519
Author(s):  
Elizabeth Pogge ◽  
Stephanie Sibicky ◽  
Ashley Campbell
Keyword(s):  
Atrial Fibrillation ◽  
Elderly Patients ◽  
Retrospective Chart Review ◽  
The Elderly ◽  
Current Treatment ◽  
Vital Role ◽  
New Order ◽  
Prescribing Practices ◽  
Treatment Dose ◽  
Inpatient Settings

OBJECTIVE: The aim of this study was to evaluate prescribing practices for elderly patients started on apixaban in multiple practice settings.<br/> DESIGN: Retrospective, chart review.<br/> SETTING: One outpatient and three inpatient settings in Arizona and Massachusetts.<br/> PATIENT, PARTICIPANTS: Patients who received a new order for apixaban between July 1, 2015, and December 31, 2016. Inclusion criteria included adults 65 years of age and older who were receiving apixaban for atrial fibrillation or venous thromboembolism (VTE) at a current treatment dose.<br/> There were 1,045 patients included, the average age was 78 years, 52% were male, and 90% had atrial fibrillation.<br/> MAIN OUTCOME MEASURE: Appropriate prescribing of apixaban based on Food and Drug Administration (FDA)-labeling (age, weight, serum creatinine).<br/> RESULTS: Six patients who were on hemodialysis were excluded from the analysis, leaving 1,039 patients to be analyzed. 16.2% (168/1,039) of patients had an incorrect dose of apixaban prescribed based on their indication. Of those, 75% (126/168) were taking the medication for atrial fibrillation and 25% (42/168) for VTE. For those with atrial fibrillation (n = 126), the majority of inappropriate orders resulted from doses that were lower than indicated (113/126).<br/> CONCLUSION: This research suggests that elderly patients may receive inappropriately lower doses of apixaban than indicated, which may decrease the effectiveness of the medication. This research supports the fact that pharmacists can play a vital role in anticoagulation stewardship by verifying apixaban doses for accuracy.

RA05.09: THE INFLUENCE OF AGE ON OVERALL SURVIVAL AND COMPLICATIONS AFTER IVOR LEWIS TOTALLY MINIMALLY INVASIVE ESOPHAGEAL SURGERY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 29-29
Author(s):  
Nikolaj Baranov ◽  
Frans Van Workum ◽  
Jolijn Van Der Maas ◽  
Ewout Kouwenhoven ◽  
Marc Van Det ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Elderly Patients ◽  
Surgical Complications ◽  
Conflicts Of Interest ◽  
Postoperative Mortality ◽  
The Elderly ◽  
Elderly Group ◽  
Ivor Lewis ◽  
Significant Difference

Abstract Background Worldwide, the number of elderly patients suffering from esophageal cancer is increasing due to the increasing incidence of esophageal cancer and increasing life expectancy of the general population. The effect of age on morbidity, mortality and survival after Ivor Lewis totally minimally invasive esophagectomy (TMIE) with curative intention are not well known since elderly patients have been excluded in randomized trials. Methods A retrospective analysis of a prospectively documented database from December 2010 to June 2017 was performed, including all patients who underwent Ivor Lewis TMIE with curative intent for esophageal cancer in three Dutch hospitals. Patients younger than 75 years (younger group) were compared to patients aged 75 years or older (elderly group). Postoperative complications, in-hospital mortality, 30 and 90 days mortality, long-term complications and survival were compared between these two groups. Results Four hundred and forty-six patients were included, 89 patients in the elderly group and 357 patients in the younger group. In the elderly group, a significantly higher incidence of non-surgical complications (77.5% versus 66.7%; P = 0.048), cardiovascular complications (24.7% versus 14.0%; P = 0.014) and delirium (27.0% versus 11.8%; P = 0.000) was found. There was no significant difference in surgical complications, overall complications, 30-day mortality, 90-day mortality, 1-year survival and 2-year survival. Conclusion Although Ivor Lewis TMIE in elderly patients is associated with a higher rate of non-surgical complications, it can be safely performed without increasing postoperative mortality. Disclosure All authors have declared no conflicts of interest.

scholarly journals The Utility of the Alvarado Score in the Diagnosis of Acute Appendicitis in the Elderly

2017 ◽  
Vol 83 (7) ◽  
pp. 793-798 ◽  
Author(s):  
Anastasiya Shchatsko ◽  
Rebecca Brown ◽  
Trista Reid ◽  
Sasha Adams ◽  
Amy Alger ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Elderly Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
The Elderly ◽  
Inclusion Criteria ◽  
Alvarado Score ◽  
Lower Quadrant ◽  
Left Shift ◽  
Right Lower Quadrant

Clinical scores determining the likelihood of acute appendicitis (AA), including the Alvarado score, were devised using a younger population, and their efficacy in predicting AA in elderly patients is not well documented. This study's purpose is to evaluate the utility of Alvarado scores in this population. A retrospective chart review of patients >65 years old presenting with pathologically diagnosed AA from 2000 to 2010 was performed. Ninety-six patients met inclusion criteria. The average age was 73.7 ± 1.5 years and our cohort was 41.7 per cent male. The average Alvarado score was 6.9 ± 0.33. The distribution of scores was 1 to 4 in 3.7 per cent, 5 to 6 in 37.8 per cent, and 7 to 10 in 58.5 per cent of cases. There was a statistically significant increase in patients scoring 5 or 6 in our cohort versus the original Alvarado cohort (P < 0.01). Right lower quadrant tenderness (97.6%), left shift of neutrophils (91.5%), and leukocytosis (84.1%) were the most common symptoms on presentation. In conclusion, our data suggest that altering our interpretation of the Alvarado score to classify elderly patients presenting with a score of ≥5 as high risk may lead to earlier diagnosis of AA. Physicians should have a higher clinical suspicion of AA in elderly patients presenting with right lower quadrant tenderness, left shift, or leukocytosis.

Safety of Endoscopic Sinus Surgery in the Elderly—Are Octogenarian Patients at a Higher Risk?

2021 ◽  
pp. 194589242110253
Author(s):  
Lirit Levi ◽  
Yonatan Reuven ◽  
Daniel Ben-Ner ◽  
Noam Koch ◽  
Mor Gunders-Peleg ◽  
...  
Keyword(s):  
Risk Factor ◽  
Elderly Patients ◽  
Surgical Complications ◽  
Endoscopic Sinus Surgery ◽  
The Elderly ◽  
Sinus Surgery ◽  
P Value ◽  
Safe Procedure ◽  
Younger Patients ◽  
Duration Of Surgery

Background Surgeons are often faced with concerns regarding the risks versus benefits of endoscopic sinus surgery (ESS) in elderly patients. Objective To analyze the risk for complications of ESS in the elderly (age ≥70 years) compared to younger patients, with emphasis on octogenarians. Methods Retrospective review of medical charts of adult patients who underwent ESS at a tertiary referral center during the years 2014 to 2018. Results We compared 128 elderly patients with 276 matched younger patients. In the elderly group mean age was 76 years (range, 70-91 years ). Thirty-one elderly patients were 80 years or older. Surgical complications in the elderly patients were 3.9%. Minor complications were 2.3% and major complications were 1.7%. The surgical complications rate was similar in the younger group (8%, P value: .127). Medical complications were observed in 2.3% comparing to 0.7% in younger patients. Interestingly, age, revision surgery, extent and duration of surgery, and modality of anesthesia were not identified as risk factors. Only ischemic heart disease (IHD) was identified as a risk factor for complications in a multivariate analysis in elderly patients. Comparison of elderly patients younger than 80 years with octogenarians revealed no difference in complication rate between these groups. Conclusions Overall, ESS was found to be a safe procedure in elderly patients compared to younger patients. Octogenarian patients should not be denied upfront surgery. IHD is a risk factor for complications in elderly patients.

scholarly journals P059: Who will be ready to fly? Characteristics of successful and unsuccessful geriatric discharges from the Nanaimo Regional General Hospital emergency department through the ED2Home program

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S77-S78
Author(s):  
E.E. Hack ◽  
A. Rashidi
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Elderly Patients ◽  
General Hospital ◽  
Retrospective Chart Review ◽  
The Elderly ◽  
Chief Complaint ◽  
Quality Improvement Project ◽  
Living Situation ◽  
Improvement Project

Introduction: As the baby-boomer generation ages, the number of elderly patients with complex health issues visiting emergency departments (EDs) will continue to increase. Evidence suggests elderly patients often have better health outcomes if they can be managed at home with appropriate community and primary care supports in place, rather than being admitted to hospital. ED2Home is a program that launched March 1, 2016 in the Nanaimo Regional General Hospital (NRGH) ED. It aims to assess admitted patients aged 70 and over and discharge them with community supports and follow-up. The aim of this Quality Improvement project was to evaluate how many patients were successfully discharged by the ED2Home program in its first few months, and to characterize which patients were more likely to be successfully discharged versus bounce back to the ED. Methods: This Quality Improvement project audited the charts of 87 patients discharged by ED2Home from June-Sept 2016. Variables examined included the following: age, gender, chief complaint, mobility status, living situation, which ED2Home health care provider (RN vs MD) to facilitate discharge, whether patient had a family physician, and resources used (ex. pharmacy, physiotherapy, occupational therapy, etc.) to help facilitate discharge. Our evaluation was conducted by means of a retrospective chart review. Descriptive statistics were derived for variables of interest. Results: There were 87 patients discharged home by the ED2Home whose charts were reviewed. 48 (55%) of these patients were successfully discharged home without revisit to the NRGH ED within 30 days of discharge. 29 patients returned to the NRGH ED within 30 days of original discharge for the same original chief complaint. Patients successfully discharged were similar to those who bounced back in terms of gender and mean age. Patients who bounced back to the ED were more likely to have chief complaints of dyspnea and confusion compared to those successfully discharged. Patients who were successfully discharged had a higher proportion of patients with social admissions compared to those who bounced back to the ED within 30 days. A higher proportion of patients successfully discharged had been evaluated by the ED2Home physician (versus nursing alone) compared to patients who bounced back within 30 days. Conclusion: ED2Home appears to be successful at discharging patients and preventing revisit to the ED and re-hospitalization, similar to other transitional programs for the elderly that have been reviewed in the literature. Patients presenting with more complex issues, such as dyspnea and confusion, may not be as suitable for rapid discharge from the ED through this program as patients presenting with issues helped by additional allied health care supports, such as failure to thrive/social admission. Additional Quality Improvement iterations of the ED2Home program should be undertaken in the future, using these suggestions.

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