Propensity Score–matched Comparison of Postoperative Adverse Outcomes between Geriatric Patients Given a General or a Neuraxial Anesthetic for Hip Surgery

2015 ◽  
Vol 123 (1) ◽  
pp. 136-147 ◽  
Author(s):  
Chin-Chen Chu ◽  
Shih-Feng Weng ◽  
Kuan-Ting Chen ◽  
Chih-Chiang Chien ◽  
Ja-Ping Shieh ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Geriatric Patients ◽  
Propensity Scores ◽  
Conditional Logistic Regression ◽  
Adverse Outcomes ◽  
Postoperative Outcomes ◽  
Hip Surgery ◽  
General Anesthetic ◽  
Hospital Outcomes ◽  
Hospital Stays

Abstract Background: The effects of the mode of anesthesia on major adverse postoperative outcomes in geriatric patients are still inconclusive. The authors hypothesized that a neuraxial anesthetic (NA) rather than a general anesthetic (GA) would yield better in-hospital postoperative outcomes for geriatric patients undergoing hip surgery. Methods: The authors used data from Taiwan’s 1997–2011 in-patient claims database to evaluate the effect of anesthesia on in-hospital outcomes. The endpoints were mortality, stroke, transient ischemic stroke, myocardial infarction, respiratory failure, and renal failure. Of the 182,307 geriatric patients who had hip surgery, a GA was given to 53,425 (29.30%) and an NA to 128,882 (70.70%). To adjust for baseline differences and selection bias, patients were matched on propensity scores, which left 52,044 GA and 52,044 NA patients. Results: GA-group patients had a greater percentage and higher odds of adverse in-hospital outcomes than did NA-group patients: death (2.62 vs. 2.13%; odds ratio [OR], 1.24; 95% CI, 1.15 to 1.35; P < 0.001), stroke (1.61 vs. 1.38%; OR, 1.18, 95% CI, 1.07 to 1.31; P = 0.001), respiratory failure (1.67 vs. 0.63%; OR, 2.71; 95% CI, 2.38 to 3.01; P < 0.001), and intensive care unit admission (11.03 vs. 6.16%; OR, 1.95; 95% CI, 1.87 to 2.05; P < 0.001), analyzed using conditional logistic regression. Moreover, patients given a GA had longer hospital stays (10.77 ± 8.23 vs. 10.44 ± 6.67 days; 95% CI, 0.22 to 0.40; P < 0.001) and higher costs (New Taiwan Dollars [NT$] 86,606 ± NT$74,162 vs. NT$74,494 ± NT$45,264; 95% CI, 11,366 to 12,859; P < 0.001). Conclusion: For geriatric patients undergoing hip surgery, NA was associated with fewer odds of adverse outcomes than GA.

Propensity Score–Matched Comparison of Postoperative Adverse Outcomes Between Geriatric Patients Given a General or a Neuraxial Anesthetic for Hip Surgery

2015 ◽  
Vol 59 (6) ◽  
pp. 273-274
Author(s):  
Chin-Chen Chu ◽  
Shih-Feng Weng ◽  
Kuan-Ting Chen ◽  
Chih-Chiang Chien ◽  
Ja-Ping Shieh ◽  
...  
Keyword(s):  
Propensity Score ◽  
Geriatric Patients ◽  
Adverse Outcomes ◽  
Hip Surgery ◽  
Matched Comparison

Smoking and postoperative outcomes in elective cranial surgery

2014 ◽  
Vol 120 (4) ◽  
pp. 811-819 ◽  
Author(s):  
Nima Alan ◽  
Andreea Seicean ◽  
Sinziana Seicean ◽  
Nicholas K. Schiltz ◽  
Duncan Neuhauser ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Propensity Scores ◽  
Adverse Outcomes ◽  
Postoperative Outcomes ◽  
Prior History ◽  
Improvement Project ◽  
Cranial Surgery ◽  
History Of ◽  
Never Smokers ◽  
Poor Outcomes

Object The goal in this study was to assess whether a current or prior history of smoking and the number of smoking pack years affect the risk for adverse outcomes in the 30-day postoperative period in patients who undergo elective cranial surgery. Methods Data from the 2006–2011 American College of Surgeons' National Surgical Quality Improvement Project were used in this study. The authors identified 8296 patients who underwent elective cranial surgery, of whom 1718 were current smokers, 854 were prior smokers, and 5724 were never smokers. Using propensity scores and age, the authors matched current and prior smokers to never smokers. Odds ratios for adverse postoperative outcomes were predicted with logistic regression. The relationship between number of pack years and poor outcomes was also examined. Results In unadjusted analyses, prior and current smokers did not differ from never smokers for having poor outcomes postoperatively. Similarly, in matched analyses, no association was found between smoking and adverse outcomes. Number of pack years in propensity-matched analyses did not predict worse outcomes in prior or current smokers versus never smokers. Conclusions The authors did not find smoking to be associated with 30-day postoperative morbidity or mortality. Although smoking cessation is beneficial for overall health, it may not improve the short-term (≤ 30 days) outcome of elective cranial surgery. Thus postponement of elective cranial cases only for smoking cessation may not be necessary.

scholarly journals Smartphone-Based Prediction Model for Postoperative Cardiac Surgery Outcomes Using Preoperative Gait and Posture Measures

Sensors ◽  
2021 ◽  
Vol 21 (5) ◽  
pp. 1704
Author(s):  
Rahul Soangra ◽  
Thurmon Lockhart
Keyword(s):  
Cardiovascular Disease ◽  
Older Adults ◽  
Cardiac Surgery ◽  
Regression Model ◽  
Mobile Phone ◽  
Gait Speed ◽  
Adverse Outcomes ◽  
Postoperative Outcomes ◽  
Mortality And Morbidity ◽  
Prediction Of Mortality

Gait speed assessment increases the predictive value of mortality and morbidity following older adults’ cardiac surgery. The purpose of this study was to improve clinical assessment and prediction of mortality and morbidity among older patients undergoing cardiac surgery through the identification of the relationships between preoperative gait and postural stability characteristics utilizing a noninvasive-wearable mobile phone device and postoperative cardiac surgical outcomes. This research was a prospective study of ambulatory patients aged over 70 years undergoing non-emergent cardiac surgery. Sixteen older adults with cardiovascular disease (Age 76.1 ± 3.6 years) scheduled for cardiac surgery within the next 24 h were recruited for this study. As per the Society of Thoracic Surgeons (STS) recommendation guidelines, eight of the cardiovascular disease (CVD) patients were classified as frail (prone to adverse outcomes with gait speed ≤ 0.833 m/s) and the remaining eight patients as non-frail (gait speed > 0.833 m/s). Treating physicians and patients were blinded to gait and posture assessment results not to influence the decision to proceed with surgery or postoperative management. Follow-ups regarding patient outcomes were continued until patients were discharged or transferred from the hospital, at which time data regarding outcomes were extracted from the records. In the preoperative setting, patients performed the 5-m walk and stand still for 30 s in the clinic while wearing a mobile phone with a customized app “Lockhart Monitor” available at iOS App Store. Systematic evaluations of different gait and posture measures identified a subset of smartphone measures most sensitive to differences in two groups (frail versus non-frail) with adverse postoperative outcomes (morbidity/mortality). A regression model based on these smartphone measures tested positive on five CVD patients. Thus, clinical settings can readily utilize mobile technology, and the proposed regression model can predict adverse postoperative outcomes such as morbidity or mortality events.

scholarly journals Age differences in clinical features and outcomes in patients with COVID-19, Jiangsu, China: a retrospective, multi-center cohort study

2020 ◽  
Author(s):  
Huanyuan Luo ◽  
Songqiao Liu ◽  
Yuancheng Wang ◽  
Penelope A. Phillips-Howard ◽  
Yi Yang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Hospital Stay ◽  
Older Patients ◽  
Adverse Outcomes ◽  
Trend Test ◽  
Chronic Obstructive ◽  
Chi Square ◽  
Chi Square Test

Objectives To determine the age-specific clinical presentations and incidence of adverse outcomes among patients with COVID-19 in Jiangsu, China. Design and setting This is a retrospective, multi-center cohort study performed at twenty-four hospitals in Jiangsu, China. Participants From January 10 to March 15, 2020, 625 patients with COVID-19 were involved. Results Of the 625 patients (median age, 46 years; 329 [52.6%] males), 37 (5.9%) were children (18 years or less), 261 (40%) young adults (19-44 years), 248 (39.7%) middle-aged adults (45-64 years), and 79 (12.6%) elderly (65 years or more). The incidence of hypertension, coronary heart disease, chronic obstructive pulmonary disease, and diabetes comorbidities increased with age (trend test, P < .0001, P = 0.0003, P < .0001, and P < .0001 respectively). Fever, cough, and shortness of breath occurred more commonly among older patients, especially the elderly, compared to children (Chi-square test, P = 0.0008, 0.0146, and 0.0282, respectively). The quadrant score and pulmonary opacity score increased with age (trend test, both P < .0001). Older patients had significantly more abnormal values in many laboratory parameters than younger patients. Elderly patients contributed the highest proportion of severe or critically-ill cases (33.0%, Chi-square test P < 0.001), intensive care unit (ICU) (35.4%, Chi-square test P < 0.001), and respiratory failure (31.6%, Chi-square test P = 0.0266), and longest hospital stay (21 days, ANOVA-test P < 0.001). Conclusions Elderly (≥65) patients with COVID-19 had the highest risk of severe or critical illness, intensive care use, respiratory failure, and the longest hospital stay, which may be due partly to that they had higher incidence of comorbidities and poor immune responses to COVID-19.

scholarly journals Frailty assessment in older urological patients prior to surgery: a systematic review and narrative synthesis

2020 ◽  
Vol 12 ◽  
pp. 175628722091661 ◽  
Author(s):  
Andrea Haren ◽  
Rajni Lal ◽  
David Walker ◽  
Rajesh Nair ◽  
Judith Partridge ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Care ◽  
Preoperative Assessment ◽  
Perioperative Period ◽  
Adverse Outcomes ◽  
Assessment Tools ◽  
Postoperative Outcomes ◽  
Narrative Synthesis ◽  
Standard Clinical Practice ◽  
Increased Risk

Background: Radical cystectomy (RC) and urinary diversion are the recommended treatment for patients with muscle invasive bladder cancer. This is complex surgery, associated with significant patient morbidity and mortality. Frailty has been shown to be an independent risk factor for adverse outcomes in several surgical populations. Preoperative assessment of frailty is advocated in current guidelines but is not yet standard clinical practice. Aims: This systematic review and narrative synthesis aims to examine whether patients undergoing RC are assessed for frailty, what tools are used, and whether an association is found between frailty and adverse outcomes in this population. Results: Nine studies, published within the last 4 years, describe the use of tools reporting to measure frailty in the RC population. All demonstrate increased risk of adverse postoperative outcomes with higher frailty levels. Only one study used a validated frailty tool. The majority of studies measure frailty using variations on a tool derived from a large database (ACS-NSQIP) effectively counting co-morbidities, rather than assessing the multidomain nature of the frailty syndrome. Conclusion: The recognition of frailty as an important consideration in the perioperative period is welcome. This systematic review and narrative synthesis demonstrates the need for collaboration in research and delivery of clinical care for older surgical patients. Such collaboration may provide clarity regarding terms such as frailty and multimorbidity, preventing the development of assessment tools inaccurately measuring these discreet syndromes interchangeably. More accurate assessment of patients in terms of frailty, multimorbidity and functional status may allow better modification and shared decision making leading to improved postoperative outcomes in older patients undergoing RC.

Sex differences of resource utilisation and outcomes in patients with atrial arrhythmias and heart failure

Heart ◽  
2019 ◽  
Vol 106 (7) ◽  
pp. 527-533 ◽  
Author(s):  
Laura Ueberham ◽  
Sebastian König ◽  
Sven Hohenstein ◽  
Rene Mueller-Roething ◽  
Michael Wiedemann ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sex Differences ◽  
Hospital Mortality ◽  
Linear Mixed Model ◽  
Adverse Outcomes ◽  
Resource Utilisation ◽  
Hospital Outcomes ◽  
Risk Of Death ◽  
Increased Risk ◽  
Generalised Linear Mixed Model

ObjectiveAtrial fibrillation or atrial flutter (AF) and heart failure (HF) often go hand in hand and, in combination, lead to an increased risk of death compared with patients with just one of both entities. Sex-specific differences in patients with AF and HF are under-reported. Therefore, the aim of this study was to investigate sex-specific catheter ablation (CA) use and acute in-hospital outcomes in patients with AF and concomitant HF in a retrospective cohort study.MethodsUsing International Statistical Classification of Diseases and Related Health Problems and Operations and Procedures codes, administrative data of 75 hospitals from 2010 to 2018 were analysed to identify cases with AF and HF. Sex differences were compared for baseline characteristics, right and left atrial CA use, procedure-related adverse outcomes and in-hospital mortality.ResultsOf 54 645 analysed cases with AF and HF, 46.2% were women. Women were significantly older (75.4±9.5 vs 68.7±11.1 years, p<0.001), had different comorbidities (more frequently: cerebrovascular disease (2.4% vs 1.8%, p<0.001), dementia (5.3% vs 2.2%, p<0.001), rheumatic disease (2.1% vs 0.8%, p<0.001), diabetes with chronic complications (9.7% vs 9.1%, p=0.033), hemiplegia or paraplegia (1.7% vs 1.2%, p<0.001) and chronic kidney disease (43.7% vs 33.5%, p<0.001); less frequently: myocardial infarction (5.4% vs 10.5%, p<0.001), peripheral vascular disease (6.9% vs 11.3%, p<0.001), mild liver disease (2.0% vs 2.3%, p=0.003) or any malignancy (1.0% vs 1.3%, p<0.001), underwent less often CA (12.0% vs 20.7%, p<0.001), had longer hospitalisations (6.6±5.8 vs 5.2±5.2 days, p<0.001) and higher in-hospital mortality (1.6% vs 0.9%, p<0.001). However, in the multivariable generalised linear mixed model for in-hospital mortality, sex did not remain an independent predictor (OR 0.96, 95% CI 0.82 to 1.12, p=0.579) when adjusted for age and comorbidities. Vascular access complications requiring interventions (4.8% vs 4.2%, p=0.001) and cardiac tamponade (0.3% vs 0.1%, p<0.001) occurred more frequently in women, whereas stroke (0.6% vs 0.5%, p=0.179) and death (0.3% vs 0.1%, p=0.101) showed no sex difference in patients undergoing CA.ConclusionsThere are sex differences in patients with AF and HF with respect to demographics, resource utilisation and in-hospital outcomes. This needs to be considered when treating women with AF and HF, especially for a sufficient patient informed decision making in clinical practice.

The association of preoperative delirium with postoperative outcomes following hip surgery in the elderly

2020 ◽  
Vol 60 ◽  
pp. 28-33 ◽  
Author(s):  
Shubham Agrawal ◽  
Robby Turk ◽  
Brittany N. Burton ◽  
Jerry Ingrande ◽  
Rodney A. Gabriel
Keyword(s):  
The Elderly ◽  
Postoperative Outcomes ◽  
Hip Surgery ◽  
Surgery In The Elderly

scholarly journals Treatment of Femoral Neck Fracture with a Minimal Invasive Surgical Approach for Hemiarthroplasty – Clinical and Radiological Results in 180 Geriatric Patients

2014 ◽  
Vol 8 (1) ◽  
pp. 225-231 ◽  
Author(s):  
A.C Unger ◽  
B Dirksen ◽  
F. G Renken ◽  
E Wilde ◽  
M Willkomm ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Social Environment ◽  
Geriatric Patients ◽  
Femoral Nerve ◽  
Femoral Neck Fractures ◽  
Hip Surgery ◽  
Nerve Lesion ◽  
Timed Up And Go ◽  
Term Care ◽  
Radiological Results

Purpose : The Direct Anterior Approach (DAA) is well established as a minimal access approach in elective orthopaedic hip surgery. For the growing number of elderly patients with femoral neck fractures treated with Bipolar Hip Hemiarthroplasty (BHH), only a few results do exist. The study shows the clinical and radiological outcome for 180 patients treated by a modified DAA with BHH. Materials and Methods : The data of 180 geriatric patients with medial femoral neck fractures were evaluated retrospectively. The general and surgical complications, mobilisation using the Timed Up and Go test (TUG), the social environment pre- and postoperative and the radiological results have been compared with established approaches for geriatric hip surgery. Results : After joint replacement, 18 (10%) patients were developed pneumonia, of which 3 (1.7%) died during hospitalisation. In 7 cases (4%), surgical revision had to be carried out: three times (1.7%) because of a seroma, three times (1.7%) because of subcutaneous infection, and one time (0.6%) because the BHH was removed, owing to deep wound infection. One dislocation (0.6%) occurred, as well as one femoral nerve lesion (0.6%) occured. 88.3% of patients were mobilised on walkers or crutches; the Timed Up and Go Test showed a significant improvement during inpatient rehabilitation. 83% were discharged to their usual social environment, 10% were transferred to a short-term care facility and 7% were relocated permanently to a nursing home. 3/4 of patients had a cemented stem alignment in the range between -5° and 5°, while 2/3 of patients had a maximum difference of 1 cm in leg length. Conclusion : Using the modified DAA, a high patient satisfaction is achieved after implantation of a BHH. The rate of major complications is just as low as in conventional approaches, and rapid mobilisation is possible.

Sign in / Sign up

Export Citation Format

Share Document