scholarly journals Risk Factors for Postoperative Complications among the Elderly after Plastic Surgery Procedures Performed under General Anesthesia

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Kiyoko Fukui ◽  
Masaki Fujioka ◽  
Kazumi Yamasaki ◽  
Sho Yamakawa ◽  
Haruka Matsuo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
General Anesthesia ◽  
Plastic Surgery ◽  
Medical Center ◽  
Performance Status ◽  
Multiple Logistic Regression Analysis ◽  
The Elderly ◽  
Albumin Level ◽  
Hospital Organization

Background. The frequency of surgery involving elderly patients has been increasing. The use of free tissue transfers in the elderly has been examined previously (Howard et al., 2005, Hwang et al., 2016, Grammatica et al., 2015, Serletti et al., 2000, and Sierakowski et al., 2017), whereas there have not been any such studies of plastic surgery procedures. We evaluated the risk factors for complications after plastic surgery procedures performed under general anesthesia in patients aged ≥75 years. Methods. The cases of patients aged ≥75 years who underwent plastic surgery procedures under general anesthesia at the Department of Plastic and Reconstructive Surgery, National Hospital Organization Nagasaki Medical Center, between 2009 and 2016 were reviewed retrospectively. Multiple logistic regression analysis was used to identify the risk factors for postoperative complications. Results. Two hundred and sixty-three cases were reviewed. Complications were seen in 137 patients. Age was not predictive of complications. The risk factors included a serum albumin level of <2.8 g/dl (odds ratio (OR): 2.96), an operative time of ≥120 min (OR: 6.22), and an American Society of Anesthesiologists performance status of ≥3 (OR: 2.39). Conclusions. Age is not contraindication for surgery in the elderly. It is important to assess comorbidities and perform surgical procedures as soon as possible to shorten the surgical period.

Efficacy and safety of surgery for spontaneous pneumothorax in elderly patients

2019 ◽  
Author(s):  
Shunichi Nagata ◽  
Mitsugu Omasa ◽  
Kosuke Tokushige ◽  
Takao Nakanishi ◽  
Hideki Motoyama
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Postoperative Complications ◽  
Elderly Patients ◽  
Spontaneous Pneumothorax ◽  
Performance Status ◽  
Multivariable Analysis ◽  
Efficacy And Safety ◽  
Air Leaks ◽  
Grade 3

Abstract OBJECTIVES There is no clear consensus on the surgical indications for spontaneous pneumothorax in elderly patients. In this study, we aimed to assess the efficacy and safety of surgical treatment of spontaneous pneumothorax in patients aged ≥70 years. We also sought to identify the risk factors for postoperative prolonged air leaks and complications in such patients. METHODS Data pertaining to 104 elderly patients who underwent surgery out of 206 patients (aged ≥70 years) who were diagnosed with spontaneous pneumothorax at our institution between 1994 and 2018 were retrospectively reviewed. The incidences of postoperative persistent air leaks (≥2 days) and postoperative complications (≥grade 3; Clavien–Dindo classification) were analysed for efficacy and safety assessment, respectively. RESULTS Median postoperative air leaks continued for 0 days (range 0–25); 14.4% patients developed ≥grade 3 postoperative complications. On the basis of results of multivariable analysis, it was observed that a higher PaCO2 level was significantly associated with prolonged postoperative air leaks [odds ratio (OR) 1.08, 95% confidence interval (CI) 1.00–1.17; P = 0.047]. Poorer performance status was associated with a significantly increased risk of postoperative complications, as assessed by multivariable analysis (OR 6.13, 95% CI 1.38–27.3; P = 0.017). The recurrence rate was 4.8%; mortality rate of patients was 2.9%. Three-year survival rate after surgery was 73.8%. CONCLUSIONS Surgical treatment of spontaneous pneumothorax may be effective and safe in selected elderly patients. Moreover, higher PaCO2 and poorer performance status were independent risk factors for postoperative persistent air leaks and complications, respectively.

Risk factors for venous thromboembolism in elderly patients with glioblastoma.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e13031-e13031
Author(s):  
Neda Hashemi-Sadraei ◽  
Roozbeh Sharif ◽  
Jorge Machicado ◽  
Saurabh Dahiya ◽  
Manmeet Singh Ahluwalia
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Elderly Patients ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Multivariable Analysis ◽  
Tumor Resection ◽  
Cleveland Clinic ◽  
The Elderly ◽  
Categorical Variables

e13031 Background: Venous thromboembolism (VTE) is a common complication in glioblastoma (GBM) patients. Physicians are reluctant to administer anticoagulants to GBM patients with VTE, particularly to the elderly patients. Methods: After obtaining IRB approval, the Cleveland Clinic Brain Tumor and Neuro-Oncology Center’s database was used to identify patients with histologically confirmed GBM who were diagnosed with VTE and were ≥65 years of age at the time of diagnosis of GBM. Bivariate comparison of demographic and clinical features was performed by occurrence of DVT, using t-test for continuous data and fishers exact test for categorical variables. Multivariate proportional hazard model was developed adjusting for number of comorbidities (none, 1, 2-3, >3), Karnofsky Performance Status (KPS) at presentation (>70, ≤70), age (>75, ≤75), race, treatment (chemotherapy, radiation therapy, tumor resection). All p-values were 2-sided and were considered significant when <0.005. Results: Chart records of 517 patients diagnosed between 1990 and 2010 were included for analysis. Among 517 cases, 99 patients (54% male, median age at presentation 72 years, range 65-92 years) developed VTE. Median follow-up was 6.58 ± 9.58 months. Eighty-nine (90.8%) cases were diagnosed within 3 months of craniotomy. On univariable analysis, risk factors for VTE included lower KPS (HR 0.98, CI 0.96– 0.99, p = 0.001), thalamic tumors (HR 3.11, CI 1.14– 8.50, p = 0.027), and lower extremity paresis (HR 2.24, CI 1.46-3.46, p < 0.0001). Caucasian patients had a lower trend for developing VTE, however this was not statistically significant. On multivariable analysis, lower KPS was found to be related with higher incidence of VTE (HR 0.35, CI 0.18 – 0.66, p = 0.001). Conclusions: Lower KPS is associated with higher incidence of VTE. Further studies are needed to determine risk stratification and whether the use of medical prophylaxis after neurosurgical intervention can lead to decrease in the rates of VTE in elderly GBM patients.

Influence of Hypertension and Diabetes on Postoperative Outcomes In Cancer Patients Undergoing Moderate/High Risk Surgical Procedures

2021 ◽  
Author(s):  
Lafayete William Ferreira Ramos ◽  
Beatriz Nery Nascimento ◽  
Gabriel Rossi Silva ◽  
Marcos Vinícius Ferreira Ramos ◽  
Barbara Cristina Ferreira Ramos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Cancer Patients ◽  
Multiple Logistic Regression Analysis ◽  
Diabetic Group ◽  
Postoperative Outcomes ◽  
Morbidity And Mortality ◽  
Systemic Hypertension ◽  
Surgical Time ◽  
Increased Risk

Abstract Background: Systemic hypertension (HTN) and diabetes mellitus (DM) are believed to be risk factors for adverse postoperative outcomes in patients undergoing surgical interventions, but evidence is lacking. This retrospective study evaluated the effects of HTN and DM, alone or in combination, on postoperative outcomes of elective noncardiac surgery in cancer patients. Methods: Patients (n = 844) with malignancies, who underwent elective surgery at a tertiary hospital, were categorised into healthy (group A, n = 339), hypertensive (group B, n = 357), diabetic (group C, n = 21), and hypertensive and diabetic (group D, n = 127) groups. Preoperatively, all patients had systolic blood pressure ≤ 160 mmHg and plasma glucose level ≤ 140 mg/dl. Postoperative in-hospital morbidity and mortality were compared among groups. Results: Postoperative complications occurred in 22 (6.5%), 21 (5.9%), 2 (9.5%), and 11 (8.7%) patients in groups A, B, C, and D, respectively (p = 0.712). HTN (p = 0.538), DM (p = 0.990), and HTN+DM (p = 0.135) did not impact the occurrence of adverse events. Patients with higher surgical risk (ASA III or IV) and those with longer surgical time had higher morbidity and mortality (p = 0.001, p < 0.001, respectively). In multiple logistic regression analysis, ASA status and surgical time were independent risk factors for postoperative complications (both p < 0.001). Conclusion: Cancer patients with preoperative comorbidities, such as HTN and DM, alone or in combination, regardless of other characteristics, do not have an increased risk of adverse postoperative outcomes.Trial registration: Retrospectively registered.

scholarly journals ECOG and BMI as preoperative risk factors for severe postoperative complications in ovarian cancer patients: results of a prospective study (RISC-GYN—trial)

2021 ◽  
Author(s):  
Melisa Guelhan Inci ◽  
Julia Rasch ◽  
Hannah Woopen ◽  
Kristina Mueller ◽  
Rolf Richter ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ovarian Cancer ◽  
Postoperative Complications ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Patient Characteristics ◽  
Fresh Frozen Plasma ◽  
Physical Status Classification ◽  
Ecog Ps ◽  
The Impact

Abstract Background Accompanying co-morbidities in patients with ovarian cancer are of major relevance for scheduling debulking surgery, especially in the anesthesiological consultations. Aim of this study was to evaluate the impact of co-morbidities and patient characteristics on postoperative complications. Methods Patients undergoing maximal cytoreductive surgery were prospectively enrolled from October 2015 to January 2017. Various variables were recorded, such as the Charlson comorbidity index, Eastern cooperative oncology group scale of performance status (ECOG PS) and the American society of anesthesiologists physical status classification system (ASA PS). Surgical complications were graded using the Clavien–Dindo criteria. Logistic regression models were used to analyze risk factors for severe postoperative complications. Results Of 106 enrolled patients, 19 (17.9%) developed severe postoperative complications grade ≥ IIIb according to Clavien–Dindo criteria. In the multivariable regression analysis impaired (ECOG PS) > 1 (odds ratio OR) 13.34, 95% confidence interval (CI) 1.74–102.30, p = 0.01), body mass index (BMI) > 25 kg/m2 (OR 10.48, 95% CI 2.38–46.02, p = 0.002) along with the use of intraoperative norepinephrine > 0.11 µg/kg/min (OR 4.69, 95% CI 1.13–19.46, p = 0.03) and intraoperative fresh frozen plasma (FFP) > 17 units (OR 4.11, 95% CI 1.12–15.14, p = 0.03) appeared as significant predictors of severe postoperative complications. Conclusion We demonstrated that neither the presence of a certain comorbidity nor the summation of the co-morbidities were associated with adverse outcome. Patient characteristics, such as ECOG PS > 1 and obesity (BMI > 25 kg/m2), are highly predictive factors for severe postoperative complications. The analysis of intraoperative data showed that the need for more than > 0.11 µg/kg/min of norepinephrine and transfusions of FFPs more than 17 units were strongly associated with severe postoperative complications.

scholarly journals Characteristics of and risk factors for death in elderly patients with acute kidney injury: a multicentre retrospective study in China

2018 ◽  
Vol 94 (1111) ◽  
pp. 249-253 ◽  
Author(s):  
Jie-Qiong Liu ◽  
Guang-Yan Cai ◽  
Shuang Liang ◽  
Wen-Ling Wang ◽  
Si-Yang Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Elderly Patients ◽  
Multiple Logistic Regression Analysis ◽  
Significant Risk ◽  
Kidney Injury ◽  
The Elderly ◽  
Younger Patients

Purpose of the studyThe incidence of acute kidney injury (AKI) with a poor prognosis in the elderly has been increasing each year. This study aimed to investigate the clinical characteristics of and risk factors for death from AKI in the elderly and help improve prognosis.Study designThis study was a retrospective cohort study based on data from adult patients (≥18 years old) admitted to 15 hospitals in China between 1 January 2009 and 31 December 2011. The characteristics of AKI in the elderly were compared with those in younger patients.ResultsIn elderly patients with AKI, rates of hypertension, cardiovascular disease and multiple organ dysfunction syndrome (MODS) were higher than in younger patients (44.2% vs 31.2%, 16.1% vs 4.6% and 20.9% vs 16.9%, respectively), the length of ICU stay was longer (3.8 days vs 2.7 days, P=0.019) and renal biopsy (1.0% vs 7.13%, P<0.001) and dialysis (9.6% vs 19.2%, P<0.001) were performed less. Hospital-acquired (HA) AKI was more common than community-acquired (CA) AKI (60.3% vs 39.7%), while the most common cause of AKI was pre-renal (53.5%). Multiple logistic regression analysis showed that age (OR 1.041, 95% CI 1.023 to 1.059), cardiovascular disease (OR 1.980, 95% CI 1.402 to 2.797), cancer (OR 2.302, 95% CI 1.654 to 3.203), MODS (OR 3.023, 95% CI 1.627 to 5.620) and mechanical ventilation (OR 2.408, 95% CI 1.187 to 4.887) were significant risk factors for death.ConclusionsHA-AKI and pre-renal AKI were more common in the elderly. Age, cardiovascular disease, cancer, MODS and mechanical ventilation were independent risk factors for death in the elderly with AKI.

scholarly journals Predictors associated with failure of metronidazole in treatment of clostridium difficile infection in the elderly

2014 ◽  
Vol 67 (suppl. 2) ◽  
pp. 18-23
Author(s):  
Nadica Kovacevic ◽  
Grozdana Canak ◽  
Tomislav Preveden ◽  
Slavica Tomic ◽  
Vedrana Petric ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Treatment Failure ◽  
Clostridium Difficile Infection ◽  
Clinical Symptoms ◽  
Concomitant Administration ◽  
The Elderly ◽  
Albumin Level ◽  
Nosocomial Diarrhea ◽  
Clinical Center

Introduction. Clostridium difficile is the most common infectious cause of nosocomial diarrhea. Recommended treatments for Clostridium difficile infection include metronidazole and vancomycin. Recent investigation has shown an increasing rate of metronidazole treatment failure, particularly among the elderly. The authors studied the outcome of metronidazole therapy for Clostridium difficile infection in patients over 65 years of age and risk factors associated with metronidazole treatment failure. Material and Methods. This retrospective study was performed at the Department of Infectious Diseases, Clinical Center of Vojvodina from January 2011 to January 2014. The study sample included 112 patients, over 65 years of age, diagnosed with Clostridium difficile infection, who were treated with oral metronidazole 400 mg 3 times per day for 10 days. The efficacy of treatment regimen was assessed by resolution of diarrhea and rates of recurrence within 60 days after completion of therapy Results. Metronidazole was administrated to 112 patients over 65 years of age. Treatment with metronidazole resulted in resolution of diarrhea in 78 patients (69.65%). After successful metronidazole treatment, clinical symptoms of Clostridium difficile infection recurred in 28 the patients (36.60%) . Risk factors for metronidazole treatment failure are duration of diarrhea before treatment, leucocytosis >15 000/mm3, albumin level ?25 g/l, serum creatinine level ?200 ?mol/l, increased C-reactive protein, and concomitant administration of antibiotic and immunosuppressives. Conclusion. Our data suggest that patients with predictors of metronidazole treatment failure may benefit from initial oral vancomycin therapy for Clostridium difficile infection.

scholarly journals Increasing Burden of Nursing Care on the Treatment of COVID-19 Patients in the Aging Society: Analyses During the First to the Third Wave of Pandemic in Kyoto City, Japan

2021 ◽  
Vol 8 ◽  
Author(s):  
Kohei Fujita ◽  
Eriko Kashihara ◽  
Osamu Kanai ◽  
Hiroaki Hata ◽  
Akihiro Yasoda ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Nursing Care ◽  
Medical Center ◽  
The Elderly ◽  
Underlying Disease ◽  
Third Wave ◽  
Hospital Organization ◽  
Healthcare Resources ◽  
Aging Society

Background: The coronavirus disease 2019 (COVID-19) pandemic is associated with a heavy burden on patient's mental and physical health, regional healthcare resources, and global economic activity. An aging society such as Japan has many retirement homes and long-term stay hospitals for the elderly and their inhabitants. During the COVID-19 pandemic, disease clusters are often identified in retirement homes and long-term stay hospitals. Although we hypothesize that additional burdens of nursing care for elderly patients will reinforce the anxiety and exhaustion of medical staff and healthcare resources in the aging society, the actual situation is not well understood. In this study, we aimed to evaluate the current situation and countermeasures of the COVID-19 pandemic in the aging society.Methods: We reviewed COVID-19 patients who required hospitalization at the National Hospital Organization Kyoto Medical Center, a 600-bed capacity hospital located in Kyoto, Japan, between 1 April 2020 and 31 March 2021. We assessed the characteristics of the COVID-19 patients, disease severity, duration of hospitalization, outcome at discharge, degree of activities of daily living (ADLs), and complications unique to elderly patients.Results: We enrolled 118 patients who required hospitalization during the study period. Approximately 40% of the patients were aged ≥ 80 years. Dementia (27.1%) was the most prevalent underlying disease, followed by diabetes mellitus (23.7%) and chronic kidney disease (23.7%). Approximately 60% of hospitalized COVID-19 patients had impaired ADL at admission. The COVID-19 patients aged 80 years or older required significantly more longer-term hospitalization than the COVID-19 patients aged under 80 years (15.5 ± 8.2 vs. 13.1 ± 7.7, P = 0.032). In elderly patients aged 80 years or older, approximately 50% of patients had geriatric mental disorders, and approximately 70% had bedridden status and feeding difficulty. Poor ADL at admission was significantly associated with COVID-19 mortality (Odds ratio, 5.6; 95% confidence interval, 1.04–45.2; p-value = 0.044).Conclusions: The proportion of elderly patients aged 80 years or older was relatively high during the hospitalization for COVID-19. Poor ADL at admission in these elderly patients was significantly associated with poor prognosis of COVID-19. We should keep in mind that healthcare workers are forced to have an additional burden of nursing care in the aging society during the COVID-19 pandemic. Therefore, interventions to reduce the burden are urgently required.

Preoperative Albumin Level Serves as a Predictor for Postoperative Pulmonary Complications Following Elective Laparoscopic Gastrectomy

2018 ◽  
Vol 24 (27) ◽  
pp. 3250-3255 ◽  
Author(s):  
Yun Chen ◽  
Guorong Wu ◽  
Ruichun Wang ◽  
Junping Chen
Keyword(s):  
Risk Factors ◽  
Laparoscopic Gastrectomy ◽  
Independent Risk Factor ◽  
Multiple Logistic Regression Analysis ◽  
Albumin Level ◽  
Pulmonary Complications ◽  
Multiple Logistic Regression ◽  
Postoperative Pulmonary Complications ◽  
Potential Risk Factors ◽  
Preoperative Albumin

Objective: Postoperative Pulmonary Complications (PPCs) can contribute to increased mortality and prolonged hospital stay in surgical patients with Gastric Cancer (GC). This study aimed to investigate potential risk factors for PPCs in elderly GC patients following elective laparoscopic gastrectomy. Methods: Eligible consecutive elderly GC patients (aged over 65 years) who were scheduled to undergo elective laparoscopic gastrectomy were enrolled in this study. The demographic, clinicopathological characteristics and laboratory variables were compared in patients with or without PPCs within postoperative 30 days. Risk factors for PPCs were analyzed by multiple logistic regression analysis and receiver operating characteristic (ROC) curve analysis. Results: 35 of all the 262 enrolled patients have developed PPCs with an incidence of 13.4%. Age, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), forced expiratory volume in one second/ forced vital capacity (FEV1/FVC) ratio, duration of operation, hemoglobin, albumin and C-reactive protein (CRP) were potential risk factors for PPCs by univariate analysis. The preoperative albumin level was the only independent risk factor for PPCs (OR: 1.15, 95%CI: 1.06-1.28, P=0.011) by multiple logistic regression analysis. Preoperative albumin level was a predictor for PPCs with an area under the curve (AUC) of 0.728 and a cut-off value of 33.8 mg/dl (specificity: 54.19%, sensitivity: 77.14%, P<0.001). Conclusions: Preoperative albumin level was an independent risk factor for PPCs in elderly GC patients after elective laparoscopic gastrectomy.

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