The Benefits of a Muscle-Sparing Below Knee Amputation in the Elderly Population

2021 ◽  
pp. 153857442110451
Author(s):  
Jared M. Theriot ◽  
Prabhat Bhattarai ◽  
David J. Finlay
Keyword(s):  
Blood Loss ◽  
Elderly Patients ◽  
Blood Supply ◽  
Weight Bearing ◽  
Complete Healing ◽  
Selective Removal ◽  
Knee Amputation ◽  
Age Related ◽  
Estimated Blood Loss ◽  
Muscle Sparing

Background It is well accepted that good muscle coverage of the bones at the end of a below knee amputation (BKA) stump is preferable, for both weight bearing and protection against prosthesis failure. Elderly patients often have atrophy of the leg musculature secondary to age-related physiological changes and decreased use. These patients often have poor coverage and bulk in their stumps after the standard BKA. We propose a selective muscle-sparing approach to these patients, utilizing selective removal of muscle bundles with regard to their blood supply and fascial planes. The surgical method technique along with outcomes of patients undergoing the procedure is presented here. Methods A retrospective chart review was performed to identify patients who had undergone a muscle-sparing BKA from March 2008 to October 2017 by a single surgeon. Estimated blood loss, operative time, and perioperative and postoperative complications were assessed. Results Forty-six patients greater than 60 years of age underwent muscle-sparing BKA procedures. Complete healing was seen in 30 (65%) patients, while 7 (15%) were lost to follow-up and 9 (20%) required conversion to an above knee amputation (AKA). Intraoperative outcomes in our series were notable for an average estimated blood loss (EBL) of 84.3 ml, lower than the traditional BKA (average EBL 150-500 ml), with comparable operative times averaging 131 minutes and as short as 85 minutes (skin incision to dressing). No patients in the cohort required postoperative blood transfusions (day 0–4), significantly less than the reported 3–7 ml/kg body weight blood requirements in similar patient populations. Conclusions The muscle-sparing BKA technique should be considered in elderly patients, where the normally bulky posterior calf muscle mass is lacking. The selective removal of muscle bundles with regard to their blood supply leaves maximum coverage of the bone with decreased potential hematoma formation and blood loss.

Feasibility of robot-assisted radical prostatectomy in elderly patients: Comparative analysis of the peri-surgical/oncological outcomes with younger patients.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 134-134
Author(s):  
Takehiro Iwata ◽  
Takashi Saika ◽  
Kohei Edamura
Keyword(s):  
Comparative Analysis ◽  
Radical Prostatectomy ◽  
Blood Loss ◽  
Elderly Patients ◽  
Robot Assisted ◽  
Younger Patients ◽  
Open Conversion ◽  
Oncological Outcomes ◽  
Elder Patients ◽  
Estimated Blood Loss

134 Background: Robot-assisted radical prostatectomy (RARP) has become one of standard treatments for localized prostate cancer. However, a feasibility of RARP in elderly patients has not been clear yet. We performed a comparative analysis of peri-surgical/oncological outcomes for younger and elderly patients underwent RARP. Methods: We reviewed and compared our initial 340 consecutive patients who underwent RARP from 9/2012 to 8/2015 for peri-surgical outcomes, including surgical times, blood loss, complications, pathological findings, continence recovery, and oncological outcomes stratified by age less than 70 and over 70 years. Results: In our cohort, 202 men were age less than 70 and 138 men were ≥70. Preoperative parameters (age, PSA, Gleason score) were similar in both younger and elder groups. Operative time (median: 167 vs. 171 minutes) and estimated blood loss were similar in both groups. One of elder patients (0.7%) needed transfusion. Peri/post-operative complications in both groups appeared to be minimal with no cases of intra-operative open conversion. One of younger patients needed a surgical settlement for port site herniation. Surgical positive margin rates in organ-confined (pT2) disease were also similar (5.6%, younger vs. 9.0%,elder). Continence at 3 months was 82% in elder patients as opposed to 87% in younger patients. Median follow-up period in in elder patients and younger patients were 15.2 and 15.3 months, respectively. Biochemical recurrence free survival rates in elder patients and younger patients were 89.9% and 93.6%, respectively (p=0.1026). Conclusions: In our study, RARP in elderly patients was relatively safe and yielded good oncologic results. RARP is feasible even in elderly 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 The Influencing Factors of Postoperative Delirium in Elderly Hip Fracture Patients: What Should Treatment Focus On

2021 ◽  
Author(s):  
Chunwen Yan ◽  
Min Yang ◽  
Nasha Niu ◽  
Linmei Li ◽  
Li Pan
Keyword(s):  
Risk Factors ◽  
Hip Fracture ◽  
Blood Loss ◽  
Elderly Patients ◽  
Influencing Factors ◽  
Postoperative Delirium ◽  
Multivariate Logistic Regression Analysis ◽  
Estimated Blood Loss ◽  
Duration Of Surgery ◽  
History Of

Abstract Background: The postoperative delirium is a common yet serious complication in elderly patients with hip fracture, it’s necessary to evaluate the potential risk factors of delirium in patients with hip fracture, to provide reliable evidence to the clinical management of hip fracture.Methods: Elderly patients who underwent hip fracture surgery in our hospital from June 1, 2019 to May 31, 2021 were selected. The characteristics and treatment data of delirium and no delirium patients were collected and compared. Multivariate logistic regression analysis was conducted to analyze the influencing factors affecting postoperative delirium in elderly patients with hip fracture.Results: A total of 245 patients with hip fracture were included, the incidence of postoperative delirium in patients with hip fracture was 13.06%. There were significant differences in the age, BMI, history of delirium, estimated blood loss and duration of surgery (all p<0.05). There were significant differences in the albumin and TSH between delirium and no delirium group(all p<0.05), Logistics analyses indicated that ge≥75y(OR3.112,95%CI1.527~5.742), BMI ≥24 kg/m2(OR2.127,95%CI1.144~3.598), history of delirium(OR1.754,95%CI1.173~2.347), estimated blood loss≥400ml(OR1.698,95%CI1.427~1.946), duration of surgery≥120min(OR2.138,95%CI1.126~3.085), preoperative albumin≤40g/L(OR1.845,95%CI1.102~2.835) and TSH≤2mU/L(OR2.226, 95%CI1.329~4.011) were the independent risk factors of postoperative delirium in patients with hip fracture(all p<0.05).Conclusions: Postoperative delirium is very common in elderly patients with hip fracture, and it was associated with many risk factors, clinical preventions targeted on those risk factors are needed to reduce the postoperative delirium.

Feasibility of robot-assisted radical prostatectomy in elderly patients: Comparative analysis of the perisurgical/oncological outcomes with younger patients.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 111-111
Author(s):  
Noriyoshi Miura ◽  
Osuke Arai ◽  
Ryuta Watanabe ◽  
Yuichiro Sawada ◽  
Seiji Asai ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Radical Prostatectomy ◽  
Blood Loss ◽  
Elderly Patients ◽  
Urinary Continence ◽  
Robot Assisted ◽  
Younger Patients ◽  
Oncological Outcomes ◽  
Elder Patients ◽  
Estimated Blood Loss

111 Background: Robot-assisted radical prostatectomy (RARP) has become one of standard treatments for localized prostate cancer. However, a feasibility of RARP in high elderly patients has not been clear yet. We performed a comparative analysis of peri-surgical / oncological outcomes for younger and elder patients underwent RARP. Methods: We reviewed and compared our 631 consecutive patients who underwent RARP from 9/2012 to 6/2016 for peri-surgical outcomes, including surgical times, blood loss, complications, pathological findings, continence recovery, and oncological outcomes stratified by age less than 75 and over 75 years. Results: In our cohort, 555 men were age less than 75 and 76 men were ≥75. Preoperative parameters (age, PSA, Gleason score) were similar in both younger and high elder groups. Operative time (median: 180 vs. 180 minutes) and estimated blood loss were similar in both groups. One of elder patients (1.4%) needed transfusion. Peri/post-operative complications over grade 3 were 0.9% in younger group and 1.4% in elder group. No case needed intra-operative open conversion. Surgical positive margin rates in organ-confined (pT2) disease were also similar (13.4%, younger vs. 17.9%, elder). Continence at 3 months was 73% in elder patients as opposed to 77% in younger patients. Biochemical recurrences in short follow-up period (median 11.1 vs. 11.0 months) were observed 7.9% in elder patients as opposed 8.3% in younger patients. Conclusions: In our study, although urinary continence recovery in high elderly patients might show a short delay, RARP in high elderly patients was relatively safe and yielded good oncologic results. RARP is feasible even in elderly patients.

Feasibility of robot-assisted radical prostatectomy in high elderly patients: Comparative analysis of the perisurgical/oncological outcomes with younger patients.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 120-120 ◽  
Author(s):  
Noriyoshi Miura ◽  
Terutaka Noda ◽  
Kenichi Nishimura ◽  
Tetsuya Fukumoto ◽  
Yutaka Yanagihara ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Radical Prostatectomy ◽  
Blood Loss ◽  
Elderly Patients ◽  
Robot Assisted ◽  
Younger Patients ◽  
Open Conversion ◽  
Oncological Outcomes ◽  
Elder Patients ◽  
Estimated Blood Loss

120 Background: Robot-assisted radical prostatectomy (RARP) has become one of standard treatments for localized prostate cancer. However, a feasibility of RARP in high elderly patients has not been clear yet. We performed a comparative analysis of peri-surgical / oncological outcomes for younger and elder patients underwent RARP. Methods: We reviewed and compared our 553 consecutive patients who underwent RARP in 3 institutes from 6/2013 to 2/2018 for peri-surgical outcomes, including surgical times, blood loss, complications, pathological findings, continence recovery, and oncological outcomes stratified by age less than 75 and over 75 years. Results: In our cohort, 477 men were age less than 75 and 76 men were ≥75. Preoperative parameters (PSA, T factor) were similar in both younger and high elder groups. But Gleason score was higher in elder group than younger group ( p=0.009). Operative time (median: 232 vs. 212 minutes) and estimated blood loss (median 100 ml vs 100 ml) were similar in both groups. Two of elder patients (3.8%) needed transfusion. Peri/post-operative all grade complications were 1.4%/6.5% in younger group and 3.8%/9.6% in elder group. No case needed intra-operative open conversion. Surgical positive margin rates were also similar (29.5%, younger vs. 23.7%, elder). Both younger patients (93.6%) and elder patients (90.3%) recovered their continence at 12 months. After a median follow-up of 33.0 months, the 3-year PSA-free survival rates were 86.0% for elder patients and 88.9% for younger patients (p>0.05). Conclusions: In our study, RARP in high elderly patients was relatively safe surgical procedure with a limited complication rate, excellent oncologic and continence outcomes. RARP is feasible even in elderly patients.

scholarly journals The Motoric Types of Delirium and Estimated Blood Loss during Perioperative Period in Orthopedic Elderly Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Narei Hong ◽  
Jae-Yong Park
Keyword(s):  
Risk Factors ◽  
Blood Loss ◽  
Elderly Patients ◽  
Perioperative Period ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Text Revision ◽  
Estimated Blood Loss ◽  
Postoperative Time ◽  
Different Characteristics

Background. Delirium is a common and serious syndrome in elderly patients. The hypoactive type of delirium is known to have different characteristics, but further studies are needed to define the specificities of these characteristics. Our study aims at finding specific risk factors, especially estimated blood loss during operations of hyper- and hypoactive delirium in orthopedic elderly patients. Methods. One hundred and seventy-five elderly patients were evaluated using the Confusion Assessment Method (CAM) and the 4th edition text revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Trained psychiatrists interviewed the subjects directly at pre- and postoperative time points. We reviewed medical records after the patients were discharged. Results. Thirty-nine patients (22.3%) were diagnosed with multiple types of delirium, which included 17 hyperactive types (65.9%), 13 hypoactive types (33.3%), and 9 mixed types (23.1%). Although the mean estimated blood loss in patients with either hyper- or hypoactive symptoms was larger than in patients lacking these symptoms, the odds ratio was only significant in patients with hyperactive symptoms. In addition, age, preoperative daily function, and preoperative hyponatremia were found to be risk factors for hyperactive but not hypoactive symptoms. Conclusion. Patients with hypoactive symptoms had different risk factors than patients with hyperactive symptoms of delirium. The estimated blood loss, well-known risk factors for delirium, might be risk factors for only hyperactive delirium. The acute precipitating factors seemed to show stronger correlation with the hyperactive type of delirium than with the hypoactive type.

scholarly journals Cementless Bipolar Hemiarthroplasty Compared With Proximal Femoral Nail Anti-rotation of Unstable Intertrochanteric Fractures in Senile Patients With Osteoporosis: a Retrospective Study

2021 ◽  
Author(s):  
Chengkui Cai ◽  
Liying Tian ◽  
Zhihui Chen ◽  
Pengcheng Sun ◽  
Guozhu Wang
Keyword(s):  
Blood Loss ◽  
Elderly Patients ◽  
Weight Bearing ◽  
Perioperative Period ◽  
Fracture Site ◽  
Hospital Length Of Stay ◽  
Implant Design ◽  
Blood Transfusions ◽  
Bipolar Hemiarthroplasty ◽  
Intertrochanteric Fractures

Abstract Background: Implant design for the correction of osteoporotic unstable intertrochanteric fractures in elderly patients is a controversial issue. Our study aims to compare the efficacy of PFNA and cementless bipolar hemiarthroplasty (CBH) in treating osteoporotic unstable intertrochanteric fractures in the elderly.Methods: We retrospectively assessed 52 elderly patients, aged > 70 years old, with intertrochanteric fractures (AO/OTA 31-A2 fractures) from 2014 to 2019. Among them, 24 patients received PFNA and 28 patients received CBH, accompanied with 2-year follow-ups. Additionally, the efficacy difference between the two implants was compared.Results: Both groups had similar general variables like age, gender, fracture site, degree of osteoporosis, fracture classification, ASA score, basic diseases, preoperative preparation time, anesthesia mode, along with postoperative blood transfusions and postoperative complications (P>0.05). Conversely, significant differences were observed among intraoperative variables (amount of blood loss, amount of blood transfusions, operative time, number of intraoperative fluoroscopy), postoperative variables (amount of blood loss, weight-bearing time out of bed, hospital length of stay), and Harris hip function score within 6 months of operation (P<0.05).Conclusions: CBH showed no obvious advantage over PFNA in the perioperative period in elderly patients with osteoporotic unstable intertrochanteric fractures. However, the joint replacement allowed for earlier ambulation after the operation and rapid recovery of the hip joint function.

Primary Long Distal Fitting Bipolar Hemiarthroplasty for Unstable Intertrochanteric Fracture in Elderly Patients

2020 ◽  
Author(s):  
Reza Zandi ◽  
Amin Karimi ◽  
Mehrdad Sadighi ◽  
Mohammadreza Minator-Sajjadi ◽  
Mohammad Ali Okhovatpour ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Femoral Fracture ◽  
Intertrochanteric Fracture ◽  
Weight Bearing ◽  
Operation Time ◽  
Harris Hip Score ◽  
Bipolar Hemiarthroplasty ◽  
Intertrochanteric Femoral Fracture ◽  
Estimated Blood Loss ◽  
Unstable Intertrochanteric Fracture

Background: Intertrochanteric fracture in elderly patients is a frequent problem and is becoming more prominent as the proportion of this injury increases. The ideal treatment for an unstable intertrochanteric femoral fracture in senile osteoporotic patients remains controversial. Methods: Seventy-five patients (over 70 years of age) with unstable intertrochanteric fractures were randomized into three groups and treated with three different procedures including long-stem bipolar hemiarthroplasty, proximal femoral nail (PFN), and dynamic hip screw (DHS). Estimated blood loss, duration of the operation, time of full weight-bearing, and Harris Hip Score (HHS) were determined for each patient. Results: Surgical time was longer in hemiarthroplasty group, but the HHS and time from surgery to mobilization in these patients were significantly superior to the two other groups. PFN group had the lowest bleeding volume during surgery. Revision surgery was lower in hemiarthroplasty compared to the internal fixation, although it was not statistically significant. Conclusions: In elderly patients with an unstable intertrochanteric femoral fracture who cannot tolerate long immobilization time, primary long distal fitting bipolar hemiarthroplasty is a valid treatment option for faster mobilization, good clinical efficacy, and satisfactory functional outcome.

scholarly journals Risk Factors for Delirium After Spine Surgery in Extremely Elderly Patients Aged 80 Years or Older and Review of the Literature: Japan Association of Spine Surgeons with Ambition Multicenter Study

2017 ◽  
Vol 7 (6) ◽  
pp. 560-566 ◽  
Author(s):  
Kazuyoshi Kobayashi ◽  
Shiro Imagama ◽  
Kei Ando ◽  
Naoki Ishiguro ◽  
Masaomi Yamashita ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Blood Loss ◽  
Elderly Patients ◽  
Spine Surgery ◽  
Multicenter Study ◽  
Odds Ratio ◽  
Postoperative Delirium ◽  
Cervical Lesion ◽  
Estimated Blood Loss

Study Design: Retrospective database analysis. Objective: Spine surgeries in elderly patients have increased in recent years due to aging of society and recent advances in surgical techniques, and postoperative complications have become more of a concern. Postoperative delirium is a common complication in elderly patients that impairs recovery and increases morbidity and mortality. The objective of the study was to analyze postoperative delirium associated with spine surgery in patients aged 80 years or older with cervical, thoracic, and lumbar lesions. Methods: A retrospective multicenter study was performed in 262 patients 80 years of age or older who underwent spine surgeries at 35 facilities. Postoperative complications, incidence of postoperative delirium, and hazard ratios of patient-specific and surgical risk factors were examined. Results: Postoperative complications occurred in 59 of the 262 spine surgeries (23%). Postoperative delirium was the most frequent complication, occurring in 15 of 262 patients (5.7%), and was significantly associated with hypertension, cerebrovascular disease, cervical lesion surgery, and greater estimated blood loss ( P < .05). In multivariate logistic regression using perioperative factors, cervical lesion surgery (odds ratio = 4.27, P < .05) and estimated blood loss ≥300 mL (odds ratio = 4.52, P < .05) were significantly associated with postoperative delirium. Conclusions: Cervical lesion surgery and greater blood loss were perioperative risk factors for delirium in extremely elderly patients after spine surgery. Hypertension and cerebrovascular disease were significant risk factors for postoperative delirium, and careful management is required for patients with such risk factors.

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