Protocol for evaluation of perioperative risk in patients aged over 75 years: Aged Patient Perioperative Longitudinal Evaluation–Multidisciplinary Trial (APPLE-MDT study)

Abstract Background With the extended life expectancy of the Chinese population and improvements in surgery and anesthesia techniques, the number of aged patients undergoing surgery has been increasing annually. However, safety, effectiveness, and quality of life of aged patients undergoing surgery are facing major challenges. In order to standardize the perioperative assessment and procedures, we have developed a perioperative evaluation and auxiliary decision-making system named “Aged Patient Perioperative Longitudinal Evaluation–Multidisciplinary Trial (APPLE-MDT)”. Methods We will conduct a perioperative risk evaluation and targeted intervention, with follow-ups at 1, 3, and 6 months after surgery. The primary objective of the study is to evaluate the effectiveness of the “Aged Patient Perioperative Longitudinal Evaluation-Multiple Disciplinary Trial Path” (hereinafter referred to as the APPLE-MDT path) in surgical decision-making for aged patients (≥75 years) undergoing elective surgery under non-local anesthesia in the operating room. The secondary objectives of the study are to evaluate the postoperative outcome and health economics of the APPLE-MDT path applied to the surgical decision-making of aged patients (≥75 years) undergoing elective surgery under non-local anesthesia and to optimize intervention strategies for aged patients undergoing surgery to reduce the occurrence of postoperative complications and improve the quality of life after surgery. Discussion It is necessary to formulate a reliable, effective, and concise evaluation tool, which can effectively predict the perioperative complications and mortality of aged patients, support targeted intervention strategies, and allow for a more comprehensive risk and benefit analysis, thereby forming an effective senile perioperative surgery management path. It is expected that the implementation of this protocol can reduce the occurrence of postoperative complications, improve the postoperative quality of life, shorten hospital stay, reduce hospitalization expenses, reduce social burden, and allow the elderly to have a good quality of life after surgery. Trial registration ChiCTR, ChiCTR1800020363, Registered 15 December 2018.

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Neurosurgery concepts: Key perspectives on endoscopic versus microscopic resection for pituitary adenomas, surgical decision-making in tuberculum sellae meningiomas, optic nerve mobilization during resection of craniopharyngiomas, and evaluation of headache and quality of life after endoscopic transphenoidal surgery for pituitary adenomas

Surgical Neurology International ◽

10.4103/sni.sni_17_17 ◽

2017 ◽

Vol 8 (1) ◽

pp. 52 ◽

Cited By ~ 2

Author(s):

Isaac Yang ◽

AnandV Germanwala ◽

Ryan Hofler ◽

Carlito Lagman ◽

LawranceK Chung ◽

...

Keyword(s):

Quality Of Life ◽

Decision Making ◽

Optic Nerve ◽

Pituitary Adenomas ◽

Surgical Decision ◽

Tuberculum Sellae ◽

Surgical Decision Making

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Sexual function, anxiety, and surgical decision making in BRCA mutation carriers.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e21572 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e21572-e21572

Author(s):

Matthew T. Oliver ◽

Rebecca Kwait ◽

Jessica Kent Laprise ◽

Jennifer Scalia Wilbur ◽

Sarah Spinette ◽

...

Keyword(s):

Quality Of Life ◽

Decision Making ◽

Brca Mutation ◽

Hormone Replacement ◽

Prophylactic Surgery ◽

Surgical Decision ◽

Mutation Carriers ◽

Brca Mutation Carriers ◽

Surgical Decision Making

e21572 Background: To describe BRCA mutation carriers’ perspectives on quality of life from prophylactic surgical decision making. Methods: A cross-sectional survey of BRCA mutation carriers identified from a genetic counseling database at an academic women’s oncology program was conducted using Research Electronic Data Capture. Survey items included Female Sexual Function Index (FSFI), Hospital Anxiety and Depression Scale, and investigator-generated questions. Statistical analysis was performed using Fisher’s exact test and Wilcoxon rank-sum or Kruskal-Wallis tests. Results: 66 BRCA mutation carriers completed the survey (39% response rate) with a median age of 50 (range 18 to 79); 23% of respondents were pre- or perimenopausal and 11% reported a history of ovarian/fallopian tube cancer. Overall, 25% of respondents reported anxiety regarding the timing of bilateral salpingo-oophorectomy (BSO) or mastectomy. Women who had a BSO were less likely to be sexually active and had lower total FSFI scores, with arousal and desire approaching significance compared to women without BSO (p = 0.05). Women who had a BSO had slightly higher median total anxiety scores, but were not more likely to have abnormal levels of anxiety. Women who were < 40 years of age at discovery of mutation were more likely to have had a discussion regarding preimplantation genetic diagnosis (p < 0.0001), more likely to have anxiety regarding prophylactic surgery and childbearing (p < 0.0001), and more likely to say BRCA mutation impacted their decisions about childbearing (p = 0.001) compared to women > 40. 57% of women age 18-39 at time of mutation diagnosis delayed BSO for childbearing as compared to none of the women > 40 (p < 0.0001). Only 20% of the pre- or perimenopausal women used hormone replacement therapy after BSO. Conclusions: BRCA mutation carriers face challenging decisions concerning prophylactic surgical management. Counseling sessions often focus on effective risk reducing surgeries but may not directly address other emotional and physical consequences of prophylactic surgery. Counseling regarding use of hormone replacement therapy is an area identified in this study that may improve quality of life issues seen in women undergoing prophylactic BSO.

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NIMG-38. QUALITY OF SURGICAL DECISION MAKING FOR PATIENTS WITH A GLIOBLASTOMA IS SIMILAR BETWEEN NEURO-ONCOLOGICAL CARE TEAMS FROM THE UNITED STATES OF AMERICA AND THE NETHERLANDS

Neuro-Oncology ◽

10.1093/neuonc/nox168.613 ◽

2017 ◽

Vol 19 (suppl_6) ◽

pp. vi150-vi150

Author(s):

Domenique M J Müller ◽

Pierre Robe ◽

Seunggu J Han ◽

Frederik Barkhof ◽

William Peter Vandertop ◽

...

Keyword(s):

United States ◽

Decision Making ◽

The Netherlands ◽

United States Of America ◽

The United States ◽

Surgical Decision ◽

Oncological Care ◽

Surgical Decision Making

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Preoperative Falls and Their Association with Functional Dependence and Quality of Life

Anesthesiology ◽

10.1097/aln.0000000000001167 ◽

2016 ◽

Vol 125 (2) ◽

pp. 322-332 ◽

Cited By ~ 5

Author(s):

Vanessa L. Kronzer ◽

Rose D. Tang ◽

Allison P. Schelble ◽

Arbi Ben Abdallah ◽

Troy S. Wildes ◽

...

Keyword(s):

Quality Of Life ◽

Odds Ratio ◽

Response Rate ◽

Elective Surgery ◽

Functional Dependence ◽

Age Groups ◽

Poor Quality ◽

Aged Patients ◽

History Of

Abstract Background No study has rigorously explored the characteristics of surgical patients with recent preoperative falls. Our objective was to describe the essential features of preoperative falls and determine whether they are associated with preoperative functional dependence and poor quality of life. Methods This was an observational study involving 15,060 surveys from adult patients undergoing elective surgery. The surveys were collected between January 2014 and August 2015, with a response rate of 92%. Results In the 6 months before surgery, 26% (99% CI, 25 to 27%) of patients fell at least once, and 12% (99% CI, 11 to 13%) fell at least twice. The proportion of patients who fell was highest among patients presenting for neurosurgery (41%; 99% CI, 36 to 45%). At least one fall-related injury occurred in 58% (99% CI, 56 to 60%) of those who fell. Falls were common in all age groups, but surprisingly, they did not increase monotonically with age. Middle-aged patients (45 to 64 yr) had the highest proportion of fallers (28%), recurrent fallers (13%), and severe fall-related injuries (27%) compared to younger (18 to 44 yr) and older (65+ yr) patients (P < 0.001 for each). A fall within 6 months was independently associated with preoperative functional dependence (odds ratio, 1.94; 99% CI, 1.68 to 2.24) and poor physical quality of life (odds ratio, 2.18; 99% CI, 1.88 to 2.52). Conclusions Preoperative falls might be common and are possibly often injurious in the presurgical population, across all ages. A history of falls could enhance the assessment of preoperative functional dependence and quality of life.

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