scholarly journals Management of pertrochanteric fractures in patients over 90 years: In-hospital mortality rate, complications and associated risk factors

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mohamed Ghanem ◽  
Jonas Garthmann ◽  
Anja Redecker ◽  
Annette Brigitte Ahrberg-Spiegl ◽  
Johannes Karl Maria Fakler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Timing Of Surgery ◽  
Control Group ◽  
Study Group ◽  
Old Patients ◽  
Very Old ◽  
Pertrochanteric Fractures ◽  
Significant Difference ◽  
Very Old Patients

Abstract Purpose This study aims primarily to investigate the outcome following surgical management of pertrochanteric fractures of patients over 90 years compared to the outcome of a control group below 90 years under special consideration of the timing of surgery. The second aim was to analyze potential risk factors for early deaths in very old patients. This study allows us to draw conclusions to minimize complications linked to this particular age segment. Methods The study group consisted of very old patients aged 90 years and older. Geriatric patients aged between 60 and 89 years of age were part of the control group. Type A1 pertrochanteric fractures were typically treated by dynamic hip crews, type A2 and A3 fractures by femoral nails. Full weight bearing physiotherapy was initiated on the day after surgery to improve mobility and muscle strength. Results A total of 71 patients belonged to the study group (mean age: 92.5 years ±2.3 years), whereas 223 patients formed the control group (mean age: 79.9 ± 7.4 years). The mortality rate and the number of detected and documented complications were significantly higher in the study group (p = 0.001; p = 0.009, respectively). Despite the significantly higher complication rate in the > 90-year-old patients, there was no significant difference in the mean length of in-hospital-stay between the both groups (> 90 yrs.: 12.1d; < 90 yrs.: 13.1 d) and the timing of surgery. Conclusion The number of co-morbidities, number of daily-administered medications and the time between admission and surgery have no impact on the outcome. We noticed a longer period between admission and surgery in very old patients who survived. Patients with pertrochanteric fractures should be screened for multimorbidity and cognitive disorders in a standardized manner.

scholarly journals Real-world long-term outcomes based on three therapeutic strategies in very old patients with three-vessel disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Deshan Yuan ◽  
Sida Jia ◽  
Ce Zhang ◽  
Lin Jiang ◽  
Lianjun Xu ◽  
...  
Keyword(s):  
Real World ◽  
Cardiac Death ◽  
Artery Bypass ◽  
Therapeutic Strategies ◽  
Old Patients ◽  
Very Old ◽  
Vessel Disease ◽  
Significant Difference ◽  
Very Old Patients

Abstract Background There are relatively limited data regarding real-world outcomes in very old patients with three-vessel disease (3VD) receiving different therapeutic strategies. This study aimed to perform analysis of long-term clinical outcomes of medical therapy (MT), coronary artery bypass grafting (CABG), and percutaneous coronary intervention (PCI) in this population. Methods We included 711 patients aged ≥ 75 years from a prospective cohort of patients with 3VD. Consecutive enrollment of these patients began from April 2004 to February 2011 at Fu Wai Hospital. Patients were categorized into three groups (MT, n = 296; CABG, n = 129; PCI, n = 286) on the basis of different treatment strategies. Results During a median follow-up of 7.25 years, 262 deaths and 354 major adverse cardiac and cerebrovascular events (MACCE) occurred. Multivariate Cox analysis showed that the risk of cardiac death was significantly lower for CABG compared with PCI (adjusted hazard ratio [HR] = 0.475, 95% confidence interval [CI] 0.232–0.974, P = 0.042). Additionally, MACCE appeared to show a trend towards a better outcome for CABG (adjusted HR = 0.759, 95% CI 0.536–1.074, P = 0.119). Furthermore, CABG was significantly superior in terms of unplanned revascularization (adjusted HR = 0.279, 95% CI 0.079–0.982, P = 0.047) and myocardial infarction (adjusted HR = 0.196, 95% CI 0.043–0.892, P = 0.035). No significant difference in all-cause death between CABG and PCI was observed. MT had a higher risk of cardiac death than PCI (adjusted HR = 1.636, 95% CI 1.092–2.449, P = 0.017). Subgroup analysis showed that there was a significant interaction between treatment strategy (PCI vs. CABG) and sex for MACCE (P = 0.026), with a lower risk in men for CABG compared with that of PCI, but not in women. Conclusions CABG can be performed with reasonable results in very old patients with 3VD. Sex should be taken into consideration in therapeutic decision-making in this population.

scholarly journals Risk and Prognostic Factors in Very Old Patients with Sepsis Secondary to Community-Acquired Pneumonia

2019 ◽  
Vol 8 (7) ◽  
pp. 961 ◽  
Author(s):  
Cillóniz ◽  
Dominedò ◽  
Ielpo ◽  
Ferrer ◽  
Gabarrús ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prognostic Factors ◽  
Antibiotic Therapy ◽  
Lower Risk ◽  
Chronic Renal Disease ◽  
Community Acquired Pneumonia ◽  
Old Patients ◽  
Very Old ◽  
Independent Risk Factors ◽  
Very Old Patients

Background: Little is known about risk and prognostic factors in very old patients developing sepsis secondary to community-acquired pneumonia (CAP). Methods: We conducted a retrospective observational study of data prospectively collected at the Hospital Clinic of Barcelona over a 13-year period. Consecutive patients hospitalized with CAP were included if they were very old (≥80 years) and divided into those with and without sepsis for comparison. Sepsis was diagnosed based on the Sepsis-3 criteria. The main clinical outcome was 30-day mortality. Results: Among the 4219 patients hospitalized with CAP during the study period, 1238 (29%) were very old. The prevalence of sepsis in this age group was 71%. Male sex, chronic renal disease, and diabetes mellitus were independent risk factors for sepsis, while antibiotic therapy before admission was independently associated with a lower risk of sepsis. Thirty-day and intensive care unit (ICU) mortality did not differ between patients with and without sepsis. In CAP-sepsis group, chronic renal disease and neurological disease were independent risk factors for 30-day mortality. Conclusion: In very old patients hospitalized with CAP, in-hospital and 1-year mortality rates were increased if they developed sepsis. Antibiotic therapy before hospital admission was associated with a lower risk of sepsis.

scholarly journals Age- and Gender-Specific Prevalence of Risk Factors in Patients with First-Ever Ischemic Stroke in China

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Xiao-ying Yao ◽  
Yan Lin ◽  
Jie-li Geng ◽  
Ya-meng Sun ◽  
Ying Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Heart Diseases ◽  
Vascular Risk ◽  
Age And Gender ◽  
Old Patients ◽  
Very Old ◽  
History Of ◽  
And Gender ◽  
Very Old Patients

Background. Evidences are accumulating that age and gender have great impact on the distribution of stroke risk factors. Such data are lacking in Chinese population.Methods. 1027 patients with first-ever ischemic stroke (IS) were recruited and divided into young adult (<50 years), middle-aged (50∼80 years), and very old (>80 years) groups according to stroke onset ages. Vascular risk factors were collected and compared among groups.Results. Female patients were globally older than male patients at stroke onset and having higher prevalence of diabetes mellitus (DM), heart diseases, and atrial fibrillation (AF). However, females were less likely to drink heavily or smoke than males. Young patients had a much higher proportion of smoking and drinking than middle-aged and very old patients and the highest family history of hypertension, while very old patients had the highest prevalence of heart diseases and AF but lowest proportion of positive family history of vascular diseases. Hypertension and DM were equally frequent among three groups.Conclusion. Our study showed that vascular risk factors had a specific age and gender distribution pattern in Chinese IS patients. Secondary prevention strategy should emphasize on the control of different risk factors based on patient’s age and gender.

Prevalence and risk factors of sepsis in very old patients with CAP

2019 ◽  
Author(s):  
Catia Cilloniz Campos ◽  
Cristina Dominedò ◽  
Antonella Ielpo ◽  
Miquel Ferrer ◽  
Albert Gabarrús ◽  
...  
Keyword(s):  
Risk Factors ◽  
Old Patients ◽  
Very Old ◽  
Very Old Patients

scholarly journals Risk and Prognostic Factors in Very Old Patients with Sepsis Secondary to Community-Acquired pneumonia

2019 ◽  
Author(s):  
Catia Cilloniz ◽  
Cristina Dominedò ◽  
Antonella Ielpo ◽  
Miquel Ferrer ◽  
Albert Gabarrus ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prognostic Factors ◽  
Antibiotic Therapy ◽  
Lower Risk ◽  
Chronic Renal Disease ◽  
Community Acquired Pneumonia ◽  
Old Patients ◽  
Very Old ◽  
Independent Risk Factors ◽  
Very Old Patients

Background: Little is known about risk and prognostic factors in very old patients developing sepsis secondary to community-acquired pneumonia (CAP). Methods: We conducted a retrospective observational study of data prospectively collected at the Hospital Clinic of Barcelona over a 13-year period. Consecutive patients hospitalized with CAP were included if they were very old (&ge;80 years) and divided into those with and without sepsis for comparison. Sepsis was diagnosed based on the Sepsis-3 criteria. The main clinical outcome was 30-day mortality. Results: Among the 4,219 patients hospitalized with CAP during the study period, 1,238 (29%) were very old. The prevalence of sepsis in this aged group was 71%. Male sex, chronic renal disease, and diabetes mellitus were independent risk factors for sepsis, while antibiotic therapy before admission was independently associated with a lower risk of sepsis. Thirty-day and intensive care unit (ICU) mortality did not differ between patients with and without sepsis. In CAP-sepsis group, chronic renal disease and neurological disease were independent risk factors for 30-day mortality. Conclusion: In very old patients hospitalized with CAP, in-hospital and 1-year mortality rates were increased if they developed sepsis. Antibiotic therapy before hospital admission was associated with a lower risk of sepsis.

Escherichia colibacteraemia in adults: age-related differences in clinical and bacteriological characteristics, and outcome

2014 ◽  
Vol 142 (12) ◽  
pp. 2672-2683 ◽  
Author(s):  
C. ROUBAUD BAUDRON ◽  
X. PANHARD ◽  
O. CLERMONT ◽  
F. MENTRÉ ◽  
B. FANTIN ◽  
...  
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Death Rate ◽  
The Elderly ◽  
Age Group ◽  
Old Patients ◽  
Very Old ◽  
Comorbidity Score ◽  
Age Related ◽  
Very Old Patients

SUMMARYTo explore the specificities ofEscherichia colibacteraemia in the elderly, the demographic, clinical and bacteriological characteristics and in-hospital mortality rate of ‘young’ (18–64 years,n = 395), ‘old’ (65–79 years,n = 372) and ‘very old’ (⩾80 years,n = 284) adult patients of the multicentre COLIBAFI cohort study were compared. Clinical and bacteriological risk factors for death were jointly identified by logistic regression and multivariate analysis within each group. ‘Young’ and ‘old’ patients had more comorbidities than ‘very old’ patients (comorbidity score: 1·5 ± 1·3 and 1·6 ± 1·2vs. 1·2 ± 1·2, respectively;P < 0·001), and were more frequently nosocomially infected (22·3% and 23·8%vs. 8·8%, respectively;P < 0·001). ‘Old’ patients had the poorest prognosis (death rate: 16·4%vs.10·4% for ‘young’ and 12·0% for ‘very old’ patients, respectively;P = 0·039). Risk factors for death were age group-specific, suggesting a host–pathogen relationship evolving with age.

scholarly journals Emergent coronary angiography in a 90-plus population – outcomes at 5-years follow-up

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
R Alves Pinto ◽  
T Proenca ◽  
M Martins Carvalho ◽  
S Torres ◽  
C X Resende ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Matched Control ◽  
Left Ventricular ◽  
Multivessel Disease ◽  
Control Group ◽  
Old Patients ◽  
Very Old ◽  
Matched Control Group ◽  
Very Old Patients

Abstract Introduction Elderly people represents a vulnerable and increasing population presenting with acute coronary syndrome (ACS). Several data suggest the benefit of an early revascularization in ST-elevation (STE)-ACS or non-STE-ACS with positive troponin. However questions persist considering the unavoidable adverse prognosis, patient's functional and cognitive status, comorbidities and preferences. Purpose To evaluate a group of very old patients who underwent emergent coronary angiography (CA). Methods We retrospectively analyzed a group of very old patients (≥90 year-old) who underwent emergent CA from January 2008 to September 2020. Clinical features were collected; survival and MACE were compared with an aged-matched control population with ACS not submitted to emergent CA. MACE was defined as a composite of all-cause death, ischemic stroke, ACS or hospitalization for acute heart failure. Results A total of 34 patients were enrolled: 56% female, with mean age 92±2 year-old. As for the cardiovascular risk factors, 88% had hypertension, 49% dyslipidaemia, 12% diabetes and 15% were previous smokers. Concerning other comorbidities, 27% had atrial fibrillation, 21% chronic kidney disease, 12% had cerebrovascular disease and median modified Rankin scale for neurologic disability was 2. Almost all patients had STE-ACS, 68% anterior and 29% inferior, inferolateral or inferoposterior infarction; 3% had infarction of indeterminate location. In CA, 65% had multivessel disease, 14% of them involving left main coronary artery; coronary intervention was performed in 71% of patients (mostly stent implantation), the remaining 29% had no invasive treatment. Concerning to clinical status, median troponin was 131 517 ng/L and median BNP 496 pg/mL; 36% of patients evolved in Killip class III or IV and only 32% of patients had normal left ventricular systolic function. Regarding mortality, 38% of patients died in the index-event versus 25% in the aged-matched control group (p=0.319). During five years of follow-up, there was no significant difference in mortality between the two groups (Log Rank, p=0.403) and more than 50% of patients died in two years. Comparing MACE occurrence, both groups were similar (Log Rank, p=0,662), with more than 80% having at least one event in five years. Conclusion Very old patients submitted to emergent CA had a high percentage of multivessel disease, left ventricular dysfunction and mortality during hospitalization. Compared to an aged-matched control group, they showed no survival or MACE benefit of emergent CA strategy during a five-years follow-up. Although this is a small study, these findings highlight the efforts that should be made to optimize care in this vulnerable population, under-represented in the clinical trials. Special caution should be given to avoid possible unnecessary discomfort in this setting. FUNDunding Acknowledgement Type of funding sources: None. MACE analysis

scholarly journals Clinical characteristics of very old patients hospitalized in internal medicine wards for heart failure: a sub-analysis of the FADOI-CONFINE Study Group

2014 ◽  
Vol 8 (1) ◽  
pp. 19 ◽  
Author(s):  
Paolo Biagi ◽  
Roberto Nardi ◽  
Concetta Isabella Baldo ◽  
Giovanni Scanelli ◽  
Domenico Panuccio ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Heart Failure ◽  
Clinical Characteristics ◽  
Study Group ◽  
Old Patients ◽  
Very Old ◽  
Internal Medicine Wards ◽  
Very Old Patients
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