Can preoperative assessment of cancer in the elderly (PACE) predict 30-days postoperative outcomes?

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8537-8537 ◽  
Author(s):  
R. A. Audisio ◽  
H. S. Ramesh ◽  
R. Gennari ◽  
G. Corsini ◽  
M. Maffezzini ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Regression Models ◽  
Elective Surgery ◽  
Univariate Analysis ◽  
Preoperative Assessment ◽  
The Elderly ◽  
Postoperative Outcomes ◽  
Stepwise Logistic Regression ◽  
Short Term ◽  
Surgical Morbidity

8537 Background: Surgery is the treatment of choice for solid cancers. Frequent functional impairment/comorbidities in the elderly enhances the risk of treatment related complications. Inability to forecast short term outcomes after cancer surgery in elderly affects clinical practice, denying optimal treatment. No validated instrument is available to help make informed decision; a compilation of validated questionnaires (PACE) is established to preoperatively inform on the health condition of elderly cancer pts. This international multicentre study investigates how components of PACE preoperatively assessed are associated with postoperative outcomes. Methods: A prospective series of consenting elderly cancer pts (≥70 yrs) receiving elective surgery (moderate-major+) were recruited from 8 hospitals (UK, Netherlands, Italy, Japan, Belgium) (07/2003–12/2005) and assessed using PACE (Comorbidities, IADL, ADL, GDS, BFI, PS, MMS, ASA). 30day morbidity, hospital stay and mortality were recorded. Results: 448 pts [breast (48%), GI (30%), GU (16%), miscellaneous (6%)] were recruited and followed postoperatively. Observed morbidity was 36% (161 pts), mortality 4% (16 pts) and median hospital stay was 5 days (range 2 -10). All components of PACE but ASA were associated with morbidity (p<0.05) and hospital stay (p<0.05) on univariate analysis. Operative deaths were too few to look for associations. Forward stepwise logistic regression models (multivariate analysis) identified 3 components of PACE as best describing the occurrence of post-surgical morbidity: BFI (OR (upper quartile)= 2.4; 95% CI=1.2–4.9); PS (OR=1.9; 95% CI=1.1–3.4); IADL (OR=1.7; 95% CI=1.0–3.0). The same components were also selected into the model as best describing hospital stay beyond average: BFI (OR (upper quartile)=18.1; 95% CI=7.2–45.3), PS (OR=2.2; 95%=1.2–4.4) and IADL (OR=2.7; 95% CI=1.4–5.1). Of those pts exposed to all 3 factors entered into the regression models 61% experienced complications and >80% had a longer hospital stay. Conclusions: BFI, PS and IADL appear to be the most relevant prognosticators of short term surgical outcomes. A holistic appraisal of elderly pts undergoing surgery is warmly recommended when consenting the patient and during the decision making process. No significant financial relationships to disclose.

Goal-directed Intraoperative Fluid Administration Reduces Length of Hospital Stay after Major Surgery

2002 ◽  
Vol 97 (4) ◽  
pp. 820-826 ◽  
Author(s):  
Tong J. Gan ◽  
Andrew Soppitt ◽  
Mohamed Maroof ◽  
Habib El-Moalem ◽  
Kerri M. Robertson ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Hospital Stay ◽  
Elective Surgery ◽  
Length Of Hospital Stay ◽  
Postoperative Hospital Stay ◽  
Fluid Administration ◽  
Major Surgery ◽  
Control Group ◽  
Surgical Morbidity ◽  
Protocol Group

Background Intraoperative hypovolemia is common and is a potential cause of organ dysfunction, increased postoperative morbidity, length of hospital stay, and death. The objective of this prospective, randomized study was to assess the effect of goal-directed intraoperative fluid administration on length of postoperative hospital stay. Methods One hundred patients who were to undergo major elective surgery with an anticipated blood loss greater than 500 ml were randomly assigned to a control group (n = 50) that received standard intraoperative care or to a protocol group (n = 50) that, in addition, received intraoperative plasma volume expansion guided by the esophageal Doppler monitor to maintain maximal stroke volume. Length of postoperative hospital stay and postoperative surgical morbidity were assessed. Results Groups were similar with respect to demographics, surgical procedures, and baseline hemodynamic variables. The protocol group had a significantly higher stroke volume and cardiac output at the end of surgery compared with the control group. Patients in the protocol group had a shorter duration of hospital stay compared with the control group: 5 +/- 3 versus 7 +/- 3 days (mean +/- SD), with a median of 6 versus 7 days, respectively ( = 0.03). These patients also tolerated oral intake of solid food earlier than the control group: 3 +/- 0.5 versus 4.7 +/- 0.5 days (mean +/- SD), with a median of 3 versus 5 days, respectively ( = 0.01). Conclusions Goal-directed intraoperative fluid administration results in earlier return to bowel function, lower incidence of postoperative nausea and vomiting, and decrease in length of postoperative hospital stay.

scholarly journals C2 Versus C3 as the Upper Instrumented Vertebra for Cervicothoracic Posterior Laminectomy and Fusion Demonstrate Equivalent Postoperative Outcomes

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Ryan K Badiee ◽  
Andrew Kai-Hong Chan ◽  
Joshua Rivera ◽  
Chih-Chang Chang ◽  
Dean Chou ◽  
...  
Keyword(s):  
Univariate Analysis ◽  
Hospital Length ◽  
Postoperative Outcomes ◽  
Hospital Length Of Stay ◽  
Short Term ◽  
Radiographic Outcomes ◽  
Baseline Characteristics ◽  
Upper Instrumented Vertebra ◽  
Upper Thoracic ◽  
Laminectomy And Fusion

Abstract INTRODUCTION For patients undergoing posterior cervical laminectomy and fusion (PCLF) with an upper thoracic lower instrumented vertebra (LIV), the evidence is unclear as to whether C2 vs C3 is the ideal upper instrumented vertebra (UIV). This study analyzes short-term postoperative outcomes for PCLF comparing cervicothoracic constructs with UIV at C2 and C3. METHODS Adult patients with degenerative cervical spine disease undergoing PCLF from 2012 to 2018 at a single center were identified. Patients with UIV at C2 or C3 and a lower instrumented vertebra (LIV) at T1 or T2 were included. Univariate analysis was performed using Student's t-test, Chi-squared test, or Fisher's exact test. Multivariate regression including variables significant at P = .20 determined the effect of UIV on clinical and radiographic outcomes. RESULTS A total of 74 patients were included, of whom 30 (40.5%) and 44 (59.5%) had a UIV at C2 and C3, respectively. Mean follow-up time was 13.8 mo. Baseline characteristics including age (C2 62.4 vs C3 63.0, P = .80) and preoperative Nurick score (C2 2.3 vs C3 2.2, P = .57) were similar across groups, though the C2 UIV group had a higher rate of revision surgery (23.3% vs 2.7%, P = .006) and diabetes (40.0% vs 9.1%, P = .003). Multivariate analysis of clinical outcomes showed no significant differences, including in the rate of postoperative complications (OR: 1.5, P = .62), discharge home (OR: 1.2, P = .35), hospital length of stay (ß = −1.17 d, P = .28) or Nurick score (ß = −0.46, P = .22). Differences in radiographic outcomes including postoperative cervical lordosis (ß = −7.4 degrees, P = .09) and cSVA (ß = −8.9 degrees, P = .08) approached but did not reach significance. CONCLUSION In a study of PCLF with upper thoracic LIV, there were no significant short-term clinical or radiographic differences between a C2 and C3 UIV when adjusting for baseline characteristics. These results may aid surgeons considering PCLF for degenerative cervical spinal disease.

scholarly journals Short-Term Postoperative Outcomes between 4% Icodextrin Solution and Hyaluronic Acid- Carboxymethyl Cellulose Membrane during Emergency Cesarean Section

2019 ◽  
Vol 8 (8) ◽  
pp. 1249 ◽  
Author(s):  
Kuan-Sheng Lee ◽  
Jian-Pei Huang
Keyword(s):  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Postoperative Outcomes ◽  
Pelvic Surgery ◽  
Cellulose Membrane ◽  
Cesarean Sections ◽  
Short Term ◽  
Emergency Cesarean ◽  
Infected Wounds ◽  
Elective Cesarean

Emergency cesarean sections are associated with more postoperative complications than with elective cesarean sections. Seprafilm and Adept are commonly used adhesion reduction devices and have been applied in abdominal or pelvic surgery for a long time. This study focuses on comparing the short-term postoperative outcomes of emergency cesarean sections between two groups. We performed a retrospective study that included all patients who received emergency caesarean sections from the same surgeon at MacKay Memorial Hospital between August 2014 and November 2017, We analyzed the overall cases and conducted a subgroup analysis of cases with contaminated or dirty/infected wounds in regard to the rates of surgical-site infection (SSI), bandemia, delayed flatus passage, and length of hospital stay. The two groups were similar with respect to the rates of SSI, bandemia, and length of hospital stay. However, Seprafilm was associated with higher risk of delayed flatus passage over 48 h (OR: 2.67, 95% CI = 2.16–7.64, p = 0.001). It also needs less time for recovery of the digestive system and less medical management postoperatively. In cases of contaminated or dirty/infected wounds, Adept user also had significantly lower rates (10.3% vs. 32%, p = 0.048, OR: 4.12, CI = 1.09–15.61) of postcesarean metritis.

O148 SHORT-TERM RESULTS OF A RANDOMIZED CONTROLLED TRIAL OF STANDARD VS. PROLONGED TIME TO SURGERY AFTER NEOADJUVANT CHEMORADIATION FOR CANCER

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
K Nilsson ◽  
F Klevebro ◽  
E Szabo ◽  
I Halldestam ◽  
E Johnsson ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Postoperative Mortality ◽  
Length Of Hospital Stay ◽  
Postoperative Outcomes ◽  
Standard Group ◽  
Median Length ◽  
Short Term ◽  
Time To Surgery ◽  
Prolonged Time ◽  
Significant Difference

Abstract Aim The aim of this study was to clarify if prolonged time to surgery (TTS) improves postoperative outcomes in the curative intended treatment of an junctional cancer. Background & Methods sophagectomy is conventionally performed 4-6 weeks after completed neoadjuvant chemoradiotherapy (nCRT). However, studies have shown that prolonged TTS might be favourable. A randomized multicentre clinical trial was performed with allocation to 4-6 or 10-12 weeks between finished nCRT and surgery. All patients received nCRT according to CROSS. Primary outcome of thstudy was postoperative. Smortality, need for intensive care, and length of hospital stay. Results The study randomized 248 patients, 202have to date undergone esophagectomy 98 patients were allocated to prolonged TTS, and the groups were well matched concerning baseline characteristics. Postoperative complications were reported in 106 patients (52.5%).There was no difference in postoperative Clavien-Dindo score.In the standardgroup 17 (16.4%) patients had anastomotic leak compared to 19 (19.4%) in the prolongedgroup (P=0.572). Conduit necrosis was reported in 9 (4.5%) patients, esophago-bronchial fistula in 1 (0.5%) patient,chyle leak in 5 (2.5%) neumoni in 54 (26.7%) patients and respiratory insufficiency in 36 (17.8%) patients without significant difference . In the standard group 5 (4.8%) patients had postoperative mortality due to a complication, compared to 2 (2.0%) patients in the prolonged group (P=0.446). Median length of hospital stay was 14 days in the standard group and 17.5 days in the prolonged group (P=0.040). Conclusion In this we found no significant differences in postoperative mortality comparing standard to prolonged TTS after nCRT. Although, an observandum is that the median length of hospital stay was significantly longer in the prolonged group. We need to compare response and survival to properly evaluate prolonged TTS, but these results suggest that timing is not cardinal in short-term postoperative outcomes.

scholarly journals Primary Anastomosis Versus End-Ostomy in Left-Sided Colonic and Proximal Rectal Cancer Surgery in the Elderly Dutch Population: A Propensity Score Matched Analysis

2021 ◽  
Author(s):  
Yu Ting van Loon ◽  
Felice N. van Erning ◽  
Huub A. Maas ◽  
Laurents P. S. Stassen ◽  
David D. E. Zimmerman
Keyword(s):  
Propensity Score ◽  
The Netherlands ◽  
Elderly Patients ◽  
Primary Anastomosis ◽  
Relative Survival ◽  
The Elderly ◽  
Postoperative Outcomes ◽  
Short Term ◽  
Term Survival ◽  
Surgery In Elderly

Abstract Background Primary anastomosis (PA) in left-sided colorectal cancer (CRC) surgery in elderly patients is disputed. The aim of our study was to evaluate the differences in postoperative outcomes after left-sided CRC surgery in elderly patients in The Netherlands, comparing patients with PA and those who underwent end-ostomy (EO). Method Patients aged ≥ 75 years with stage I–III left-sided CRC, diagnosed and surgically treated in 2015–2017 were selected from the Netherlands Cancer Registry (n = 3286). Postoperative outcomes, short-term (30-, 60-, and 90-day) mortality and 3-year overall and relative survival were analyzed, stratified by surgical resection with PA versus EO. Propensity score matching (PSM) and multivariable logistic regression analysis were conducted. Results Patients with higher age, higher American Society of Anesthesiologists classification and higher tumor stage, a perforation, ileus or tumor located in the proximal rectum, and after open or converted surgery were more likely to receive EO. No difference in anastomotic leakage was seen in PA patients with or without defunctioning stoma (6.2% vs. 7.0%, p = 0.680). Postoperative hospital stay was longer (7.0 vs. 6.0 days, p < 0.0001) and more often prolonged (19% vs. 13%, p = 0.03) in EO patients. Sixty-day mortality (2.9% vs. 6.4%, p < 0.0001), 90-day mortality (3.4% vs. 7.7%, p < 0.0001), and crude 3-year survival (81.2% vs. 58.7%, p < 0.0001) were significantly higher in EO patients, remaining significant after multivariable and PSM analysis. Conclusion There are significant differences between elderly patients after left-sided CRC surgery with PA versus EO in terms of postoperative length of stay, short-term survival, 3-year overall survival, and relative survival at disadvantage of EO patients. This information could be important for decision making regarding surgical treatment in the elderly.

scholarly journals Spinal anaesthesia in elderly for laparoscopic cholecystectomy

2018 ◽  
Vol 6 (3) ◽  
pp. 83-89
Author(s):  
Binod Gautam
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
General Anaesthesia ◽  
Spinal Anaesthesia ◽  
Univariate Analysis ◽  
The Elderly ◽  
Abdominal Pressure ◽  
Co Morbidity ◽  
Conversion To Open Cholecystectomy ◽  
Operative Complications

Background: Prevalence of aging patients appearing for laparoscopic cholecystectomy to treat cholelithiasis is ever on the rise. Associated co-morbidities make the elderly prone to peri-operative complications during laparoscopic cholecystectomy performed under general anaesthesia.Objectives: This study aims to assess the safety and applicability of spinal anaesthesia for the elderly undergoing laparoscopic cholecystectomy.Methodology: In this cross-sectional study, fifty-four patients of age 65 years or more undergoing laparoscopic cholecystectomy were studied. Hyperbaric Bupivacaine 15 milligrams was used in spinal anaesthesia to obtain sensory block to fifth thoracic dermatome. Local anaesthetics were instilled intra-peritoneally before surgical dissection. Surgery was performed through three ports with carbon dioxide pneumoperitoneum at eight mmHg intra-abdominal pressure. Data included demography, co-morbidities, need for analgesics or general anaesthesia, operative and post-operative complications and hospital stay. Univariate analysis for peri-operative events and bivariate analysis for outcome and explanatory variables were done.Results: The mean age was 71.4 years with co-morbidity in 40 patients. Conversion to open cholecystectomy occurred in three patients necessitating general anaesthesia. Surgery was completed laparoscopically under spinal anaesthesia in remaining 51 patients. Increment in intra-abdominal pressure was required in five patients. Six patients needed analgesics for shoulder pain. Intra-operative hypotension and shivering occurred in 15 and four patients respectively. Post-operatively, urinary retention and nausea occurred in four and three patients respectively. Mean hospital stay was 3.2 days.Conclusion: There is no undue risk in spinal anaesthesia for conducting laparoscopic cholecystectomy in the elderly and it is efficient for uncomplicated cholelithiasis with minimal modifications in surgical technique.

525 SURGICAL MORBIDITY AND MORTALITY FROM THE NEORESII TRIAL: STANDARD VS. PROLONGED TIME TO SURGERY AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR ESOPHAGEAL CANCER

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
K Nilsson ◽  
F Klevebro ◽  
I Rouvelas ◽  
M Lindblad ◽  
E Szabo ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Esophagogastric Junction ◽  
Neoadjuvant Chemoradiotherapy ◽  
Postoperative Mortality ◽  
Length Of Hospital Stay ◽  
Postoperative Outcomes ◽  
Complication Rates ◽  
Surgical Morbidity ◽  
Carcinoma Of The Esophagus ◽  
Time To Surgery

Abstract   For carcinoma of the esophagus or esophagogastric junction the time to surgery (TTS) has traditionally been 4-6 weeks after completed neoadjuvant chemoradiotherapy (nCRT). However, the optimal timing is not known. A majority of previous non-randomized studies addressing this issue, have not detected any significant differences in complication rates comparing patients operated with standard TTS compared to prolonged TTS. The aim of this sub-study was to investigate if prolonged TTS after completed nCRT improves postoperative outcomes. Methods A multicenter clinical trial was performed with randomized allocation to standard TTS (4–6 weeks) or prolonged TTS (10–12 weeks). All patients received nCRT according to the CROSS regimen. Patients were enrolled between 2015–2019 from 10 University Hospitals in Sweden, Norway and Germany. The primary endpoint of this sub-study was overall postoperative complications defined as Clavien-Dindo grade II-V. Secondary endpoints included complication severity according to Clavien-Dindo grade IIIb-V, postoperative 90-day mortality and length of hospital stay. The study was registered in Clinicaltrials.gov (NCT02415101). Results In total 248 patients were randomized. There were no significant differences between standard TTS and prolonged TTS regarding overall complications Clavien-Dindo II-V (59.0% vs. 69.8%, P = 0.092) or Clavien-Dindo IIIb-V (31.6% vs. 35.0%, P = 0.603). Furthermore, there were no significant differences regarding anastomotic leak (P = 0.601), conduit necrosis (P = 0.524), chyle leak (P = 0.427), pneumonia (P = 0.548) or respiratory failure (P = 0.723). The 90-day postoperative mortality was 4.3% (5 patients) in the standard TTS, and 3.8% (4 patients) in the prolonged TTS arm (P = 1.0). Median length of hospital stay was 15 days in the standard TTS arm and 17 days in the prolonged TTS arm (P = 0.220). Conclusion The timing of surgery after completed nCRT for carcinoma of the esophagus or esophagogastric junction is not of major importance with regard to short-term postoperative outcomes.

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