Preoperative geriatric assessment (GA) and surgical outcomes in older women with gynecological (gyn) cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 5108-5108
Author(s):  
Daneng Li ◽  
Beatriz Korc-Grodzicki ◽  
Qin Zhou ◽  
Alexia Iasonos ◽  
Dennis Chi ◽  
...  
Keyword(s):  
Weight Loss ◽  
Functional Status ◽  
Surgical Outcomes ◽  
Length Of Hospital Stay ◽  
Cancer Center ◽  
Surgical Morbidity ◽  
Cancer History ◽  
Operative Outcomes ◽  
Comorbidity Index ◽  
Poor Functional Status

5108 Background: GA can predict surgical outcomes in older patients (pts); however, pre-surgical evaluation for older pts with gyn malignancies has not been well-described. This study will determine the association between GA variables with post-operative morbidity and mortality. Methods: Women 75yrs or older who had geriatric evaluation before any gyn surgery at Memorial Sloan Kettering Cancer Center (MSKCC) between 1/2010-6/2011 were identified. Pre-operative GA included: Mini-Cog Test (cognition), fall history, medication list, nutritional status (weight loss >10lbs, albumin), functional status (activities of daily living (ADL), instrumental I-ADL), and Charlson comorbidity index. Outcomes included: delirium, length of hospital stay (LOS), 30-day surgical adverse events (AE, grade 1-5, via prospective-MSKCC surgical database), 30-day hospital readmission and 6-month mortality. Utilizing bivariate analyses, associations between GA measures and post-operative outcomes were evaluated. Results: 72 pts (median age 79yrs, range 75-92) with gyn cancer (54% uterine, 36% ovarian/peritoneal/tubal, 10% cervical/vaginal/vulvar) had gyn surgery. 34 pts (47%) had stage III/IV disease. 21pts (30%) had secondary cancer history. Pt’s baseline GA measures: ADL-dependent (13%), IADL-dependent (19%), weight loss (18%), fall history (18%), mini cog score (median 4, range 0-5), Charlson score (median 2, range 0-9). 24pts (33%) had surgical AE; no significant association with age or GA. Median LOS was 2 days (range 0-20); 11pts (15%) required 30-day readmission. Delirium (p=0.01), nutrition (weight loss p=0.04, albumin p=0.04), anemia (p=0.003) and high comorbidity index (p=0.013) were associated with longer LOS. Six-month mortality was 8%; older age (p=0.02), poor functional status (lower ADL and IADL, p<0.001 and p=0.007), number of medications (p=0.05) and poor cognition (p<0.001) were associated with shorter survival. Conclusions: Surgical morbidity is common in older pts. Although AE’s were not associated with GA variables, GA can detect high-risk features for longer LOS and shorter survival. Further prospective studies with pre-operative GA and interventions are warranted.

Evaluation of the Charlson comorbidity index to predict outcome after esophagectomy in older patients.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 27-27
Author(s):  
A. Kothari ◽  
T. Bretl ◽  
T. Weigel
Keyword(s):  
Surgical Outcomes ◽  
Charlson Comorbidity Index ◽  
Length Of Hospital Stay ◽  
Elderly Age ◽  
Co Morbidity ◽  
Risk Patients ◽  
Comorbidity Index ◽  
Morbidity Index ◽  
Index Future ◽  
Morbid Conditions

27 Background: Esophagectomy remains a preferred treatment for several neoplastic and non-neoplastic conditions; however it is often avoided in elderly patients with several co-morbid conditions. Several centers endorse the use of the Charlson comorbidity index to predict surgical outcomes in high risk patients. To date, this standard measure of co-morbidity has not been used to predict surgical outcomes following esophagectomy in elderly (age ≥70) patients. Methods: We reviewed data from an IRB-approved, prospectively maintained thoracic surgery database over a three-year period (March, 2006 – March, 2009). We compared incidence of post-operative events, total length of stay, 30-day mortality, rate of readmission, and calculated Charlson comorbidity indices (CCI) for all patients. A validated electronic application was used to calculate CCI based on patient age, BMI, substance use, malignancy, and co-morbid diseases (CV, respiratory, GI, endocrine, inflammatory, psychiatric, neurologic, and immunologic). Results: There were 75 patients below the age of 70 and 41 patients ≥ 70 years old who underwent esophagectomy over the 3-year period studied. Patients over the age of 70 had a significantly higher CCI (5.02) than patients under the age of 70 (3.19, p < 0.05). However, the 30 day mortality in patients ≥ 70 (0.0%) and under 70 (2.3%) was not significantly different between groups (p = 0.33). There was no difference in median length of hospital stay (7 days vs. 7 days, p = 0.95) and rate of readmission (7.5% vs. 9.3%, p = 0.74) when comparing patients ≥ 70 and < 70 years old, respectively. Patients ≥ 70 had a significantly lower incidence of complications than patients under the age of 70 (34.1% vs. 60.0%, p < 0.05). Conclusions: Patients ≥ 70 years old had higher Charlson comorbidity indices than patients < 70 years old, however surgical outcomes in both groups following esophagectomy were similar. In this population, CCI may not be a valid tool for measuring surgical risk perhaps due to the inclusion of age in the index. Future study will focus on the development of a co-morbidity index which can predict outcomes following esophagectomy and is not biased by age. No significant financial relationships to disclose.

565 POST-OPERATIVE WEIGHT LOSS AND OUTCOMES FOLLOWING ESOPHAGECTOMY

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
R Khaw ◽  
S Munro ◽  
J Sturrock ◽  
H Jaretzke ◽  
S Kamarajah ◽  
...  
Keyword(s):  
Weight Loss ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Failure To Thrive ◽  
Post Discharge ◽  
Postoperative Weight Loss ◽  
Poor Outcomes ◽  
The Impact

Abstract   Oesophageal cancer is the 11th most common cancer worldwide, with oesophagectomy remaining the mainstay curative treatment, despite significant associated morbidity and mortality. Postoperative weight loss remains a significant problem and is directly correlated to poor prognosis. Measures such as the Enhanced Recovery After Surgery (ERAS) programme and intraoperative jejunostomy feed have looked to tackle this. This study investigates the impact of these on mortality, length of hospital stay and postoperative weight loss. Methods Patients undergoing oesophagectomy between January 1st 2012—December 2014 and 28th October 2015–December 31st 2019 in a national tertiary oesophagogastric unit were included retrospectively. Variables measured included comorbidities, operation, histopathology, weights (pre- and post-operatively), length of hospital stay, postoperative complications and mortality. Pre-operative body weight was measured at elective admission, and further weights were identified from a prospectively maintained database, during further clinic appointments. Other data was collected through patient notes. Results 594 patients were included. Mean age at diagnosis was 65.9 years (13–65). Majority of cases were adenocarcinoma (63.3%), with varying stages of disease (TX-4, NX-3). Benign pathology accounted for 8.75% of cases. Mean weight loss post-oesophagectomy exceeded 10% at 6 months (SD 14.49). Majority (60.1%) of patients were discharged with feeding jejunostomy, and 5.22% of these required this feed to be restarted post-discharge. Length of stay was mean 16.5 days (SD 22.3). Complications occurred in 68.9% of patients, of which 13.8% were infection driven. Mortality occurred in 26.6% of patients, with 1.83% during hospital admission. 30-day mortality rate was 1.39%. Conclusion Failure to thrive and prolonged weight-loss following oesophagectomy can contribute to poor recovery, with associated complications and poor outcomes, including increased length of stay and mortality. Further analysis of data to investigate association between weight loss and poor outcomes for oesophagectomy patients will allow for personalised treatment of high-risk patients, in conjunction with members of the multidisciplinary team, including dieticians.

Inflammation, Functional Status, and Weight Loss During Recovery From Cardiac Surgery in Older Adults

2013 ◽  
Vol 16 (3) ◽  
pp. 344-352 ◽  
Author(s):  
Rose Ann DiMaria-Ghalili ◽  
Eileen M. Sullivan-Marx ◽  
Charlene Compher
Keyword(s):  
Weight Loss ◽  
Cardiac Surgery ◽  
Activities Of Daily Living ◽  
Functional Status ◽  
Grip Strength ◽  
Daily Living ◽  
Community Dwelling ◽  
Chair Stand ◽  
Prospective Longitudinal ◽  
Over Time

Objective: To determine the nutritional, inflammatory, and functional aspects of unintentional weight loss after cardiac surgery that warrant further investigation. Research Methods and Procedures: Twenty community-dwelling adults > 65 years old undergoing cardiac surgery (coronary artery bypass graft [CABG] or CABG + valve) were recruited for this prospective longitudinal (preoperative and 4–6 weeks postdischarge) pilot study. Anthropometrics (weight, standing height, and mid-arm and calf circumference), nutritional status (Mini-Nutritional Assessment™ [MNA]), appetite, physical performance (timed chair stand), muscle strength (hand grip) and functional status (basic and instrumental activities of daily living), and inflammatory markers (plasma leptin, ghrelin, interleukin [IL]-6, high-sensitivity[hs] C-reactive protein, and serum albumin and prealbumin) were measured. Results: Participants who completed the study ( n = 11 males, n = 3 females) had a mean age 70.21 ± 4.02 years. Of these, 12 lost 3.66 ± 1.44 kg over the study period. Weight, BMI, activities of daily living, and leptin decreased over time ( p < .05). IL-6 increased over time ( p < .05). Ghrelin, hs-CRP, and timed chair stand increased over time in those who underwent combined procedures ( p < .05). Grip strength decreased in those who developed complications ( p = .004). Complications, readmission status, and lowered grip strength were found in those with low preoperative MNA scores ( p < .05). Conclusion: After cardiac surgery, postdischarge weight loss occurs during a continued inflammatory response accompanied by decreased physical functioning and may not be a positive outcome. The impacts of weight loss, functional impairment, and inflammation during recovery on disability and frailty warrant further study.

Perioperative Outcomes of Percutaneous Nephrolithotomy in Septuagenarians and Beyond

2021 ◽  
Vol 104 (9) ◽  
pp. 1497-1502
Keyword(s):  
Renal Function ◽  
Percutaneous Nephrolithotomy ◽  
Age Groups ◽  
Length Of Hospital Stay ◽  
The Elderly ◽  
Renal Calculus ◽  
Perioperative Outcomes ◽  
Kidney Calculi ◽  
Operative Outcomes ◽  
Estimated Blood Loss

Background: Life expectancy has continuously risen worldwide. Because the elderly may tolerate complications poorly, the risks and benefits of percutaneous nephrolithotomy (PCNL) in those patients should be discussed thoroughly. Objective: To analyze utility and operative outcomes of PCNL with respect to age. Materials and Methods: A retrospective study of PCNL was performed at Ramathibodi Hospital between 2011 and 2020. The patients were divided into two age groups, 1) below 70 years old and 2) 70 years old and above. Comparison of demographics, operative data, and postoperative outcomes were analyzed. Results: Of the 253 patients, the overall stone-free rate (SFR) was 59.7%. The SFR in younger groups and older groups were 59.4% (126/212) and 61.0% (25/41), respectively, which was not significantly different (p=0.999). There was a similar in-stone burden between the two groups (p=0.573). Patients in the older group had worse renal function, higher American Society of Anesthesiologists score, and more comorbidities, including hypertension and ischemic heart disease. However, estimated blood loss, length of hospital stay, operative time, percent change in eGFR, and complications were comparable between the groups. Conclusion: PCNL is a safe and effective treatment of kidney calculi in septuagenarians and older patients, even with the risk of higher comorbidities and poorer renal function than in younger patients. Keywords: Percutaneous nephrolithotomy; Renal calculus; Stone-free status; Septuagenarians

scholarly journals Meta‐analysis of the influence of lifestyle changes for preoperative weight loss on surgical outcomes

2018 ◽  
Vol 106 (3) ◽  
pp. 181-189 ◽  
Author(s):  
M. Roman ◽  
A. Monaghan ◽  
G. F. Serraino ◽  
D. Miller ◽  
S. Pathak ◽  
...  
Keyword(s):  
Weight Loss ◽  
Surgical Outcomes ◽  
Meta Analysis ◽  
Lifestyle Changes ◽  
Preoperative Weight Loss ◽  
Preoperative Weight

scholarly journals Laparoscopic Risk-Reducing Salpingo-Oophorectomy: The Brigham and Women's Experience

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Melina Shoni ◽  
Taymaa May ◽  
Allison F. Vitonis ◽  
Anjelica Garza ◽  
Michael G. Muto ◽  
...  
Keyword(s):  
Surgical Outcomes ◽  
Operative Time ◽  
Intraoperative Complications ◽  
Admission Rate ◽  
Safe Procedure ◽  
Short Term ◽  
Surgical Morbidity ◽  
Hospital Admission Rate ◽  
Estimated Blood Loss ◽  
Risk Reducing

Objective. To establish short-term surgical outcomes of three-port laparoscopic risk-reducing salpingo-oophorectomy (RRSO) in women with hereditary breast-ovarian cancer syndrome (HBOC). Methods. The medical records of all HBOC women that underwent laparoscopic RRSO between January 2001 and December 2010 were retrospectively reviewed. Demographic data, operative details, and short-term surgical outcomes were obtained and subjected to SAS. Statistical univariate and multivariate analyses were performed. Results. 358 patients met study criteria with 277 (77.4%) carrying a documented BRCA mutation. The predominant technique utilized three ports (two 5 mm and one 10/12 mm), a 5 mm laparoscope and a 5 mm Ligasure pulsatile bipolar device. Mean operative time was 58.3 minutes (SD 22.6, 26.0–197.0), significantly affected by BMI greater than 30 (P<0.0001) and status of adhesions (P=0.001). Estimated blood loss (EBL) was negligible in 96.9% of cases. Seven patients required conversion to laparotomy. No major intraoperative complications were recorded. One-night hospital admission rate was less than 2.0% while postoperative complication rate was 3.1%. Malignancy was revealed in 14 patients (3.9%). Conclusion. In HBOC population, three-port laparoscopic RRSO is a simple, reproducible, and safe procedure with low conversion rate, short operative time, minimal EBL, low surgical morbidity, and rapid postoperative recovery.

scholarly journals Elderly Patients with Locally Advanced and Unresectable Non-Small-Cell Lung Cancer May Benefit from Sequential Chemoradiotherapy

Cancers ◽  
2021 ◽  
Vol 13 (18) ◽  
pp. 4534
Author(s):  
Magdalena Zaborowska-Szmit ◽  
Marta Olszyna-Serementa ◽  
Dariusz M. Kowalski ◽  
Sebastian Szmit ◽  
Maciej Krzakowski
Keyword(s):  
Lung Cancer ◽  
Weight Loss ◽  
Elderly Patients ◽  
Charlson Comorbidity Index ◽  
Older Patients ◽  
Locally Advanced ◽  
Small Cell ◽  
Small Cell Lung ◽  
Stage Iiia ◽  
Comorbidity Index

Concurrent chemoradiotherapy is recommended for locally advanced and unresectable non-small-cell lung cancer (NSCLC), but radiotherapy alone may be used in patients that are ineligible for combined-modality therapy due to poor performance status or comorbidities, which may concern elderly patients in particular. The best candidates for sequential chemoradiotherapy remain undefined. The purpose of the study was to determine the importance of a patients’ age during qualification for sequential chemoradiotherapy. The study enrolled 196 patients. Older patients (age > 65years) more often had above the median Charlson Comorbidity Index CCI > 4 (p < 0.01) and Simplified Charlson Comorbidity Index SCCI > 8 (p = 0.03), and less frequently the optimal Karnofsky Performance Score KPS = 100 (p < 0.01). There were no significant differences in histological diagnoses, frequency of stage IIIA/IIIB, weight loss, or severity of smoking between older and younger patients. Older patients experienced complete response more often (p = 0.01) and distant metastases less frequently (p = 0.03). Univariable analysis revealed as significant for overall survival: age > 65years (HR = 0.66; p = 0.02), stage IIIA (HR = 0.68; p = 0.01), weight loss > 10% (HR = 1.61; p = 0.04). Multivariable analysis confirmed age > 65years as a uniquely favorable prognostic factor (HR = 0.54; p < 0.01) independent of lung cancer disease characteristics, KPS = 100, CCI > 4, SCCI > 8. Sequential chemoradiotherapy may be considered as favorable in elderly populations.

scholarly journals P052 EARLY OPERATIVE OUTCOMES OF ENHANCED-VIEW TOTALLY EXTRA PERITONEAL REPAIR(ETEP) FOR VENTRAL HERNIAS

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Kiyotaka Imamura ◽  
Minoru Takada ◽  
Yoshiyasu Ambo
Keyword(s):  
Length Of Hospital Stay ◽  
Transversus Abdominis ◽  
Operative Outcomes ◽  
Open Operation ◽  
Patient Reported ◽  
Attractive Option ◽  
Average Defect ◽  
Totally Extraperitoneal Repair ◽  
Ventral Hernias

Abstract Aim Early operative outcomes of enhanced-view totally extraperitoneal repair (eTEP) for ventral hernias Material and Methods We have retrospectively analysed the date of 41 patients who underwent an eTEP procedure on between November 2018 and April 2021 by a single surgeon and monitored until May 2021. Results During the study period, 29 endoscopic transversus abdominis muscle release and 12 endoscopic Rives-Stoppa techniques were performed to repair incisional (30), umbilical (6), epigastric (3), and spigelian, and parastomal hernias occurred in 1 patient each. The mean age was 68.0 years, mean BMI was 26.4 kg/m2. The hernial orifice centers were as follows: M2 in 7, M3 in 23, M4 in 5, L2 in 4, L4 in 1, and M2 and L2 (2 orifices) in 1 patient. Nine cases of large incisional hernia (width ≥10cm) were included. An average mesh area of 624cm2 was used for an average defect area of 57cm2. Mean operative time, blood loss, and length of hospital stay were 278 min, 5 ml, 6 days, respectively. Only one case was converted to an open operation due to presence of severe adhesions. Postoperative complication consisted of hematoma (n = 1) and a small bowel obstruction due to a tear of the posterior sheath (n = 1). There was no hernia recurrence at mean follow-up of 448 days. No patient reported significant pain at the surgical site at the first postoperative follow up. Conclusions Judging from our short-term results, eTEP approach for ventral hernias can be an attractive option for selected cases.

Preoperative Evaluation of the Elderly Surgical Patient

2017 ◽  
Author(s):  
Tracy S. Wang ◽  
Jennifer Roberts
Keyword(s):  
Functional Status ◽  
Surgical Outcomes ◽  
Patient Population ◽  
Preoperative Evaluation ◽  
The Elderly ◽  
Diagnostic Approach ◽  
Surgical Patient ◽  
Specific Patient ◽  
Specific Patient Population ◽  
Specific Disease

The following is a detailed approach to the preoperative evaluation of the elderly surgical patient. A focus is placed on physiologic changes in the elderly that predispose them to complications and a systems-based approach to appropriate perioperative evaluation. Specifically, recommendations on the workup of cardiovascular, pulmonary, and renal systems are discussed. We also introduce the concept of frailty as a measure of an elderly patient's overall physiologic reserve. Finally, a diagnostic approach to common elderly-specific disease processes such as decreased functional status, malnutrition, and delirium is outlined. Throughout, an emphasis is placed on how to carefully assess this specific patient population and optimize preoperative functional status to improve surgical outcomes in the elderly. This review has 1 figure, 4 tables, and 62 references.

Abstract 1818: Beneficial Effects of Weight Loss Associated with a High Protein Diet on Cardiovascular Risk Profile, Functional Status and Quality of Life in Obese Heart Failure Patients: A Feasibility Study

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Lorraine S Evangelista ◽  
David Heber ◽  
Zhaoping Li ◽  
Michele Hamilton ◽  
Gregg C Fonarow
Keyword(s):  
Heart Failure ◽  
Weight Loss ◽  
Body Weight ◽  
Functional Status ◽  
High Protein ◽  
Control Group ◽  
Long Term Effects ◽  
Weight Changes ◽  
Cardiovascular Risks ◽  
The Impact

OBJECTIVE: Clinical management of chronic heart failure (HF) related to adequate nutritional intake currently lacks a strong scientific basis. This study was conducted to evaluate the impact of 3 diet interventions on body weight and its potential to reduce cardiovascular risks and improve functional status. METHOD: Fourteen obese HF patients (BMI > 27 kg/m2) were randomized to1 of 3 diets: high protein (HP); low fat (LF) or average diet/control group (CG). Body anthropometrics (weight, BMI, waist circumference), indices of cardiovascular risks including (% body fat, blood pressure, cholesterol, triglycerides), and measures of functional status (6-minute walk, max VO2) were obtained at baseline and after a 12-week nutritional support program. Statistics included two-way RMANOVA. RESULTS: There were no significant differences in age (59±10 years), gender (78% male), NYHA (43% class II; 57% class III), HF etiology (57% non-ischemic), or ejection fraction (0.26±0.07) between the groups. The HP diet resulted in moderate reductions in body weight (Figure ) and improvements in several health parameters (Table ). CONCLUSION: The data show that in a small group of obese HF patients, a 12-week HP diet resulted in moderate weight loss that was associated with reduced cardiovascular risks and better functional status. However, the long-term effects of a HP diet remain uncertain. Figure Comparison of Weight Changes in the HP, LF and CG from Baseline to 12 Weeks Mean changes in outcomes from baseline to 12 weeks, by diet group and time

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