Frailty and emergency surgery in the elderly: Protocol of a prospective, multicenter study in Italy for evaluating perioperative outcome (The FRAILESEL Study)

Introduction: Improvements in living conditions and progress in medical management have resulted in better quality of life and longer life expectancy. Therefore, the number of older people undergoing surgery is increasing. Frailty is often described as a syndrome in aged patients where there is augmented vulnerability due to progressive loss of functional reserves. Studies suggest that frailty predisposes elderly to worsening outcome after surgery. Since emergency surgery is associated with higher mortality rates, it is paramount to have an accurate stratification of surgical risk in such patients. The aim of our study is to characterize the clinico-pathological findings, management, and short-term outcome of elderly patients undergoing emergency surgery. The secondary objectives are to evaluate the presence and influence of frailty and analyze the prognostic role of existing risk-scores. The final FRAILESEL protocol was approved by the Ethical Committee of “Sapienza” University of Rome, Italy. Methods and analysis: The FRAILESEL study is a nationwide, Italian, multicenter, observational study conducted through a resident-led model. Patients over 65 years of age who require emergency surgical procedures will be included in this study. The primary outcome measures are 30-day postoperative mortality and morbidity rates. The Clavien-Dindo classification system will be used to categorize complications. Secondary outcome measures include length of hospital stay, length of stay in intensive care unit, and the predictive value for morbidity and mortality of several frailty and surgical risk scores. The results of the FRAILESEL study will be disseminated through national and international conference presentations and peer-reviewed journals. The study is also registered at ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT02825082).

Download Full-text

Comparison of accuracy of prediction of postoperative mortality and morbidity between a new, parsimonious risk calculator (SURPAS) and the ACS Surgical Risk Calculator

The American Journal of Surgery ◽

10.1016/j.amjsurg.2019.07.036 ◽

2020 ◽

Vol 219 (6) ◽

pp. 1065-1072 ◽

Cited By ~ 6

Author(s):

Sina Khaneki ◽

Michael R. Bronsert ◽

William G. Henderson ◽

Maryam Yazdanfar ◽

Anne Lambert-Kerzner ◽

...

Keyword(s):

Postoperative Mortality ◽

Risk Calculator ◽

Surgical Risk ◽

Mortality And Morbidity ◽

Accuracy Of Prediction

Download Full-text

30-Day Postoperative Morbidity of Emergency Surgery for Obstructive Right- and Left-Sided Colon Cancer in Obese Patients: A Multicenter Cohort Study of the French Surgical Association

Digestive Surgery ◽

10.1159/000497450 ◽

2019 ◽

Vol 37 (2) ◽

pp. 111-118

Author(s):

Laurent Genser ◽

Gilles Manceau ◽

Diane Mege ◽

Valérie Bridoux ◽

Zaher Lakkis ◽

...

Keyword(s):

Colon Cancer ◽

Emergency Surgery ◽

Postoperative Morbidity ◽

Postoperative Mortality ◽

Hemodynamic Instability ◽

Normal Weight ◽

Obese Patients ◽

Multicenter Cohort Study ◽

Mortality And Morbidity ◽

Cardiovascular Comorbidity

Background: Emergency surgery impairs postoperative outcomes in colorectal cancer patients. No study has assessed the relationship between obesity and postoperative results in this setting. Objective: To compare the results of emergency surgery for obstructive colon cancer (OCC) in an obese patient population with those in overweight and normal weight patient groups. Methods: From 2000 to 2015, patients undergoing emergency surgery for OCC in French surgical centers members of the French National Surgical Association were included. Three groups were defined: normal weight (body mass index [BMI] < 25.0 kg/m2), overweight (BMI 25.0–29.9 kg/m2), and obese (BMI ≥30.0 kg/m2). Results: Of 1,241 patients, 329 (26.5%) were overweight and 143 (11.5%) were obese. Obese patients had significantly higher American society of anesthesiologists score, more cardiovascular comorbidity and more hemodynamic instability at presentation. Overall postoperative mortality and morbidity were 8 and 51%, respectively, with no difference between the 3 groups. For obese patients with left-sided OCC, stoma-related complications were significantly increased (8 vs. 5 vs. 15%, p = 0.02). Conclusion: Compared with lower BMI patients, obese patients with OCC had a more severe presentation at admission but similar surgical management. Obesity did not increase 30-day postoperative morbidity except stoma-related complications for those with left-sided OCC.

Download Full-text

Independent assessment and outcomes of 196 short-tapered stems short-term follow-up and review of the literature

Journal of Orthopaedic Surgery ◽

10.1177/2309499018812236 ◽

2018 ◽

Vol 26 (3) ◽

pp. 230949901881223 ◽

Cited By ~ 5

Author(s):

Sam Nahas ◽

Akash Patel ◽

Nicola Blucher ◽

Vikas Vedi

Keyword(s):

Outcome Measures ◽

Case Series ◽

Outcome Data ◽

Secondary Outcome ◽

Complication Rates ◽

Short Term ◽

Safe Alternative ◽

Term Outcome ◽

Patient Reported

Background: Longer term outcome data are now becoming available for short-tapered femoral stems for cementless total hip arthroplasty. The shorter stem has a metaphyseal fit, loading the bone in this area, leading to physiological bone remodelling. It is also bone preserving, as it is 35 mm shorter. It may be easier to insert through a smaller incision and potentially reduce complication rates. We present a retrospective single surgeon case series of 196 patients (>53% follow-up over 5 years). All patients had the cementless ‘Microplasty Taperloc’ (Biomet). Primary outcome measures were femoral component revision rates. Secondary outcome measures included complications, patient-reported functional outcome scores (Oxford hip) and radiographic evidence of loosening. Methods: Patients were identified using electronic software. All were routinely followed up and assessed in clinic since implant introduction in 2009. Oxford hip scores were routinely obtained. A surgeon who had not carried out the procedure independently assessed radiographs. Results: One hundred ninety-six patients were identified. The revision rate was 0.5% due to an intraoperative peri-prosthetic fracture of the femur identified on post-operative radiograph. The complication rate was 2%, attributable to: subsidence of the prosthesis (one hip), post-operative dislocation (two hips), one of which required acetabular revision. Oxford hip scores increased on average from 21 to 45 (pre- to post-operatively). There were no signs of radiographic loosening. Conclusion: The results show that using the short-tapered stem is proving so far to be a reliable and safe alternative to its longer counterpart, with low complication rates in the short term.

Download Full-text

Relevance of Preoperative Hyperbilirubinemia in Patients Undergoing Hepatobiliary Resection for Hilar Cholangiocarcinoma

Journal of Clinical Medicine ◽

10.3390/jcm8040458 ◽

2019 ◽

Vol 8 (4) ◽

pp. 458 ◽

Cited By ~ 3

Author(s):

Karolina Wronka ◽

Michał Grąt ◽

Jan Stypułkowski ◽

Emil Bik ◽

Waldemar Patkowski ◽

...

Keyword(s):

Decision Making ◽

Risk Factor ◽

Biliary Drainage ◽

Hilar Cholangiocarcinoma ◽

Postoperative Mortality ◽

Preoperative Biliary Drainage ◽

Secondary Outcome ◽

Bilirubin Concentration ◽

Mortality And Morbidity ◽

C Statistic

Preoperative hyperbilirubinemia is known to increase the risk of mortality and morbidity in patients undergoing resection for hilar cholangiocarcinoma. The aim of this study was to characterize the associations between the preoperative bilirubin concentration and the risk of postoperative mortality and severe complications to guide decision-making regarding preoperative biliary drainage. Eighty-one patients undergoing liver and bile duct resection for hilar cholangiocarcinoma between 2005 and 2015 were analyzed retrospectively. Postoperative mortality and severe complications, defined as a Clavien–Dindo grade of ≥III, were the primary and secondary outcome measures, respectively. The severe postoperative complications and mortality rates were 28.4% (23/81) and 11.1% (9/81), respectively. Patients with preoperative biliary drainage had significantly lower bilirubin concentrations (p = 0.028) than did those without. The preoperative bilirubin concentration was a risk factor of postoperative mortality (p = 0.003), with an optimal cut-off of 6.20 mg/dL (c-statistic = 0.829). The preoperative bilirubin concentration was a risk factor of severe morbidity (p = 0.018), with an optimal cut-off of 2.48 mg/dL (c-statistic = 0.662). These results indicate that preoperative hyperbilirubinemia is a major risk factor of negative early postoperative outcomes of patients who undergo surgical treatment for hilar cholangiocarcinoma and may aid in decision-making with respect to preoperative biliary drainage.

Download Full-text

Registration and publication of emergency and elective randomised controlled trials in surgery: a cohort study from trial registries

BMJ Open ◽

10.1136/bmjopen-2018-021700 ◽

2018 ◽

Vol 8 (7) ◽

pp. e021700 ◽

Cited By ~ 4

Author(s):

Rachael L Morley ◽

Matthew J Edmondson ◽

Ceri Rowlands ◽

Jane M Blazeby ◽

Robert J Hinchliffe

Keyword(s):

Outcome Measures ◽

Emergency Surgery ◽

Randomised Controlled Trials ◽

Primary Outcome ◽

Elective Surgery ◽

Secondary Outcome ◽

Controlled Trials ◽

Surgical Trials ◽

Surgical Interventions ◽

Randomised Controlled

ObjectivesEmergency surgical practice constitutes 50% of the workload for surgeons, but there is a lack of high quality randomised controlled trials (RCTs) in emergency surgery. This study aims to establish the differences between the registration, completion and publication of emergency and elective surgical trials.DesignThe clinicaltrials.gov and ISRCTN.com trials registry databases were searched for RCTs between 12 July 2010 and 12 July 2012 using the keyword ‘surgery’. Publications were systematically searched for in Pubmed, MEDLINE and EMBASE.ParticipantsResults with no surgical interventions were excluded. The remaining results were manually categorised into ‘emergency’ or ‘elective’ and ‘surgical’ or ‘adjunct’ by two reviewers.Primary outcome measuresNumber of RCTs registered in emergency versus elective surgery.Secondary outcome measuresNumber of RCTs published in emergency versus elective surgery; reasons why trials remain unpublished; funding, sponsorship and impact of published articles; number of adjunct trials registered in emergency and elective surgery.Results2700 randomised trials were registered. 1173 trials were on a surgical population and of these, 414 trials were studying surgery. Only 9.4% (39/414) of surgical trials were in emergency surgery. The proportion of trials successfully published did not significantly differ between emergency and elective surgery (0.46 vs 0.52; mean difference (MD) −0.06, 95% CI −0.24 to 0.12). Unpublished emergency surgical trials were statistically equally likely to be terminated early compared with elective trials (0.33 vs 0.16; MD −0.18, 95% CI −0.06 to 0.41). Low accrual accounted for a similar majority in both groups (0.43 vs 0.46; MD −0.04, 95% CI −0.48 to 0.41). Unpublished trials in both groups were statistically equally likely to still be planning publication (0.52 vs 0.71; MD −0.18, 95% CI −0.43 to 0.07).ConclusionFewer RCTs are registered in emergency than elective surgery. Once trials are registered both groups are equally likely to be published.

Download Full-text

Laparoscopic-assisted pancreaticoduodenectomy for periampullary cancer

Vietnam Journal of Endolaparoscopic Surgery ◽

10.51199/vjsel.2020.4.9 ◽

2020 ◽

Vol 10 (4) ◽

Author(s):

Ngoc Bich Vo ◽

Keyword(s):

Postoperative Bleeding ◽

Case Series ◽

Postoperative Mortality ◽

Operation Time ◽

Whipple Procedure ◽

Periampullary Cancer ◽

Biliary Surgery ◽

Term Outcome ◽

Mortality And Morbidity ◽

Laparoscopic Assisted

Abstract Introduction: Laparoscopic pancreaticoduodenectomy is one of the most complicated major surgeries. The postoperative mortality and morbidity are still a burden of hepato-pancreato-biliary surgery. Aim of this study is to assess the short-term outcome of laparoscopic Whipple procedure for periampullary cancer. Materials and methods: Case series report. Results: From 1/2018 to 1/2019, we had performed laparoscopic Whipple procedure in 21 patients. The intracorporeal hepatico-jejunal anastomosis had been formed in all the cases. The pancreaticojejunal and gastro-jejunal anastomosis had been formed extracorporeally through small 5cm midline incision. The pancreatic duct had been drained with 8F drainage. The average operation time was 364 minutes. The average intraoperation blood loss was 175ml. Postoperative mean length of stay was 12.1 days. Pancreaticojejunal anastomosis accounted for 19,0%. Postoperative bleeding occurred in 2 patient (9%) whom were converted to open surgery for control bleeding. In our series, there was no postoperative mortality. Conclusions: Laparoscopic-assisted pancreaticoduodenectomy is safe with low postoperative morbidity and mortality. This procedure is feasible for treatment of periampullary cancer.

Download Full-text

Incidence, Predictors and Risk Scores to Predict Postoperative Mortality After Vascular Noncardiac Surgery

Case Medical Research ◽

10.31525/ct1-nct04051749 ◽

2019 ◽

Author(s):

Keyword(s):

Postoperative Mortality ◽

Noncardiac Surgery ◽

Risk Scores

Download Full-text

Correlation of perioperative risk scores with hospital costs in neurosurgical patients

Journal of Neurosurgery ◽

10.3171/2018.10.jns182041 ◽

2020 ◽

Vol 132 (3) ◽

pp. 818-824

Author(s):

Sasha Vaziri ◽

Joseph M. Abbatematteo ◽

Max S. Fleisher ◽

Alexander B. Dru ◽

Dennis T. Lockney ◽

...

Keyword(s):

Surgical Site Infection ◽

Hospital Costs ◽

Patient Characteristics ◽

Risk Scores ◽

Site Infection ◽

Risk Calculator ◽

Surgical Risk ◽

Acs Nsqip ◽

Neurosurgical Patients ◽

Predicted Risk

OBJECTIVEThe American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) online surgical risk calculator uses inherent patient characteristics to provide predictive risk scores for adverse postoperative events. The purpose of this study was to determine if predicted perioperative risk scores correlate with actual hospital costs.METHODSA single-center retrospective review of 1005 neurosurgical patients treated between September 1, 2011, and December 31, 2014, was performed. Individual patient characteristics were entered into the NSQIP calculator. Predicted risk scores were compared with actual in-hospital costs obtained from a billing database. Correlational statistics were used to determine if patients with higher risk scores were associated with increased in-hospital costs.RESULTSThe Pearson correlation coefficient (R) was used to assess the correlation between 11 types of predicted complication risk scores and 5 types of encounter costs from 1005 health encounters involving neurosurgical procedures. Risk scores in categories such as any complication, serious complication, pneumonia, cardiac complication, surgical site infection, urinary tract infection, venous thromboembolism, renal failure, return to operating room, death, and discharge to nursing home or rehabilitation facility were obtained. Patients with higher predicted risk scores in all measures except surgical site infection were found to have a statistically significant association with increased actual in-hospital costs (p < 0.0005).CONCLUSIONSPrevious work has demonstrated that the ACS NSQIP surgical risk calculator can accurately predict mortality after neurosurgery but is poorly predictive of other potential adverse events and clinical outcomes. However, this study demonstrates that predicted high-risk patients identified by the ACS NSQIP surgical risk calculator have a statistically significant moderate correlation to increased actual in-hospital costs. The NSQIP calculator may not accurately predict the occurrence of surgical complications (as demonstrated previously), but future iterations of the ACS universal risk calculator may be effective in predicting actual in-hospital costs, which could be advantageous in the current value-based healthcare environment.

Download Full-text