scholarly journals The geriatric patient: special aspects of peri-operative management

2019 ◽  
Vol 4 (6) ◽  
pp. 240-247 ◽  
Author(s):  
Dieter Wirtz ◽  
Hendrik Kohlhof

This article offers a German perspective on orthopaedic management of geriatric populations in higher-income countries. Specific orthopaedic procedures necessitate a more intensive level of care in older adult patients, especially with co-morbidities, than in younger patients. During the pre-, peri- and post-operative periods, several aspects such as patient blood management principles improve the outcomes of geriatric patients. New interdisciplinary geriatric models of care including geriatric and orthopaedic specialties have to be established to take care of the special needs of geriatric patients. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180087

2021 ◽  
pp. 1-4
Author(s):  
Andrei Braester ◽  
Ety Shaoul ◽  
Oded Mizrachi ◽  
Luiza Akria ◽  
Liron Shelev ◽  
...  

<b><i>Background:</i></b> Red blood cell transfusion (RBCT) is a therapeutic procedure with important and undesirable secondary effects. Inappropriate overuse of RBCT is significant, and a significant percentage of physicians prescribe RBCT unnecessarily. Patient involvement in treatment decision-making is poor worldwide. Shared (with the patient) transfusion decision-making (TrDM) can temper a “quick finger on the trigger” of blood transfusion (BT). The objective of this study was to determine patients’ preferences surrounding their involvement in the TrDM process as well as physicians’ willingness to involve the patient in TrDM. The study also determined the role of patient age, gender, ethnicity, and schooling years in the TrDM process. <b><i>Methods:</i></b> This cross-sectional study was conducted in a variety of departments, with 123 patients over 18 years old, who received a BT for the first time. The patients completed an anonymous questionnaire which included demographic characteristics (age, gender, ethnicity, and schooling years) and 2 questions linked to potential willingness to participate in the decision to transfuse. <b><i>Results:</i></b> The questionnaire response rate was 100%. The data showed that 60% of patients (especially younger patients), independent of ethnicity, preferred a passive role in TrDM and 40% preferred to share the decision. <b><i>Conclusions:</i></b> The majority of patients, especially younger patients, prefer a passive role in TrDM, possibly due to insufficient information about the need for BT and its significance. We feel that active involvement on the part of the patient can provoke a more judicious thought process about the real need of BT on the part of the physician and have a positive influence on patient blood management.


2021 ◽  
Vol 32 (3) ◽  
pp. 332-340
Author(s):  
Dalton Skipper

Surgical oncology is cancer care that focuses on using surgery to diagnose, stage, and treat cancer and is one of the main treatments for malignancy. Patients older than 65 years are generally considered geriatric. The incidence of cancer in geriatric patients is increasing annually. Candidacy for surgical intervention depends on factors such as cancer type, size, location, grade and stage of the tumor, and the patient’s overall health status and age. Despite increasing agreement that age should not limit treatment options, geriatric patients tend to be undertreated. Cancer in geriatric patients has different features than in younger patients. As such, treatment options may be dissimilar in these 2 cohorts. Here, care of the geriatric patient undergoing surgical oncology interventions is discussed.


2020 ◽  
Vol 15 (03) ◽  
pp. 239-255
Author(s):  
Lea Valeska Blum ◽  
Hendrik Kohlhof ◽  
Dieter Wirtz ◽  
Kai Zacharowski ◽  
Patrick Meybohm

Author(s):  
Markus Müller ◽  
Dania Fischer ◽  
Ulrich Stock ◽  
Christof Geisen ◽  
Björn Steffen ◽  
...  

2021 ◽  
Vol 10 (10) ◽  
pp. 2141
Author(s):  
Aimilia Tsante ◽  
Anastasia Papandreadi ◽  
Andreas G. Tsantes ◽  
Elias Kyriakou ◽  
Panagiota Douramani ◽  
...  

Objectives: Our aim was to assess blood utilization after implementation of a patient blood management (PBM) program in a Greek tertiary hospital. Methods: An electronic transfusion request form and a prospective audit of transfusion practice were implemented. After the one-year implementation period, a retrospective review was performed to assess transfusion practice in medical patients. Results: Pre-PBM, a total of 9478 RBC units were transfused (mean: 1.75 units per patient) compared with 9289 transfused units (mean: 1.57 units per patient) post-PBM. Regarding the post-PBM period, the mean hemoglobin (Hb) level of the 3099 medical patients without comorbidities transfused was 7.19 ± 0.79 gr/dL. Among them, 2065 (66.6%) had Hb levels >7.0 gr/dL, while 167 (5.3%) had Hb levels >8.0 gr/dL. In addition, 331 (25.3%) of the transfused patients with comorbidities had Hb >8.0 gr/dL. The Hb transfusion thresholds significantly differed across the clinics (p < 0.001), while 21.8% of all medical non-bleeding patients received more than one RBC unit transfusion. Conclusion: A poor adherence with the restrictive transfusion threshold of 7.0 gr/dL was observed. The adoption of a less strict threshold might be a temporary step to allow physicians to become familiar with the program and be informed on the safety and advantages of the restrictive transfusion strategy.


2014 ◽  
Vol 120 (4) ◽  
pp. 852-860 ◽  
Author(s):  
Cynthia So-Osman ◽  
Rob G. H. H. Nelissen ◽  
Ankie W. M. M. Koopman-van Gemert ◽  
Ewoud Kluyver ◽  
Ruud G. Pöll ◽  
...  

Abstract Background: Patient blood management is introduced as a new concept that involves the combined use of transfusion alternatives. In elective adult total hip- or knee-replacement surgery patients, the authors conducted a large randomized study on the integrated use of erythropoietin, cell saver, and/or postoperative drain reinfusion devices (DRAIN) to evaluate allogeneic erythrocyte use, while applying a restrictive transfusion threshold. Patients with a preoperative hemoglobin level greater than 13 g/dl were ineligible for erythropoietin and evaluated for the effect of autologous blood reinfusion. Methods: Patients were randomized between autologous reinfusion by cell saver or DRAIN or no blood salvage device. Primary outcomes were mean intra- and postoperative erythrocyte use and proportion of transfused patients (transfusion rate). Secondary outcome was cost-effectiveness. Results: In 1,759 evaluated total hip- and knee-replacement surgery patients, the mean erythrocyte use was 0.19 (SD, 0.9) erythrocyte units/patient in the autologous group (n = 1,061) and 0.22 (0.9) erythrocyte units/patient in the control group (n = 698) (P = 0.64). The transfusion rate was 7.7% in the autologous group compared with 8.3% in the control group (P = 0.19). No difference in erythrocyte use was found between cell saver and DRAIN groups. Costs were increased by €298 per patient (95% CI, 76 to 520). Conclusion: In patients with preoperative hemoglobin levels greater than 13 g/dl, autologous intra- and postoperative blood salvage devices were not effective as transfusion alternatives: use of these devices did not reduce erythrocyte use and increased costs.


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