scholarly journals Systematic review and meta-analysis of the association between frailty and outcome in surgical patients

2016 ◽  
Vol 98 (2) ◽  
pp. 80-85 ◽  
Author(s):  
K Oakland ◽  
R Nadler ◽  
L Cresswell ◽  
D Jackson ◽  
PA Coughlin
Keyword(s):  
Mortality Rate ◽  
Hospital Stay ◽  
Surgical Intervention ◽  
Discharge Rate ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
The Elderly ◽  
Surgical Patients ◽  
Step Down ◽  
One Year

Introduction Frailty is becoming increasingly prevalent in the elderly population although a lack of consensus regarding a clinical definition hampers comparison of clinical studies. More elderly patients are being assessed for surgical intervention but the effect of frailty on surgical related outcomes is still not clear. Methods A systematic literature search for studies prospectively reporting frailty and postoperative outcomes in patients undergoing surgical intervention was performed with data collated from a total of 12 studies. Random effects meta-analysis modelling was undertaken to estimate the association between frailty and mortality rates (in-hospital and one-year), length of hospital stay and the need for step-down care for further rehabilitation/nursing home placement. Results Frailty was associated with a higher in-hospital mortality rate (pooled odds ratio [OR]: 2.77, 95% confidence interval [CI]: 1.62–4.73), a higher one-year mortality rate (pooled OR: 1.99, 95% CI: 1.49–2.66), a longer hospital stay (pooled mean difference: 1.05 days, 95% CI: 0.02–2.07 days) and a higher discharge rate to further rehabilitation/step-down care (pooled OR: 5.71, 95% CI: 3.41–9.55). Conclusions The presence of frailty in patients undergoing surgical intervention is associated with poorer outcomes with regard to mortality and return to independence. Further in-depth studies are required to identify factors that can be optimised to reduce the burden of frailty in surgical patients.

scholarly journals One-year postoperative mortality rate among the elderly with hip fractures at a single tertiary care center

2020 ◽  
Vol 40 (4) ◽  
pp. 298-304
Author(s):  
Khalid A. Alsheikh ◽  
Firas M. Alsebayel ◽  
Faisal Abdulmohsen Alsudairy ◽  
Abdullah Alzahrani ◽  
Ali Alshehri ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Mortality Rate ◽  
Hip Fractures ◽  
Surgical Intervention ◽  
Care Center ◽  
Tertiary Care ◽  
The Elderly ◽  
Tertiary Care Center ◽  
Factors Associated ◽  
One Year

ABSTRACT BACKGROUND: Hip fractures are one of the leading causes of disability and dependency among the elderly. The rate of hip fractures has been progressively increasing due to the continuing increase in average life expectancy. Surgical intervention is the mainstay of treatment, but with an increasing prevalence of comorbid conditions and decreased functional capacity in elderly patients, more patients are prone to postoperative complications. OBJECTIVES: Assess the value of surgical intervention for hip fractures among the elderly by quantifying the 1-year mortality rate and assessing factors associated with mortality. DESIGN: Medical record review. SETTING: Tertiary care center. PATIENTS AND METHODS: All patients 60 years of age or older who sustained a hip fracture between the period of 2008 to 2018 in a single tertiary healthcare center. Data was obtained from case files, using both electronic and paper files. MAIN OUTCOME MEASURES: The 1-year mortality rate for hip fracture, postoperative complications and factors associated with mortality. SAMPLE SIZE: 802 patients. RESULTS: The majority of patients underwent surgical intervention (93%). Intra- and postoperative complications were 3% and 16%, respectively. Four percent of the sample died within 30 days, and 11% died within one year. In a multivariate analysis, an increased risk of 1-year mortality was associated with neck of femur fractures and postoperative complications ( P =.034, <.001, respectively) CONCLUSION: The 1-year mortality risk in our study reinforces the importance of aggressive surgical intervention for hip fractures. LIMITATION: Single-centered study. CONFLICT OF INTEREST: None.

scholarly journals 1369 Clinical Outcomes in Patients Undergoing Emergency General Surgery During the Covid-19 Pandemic Versus Control Patients: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J Hebding ◽  
L Wingfield ◽  
Y Negreskul ◽  
J Gilmour
Keyword(s):  
Systematic Review ◽  
Mortality Rate ◽  
Hospital Stay ◽  
General Surgery ◽  
Complication Rate ◽  
Emergency Surgery ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Emergency General Surgery ◽  
Significant Difference

Abstract Introduction Throughout the Covid-19 pandemic, the surgical community has attempted to address whether it is safe to continue surgery. The aim of this research was to review evidence on emergency general patients operated on during the pandemic compared to patients undergoing emergency surgery during non-pandemic times to determine if operating during the Covid-19 pandemic led to an increased risk of death, length of hospital stay and complications. Method A systematic review of the literature was performed. PubMed, Cochrane, MEDLINE, Science Direct, Springer Link, Elsevier, and reference lists were analysed for inclusion on 2 January 2021. Results Nine studies and 5,022 patients were included. There were no significant differences in the control group vs pandemic group in mean age (52.3yrs vs 51.9yrs, p = 0.67) or gender (44.4% females vs 49.3%, p = 0.173). Pooled analysis of control vs pandemic showed a mortality rate of 1.26% vs 3.06% (CI:-6.58–6.58, p = 1.00). Mean length of hospital stay was 7.9 vs 7.7 days in control v. pandemic (CI: -2.93-3.33, p = 0.87) and post-operative complication rate of 20.2% vs 25.7% (CI -6.4-25.0, p = 0.20), (control vs pandemic). The pandemic group had significantly more operative management (47.0% vs 40.0%, p = 0.03) with no significant difference in laparoscopic vs open technique (46.0% vs 43.6%, p = 0.20). Conclusions This meta-analysis shows there is no statistically significant difference in mortality rate, length of hospital stay and postoperative complication rate between the pandemic and control cohorts in emergency general surgery patients. This data suggests that general emergency surgery should continue in spite of the pandemic with appropriate precautions in place.

scholarly journals Mortality Following Hip Fractures in the Elderly: Relation with Timing of Fixation, Length of Hospital Stay and Comorbidities

2018 ◽  
Vol 17 (1) ◽  
Author(s):  
Khairul Mohd Khalid ◽  
Nik Mohd Fatmy Nik Mohd Najmi ◽  
Mohamad Fauzlie Yusof
Keyword(s):  
Logistic Regression ◽  
Mortality Rate ◽  
Hospital Stay ◽  
Hip Fractures ◽  
Length Of Hospital Stay ◽  
The Elderly ◽  
Significant Variable ◽  
International Studies ◽  
Cross Sectional ◽  
Phone Calls

Introduction: The incidence of hip fractures in Malaysia was 218 per 100,000 for females and 88 per 100,000 for men and they are associated with mortality rate up to 33 % at 1 year as shown by international studies. There are no local studies available in regards to mortality rate and associated factors. We aimed to determine mortality rate in elderly patient following hip fractures within 1 year. In addition, we evaluated the association of timing of fixation, length of hospital stay and number of comorbidities with mortality in these patients. Materials And Methods: This was a cross sectional study conducted in Hospital Melaka. All patients aged 65 and older who were admitted and underwent surgery for hip fractures from January 2014 to January 2017 were included. Patients or relatives were contacted via phone calls to determine their status of living. From the records, timing of fixation, length of hospital stay and number of comorbidities were recorded. Results: Mortality rate at 1 year was 10.55%. From Simple Logistic Regression analysis, all three factors of timing of fixation, length of hospital stay and number of comorbidities were found to have significant value less than 0.25. From Multiple Logistic Regression, only length of stay was found to be significant (p<0.0001). The significant variable can be interpreted as follows: a person with one day longer in hospital stay has 1.89 times the chance to be deceased at 1 year. Conclusion: This study shows 10.55% mortality rate at 1 year following hip fractures in the elderly. There were an association between mortality and timing of fixation, length of hospital stay and patients’ comorbidities.

scholarly journals 723 Neuroendoscopy versus Craniotomy in Basal Ganglia Haemorrhage: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
T K Tan ◽  
J Merola ◽  
M Zaben ◽  
W Gray ◽  
P Leach
Keyword(s):  
Systematic Review ◽  
Basal Ganglia ◽  
Mortality Rate ◽  
Blood Loss ◽  
Hospital Stay ◽  
Operative Time ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Endoscopic Approach ◽  
Intraoperative Blood Loss

Abstract Aim Basal ganglia haemorrhage (BGH) is the most common type of intracerebral bleed with high morbidity and mortality rate. The efficacy between craniotomy and endoscopic approach in BGH is still debatable and advancement in minimally invasive technique has made endoscopic approach the preferred option. The aim of this systematic review and meta-analysis was to evaluate the outcomes of craniotomy and endoscopic approach in BGH. Method Databases of PubMed, EMBASE, MEDLINE and CENTRAL were systematically searched from its inception until December 2020. All randomized clinical trials and observational studies comparing craniotomy versus endoscopic approach in BGH were included. Results Twelve studies enrolling 1297 patients (craniotomy:675, endoscopy:632) were included for qualitative and quantitative analysis. Endoscopic approach was associated with significantly lower postoperative mortality (OR:0.35, P &lt; 0.00001), higher haematoma evacuation rate (MD:4.95, P = 0.0002), shorter operative time (MD:-117.03, P &lt; 0.00001), lesser intraoperative blood loss (MD:-328.47, P &lt; 0.00001), higher postoperative Glasgow Coma Scale (GCS) (MD:1.14, P = 0.01), higher postoperative Glasgow Outcome Scale (GOS) (MD:0.44, P = 0.05), shorter length of hospital stay (MD:-2.90, P &lt; 0.00001), lower complication rate (OR:0.30, P = 0.0004), lower infection rate (OR:0.29, P &lt; 0.00001) and lower modified Rankin Scale (mRS) (MD:-0.57, P = 0.004) compared to craniotomy. No significant difference was detected in reoperation, intracranial infection, re-bleeding. Conclusions The best available evidence suggest that endoscopic approach has better outcomes in mortality rate, operative time, haematoma evacuation rate, intraoperative blood loss, length of hospital stay, mRS, postoperative GCS and GOS compared with craniotomy in the management of BGH. However, there is a need for high quality randomised controlled trials with large sample size for definite conclusions.

scholarly journals A systematic review and meta-analysis of trainee- versus consultant surgeon-performed elective total hip arthroplasty

2019 ◽  
Vol 4 (2) ◽  
pp. 44-55 ◽  
Author(s):  
Prashant Singh ◽  
Suroosh Madanipour ◽  
Andreas Fontalis ◽  
Jagmeet Singh Bhamra ◽  
Hani B. Abdul-Jabar
Keyword(s):  
Total Hip Arthroplasty ◽  
Hospital Stay ◽  
Hip Arthroplasty ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Deep Infection ◽  
Total Hip ◽  
Trainee Group ◽  
One Year

Total hip arthroplasty (THA) is one of the most commonly performed orthopaedic procedures. Some concern exists that trainee-performed THA may adversely affect patient outcomes. The aim of this meta-analysis was to compare outcomes following THA performed by surgical trainees and consultant surgeons. A systematic search was performed to identify articles comparing outcomes following trainee- versus consultant-performed THA. Outcomes assessed included rate of revision surgery, dislocation, deep infection, mean operation time, length of hospital stay and Harris Hip Score (HHS) up to one year. A meta-analysis was conducted using odds ratios (ORs) and weighted mean differences (WMDs). A subgroup analysis for supervised trainees versus consultants was also performed. The final analysis included seven non-randomized studies of 40 810 THAs, of which 6393 (15.7%) were performed by trainees and 34 417 (84.3%) were performed by consultants. In total, 5651 (88.4%) THAs in the trainee group were performed under supervision. There was no significant difference in revision rate between the trainee and consultant groups (OR 1.09; p = 0.51). Trainees took significantly longer to perform THA compared with consultants (WMD 12.9; p < 0.01). The trainee group was associated with a lower HHS at one year compared with consultants (WMD -1.26; p < 0.01). There was no difference in rate of dislocation, deep infection or length of hospital stay between the two groups. The present study suggests that supervised trainees can achieve similar clinical outcomes to consultant surgeons, with a slightly longer operation time. In selected patients, trainee-performed THA is safe and effective. Cite this article: EFORT Open Rev 2019;4:44-55. DOI: 10.1302/2058-5241.4.180034.

scholarly journals Risk factors for high length of hospital stay and in-hospital mortality in hip fractures in the elderly

2021 ◽  
Vol 65 (5) ◽  
pp. 322-330
Author(s):  
J. Salvador Marín ◽  
F.J. Ferrández Martínez ◽  
C. Fuster Such ◽  
J.M. Seguí Ripoll ◽  
D. Orozco Beltrán ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Hip Fractures ◽  
Length Of Hospital Stay ◽  
The Elderly ◽  
High Length

Advanced Endoscopic Tools

2021 ◽  
Author(s):  
Eleanor C. Fung
Keyword(s):  
Gastrointestinal Bleeding ◽  
Hospital Stay ◽  
Surgical Intervention ◽  
Length Of Hospital Stay ◽  
Therapeutic Endoscopy ◽  
Full Thickness ◽  
Evolution And Development ◽  
Improved Outcomes ◽  
Endoscopic Clips

AbstractThe advent and success of therapeutic endoscopy has expanded the utilization of endoscopy as an effective alternative to surgical intervention in some cases with decreased morbidity, improved outcomes, and shortened length of hospital stay. Gastrointestinal bleeding, perforations, leaks, fistulas, and strictures have become increasingly managed by endoscopy with the evolution and development of endoscopic tools for effective closure of full-thickness gastrointestinal defects, dilation, and hemostasis. This article reviews the characteristics and role of endoscopic clips, stents, dilation balloons, endoscopic knives, and suturing devices.

Haemostatic devices in parotid surgery: a systematic review

2021 ◽  
pp. 1-7
Author(s):  
L Allen ◽  
C MacKay ◽  
M H Rigby ◽  
J Trites ◽  
S M Taylor
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Facial Nerve ◽  
Hospital Stay ◽  
Outcome Measures ◽  
Meta Analysis ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Operative Blood Loss ◽  
Parotid Surgery

Abstract Objective The Harmonic Scalpel and Ligasure (Covidien) devices are commonly used in head and neck surgery. Parotidectomy is a complex and intricate surgery that requires careful dissection of the facial nerve. This study aimed to compare surgical outcomes in parotidectomy using these haemostatic devices with traditional scalpel and cautery. Method A systematic review of the literature was performed with subsequent meta-analysis of seven studies that compared the use of haemostatic devices to traditional scalpel and cautery in parotidectomy. Outcome measures included: temporary facial paresis, operating time, intra-operative blood loss, post-operative drain output and length of hospital stay. Results A total of 7 studies representing 675 patients were identified: 372 patients were treated with haemostatic devices, and 303 patients were treated with scalpel and cautery. Statistically significant outcomes favouring the use of haemostatic devices included operating time, intra-operative blood loss and post-operative drain output. Outcome measures that did not favour either treatment included facial nerve paresis and length of hospital stay. Conclusion Overall, haemostatic devices were found to reduce operating time, intra-operative blood loss and post-operative drain output.

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