scholarly journals Management of Geriatric Anesthesia on Emergency Surgery

2021 ◽  
Vol 2 (2) ◽  
pp. 70-75
Author(s):  
Achmad Hariyanto ◽  
◽  
Isngadi Isngadi ◽  
Keyword(s):  
Postoperative Complications ◽  
Emergency Surgery ◽  
Geriatric Patients ◽  
Elective Surgery ◽  
Medical Complications ◽  
Short Term ◽  
Term Survival ◽  
Speed Up ◽  
Geriatric Anesthesia

In geriatric patients, emergency surgery is more common than elective surgery. The incidence of medical complications increases along with aging while the rate of surgical complications remains constant. Postoperative complications escalates short-term morbidity and mortality and also associated with decreasing long-term survival. The main purposes of geriatric patients' care were to maintain hemodynamics, speed up recovery, and perform an assessment to avoid any further decline in functional capacity. The choice of anesthesia and how to administer anesthesia agents should be adjusted for the geriatric patient.

scholarly journals Correlation between neutrophil-to-lymphocyte ratio and postoperative mortality in elderly patients with hip fracture: a meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yu-Hang Chen ◽  
Ching-Hsin Chou ◽  
Hsin-Hsien Su ◽  
Yu-Ting Tsai ◽  
Ming-Hsiu Chiang ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Geriatric Patients ◽  
Meta Analysis ◽  
Postoperative Mortality ◽  
Short Term ◽  
Term Survival ◽  
Lymphocyte Ratio ◽  
Long Term Mortality

Abstract Introduction The neutrophil-to-lymphocyte ratio (NLR) is a crucial prognosis predictor following several major operations. However, the association between NLR and the outcome after hip fracture surgery is unclear. In this meta-analysis, we investigated the correlation between NLR and postoperative mortality in geriatric patients following hip surgery. Method PubMed, Embase, Cochrane library, and Google Scholar were searched for studies up to June 2021 reporting the correlation between NLR and postoperative mortality in elderly patients undergoing surgery for hip fracture. Data from studies reporting the mean of NLR and its 95% confidence interval (CI) were pooled. Both long-term (≥ 1 year) and short-term (≤ 30 days) mortality rates were included for analysis. Result Eight retrospective studies comprising a total of 1563 patients were included. Both preoperative and postoperative NLRs (mean difference [MD]: 2.75, 95% CI: 0.23–5.27; P = 0.03 and MD: 2.36, 95% CI: 0.51–4.21; P = 0.01, respectively) were significantly higher in the long-term mortality group than in the long-term survival group. However, no significant differences in NLR were noted between the short-term mortality and survival groups (MD: − 1.02, 95% CI: − 3.98 to 1.93; P = 0.5). Conclusion Higher preoperative and postoperative NLRs were correlated with a higher risk of long-term mortality following surgery for hip fracture in the geriatric population, suggesting the prognostic value of NLR for long-term survival. Further studies with well-controlled confounders are warranted to clarify the predictive value of NLR in clinical practice in geriatric patients with hip fracture.

scholarly journals COVID-19 and Perioperative Management Strategies for Gastrointestinal Surgery: An Experience From Jiaxing, China

2021 ◽  
pp. 000313482199508
Author(s):  
Yuan Zhou ◽  
Lusha Cen
Keyword(s):  
Emergency Surgery ◽  
Perioperative Management ◽  
Elective Surgery ◽  
Management Strategies ◽  
Gastrointestinal Surgery ◽  
Postoperative Management ◽  
Surgical Operation ◽  
Short Term ◽  
Investigation Period

Background The coronavirus disease (COVID-19) was leading to a worldwide pandemic, which affected surgical operation. This study assessed the efficacy of perioperative management of patients scheduled for gastrointestinal surgery during COVID-19 pandemic of 2020. Methods We retrospectively analyzed 188 patients who underwent gastrointestinal surgery during the COVID-19 outbreak in Jiaxing, China. Perioperative data were collected, including data on pre-, intra-, and postoperative management strategies. The same data over the same period in 2019 were also collected for comparison. Results A total of 117, 63, and 8 patients underwent emergency, semi-elective, and elective surgeries, respectively. The locals: nonlocals ratio was significantly higher during this investigation period in 2020 than during the same period in 2019 ( P < .05). After screening, 12 patients were identified as unqualified. The number of gastrointestinal surgeries was reduced in 2020. There were no differences in the ratio of emergency surgery or semi-elective surgery between in 2020 and in 2019. The elective surgery ratio between January 27 and February 28 was found to be lower in 2020 than in 2019 ( P < .05). The disease spectra of emergency surgery and semi-elective surgery were similar. A total of 31 elective surgeries were postponed. There were five cases of short-term complications for emergency surgeries and two cases of short-term complications for semi-elective surgeries. No long-term complications or COVID-19 infection occurred in any of the cases, and no medical staff member was infected. Conclusion Perioperative management strategies minimize the risk of nosocomial infection and reduce the influence of epidemics on gastrointestinal surgery.

scholarly journals FA01.02: THE EFFECT OF POSTOPERATIVE COMPLICATIONS AFTER MIE ON LONG-TERM SURVIVAL: A RETROSPECTIVE, MULTI-CENTER COHORT STUDY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 1-1 ◽  
Author(s):  
Laura Fransen ◽  
Gijs Berkelmans ◽  
Emanuele Asti ◽  
Mark Van Berge Henegouwen ◽  
Felix Berlth ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Postoperative Complications ◽  
Anastomotic Leakage ◽  
Postoperative Morbidity ◽  
Cardiac Complications ◽  
Short Term ◽  
Term Survival ◽  
Long Term Survival ◽  
Grade 3

Abstract Background Esophagectomy has a high incidence of postoperative morbidity. Complications lead to a decreased short-term survival, however the influence of those complications on long-term survival is still unclear. Most of the performed studies are small, single center cohort series with inconclusive or conflicting results. Minimally invasive esophagectomy (MIE) has been shown to be associated with a reduced postoperative morbidity. In this study, the influence of complications on long-term survival for patients with esophageal cancer undergoing a MIE were investigated. Methods Data was collected from the EsoBenchmark database, a collaboration of 13 high-volume centers routinely performing MIE. Patients were included in this database from June 1, 2011 until May 31, 2016. Complications were scored according to the Clavien-Dindo (CD) classification for surgical complications. Major complications were defined as a CD grade ≥ 3. The data were corrected for 90-day mortality to correct for the short-term effect of postoperative complications on mortality. Overall survival was analyzed using the Kaplan Meier, log rank- and (uni- and multivariable) Cox-regression analyses. Results A total of 926 patients were eligible for analysis. Mean follow-up time was 30.8 months (SD 17.9). Complications occurred in 543 patients (59.2%) of which 39.3% had a major complication. Anastomotic leakage (AL) occurred in 135 patients (14.5%) of which 9.2% needed an intervention (CD grade ≥ 3). A significant worse long-term survival was observed in patients with any AL (HR 1.73, 95% CI 1.29–2.32, P < 0.001) and for patients with AL CD grade ≥3 (HR 1.86, 95% CI 1.32–2.63, P < 0.001). Major cardiac complications occurred in 18 patients (1.9%) and were related to a decreased long-term survival (HR 2.72, 95% CI 1.38–5.35, p 0.004). For all other complications, no significant influence on long-term survival was found. Conclusion The occurrence and severity of anastomotic leakage and cardiac complications after MIE negatively affect long-term survival of esophageal cancer patients. Disclosure All authors have declared no conflicts of interest.

scholarly journals Correlation Between Neutrophil-to-lymphocyte Ratio and Postoperative Mortality in Elderly Patients With Hip Fracture: a Meta-analysis

2021 ◽  
Author(s):  
Ching-Hsin Chou ◽  
Yu-Hang Chen ◽  
Hsin-Hsien Su ◽  
Yu-Ting Tsai ◽  
Ming-Hsiu Chiang ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Geriatric Patients ◽  
Meta Analysis ◽  
Postoperative Mortality ◽  
Short Term ◽  
Term Survival ◽  
Lymphocyte Ratio ◽  
Long Term Mortality

Abstract Introduction: The neutrophil-to-lymphocyte ratio (NLR) is a crucial prognosis predictor following several major operations. However, the association between NLR and the outcome after hip fracture surgery is unclear. In this meta-analysis, we investigated the correlation between NLR and postoperative mortality in geriatric patients following hip surgery. Method: PubMed, Embase, Cochrane library, and Google Scholar were searched for studies up to June 2021 reporting the correlation between NLR and postoperative mortality in elderly patients undergoing surgery for hip fracture. Data from studies reporting the mean of NLR and its 95% confidence interval (CI) were pooled. Both long-term (≥1 year) and short-term (≤30 days) mortality rates were included for analysis.Result: Eight retrospective studies comprising a total of 1563 patients were included. Both preoperative and postoperative NLRs (mean difference [MD]: 2.75, 95% CI: 0.23–5.27; P = 0.03 and MD: 2.36, 95% CI: 0.51–4.21; P = 0.01, respectively) were significantly higher in the long-term mortality group than in the long-term survival group. However, no significant differences in NLR were noted between the short-term mortality and survival groups (MD: −1.02, 95% CI: −3.98 to 1.93; P = 0.5).Conclusion: Higher preoperative and postoperative NLRs were correlated with a higher risk of long-term mortality following surgery for hip fracture in the geriatric population, suggesting the prognostic value of NLR for long-term survival. Further studies with well-controlled confounders are warranted to clarify the predictive value of NLR in clinical practice in geriatric patients with hip fracture.Trial registration: no registration needed

Short-term weight loss after hospitalization predicts long-term survival in patients with chronic heart failure

2006 ◽  
Vol 31 (03) ◽  
Author(s):  
M Lainscak ◽  
S von Haehling ◽  
A Sandek ◽  
I Keber ◽  
M Kerbev ◽  
...  
Keyword(s):  
Heart Failure ◽  
Weight Loss ◽  
Chronic Heart Failure ◽  
Short Term ◽  
Term Survival ◽  
Long Term Survival

Cancer related nutritional and inflammatory markers as predictive parameters of immediate postoperative complications and long-term survival after hepatectomies

2021 ◽  
Vol 37 ◽  
pp. 101526
Author(s):  
Sohan Lal Solanki ◽  
Jasmeen Kaur ◽  
Amit M. Gupta ◽  
Shraddha Patkar ◽  
Riddhi Joshi ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Inflammatory Markers ◽  
Term Survival ◽  
Long Term Survival ◽  
Predictive Parameters

scholarly journals Parenteral Nutrition and Oxidant Load in Neonates

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2631
Author(s):  
Kandeepan Karthigesu ◽  
Robert F. Bertolo ◽  
Robert J. Brown
Keyword(s):  
Parenteral Nutrition ◽  
Storage Temperature ◽  
Oral Feeding ◽  
Published Data ◽  
Short Term ◽  
Antioxidant Defences ◽  
Term Survival ◽  
Nutrient Sources ◽  
Short Term Survival

Neonates with preterm, gastrointestinal dysfunction and very low birth weights are often intolerant to oral feeding. In such infants, the provision of nutrients via parenteral nutrition (PN) becomes necessary for short-term survival, as well as long-term health. However, the elemental nutrients in PN can be a major source of oxidants due to interactions between nutrients, imbalances of anti- and pro-oxidants, and environmental conditions. Moreover, neonates fed PN are at greater risk of oxidative stress, not only from dietary sources, but also because of immature antioxidant defences. Various interventions can lower the oxidant load in PN, including the supplementation of PN with antioxidant vitamins, glutathione, additional arginine and additional cysteine; reduced levels of pro-oxidant nutrients such as iron; protection from light and oxygen; and proper storage temperature. This narrative review of published data provides insight to oxidant molecules generated in PN, nutrient sources of oxidants, and measures to minimize oxidant levels.

An oncology clinical trial design with randomization adaptive to both short- and long-term responses

2017 ◽  
Vol 28 (7) ◽  
pp. 2015-2031 ◽  
Author(s):  
Hao Liu ◽  
Xiao Lin ◽  
Xuelin Huang
Keyword(s):  
Trial Design ◽  
Clinical Trial Design ◽  
Therapeutic Benefit ◽  
Survival Outcome ◽  
Operating Characteristics ◽  
Short Term ◽  
Term Survival ◽  
Long Term Survival ◽  
Term Response

In oncology clinical trials, both short-term response and long-term survival are important. We propose an urn-based adaptive randomization design to incorporate both of these two outcomes. While short-term response can update the randomization probability quickly to benefit the trial participants, long-term survival outcome can also change the randomization to favor the treatment arm with definitive therapeutic benefit. Using generalized Friedman’s urn, we derive an explicit formula for the limiting distribution of the number of subjects assigned to each arm. With prior or hypothetical knowledge on treatment effects, this formula can be used to guide the selection of parameters for the proposed design to achieve desirable patient number ratios between different treatment arms, and thus optimize the operating characteristics of the trial design. Simulation studies show that the proposed design successfully assign more patients to the treatment arms with either better short-term tumor response or long-term survival outcome or both.

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