Complications and outcomes after spinal deformity surgery in the elderly: review of the existing literature and future directions

2011 ◽  
Vol 31 (4) ◽  
pp. E3 ◽  
Author(s):  
Doniel Drazin ◽  
Ali Shirzadi ◽  
Jack Rosner ◽  
Paula Eboli ◽  
Michael Safee ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Spinal Deformity ◽  
Elderly Population ◽  
The Elderly ◽  
Spine Deformity ◽  
Scoliosis Surgery ◽  
Patient Reported ◽  
Spinal Deformity Surgery ◽  
Surgery In The Elderly ◽  
The Mean

Object The elderly population (age > 60 years) is the fastest-growing age group in the US. Spinal deformity is a major problem affecting the elderly and, therefore, the demand for surgery for spinal deformity is becoming increasingly prevalent in elderly patients. Much of the literature on surgery for adult deformity focuses on patients who are younger than 60 years, and therefore there is limited information about the complications and outcomes of surgery in the elderly population. In this study, the authors undertook a review of the literature on spinal deformity surgery in patients older than 60 years. The authors discuss their analysis with a focus on outcomes, complications, discrepancies between individual studies, and strategies for complication avoidance. Methods A systematic review of the MEDLINE and PubMed databases was performed to identify articles published from 1950 to the present using the following key words: “adult scoliosis surgery” and “adult spine deformity surgery.” Exclusion criteria included patient age younger than 60 years. Data on major Oswestry Disability Index (ODI) scores, visual analog scale (VAS) scores, patient-reported outcomes, and complications were recorded. Results Twenty-two articles were obtained and are included in this review. The mean age was 74.2 years, and the mean follow-up period was 3 years. The mean preoperative ODI was 48.6, and the mean postoperative reduction in ODI was 24.1. The mean preoperative VAS score was 7.7 with a mean postoperative decrease of 5.2. There were 311 reported complications for 815 patients (38%) and 5 deaths for 659 patients (< 1%). Conclusions Elderly patient outcomes were inconsistent in the published studies. Overall, most elderly patients obtained favorable outcomes with low operative mortality following surgery for adult spinal deformity.

scholarly journals The prevalence of complications associated with lumbar and thoracic spinal deformity surgery in the elderly population: a meta-analysis

2019 ◽  
Vol 5 (2) ◽  
pp. 223-235 ◽  
Author(s):  
Colleen Smith ◽  
Nayan Lamba ◽  
Zhonghui Ou ◽  
Quynh-Anh Vo ◽  
Lita Araujo-Lama ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Elderly Population ◽  
Meta Analysis ◽  
The Elderly ◽  
Thoracic Spinal ◽  
Spinal Deformity Surgery ◽  
Surgery In The Elderly

P1339ARTERIOVENOUS FISTULA AND BASILIC VEIN TRANSPOSITION IN ELDERLY PATIENTS ON HEMODIALYSIS: AN OBSERVATIONAL STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Vinant Bhargava ◽  
Priti Meena ◽  
Ambrish Satwik ◽  
Apurv Srivastava ◽  
A K Bhalla ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Vascular Access ◽  
Elderly Population ◽  
The Elderly ◽  
Primary Patency ◽  
New Delhi ◽  
Secondary Patency ◽  
Basilic Vein ◽  
The Mean

Abstract Background and Aims With the increase in the line expectancy of chronic kidney disease in the older population (&gt;60 years), the numbers requiring haemodialysis is progressively rising. The elderly population may be different from the younger in terms of non-suitable vessels for access creation, non-maturation, and vascular calcifications, and this may alter the outcomes of use of arteriovenous fistula (AVF). This study was conducted to analyse the outcomes of AVF in elderly patients (&gt;60 years). Method Retrospective study was conducted in the Department of Nephrology at Sir Ganga Ram Hospital, New Delhi. Patients of more than 60 years of age in whom AVF was created from 1st January 2012 to 31st December 2016 were included in the study. Follow-up data of 3.5 years was analysed. The primary endpoint was to assess primary and secondary patency rates. Results A total of 300 patients were included in the study. The mean age was 63.8 years. Radiocephalic AVF (RCAVF) was the most common site of [69.8% (n = 210)], followed by brachiocephalic (BCAVF) in 25.2% (n = 75) and basilic vein transposition (BVT) in 5% (n = 15). At 12 months, overall survival of the AVF was 66.8%. At 42 months, the primary patency rate of RCAVF, BCAVF, and BVT was 50.6%, 52.6%, and 50.4% respectively. The commonest cause of access failure was thrombosis (20.4%) followed by non-maturation (9%). Vascular access abandonment was found least in BCAVF. Conclusion AVF remains the preferred vascular access for haemodialysis in the elderly population. Brachiocephalic AVF has higher primary and secondary patency rates. Thrombosis and failure of maturation are major concerns in the elderly AVF.

313. Risk factors for increased length of stay, reoperation and readmission following adult spinal deformity surgery in the elderly

2019 ◽  
Vol 19 (9) ◽  
pp. S152
Author(s):  
Paramjit Singh ◽  
John Ibrahim ◽  
Deeptee Jain ◽  
Paul Eichenseer ◽  
Mayur Kardile ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
The Elderly ◽  
Spinal Deformity Surgery ◽  
Surgery In The Elderly

scholarly journals Factors Affecting Mortality in Elderly Patients Hospitalized for Nonmalignant Reasons

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Teslime Ayaz ◽  
Serap Baydur Sahin ◽  
Osman Zikrullah Sahin ◽  
Ozlem Bilir ◽  
Halil Rakıcı
Keyword(s):  
Diabetes Mellitus ◽  
Elderly Patients ◽  
Elderly Population ◽  
Demographic Data ◽  
The Elderly ◽  
Hospital Records ◽  
Factors Affecting ◽  
Duration Of Hospital Stay ◽  
Patient Profiles ◽  
The Mean

Elderly population is hospitalized more frequently than young people, and they suffer from more severe diseases that are difficult to diagnose and treat. The present study aimed to investigate the factors affecting mortality in elderly patients hospitalized for nonmalignant reasons. Demographic data, reason for hospitalization, comorbidities, duration of hospital stay, and results of routine blood testing at the time of first hospitalization were obtained from the hospital records of the patients, who were over 65 years of age and hospitalized primarily for nonmalignant reasons. The mean age of 1012 patients included in the study was 77.8 ± 7.6. The most common reason for hospitalization was diabetes mellitus (18.3%). Of the patients, 90.3% had at least a single comorbidity. Whilst 927 (91.6%) of the hospitalized patients were discharged, 85 (8.4%) died. Comparison of the characteristics of the discharged and dead groups revealed that the dead group was older and had higher rates of poor general status and comorbidity. Differences were observed between the discharged and dead groups in most of the laboratory parameters. Hypoalbuminemia, hypertriglyceridemia, hypopotassemia, hypernatremia, hyperuricemia, and high TSH level were the predictors of mortality. In order to meet the health necessities of the elderly population, it is necessary to well define the patient profiles and to identify the risk factors.

Effects of Melatonin and Rilmazafone on Nocturia in the Elderly

2007 ◽  
Vol 35 (5) ◽  
pp. 685-691 ◽  
Author(s):  
K Sugaya ◽  
S Nishijima ◽  
M Miyazato ◽  
K Kadekawa ◽  
Y Ogawa
Keyword(s):  
Quality Of Life ◽  
Elderly Patients ◽  
Sleep Disturbance ◽  
The Elderly ◽  
Treated Group ◽  
Melatonin Level ◽  
Significant Difference ◽  
Patient Reported ◽  
The Mean

We compared the effects of melatonin, an antioxidant and sleep inducer in humans, and rilmazafone hydrochloride, a hypnotic, in elderly patients with nocturia. Patients received either melatonin (2 mg/day; n = 20) or rilmazafone (2 mg/day; n = 22) for 4 weeks. There were no significant differences in the mean age, the quality of life (QoL) score and the serum melatonin levels between the two groups at baseline. After 4 weeks' treatment, the number of nocturnal urinations was significantly decreased and the QoL score was significantly improved in both groups. There was no significant difference between the patient-reported effectiveness ratings between the two groups. The serum melatonin level was significantly increased in the melatonin-treated group, but it remained unchanged in the rilmazafone-treated group. Melatonin and rilmazafone were equally effective for nocturia in the elderly. We recommend that the problems of sleep disturbance should be considered when choosing a therapy for nocturia.

scholarly journals Intraoperative transfusion practices and perioperative outcome in the European elderly: A secondary analysis of the observational ETPOS study

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262110
Author(s):  
Linda Grüßer ◽  
András Keszei ◽  
Mark Coburn ◽  
Rolf Rossaint ◽  
Sebastian Ziemann ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Elderly Population ◽  
Elective Surgery ◽  
Secondary Analysis ◽  
The Elderly ◽  
Transfusion Practice ◽  
Demographic Development ◽  
Red Blood Cell Transfusions ◽  
The Mean ◽  
Dramatic Growth

The demographic development suggests a dramatic growth in the number of elderly patients undergoing surgery in Europe. Most red blood cell transfusions (RBCT) are administered to older people, but little is known about perioperative transfusion practices in this population. In this secondary analysis of the prospective observational multicentre European Transfusion Practice and Outcome Study (ETPOS), we specifically evaluated intraoperative transfusion practices and the related outcomes of 3149 patients aged 65 years and older. Enrolled patients underwent elective surgery in 123 European hospitals, received at least one RBCT intraoperatively and were followed up for 30 days maximum. The mean haemoglobin value at the beginning of surgery was 108 (21) g/l, 84 (15) g/l before transfusion and 101 (16) g/l at the end of surgery. A median of 2 [1–2] units of RBCT were administered. Mostly, more than one transfusion trigger was present, with physiological triggers being preeminent. We revealed a descriptive association between each intraoperatively administered RBCT and mortality and discharge respectively, within the first 10 postoperative days but not thereafter. In our unadjusted model the hazard ratio (HR) for mortality was 1.11 (95% CI: 1.08–1.15) and the HR for discharge was 0.78 (95% CI: 0.74–0.83). After adjustment for several variables, such as age, preoperative haemoglobin and blood loss, the HR for mortality was 1.10 (95% CI: 1.05–1.15) and HR for discharge was 0.82 (95% CI: 0.78–0.87). Pre-operative anaemia in European elderly surgical patients is undertreated. Various triggers seem to support the decision for RBCT. A closer monitoring of elderly patients receiving intraoperative RBCT for the first 10 postoperative days might be justifiable. Further research on the causal relationship between RBCT and outcomes and on optimal transfusion strategies in the elderly population is warranted. A thorough analysis of different time periods within the first 30 postoperative days is recommended.

Outcomes of Laparoscopic Bariatric Surgery in the Elderly Population

2018 ◽  
Vol 84 (10) ◽  
pp. 1600-1603 ◽  
Author(s):  
Christina Y. Koh ◽  
Colette S. Inaba ◽  
Sarath Sujatha-Bhaskar ◽  
Ninh T. Nguyen
Keyword(s):  
Bariatric Surgery ◽  
Elderly Patients ◽  
Elderly Population ◽  
Multivariate Analyses ◽  
The Elderly ◽  
Laparoscopic Bariatric Surgery ◽  
Obese Patients ◽  
Limited Data ◽  
Severely Obese ◽  
Surgery In The Elderly

There have been limited data on the safety of laparoscopic bariatric surgery in the elderly. To compare outcomes of laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) between elderly (‡65 years) and nonelderly (18–64 years) patients. Using the 2011 to 2015 NSQIP database, we analyzed severely obese patients who underwent LRYGB or LSG. Univariate and multivariate analyses were performed to assess primary outcomes including 30-day mortality, serious morbidity, length of stay, and readmission. There were 41,475 LRYGB cases performed, including 2,010 (4.8%) cases in elderly patients. Compared with the nonelderly, elderly patients who underwent LRYGB had higher serious morbidity [odds ratio (OR) = 1.43, confidence interval (CI) = 1.16–1.76, P = 0.001], but similar 30-day mortality (OR = 0.8, CI = 0.28–2.34, P = 0.688). There were 44,550 LSG cases performed, including 2,055 (4.6%) cases in elderly patients. Compared with the nonelderly, elderly patients who underwent LSG had significantly higher serious morbidity (OR = 1.44, CI = 1.12–1.84, P = 0.005) and higher 30-day mortality (OR = 3.62, CI = 1.34–9.83, P = 0.011). Laparoscopic bariatric surgery is safe in the elderly population, and is similar between bariatric procedures. However, elderly patients have higher serious morbidity; therefore, they should be counseled regarding their higher risk, but should not be denied bariatric surgery based solely on their age.

Characteristics of false-positive alerts on transcranial motor evoked potential monitoring during pediatric scoliosis and adult spinal deformity surgery: an “anesthetic fade” phenomenon

2020 ◽  
Vol 32 (3) ◽  
pp. 423-431 ◽  
Author(s):  
Hiroki Ushirozako ◽  
Go Yoshida ◽  
Tomohiko Hasegawa ◽  
Yu Yamato ◽  
Tatsuya Yasuda ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
False Positive ◽  
Adult Spinal Deformity ◽  
False Positive Rate ◽  
Multivariate Logistic Regression Analysis ◽  
Motor Evoked Potential ◽  
Scoliosis Surgery ◽  
True Negative ◽  
Duration Of Surgery ◽  
Spinal Deformity Surgery

OBJECTIVETranscranial motor evoked potential (TcMEP) monitoring may be valuable for predicting postoperative neurological complications with a high sensitivity and specificity, but one of the most frequent problems is the high false-positive rate. The purpose of this study was to clarify the differences in the risk factors for false-positive TcMEP alerts seen when performing surgery in patients with pediatric scoliosis and adult spinal deformity and to identify a method to reduce the false-positive rate.METHODSThe authors retrospectively analyzed 393 patients (282 adult and 111 pediatric patients) who underwent TcMEP monitoring while under total intravenous anesthesia during spinal deformity surgery. They defined their cutoff (alert) point as a final TcMEP amplitude of ≤ 30% of the baseline amplitude. Patients with false-positive alerts were classified into one of two groups: a group with pediatric scoliosis and a group with adult spinal deformity.RESULTSThere were 14 cases of false-positive alerts (13%) during pediatric scoliosis surgery and 62 cases of false-positive alerts (22%) during adult spinal deformity surgery. Compared to the true-negative cases during adult spinal deformity surgery, the false-positive cases had a significantly longer duration of surgery and greater estimated blood loss (both p < 0.001). Compared to the true-negative cases during pediatric scoliosis surgery, the false-positive cases had received a significantly higher total fentanyl dose and a higher mean propofol dose (0.75 ± 0.32 mg vs 0.51 ± 0.18 mg [p = 0.014] and 5.6 ± 0.8 mg/kg/hr vs 5.0 ± 0.7 mg/kg/hr [p = 0.009], respectively). A multivariate logistic regression analysis revealed that the duration of surgery (1-hour difference: OR 1.701; 95% CI 1.364–2.120; p < 0.001) was independently associated with false-positive alerts during adult spinal deformity surgery. A multivariate logistic regression analysis revealed that the mean propofol dose (1-mg/kg/hr difference: OR 3.117; 95% CI 1.196–8.123; p = 0.020), the total fentanyl dose (0.05-mg difference; OR 1.270; 95% CI 1.078–1.497; p = 0.004), and the duration of surgery (1-hour difference: OR 2.685; 95% CI 1.131–6.377; p = 0.025) were independently associated with false-positive alerts during pediatric scoliosis surgery.CONCLUSIONSLonger duration of surgery and greater blood loss are more likely to result in false-positive alerts during adult spinal deformity surgery. In particular, anesthetic doses were associated with false-positive TcMEP alerts during pediatric scoliosis surgery. The authors believe that false-positive alerts during pediatric scoliosis surgery, in particular, are caused by “anesthetic fade.”

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