scholarly journals The impact of age on approach-related complications with navigated lateral lumbar interbody fusion

2020 ◽  
Vol 49 (3) ◽  
pp. E8
Author(s):  
Yamaan S. Saadeh ◽  
Clay M. Elswick ◽  
Eleanor Smith ◽  
Timothy J. Yee ◽  
Michael J. Strong ◽  
...  
Keyword(s):  
Risk Factor ◽  
Elderly Patients ◽  
Interbody Fusion ◽  
Multivariable Analysis ◽  
The Elderly ◽  
Lumbar Interbody Fusion ◽  
Related Complication ◽  
Lateral Lumbar Interbody Fusion ◽  
Increased Risk ◽  
The Impact

OBJECTIVEAge is known to be a risk factor for increased complications due to surgery. However, elderly patients can gain significant quality-of-life benefits from surgery. Lateral lumbar interbody fusion (LLIF) is a minimally invasive procedure that is commonly used to treat degenerative spine disease. Recently, 3D navigation has been applied to LLIF. The purpose of this study was to determine whether there is an increased complication risk in the elderly with navigated LLIF.METHODSPatients who underwent 3D-navigated LLIF for degenerative disease from 2014 to 2019 were included in the analysis. Patients were divided into elderly and nonelderly groups, with those 65 years and older categorized as elderly. Ninety-day medical and surgical complications were recorded. Patient and surgical characteristics were compared between groups, and multivariate regression analysis was used to determine independent risk factors for complication.RESULTSOf the 115 patients included, 56 were elderly and 59 were nonelderly. There were 15 complications (25.4%) in the nonelderly group and 10 (17.9%) in the elderly group, which was not significantly different (p = 0.44). On multivariable analysis, age was not a risk factor for complication (p = 0.52). However, multiple-level LLIF was associated with an increased risk of approach-related complication (OR 3.58, p = 0.02).CONCLUSIONSElderly patients do not appear to experience higher rates of approach-related complications compared with nonelderly patients undergoing 3D navigated LLIF. Rather, multilevel surgery is a predictor for approach-related complication.

Abstract T P136: Potential Contributors to the Declining Impact of Stroke Risk Factors with Age: Implications for Stroke Epidemiology in the Elderly

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
George Howard ◽  
Mary Cushman ◽  
Maciej Banach ◽  
Brett M Kissela ◽  
David C Goff ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Stroke Risk ◽  
Multivariable Analysis ◽  
The Elderly ◽  
Stroke Risk Factors ◽  
Age Related ◽  
Increased Risk ◽  
The Impact ◽  
Age Related Changes

Purpose: The importance of stroke research in the elderly is increasing as America is “graying.” For most risk factors for most diseases (including stroke), the magnitude of association with incident events decreases at older ages. Potential changes in the impact of risk factors could be a “true” effect, or could be due to methodological issues such as age-related changes in residual confounding. Methods: REGARDS followed 27,748 stroke-free participants age 45 and over for an average of 5.3 years, during which 715 incident strokes occurred. The association of the “Framingham” risk factors (hypertension [HTN], diabetes, smoking, AFib, LVH and heart disease) with incident stroke risk was assessed in age strata of 45-64 (Young), 65-74 (Middle), and 75+ (Old). For those with and without an “index” risk factor (e.g., HTN), the average number of “other” risk factors was calculated. Results: With the exception of AFib, there was a monotonic decrease in the magnitude of the impact across the age strata, with HTN, diabetes, smoking and LVH even becoming non-significant in the elderly (Figure 1). However, for most factors, the increasing prevalence of other risk factors with age impacts primarily those with the index risk factor absent (Figure 2, example HTN as the “index” risk factor). Discussion: The impact of stroke risk factors substantially declined at older ages. However, this decrease is partially attributable to increases in the prevalence of other risk factors among those without the index risk factor, as there was little change in the prevalence of other risk factors in those with the index risk factor. Hence, the impact of the index risk factor is attenuated by increased risk in the comparison group. If this phenomenon is active with latent risk factors, estimates from multivariable analysis will also decrease with age. A deeper understanding of age-related changes in the impact of risk factors is needed.

scholarly journals The impact of non-steroidal anti-inflammatory drugs use in elderly cardiovascular patients: an observational study from tertiary care in South India

2019 ◽  
Vol 7 (5) ◽  
pp. 1787
Author(s):  
Sadhna Sharma ◽  
Biju Govind ◽  
Kondal Rao
Keyword(s):  
Observational Study ◽  
Elderly Patients ◽  
Tertiary Care ◽  
The Elderly ◽  
Left Ventricular ◽  
Risk Of Death ◽  
Increased Risk ◽  
High Prevalence ◽  
One Year ◽  
The Impact

Background: Long-term use of NSAIDs, by patients having cardiovascular conditions, has shown to increase the risk of cardiovascular events and increased risk of death. Hence, the study was conducted to determine the complications related to NSAID use by the elderly patients with cardiovascular disease (CVD).Methods: The study was a single-center prospective observational study conducted November 2017 to October 2018. Elderly patients (>60 years) suffering from various CVDs and reported NSAID intake daily for at least one month were included. A questionnaire included demographic, treatment related history and complete details of NSAIDs intake including nature, dose, indication, source etc. The same questionnaire was again filled at the end of one-year follow-up.Results: A total of 100 participants were included in the study. The mean age was 72±8.6 years. Majority of the patients (93%) had hypertension, and 69% of the patient had previous MI.  Five NSAIDs (diclofenac, ibuprofen, mefenamic acid, naproxen, and ketorolac) were used routinely. At least one over the counter NSAID used was reported by 86%, 57% were prescribed at least one NSAIDs by their orthopaedics and physicians. At the end of 1-year follow-up, authors found that 71% had MI (2% increase), 4% developed reinfarction, 20% had severe left ventricular failure (4% increase), 7% had atrial fibrillation (1% increase), and 2% patients died and 63% patients reported raise in systolic blood pressure by 5mmHg.Conclusions: High prevalence of concomitant NSAID use among elderly CVD patients, which might be contributing towards increase in CVS morbidity and mortality.

Treatment Outcomes of Head and Neck Cancer Patients in the Elderly Receiving Different Chemoradiation Combinations: A Single-Center Experience

2021 ◽  
pp. 1-7
Author(s):  
Vidhya Karivedu ◽  
Marcelo Bonomi ◽  
Majd Issa ◽  
Adriana Blakaj ◽  
Brett G. Klamer ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Head And Neck ◽  
Chemotherapy Regimen ◽  
Single Agent ◽  
Locally Advanced ◽  
Multivariable Analysis ◽  
The Elderly ◽  
Increased Risk ◽  
Significant Difference ◽  
Weekly Cisplatin

<b><i>Objectives:</i></b> This study aimed to assess the effect of definitive or adjuvant concurrent chemoradiation (CRT) among elderly patients with locally advanced head and neck squamous cell carcinoma (LA HNSCC). <b><i>Materials and Methods:</i></b> We retrospectively analyzed 150 elderly LA HNSCC patients (age ≥70) at a single institution. Demographics, disease control outcomes, and toxicities with different chemotherapy regimens were reviewed. The Kaplan-Meier method was used to estimate progression-free survival (PFS) and overall survival (OS) estimates. <b><i>Results:</i></b> Median age at diagnosis was 74 years (range 70–88). Of the cohort, 98 (65.3%) patients received definitive and 52 (34.7%) received adjuvant CRT; 44 (29.3%) patients received weekly carboplatin and paclitaxel, 43 (28.7%) weekly cetuximab, 33 (22%) weekly carboplatin, and 30 (20%) weekly cisplatin. The OS at 2 years was 70% (95% confidence interval [CI]: 63–79%), and PFS at 2 years was 61% (95% CI: 53–70%). There was no significant difference in OS or PFS between definitive and adjuvant CRT (<i>p</i> = 0.867 and <i>p</i> = 0.475, respectively). Type of chemotherapy regimen (single-agent carboplatin vs. others) (95% CI: 1.1–3.9; <i>p</i> = 0.009) was a key prognostic factor in predicting OS in multivariable analysis. Concurrent use of cetuximab was associated with increased risk of PEG tube dependence at 6 months (<i>p</i> &#x3c; 0.001). <b><i>Conclusions:</i></b> Management of LA HNSCC in the elderly is a challenging scenario. Our study shows that CRT is a feasible treatment modality for elderly patients with LA HNSCC. We recommend CRT with weekly cisplatin or weekly carboplatin and paclitaxel. A chemotherapy regimen should be carefully selected in this difficult to treat population.

scholarly journals Sex Differences in the Outcomes of Elderly Patients with Acute Coronary Syndrome

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Shi Tai ◽  
Xuping Li ◽  
Hui Yang ◽  
Zhaowei Zhu ◽  
Liang Tang ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Mortality Rate ◽  
Elderly Patients ◽  
Protective Factor ◽  
Multivariable Analysis ◽  
The Elderly ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
The Impact

Background. The impact of sex on the outcome of patients with acute coronary syndrome (ACS) has been suggested, but little is known about its impact on elderly patients with ACS. Methods. This study analyzed the impact of sex on in-hospital and 1-year outcomes of elderly (≥75 years of age) patients with ACS hospitalized in our department between January 2013 and December 2017. Results. A total of 711 patients were included: 273 (38.4%) women and 438 (61.6%) men. Their age ranged from 75 to 94 years, similar between women and men. Women had more comorbidities (hypertension (79.5% vs. 72.8%, p=0.050), diabetes mellitus (35.2% vs. 26.5%, p=0.014), and hyperuricemia (39.9% vs. 32.4%, p=0.042)) and had a higher prevalence of non-ST-segment elevation ACS (NSTE-ACS) (79.5% vs. 71.2%, p=0.014) than men. The prevalence of current smoking (56.5% vs. 5.4%, p<0.001), creatinine levels (124.4 ± 98.6 vs. 89.9 ± 54.1, p<0.001), and revascularization rate (39.7% vs. 30.0%, p=0.022) were higher, and troponin TnT and NT-proBNP tended to be higher in men than in women. The in-hospital mortality rate was similar (3.5% vs. 4.4%, p=0.693), but the 1-year mortality rate was lower in women than in men (14.7% vs. 21.7%, p=0.020). The multivariable analysis showed that female sex was a protective factor for 1-year mortality in all patients (OR = 0.565, 95% CI 0.351–0.908, p=0.018) and in patients with STEMI (OR = 0.416, 95% CI 0.184–0.940, p=0.035) after adjustment. Conclusions. Among the elderly patients with ACS, the 1-year mortality rate was lower in women than in men, which could be associated with comorbidities and ACS type.

The Impact of Age upon Contingency Planning for Multiple-casualty Incidents Based on a Single Center’s Experience

2016 ◽  
Vol 31 (5) ◽  
pp. 492-497 ◽  
Author(s):  
Itamar Ashkenazi ◽  
Sharon Einav ◽  
Oded Olsha ◽  
Fernando Turegano-Fuentes ◽  
Michael M. Krausz ◽  
...  
Keyword(s):  
Elderly Patients ◽  
The Elderly ◽  
Multiple Organ ◽  
Contingency Planning ◽  
Trauma Patients ◽  
Publication Type ◽  
Level Ii ◽  
Increased Risk ◽  
Multiple Casualty Incidents ◽  
The Impact

AbstractIntroductionTrauma patients in the extremes of age may require a specialized approach during a multiple-casualty incident (MCI).ProblemThe aim of this study was to examine the type of injuries encountered in children and elderly patients and the implications of these injuries for treatment and organization.MethodsA review of medical record files of patients admitted in MCIs in one Level II trauma center was conducted. Patients were classified according to age: children (≤12 years), adults (between 12-65 years), and elders (≥65 years).ResultsThe files of 534 were screened: 31 (5.8%) children and 54 (10.1%) elderly patients. One-third of the elderly patients were either moderately or severely injured, compared to only 6.5% of the children and 11.1% of the adults (P<.001). Elderly patients required more blood transfusions (P=.0001), more computed tomography imaging (P=.0001), and underwent more surgery (P=.0004). Elders were hospitalized longer (P=.0003). There was no mortality among injured children, compared to nine (2.0%) of the adults and seven (13.0%) of the elderly patients (P<.0001). All the adult deaths occurred early and directly related to their injuries, whereas most of the deaths among the elderly patients (four out of seven) occurred late and were due to complications and multiple organ failure.ConclusionsInjury at an older age confers an increased risk of complications and death in victims of MCIs.AshkenaziI, EinavS, OlshaO, Turegano-FuentesF, KrauszMM, AlficiR. The impact of age upon contingency planning for multiple-casualty incidents based on a single center’s experience. Prehosp Disaster Med. 2016;31(5):492–497.

scholarly journals Use of 3D CT-based navigation in minimally invasive lateral lumbar interbody fusion

2016 ◽  
Vol 25 (3) ◽  
pp. 339-344 ◽  
Author(s):  
Jacob R. Joseph ◽  
Brandon W. Smith ◽  
Rakesh D. Patel ◽  
Paul Park
Keyword(s):  
Interbody Fusion ◽  
Cone Beam Ct ◽  
Psoas Muscle ◽  
Lumbar Interbody Fusion ◽  
Related Complication ◽  
Disc Space ◽  
Image Guided ◽  
Lateral Lumbar Interbody Fusion ◽  
Intraoperative Fluoroscopy ◽  
Spinal Navigation

OBJECTIVE Lateral lumbar interbody fusion (LLIF) is an increasingly popular technique used to treat degenerative lumbar disease. The technique of using an intraoperative cone-beam CT (iCBCT) and an image-guided navigation system (IGNS) for LLIF cage placement has been previously described. However, other than a small feasibility study, there has been no clinical study evaluating its accuracy or safety. Therefore, the purpose of this study was to evaluate the accuracy and safety of image-guided spinal navigation in LLIF. METHODS An analysis of a prospectively acquired database was performed. Thirty-one consecutive patients were identified. Accuracy was initially determined by comparison of the planned trajectory of the IGNS with post–cage placement intraoperative fluoroscopy. Accuracy was subsequently confirmed by postprocedural CT and/or radiography. Cage placement was graded based on a previously described system separating the disc space into quarters. RESULTS The mean patient age was 63.9 years. A total of 66 spinal levels were treated, with a mean of 2.1 levels (range 1–4) treated per patient. Cage placement was noted to be accurate using IGNS in each case, as confirmed with intraoperative fluoroscopy and postoperative imaging. Sixty-four (97%) cages were placed within Quarters 1 to 2 or 2 to 3, indicating placement of the cage in the anterior or middle portions of the disc space. There were no instances of misguidance by IGNS. There was 1 significant approach-related complication (psoas muscle abscess) that required intervention, and 8 patients with transient, mild thigh paresthesias or weakness. CONCLUSIONS LLIF can be safely and accurately performed utilizing iCBCT and IGNS. Accuracy is acceptable for multilevel procedures.

scholarly journals Influential Factors of Successful Hepatitis C Treatment in Elderly Patients

2019 ◽  
Vol 10 (3) ◽  
pp. 14
Author(s):  
Jennifer Andres ◽  
Mandee Noval ◽  
Christine Mauriello ◽  
Derek Peiffer ◽  
Huaqing Zhao
Keyword(s):  
Hepatitis C ◽  
Elderly Patients ◽  
Drug Interactions ◽  
Elderly Population ◽  
Treatment Success ◽  
The Elderly ◽  
Pill Burden ◽  
Hcv Treatment ◽  
Increased Risk ◽  
The Impact

Background: Chronic Hepatitis C virus (HCV) is an infection associated with an increased risk of cirrhosis, hepatocellular carcinoma (HCC), and morbidity and mortality. Treating HCV poses challenges in the elderly population due to the lack of evidence and complexity of patients. Objective: This study aims to evaluate factors that influence HCV treatment success in elderly patients, especially those over age of 70, such as pill burden and comorbidities, in addition to drug interactions and adverse effects. Methods: This was a retrospective chart review of patients treated at our urban academic institution from 2014-2016. Results: Sixty-two patients over the age of 70 were included in this study. The sustained virologic response rate 12 weeks after the completion of treatment (SVR12) was 79%. In a multi-variate analysis, cirrhosis, age closer to 70, and longer duration of treatment were statistically significantly more likely to lead to treatment failure. Though not statistically significant, other factors that may negatively influence achievement of SVR12 were cognitive impairment, cardiovascular disease, multi-tablet HCV regimen, time to initiation of HCV treatment > 90 days, and prior treatment experience. Pill burden of other prescribed medications did not impact SVR12. Adverse events and drug interactions were common in the population. Conclusions: Overall SVR12 rate in the elderly population was lower than that reported in the literature. Factors associated with lower treatment success, especially cirrhosis, should be considered when treating an elderly population. Further data is needed on the impact of other factors on SVR12 attainment in an elderly patient population.   Article Type: Original Research

scholarly journals Association of Frailty With the Risk of Mortality and Resource Utilization in Elderly Patients in Intensive Care Units: A Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Feiping Xia ◽  
Jing Zhang ◽  
Shanshan Meng ◽  
Haibo Qiu ◽  
Fengmei Guo
Keyword(s):  
Intensive Care ◽  
Elderly Patients ◽  
Resource Utilization ◽  
Meta Analysis ◽  
The Elderly ◽  
Cochrane Central Register ◽  
Old Patients ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
The Impact

Background: The associations of frailty with the risk of mortality and resource utilization in the elderly patients admitted to intensive care unit (ICU) remain unclear. To address these issues, we performed a meta-analysis to determine whether frailty is associated with adverse outcomes and increased resource utilization in elderly patients admitted to the ICU.Methods: We searched PubMed, EMBASE, ScienceDirect, and Cochrane Central Register of Controlled Trials through August 2021 to identify the relevant studies that investigated frailty in elderly (≥ 65 years old) patients admitted to an ICU and compared outcomes and resource utilization between frail and non-frail patients. The primary outcome was mortality. We also investigated the prevalence of frailty and the impact of frailty on the health resource utilization, such as hospital length of stay (LOS) and resource utilization of ICU.Results: A total of 13 observational studies enrolling 64,279 participants (28,951 frail and 35,328 non-frail) were finally included. Frailty was associated with an increased risk of short-term mortality (10 studies, relative risk [RR]: 1.70; 95% CI: 1.45–1.98), in-hospital mortality (five studies, RR: 1.73; 95% CI: 1.55–1.93), and long-term mortality (six studies, RR: 1.86; 95% CI: 1.44–2.42). Subgroup analysis showed that retrospective studies identified a stronger correlation between frailty and hospital LOS (three studies, MD 1.14 d; 95% CI: 0.92–1.36).Conclusions: Frailty is common in the elderly patients admitted to ICU, and is associated with increased mortality and prolonged hospital LOS.Trial registration: This study was registered in the PROSPERO database (CRD42020207242).

scholarly journals Characterization and rate of symptomatic adjacent-segment disease after index lateral lumbar interbody fusion: a single-institution, multisurgeon case series with long-term follow-up

2021 ◽  
pp. 1-8
Author(s):  
Timothy Y. Wang ◽  
Vikram A. Mehta ◽  
Eric W. Sankey ◽  
Khoi D. Than ◽  
C. Rory Goodwin ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Case Series ◽  
Adjacent Segment Disease ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Lateral Lumbar Interbody Fusion ◽  
Additional Surgery ◽  
Increased Risk

OBJECTIVE The rate of symptomatic adjacent-segment disease (ASD) after newer minimally invasive techniques, such as lateral lumbar interbody fusion (LLIF), is not known. This study aimed to assess the incidence of surgically significant ASD in adult patients who have undergone index LLIF and to identify any predictive factors. METHODS Patients who underwent index LLIF with or without additional posterior pedicle screw fixation between 2010 and 2012 and received a minimum of 2 years of postoperative follow-up were retrospectively included. Demographic and perioperative data were recorded, as well as radiographic data and immediate perioperative complications. The primary endpoint was revision surgery at the level above or below the previous construct, from which a survivorship model of patients with surgically significant symptomatic ASD was created. RESULTS Sixty-seven patients with a total of 163 interbody levels were included in this analysis. In total, 17 (25.4%) patients developed surgically significant ASD and required additional surgery, with a mean ± SD time to revision of 3.59 ± 2.55 years. The mean annual rate of surgically significant ASD was 3.49% over 7.27 years, which was the average follow-up. One-third of patients developed significant disease within 2 years of index surgery, and 1 patient required surgery at the adjacent level within 1 year. Constructs spanning 3 or fewer interbody levels were significantly associated with increased risk of surgically significant ASD; however, instrument termination at the thoracolumbar junction did not increase this risk. Surgically significant ASD was not impacted by preoperative disc height, foraminal area at the adjacent levels, or changes in global or segmental lumbar lordosis. CONCLUSIONS The risk of surgically significant ASD after LLIF was similar to the previously reported rates of other minimally invasive spine procedures. Patients with shorter constructs had higher rates of subsequent ASD.

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