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).

HYPERTENSION IN ELDERLY:OUR CURRENT TRENDS

2021 ◽  
pp. 56-57
Author(s):  
Rohit Arora ◽  
D.K Sharma
Keyword(s):  
Blood Pressure ◽  
Elderly Patients ◽  
The Elderly ◽  
Common Disease ◽  
Old Patients ◽  
Current Trends ◽  
Increased Risk ◽  
Individualized Approach ◽  
Risk Of Falls ◽  
Optimal Target

Hypertension is a common disease in the elderly associated with signicant morbidity and mortality. Due to the complexity of this population, the optimal target of blood pressure (BP) control is still controversial. In this article, we conduct a literature review of trials published in English in the last 10 years which were specically designed to study the efcacy and safety of various BP targets in patients who are 70 years or older. Using these criteria, we found that the benets in the positive studies were demonstrated even with a minimal BPcontrol (systolic BP[SBP] <150 mmHg) and continued to be reported for a SBP<120 mmHg. On the other hand, keeping SBP<140 mmHg seemed to be safely achieved in elderly patients. Although the safety of lowering SBP to <120 mmHg is debated, Systolic Blood Pressure Intervention Trial study has shown no increased risk of falls, fractures, or kidney failure in elderly patients with SBP lower than this threshold. While the recent guidelines recommended to keep BP <130/80 mmHg in the elderly, more individualized approach should be considered to achieve this goal in order to avoid undesirable complications. Furthermore, further studies are required to evaluate BPtarget in very old patients or those with multiple comorbidities.

scholarly journals Protocol for a systematic review and meta-analysis of respiratory rehabilitation following intensive care unit discharge for COVID-19 survivors

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e041184
Author(s):  
Dan Wang ◽  
Jin Li ◽  
Feilong Zhu ◽  
Qianqin Hong ◽  
Ming Zhang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Meta Analysis ◽  
Biomedical Literature ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
The Impact ◽  
Respiratory Rehabilitation

IntroductionBoth physical and mental disorders may be exacerbated in patients with COVID-19 due to the experience of receiving intensive care; undergoing prolonged mechanical ventilation, sedation, proning and paralysis. Pulmonary rehabilitation is aimed to improve dyspnoea, relieve anxiety and depression, reduce the incidence of related complications, as well as prevent and improve dysfunction. However, the impact of respiratory rehabilitation on discharged patients with COVID-19 is currently unclear, especially on patients who have been mechanically ventilated over 24 hours. Therefore, we aim to investigate the efficacy of respiratory rehabilitation programmes, initiated after discharge from the intensive care unit, on the physical and mental health and health-related quality of life in critical patients with COVID-19.Methods and analysisWe have registered the protocol on PROSPERO and in the process of drafting it, we strictly followed the checklist of Preferred Reporting Items for Systematic Review and Meta-Analysis Potocols. We will search the PubMed, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, WanFang, VIP information databases and Chinese Biomedical Literature Database. Additionally, ongoing trials in the WHO International Clinical Trials Registry Platform, ClinicalTrials.gov and ISRCTN registry will be searched as well. Studies in English or Chinese and from any country will be accepted regardless of study design. Two review authors will independently extract data and assess the quality of included studies. Continuous data are described as standard mean differences (SMDs) with 95% CIs. Dichotomous data from randomised controlled trials are described as risk ratio(RR) with 95% CIs; otherwise, it is described as odds ratio(OR) with 95% CIs. I2 and the Cochrane’s Q statistic will be used to conduct heterogeneity assessment. The quality of evidence of main outcomes will be evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation(GRADE) criteria. When included studies are sufficient, we will conduct subgroup analysis and sensitivity analysis; the publication bias will be statistically analysed using a funnel plot analysis and Egger’s test.Ethics and disseminationOur review, planning to include published studies, does not need the request to the ethical committee. The final results of this review will be published in a peer-reviewed journal after completion.Patient and public involvementNo patient involved.PROSPERO registration numberCRD42020186791.

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.

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.

Systematic review and meta-analysis of interventions for operating room to intensive care unit handoffs

2021 ◽  
pp. bmjqs-2020-012474
Author(s):  
Joanna Abraham ◽  
Alicia Meng ◽  
Sanjna Tripathy ◽  
Michael S Avidan ◽  
Thomas Kannampallil
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Operating Room ◽  
Meta Analysis ◽  
Intervention Group ◽  
Future Research ◽  
Original Research ◽  
Cochrane Central Register ◽  
The Impact

ObjectiveTo conduct a systematic review and meta-analysis to ascertain the impact of operating room (OR) to intensive care unit (ICU) handoff interventions on process-based and clinical outcomes.MethodWe included all English language, prospective evaluation studies of OR to ICU handoff interventions published as original research articles in peer-reviewed journals. The search was conducted on 11 November 2019 on MEDLINE, CINAHL, EMBASE, Scopus and the Cochrane Central Register of Controlled Trials databases, with no prespecified criteria for the type of comparison or outcome. A meta-analysis of similar outcomes was conducted using a random effects model. Quality was assessed using a modified Downs and Black (D&B) checklist.Results32 studies were included for review. 31 studies were conducted at a single site and 28 studies used an observational study design with a control. Most studies (n=28) evaluated bundled interventions which comprised information transfer/communication checklists and protocols. Meta-analysis showed that the handoff intervention group had statistically significant improvements in time to analgesia dosing (mean difference (MD)=−42.51 min, 95% CI −60.39 to −24.64), fewer information omissions (MD=−2.22, 95% CI −3.68 to –0.77), fewer technical errors (MD=−2.38, 95% CI −4.10 to –0.66) and greater information sharing scores (MD=30.03%, 95% CI 19.67% to 40.40%). Only 15 of the 32 studies scored above 9 points on the modified D&B checklist, indicating a lack of high-quality studies.DiscussionBundled interventions were commonly used to support OR to ICU handoff standardisation. Although the meta-analysis showed significant improvements for a number of clinical and process outcomes, the statistical and clinical heterogeneity must be accounted for when interpreting these findings. Implications for OR to ICU handoff practice and future research are discussed.

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 Sarcopenia as a predictor of mortality among the critically ill in an intensive care unit: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiao-Ming Zhang ◽  
Denghong Chen ◽  
Xiao-Hua Xie ◽  
Jun-E Zhang ◽  
Yingchun Zeng ◽  
...  
Keyword(s):  
Systematic Review ◽  
Skeletal Muscle ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Muscle Area ◽  
Risk Of Mortality ◽  
Increased Risk

Abstract Background The evidence of sarcopenia based on CT-scan as an important prognostic factor for critically ill patients has not seen consistent results. To determine the impact of sarcopenia on mortality in critically ill patients, we performed a systematic review and meta-analysis to quantify the association between sarcopenia and mortality. Methods We searched studies from the literature of PubMed, EMBASE, and Cochrane Library from database inception to June 15, 2020. All observational studies exploring the relationship between sarcopenia based on CT-scan and mortality in critically ill patients were included. The search and data analysis were independently conducted by two investigators. A meta-analysis was performed using STATA Version 14.0 software using a fixed-effects model. Results Fourteen studies with a total of 3,249 participants were included in our meta-analysis. The pooled prevalence of sarcopenia among critically ill patients was 41 % (95 % CI:33-49 %). Critically ill patients with sarcopenia in the intensive care unit have an increased risk of mortality compared to critically ill patients without sarcopenia (OR = 2.28, 95 %CI: 1.83–2.83; P < 0.001; I2 = 22.1 %). In addition, a subgroup analysis found that sarcopenia was associated with high risk of mortality when defining sarcopenia by total psoas muscle area (TPA, OR = 3.12,95 %CI:1.71–5.70), skeletal muscle index (SMI, OR = 2.16,95 %CI:1.60–2.90), skeletal muscle area (SMA, OR = 2.29, 95 %CI:1.37–3.83), and masseter muscle(OR = 2.08, 95 %CI:1.15–3.77). Furthermore, critically ill patients with sarcopenia have an increased risk of mortality regardless of mortality types such as in-hospital mortality (OR = 1.99, 95 %CI:1.45–2.73), 30-day mortality(OR = 2.08, 95 %CI:1.36–3.19), and 1-year mortality (OR = 3.23, 95 %CI:2.08 -5.00). Conclusions Sarcopenia increases the risk of mortality in critical illness. Identifying the risk factors of sarcopenia should be routine in clinical assessments and offering corresponding interventions may help medical staff achieve good patient outcomes in ICU departments.

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 Endoscopic Submucosal Dissection for Early Gastric Cancer in Elderly vs. Non-Elderly Patients: A Systematic Review and Meta-Analysis

2022 ◽  
Vol 11 ◽  
Author(s):  
Jiting Zhao ◽  
Zhen Sun ◽  
Junwei Liang ◽  
Song Guo ◽  
Di Huang
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Elderly Patients ◽  
Subgroup Analysis ◽  
Meta Analysis ◽  
The Elderly ◽  
Complete Resection ◽  
En Bloc ◽  
Increased Risk ◽  
Significant Difference

ObjectiveThis study aimed to review the applicability and complications rate associated with endoscopic submucosal dissection (ESD) for early gastric cancer in elderly patients.MethodsDatabases of PubMed, Embase, CENTRAL, and ScienceDirect were searched till 15th April 2021. All types of studies comparing ESD in the elderly vs non-elderly were included. Subgroup analysis was conducted for the following groups: ≥80 years vs &lt;80 years, ≥75 years vs &lt; 75 years, and ≥65 years vs &lt;65 years.Results17 studies were included. Meta-analysis indicated no statistically significant difference in the en-bloc resection rates (OR: 0.92 95% CI: 0.68, 1.26 I2 = 8% p=0.62) and histological complete resection rates (OR: 0.93 95% CI: 0.75, 1.15 I2 = 26% p=0.50) between elderly and non-elderly patients. The results were non-significant even on subgroup analysis. Overall, we found a non-significant but a tendency of increased perforation rates in the elderly as compared to non-elderly patients (OR: 1.22 95% CI: 0.99, 1.52 I2 = 0% p=0.06). However, there was a significantly increased risk of perforation in elderly patients aged ≥80 years as compared to patients &lt;80 years (OR: 1.50 95% CI: 1.00, 2.24 I2 = 3% p=0.05). Bleeding rates were not different in the two groups (OR: 1.07 95% CI: 0.87, 1.32 I2 = 19% p=0.52). Pooled analysis indicated a statistically significantly increased risk of pneumonia in elderly patients (OR: 2.52 95% CI: 1.72, 3.70 I2 = 7% p&lt;0.00001). Length of hospital stay was reported only by five studies. Meta-analysis indicated no significant difference between the two study groups (MD: 0.67 95% CI: -0.14, 1.48 I2 = 83% p=0.10).ConclusionEn-bloc and histological complete resection rates do not differ between elderly and non-elderly patients undergoing ESD for early gastric cancer. Elderly patients have a small tendency of increased risk of perforation with significantly increased rates in the super-elderly (≥80 years of age). The risk of pneumonia is significantly higher in elderly patients but the rates of bleeding do not differ. The certainty of evidence is “very low” and there is a need for high-quality studies taking into account confounding factors to enhance the quality of evidence.

scholarly journals Exploring the Relationship between Biologics and Postoperative Surgical Morbidity in Ulcerative Colitis: A Review

2021 ◽  
Vol 10 (4) ◽  
pp. 710
Author(s):  
Abel Botelho Quaresma ◽  
Fernanda da Silva Barbosa Baraúna ◽  
Fábio Vieira Teixeira ◽  
Rogério Saad-Hossne ◽  
Paulo Gustavo Kotze
Keyword(s):  
Ulcerative Colitis ◽  
Postoperative Complications ◽  
Meta Analysis ◽  
Qualitative Evaluation ◽  
Complication Rates ◽  
Surgical Morbidity ◽  
Randomized Studies ◽  
Pubmed Database ◽  
Increased Risk ◽  
The Impact

Background: With the paradigm shift related to the overspread use of biological agents in the treatment of inflammatory bowel diseases (IBD), several questions emerged from the surgical perspective. Whether the use of biologicals would be associated with higher rates of postoperative complications in ulcerative colitis (UC) patients still remains controversial. Aims: We aimed to analyze the literature, searching for studies that correlated postoperative complications and preoperative exposure to biologics in UC patients, and synthesize these data qualitatively in order to check the possible impact of biologics on postoperative surgical morbidity in this population. Methods: Included studies were identified by electronic search in the PUBMED database according to the PRISMA (Preferred Items of Reports for Systematic Reviews and Meta-Analysis) guidelines. The quality and bias assessments were performed by MINORS (methodological index for non-randomized studies) criteria for non-randomized studies. Results: 608 studies were initially identified, 22 of which were selected for qualitative evaluation. From those, 19 studies (17 retrospective and two prospective) included preoperative anti-TNF. Seven described an increased risk of postoperative complications, and 12 showed no significant increase postoperative morbidity. Only three studies included surgical UC patients with previous use of vedolizumab, two retrospective and one prospective, all with no significant correlation between the drug and an increase in postoperative complication rates. Conclusions: Despite conflicting results, most studies have not shown increased complication rates after abdominal surgical procedures in patients with UC with preoperative exposure to biologics. Further prospective studies are needed to better establish the impact of preoperative biologics and surgical complications in UC.

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