Faculty Opinions recommendation of Risk factors for postoperative systemic complications in elderly patients with brain tumors. Clinical article.

2009 ◽  
Author(s):  
Zvi Ram
Keyword(s):  
Risk Factors ◽  
Brain Tumors ◽  
Elderly Patients ◽  
Systemic Complications ◽  
Clinical Article

Risk factors for postoperative systemic complications in elderly patients with brain tumors

2009 ◽  
Vol 111 (2) ◽  
pp. 258-264 ◽  
Author(s):  
Kenichiro Asano ◽  
Takahiro Nakano ◽  
Tetsuji Takeda ◽  
Hiroki Ohkuma
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Brain Tumors ◽  
Blood Loss ◽  
Elderly Patients ◽  
Univariate Analysis ◽  
Intraoperative Blood Loss ◽  
Systemic Complications ◽  
Level Difference ◽  
Cutoff Values

Object In elderly patients with brain tumors, the prevention of postoperative systemic complications is extremely important, and identification of the risk factors would be useful for planning therapy. The authors investigated ways to avoid postoperative complications by identifying risk factors. Methods The study population included 84 patients, 70 years of age or older, who underwent surgical brain tumor removal. The following independent factors were assessed by univariate and multivariate analyses: sex, age, preoperative underlying diseases and complications, histopathological findings, preoperative Karnofsky Performance Scale (KPS) score, preoperative whole blood hemoglobin (Hb) level, preoperative serum total protein (TP) level, operation time, intraoperative blood loss, change in Hb level (difference between pre- and postoperative values), and change in TP level (difference between pre- and postoperative values). The cutoff values for significant independent factors were also determined. Results Overall, 35 (41.7%) of the 84 patients had a total of 56 postoperative systemic complications. Univariate analysis identified the preoperative KPS score, intraoperative blood loss, change in Hb level, and change in TP level as risk factors for postoperative complications, and multivariate analysis extracted the following risk factors: the preoperative KPS score (p = 0.0450, OR 4.020), intraoperative blood loss (p = 0.0104, OR 6.571), and change in Hb levels (p = 0.0023, OR 9.301). The cutoff values were: KPS score < 80%, intraoperative blood loss ≥ 350 ml, and change in Hb level ≥ 2.0 g/dl. Conclusions In elderly patients with brain tumors, low preoperative KPS score, high intraoperative blood loss, and a large difference between pre- and postoperative Hb levels are significant risk factors for postoperative systemic complications.

Impact of Age and Comorbidity on the Short-Term Surgical Outcome after Laparoscopy-Assisted Distal Gastrectomy for Adenocarcinoma

2013 ◽  
Vol 79 (1) ◽  
pp. 40-48 ◽  
Author(s):  
Han-A Park ◽  
Seong-Heum Park ◽  
Sung-Il Cho ◽  
You-Jin Jang ◽  
Jong-Han Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Surgical Outcomes ◽  
Surgical Outcome ◽  
Distal Gastrectomy ◽  
Outcome Data ◽  
University Hospitals ◽  
Short Term ◽  
Aged Patients ◽  
Systemic Complications

The aim of this study was to determine whether age and comorbidity are valuable risk factors of the short-term surgical outcome after laparoscopy-assisted distal gastrectomy (LADG) in patients with adenocarcinoma. A series of 387 patients who underwent LADG at three university hospitals between March 2006 and December 2010 were retrospectively studied. To compare the short-term surgical outcomes of LADG of elderly patients with those of younger patients, patients were categorized into an elderly group (older than 70 years of age) and a younger group (70 years of age or younger). For another comparative analysis to identify risk factors of postoperative complications after LADG, patients were categorized into two groups: those with complications and those without complications. With the exception of sex ratio and comorbidity rate, two age groups were nonsignificantly different in terms of demographic, operative, pathologic, and short-term surgical outcome data. Our data support the safety and feasibility of LADG in elderly patients. However, our data show that comorbidity is an important predictor of postoperative systemic complications after LADG. Patients with an age-adjusted Charlson comorbidity index (CCI) of 3 or greater were found to be at a greater risk of developing systemic complications, which suggests that age-adjusted CCI is a useful predictor of systemic complications after LADG and that it could be used routinely for the perioperative care of aged patients with comorbidity. We recommend age-adjusted CCI be used in comparative clinical research studies on the surgical outcomes across surgeons and hospitals.

scholarly journals Risk factors related to perioperative systemic complications and mortality in elderly patients with osteoporotic vertebral fractures—analysis of a large national inpatient database

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Shingo Morishita ◽  
Toshitaka Yoshii ◽  
Atsushi Okawa ◽  
Hiroyuki Inose ◽  
Takashi Hirai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Renal Failure ◽  
Elderly Patients ◽  
Vertebral Fractures ◽  
Hospital Death ◽  
Systemic Complications ◽  
Osteoporotic Vertebral Fractures ◽  
Complications And Mortality ◽  
Inpatient Database

Abstract Background The surgical treatment of osteoporotic vertebral fractures (OVF) is generally associated with a high risk of complications due to an aging population with osteoporosis; however, the detailed risk factors for systemic complications and mortality have not been clarified. We evaluated the risk factors for systemic complications and mortality in surgically treated OVF patients using a large national inpatient database. Methods Patients over 65 years old who were diagnosed with OVF and received either anterior fusion (AF) or posterior fusion (PF), from 2012 to 2016, were extracted from the diagnosis procedure combination (DPC) database. In each of the perioperative systemic complications (+) or (−) group, and the in-hospital death (+) or (−) group, we surveyed the various risk factors related to perioperative systemic complications and in-hospital death. Results The significant factors associated with systemic complications were older age (OR 1.38, 95% CI 1.09–1.74), a lower activity of daily living score upon admission (OR 1.52, 95%CI 1.19–1.94), atrial fibrillation (OR 2.14, 95%CI 1.25–3.65), renal failure (OR 2.29, 95%CI 1.25–4.20), and surgical procedure (AF, OR 1.73, 95%CI 1.35–2.22). The significant explanatory variables for in-hospital death were revealed to be male sex (OR 3.26, 95%CI 1.20–8.87), a lower body mass index (OR 3.97, 95%CI 1.23–12.86), unscheduled admission (OR 3.52, 95%CI 1.17–10.63), atrial fibrillation (OR 8.31, 95%CI 2.25–30.70), renal failure (OR 7.15, 95%CI 1.32-38.77), and schizophrenia (OR 8.23, 95%CI 1.66–42.02). Conclusions Atrial fibrillation and renal failure as preoperative comorbidities were common factors between perioperative systemic complications and mortality in elderly patients for OVF.

scholarly journals Perioperative outcomes following surgery for brain tumors: Objective assessment and risk factor evaluation

2012 ◽  
Vol 03 (01) ◽  
pp. 28-35 ◽  
Author(s):  
Aliasgar V Moiyadi ◽  
Prakash M Shetty
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Brain Tumors ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Morbidity And Mortality ◽  
Perioperative Outcomes ◽  
Related Factors ◽  
Important Indicator ◽  
Systemic Complications

ABSTRACT Background: Perioperative outcomes following surgery for brain tumors are an important indicator of the safety as well as efficacy of surgical intervention. Perioperative morbidity not only has implications on direct patient care, but also serves as an indicator of the quality of care provided, and enables objective documentation, for comparision in various clinical trials. We document our experience at a tertiary care referral, a dedicated neuro-oncology center in India. Materials and Methods: One hundred and ninety-six patients undergoing various surgeries for intra-axial brain tumors were analyzed. Routine microsurgical techniques and uniform antibiotic policy were used. Navigation/ intraoperative electrophysiological monitoring was not available. The endpoints assessed included immediate postoperative neurological status, neurological outcome at discharge, regional complications, systemic complications, overall morbidity, and mortality. Various risk factors assessed included clinico-epidemiological factors, tumor-related factors, and surgery-related factors. Univariate and multivariate analysis were performed. Results: Median age was 38 years. 72% had tumors larger than 4 cm. Neurological morbidity, and regional and systemic complications occurred in 16.8, 17.3, and 10.7%, respectively. Overall, major morbidity occurred in 18% and perioperative mortality rate was 3.6%. Although a few of the known risk factors were found to be significant on univariate analysis, none achieved significance on multivariate analysis. Conclusions: Our patients were younger and had larger tumors than are generally reported. Despite the unavailability of advanced intraoperative aids we could achieve acceptable levels of morbidity and mortality. Objective recording of perioperative events is crucial to document outcomes after surgery for brain tumors.

scholarly journals A retrospective study of perioperative outcomes following surgery for brain tumors: objective assessment and risk factor evaluation in rural centre

2018 ◽  
Vol 32 (2) ◽  
pp. 366-376
Author(s):  
Sachidanand Gautam ◽  
Ojha Piyush ◽  
Sharma Anubhav
Keyword(s):  
Risk Factors ◽  
Brain Tumors ◽  
Objective Assessment ◽  
Surgical Techniques ◽  
Morbidity And Mortality ◽  
Perioperative Outcomes ◽  
Neurosurgical Department ◽  
Related Factors ◽  
Important Indicator ◽  
Systemic Complications

Abstract Background: Extensive surgical resection remains nowadays the best treatment available for most brain tumours. Perioperative outcomes following surgery for brain tumors are an important indicator of the safety as well as efficacy of surgical intervention. The goal of this study was to review the results of surgical treatment in our Department, run by a single neurosurgeon, in order to quantify morbidity and mortality and determine predictive risk factors for each patient. Materials and Methods: A total of Three hundred patients undergoing various surgeries for brain tumors were analyzed. Routine surgical techniques and uniform antibiotic policy were used. Navigation advanced operating microscope/ intraoperative electrophysiological monitoring was not available. The endpoints assessed included immediate postoperative neurological status, neurological outcome at discharge, regional complications, systemic complications, overall morbidity, and mortality. Various risk factors assessed included clinicoepidemiological factors, tumor-related factors, and surgery-related factors. Results: Median age was 36.37 years. 74.3% had tumors larger than 4 cm. Neurological morbidity, and regional and systemic complications occurred in 14.3, 14.3, and 11.3%, respectively. Overall, major morbidity occurred in 14.3% and perioperative mortality rate was 3.3%. Conclusions: Our patients were younger and had larger tumors than were generally reported. Despite the unavailability of advanced intraoperative aids, we could achieve acceptable levels of morbidity and mortality rates. The knowledge of the complications rate in each particular neurosurgical department turns out essentially to provide the patient with tailored information about risks before surgery.

scholarly journals Perioperative complications of spine surgery in patients 80 years of age or older: a multicenter prospective cohort study

2020 ◽  
Vol 32 (4) ◽  
pp. 622-630 ◽  
Author(s):  
Takamasa Watanabe ◽  
Masahiro Kanayama ◽  
Masahiko Takahata ◽  
Itaru Oda ◽  
Kota Suda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Elderly Patients ◽  
Spine Surgery ◽  
Perioperative Complications ◽  
Operation Time ◽  
Systemic Complications ◽  
Multicenter Prospective Cohort Study ◽  
Ecog Ps ◽  
Multicenter Prospective Cohort

OBJECTIVEThe number of spine surgeries performed in elderly patients is consistently increasing. However, to date the prevalence of and risk factors for perioperative complications remain unclear, especially in patients 80 years of age or older. This study had two goals: 1) determine the perioperative complications of spine surgery associated with patients 80 years of age or older; and 2) investigate the risk factors for perioperative systemic complications.METHODSIn this paper, the authors describe a multicenter prospective cohort study. Seven spine centers with board-certified spine surgeons participated in this all-case investigation. A total of 270 consecutively enrolled patients (109 males and 161 females), 80 years of age or older, underwent spine surgery between January and December 2017. Patients with trauma, infection, or tumor were excluded in this cohort. Perioperative complications were defined as adverse events that occurred intraoperatively or within 30 days postoperatively. The patients’ preoperative health status was determined using the following means of assessment: 1) the Charlson Comorbidity Index, 2) the American Society of Anesthesiologists Physical Status Classification System, 3) the Eastern Cooperative Oncology Group Performance Status (ECOG-PS), 4) the presence of sarcopenia, and 5) the Geriatric Nutritional Risk Index. Associations among patient age, preoperative health status, surgical factors (instrumentation surgery, operation time, number of spinal levels treated, and estimated blood loss), and perioperative systemic complications were analyzed.RESULTSOverall perioperative, surgical site, and minor systemic complications were observed in 20.0%, 8.1%, and 14.8% of patients, respectively. Major systemic complications, on the other hand, were not observed. The reoperation rate was low—only 4.1%. Multivariate analysis revealed that the ECOG-PS (p = 0.013), instrumentation surgery (p = 0.024), and an operation time longer than 180 minutes (p = 0.016) were associated with minor systemic complications.CONCLUSIONSTo the best of the authors’ knowledge, this is the first multicenter prospective all-case investigation of perioperative complications of spine surgery in elderly patients. Although decreased daily activity (ECOG-PS), instrumentation surgery, and longer operation time were associated with minor systemic complications, no major systemic complications were observed in these elderly patients. Thus, spine surgery can be safely performed in elderly patients 80 years of age or older.

Differences in risk factors among early and late readmission of elderly patients from convalescence care unit and 30 and 90 days outcome: A cohort study

2018 ◽  
Vol 9 (4) ◽  
pp. 137-142
Author(s):  
Ka Ying Miu ◽  
Ching Wai Chan ◽  
Pui Shan Lam ◽  
Ching Kok ◽  
Kai Yin Lam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Elderly Patients

Evaluation of the correlation between risk factors and mortality in elderly patients with femoral neck fracture with 5-year follow-up

2008 ◽  
Vol 149 (11) ◽  
pp. 493-503 ◽  
Author(s):  
Andor Sebestyén ◽  
Imre Boncz ◽  
Ferenc Tóth ◽  
Márta Péntek ◽  
József Nyárády ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Neck ◽  
Elderly Patients ◽  
Femoral Neck Fracture ◽  
Neck Fracture

A csípőtáji törésekhez idős korban magas halálozás társul. A szakirodalomban kevés a nagy beteganyagot feldolgozó, országos kiterjedésű ellátórendszer adatain alapuló feldolgozás. Célkitűzés: A tanulmány célja a 60 év feletti akut, monotraumás combnyaktöröttek primer ellátását követő halálozások vizsgálata havonta és évente ötéves utánkövetéssel, valamint a különböző rizikófaktoraik halálozásra gyakorolt hatásainak értékelése az egyes időperiódusokban. Módszer: Az adatok az Országos Egészségbiztosítási Pénztár adatbázisából származnak. Az értékelés bázisát a fekvőbeteg-ellátást végző intézményekből combnyaktörés primer műtéti ellátását követően 2000. évben emittált betegek képezik. Bemutatjuk az átlagos évenkénti, havonkénti és heti halálozási arányokat, valamint rizikótényezők szerinti alakulásukat havonként és évenként. A rizikótényezők és a halálozás kapcsolatának értékelése logisztikus és Cox-regressziós analízissel történik. Eredmények: A tanulmányban 3783 fő került elemzésre. Átlagéletkoruk 77,97 (SD 8,52) év. A halálozás az első héten 1,71%, 30 napon belül 8,99%, az első évben 30,74%, öt év alatt 61,88% volt. A halálozás havi szinten az első 5 hónapig mutat csökkenést, éves szinten az első év után stagnál. A rizikófaktorok közül a férfinem és a magasabb életkor öt évig, a kísérőbetegségek hatásai a negyedik évig, a laterális combnyaktöréstípus és a 12 órán túli ellátás két évig, a korai lokális szövődmények egy évig, a hétvégi ellátások az első hónapban eredményeznek magasabb halálozási kockázatot. Az országos és egyetemi ellátásokat követően az első évben alacsonyabb a halálozási kockázat. Következtetések: A csípőtáji törések managementjében a halálozások csökkentése érdekében hangsúlyozzuk a 12 órán belüli ellátás, a törési típusnak megfelelő módszerválasztás, a hét minden napján történő azonos ellátási feltételek biztosítása, az ellátások centrumokba történő szervezése, a beteg általános állapotának és kísérőbetegségeinek megfelelő akut ellátás és az utókezelések fontosságát.

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