The Prediction of Postoperative Pulmonary Complications in the Elderly Patients

Abstract Aim To evaluate morbidity and mortality after esophagectomy among elderly patients Background & Methods Esophagectomy is associated with significant morbidity1, and with the aging population we are faced with an increasing number of elderly patients eligible for surgery. In this retrospective study we analyzed both minor and major postoperative complications (Clavidien-Dindo II-V), in-hospital and 90-day mortality, and overall survival in all carcinoma patients ≥75 yo undergoing esophagectomy for cancer between 2009 and 2018 at a high-volume center. Results 47 patients underwent esophagectomy during the 10-yr. period, 95,7% either minimally invasively or with a hybrid approach. Median age was 77, and the oldest patient 85 yo. The majority were in otherwise good health, 39 had an ASA score of 1-2, and all but one was ECOG 0. 70% had adenocarcinomas, and 70% received neoadjuvant treatment. 68,1% of the patients suffered some sort of complication. 19 patients (40,4%) had a C-D III-IV complication, 9 of which were pulmonary requiring a median of 5 days in the ICU. Only 4 patients (8,5%) had anastomotic leakage requiring an intervention, 2 were managed endoscopically, 1 early dehiscence was sutured and one required a revision and LD plasty. One patient had non-fatal gastric tube necrosis that was excised. Atrial fibrillation (34%) was the most common but easily managed issue, followed by pulmonary complications (C-D II 5pts /10,6%, C-D III-IV 10 pts / 21,3%). We had 3 re-operations for bowl herniation, and one for bleeding. Our in-hospital and 90-day mortality were 0%, in spite of the high complication rate. 63,8% were discharged home. Mean and median survival times 68,2 mo. and 47 mo., respectively. At time of follow up, 28 patients (59,6%) were still alive. Conclusion Esophagectomy comes with high morbidity, but with acceptable long term results it should be considered for elderly patients otherwise fit for surgery. Our results show that in select cases age is just a number 1. Low DE, Kuppusamy MK, Alderson D, Cecconello I, Chang AC, Darling G, Davies A, D'Journo XB, Gisbertz SS, Griffin SM, Hardwick R, Hoelscher A, et al. Benchmarking Complications Associated with Esophagectomy. Ann Surg 2017;:1.

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Pulmonary Complications after Surgery for Rectal Cancer in Elderly Patients: Evaluation of Laparoscopic versus Open Approach from a Multicenter Study on 477 Consecutive Cases

Gastroenterology Research and Practice ◽

10.1155/2017/5893890 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 5

Author(s):

Marco Milone ◽

Ugo Elmore ◽

Andrea Vignali ◽

Alfredo Mellano ◽

Nicola Gennarelli ◽

...

Keyword(s):

Rectal Cancer ◽

Laparoscopic Surgery ◽

Elderly Patients ◽

Rectal Surgery ◽

Laparoscopic Group ◽

Pulmonary Complications ◽

Open Approach ◽

Postoperative Pulmonary Complications ◽

Old Patients ◽

The Impact

Aim. To evaluate the impact of open or laparoscopic rectal surgery on pulmonary complications in elderly (>75 years old) patients. Methods. Data from consecutive patients who underwent elective laparoscopic or open rectal surgery for cancer were collected prospectively from 3 institutions. Pulmonary complications were defined according to the ACS/NSQUIP definition. Results. A total of 477 patients (laparoscopic group: 242, open group: 235) were included in the analysis. Postoperative pulmonary complications were significantly more common after open surgery (8 out of 242 patients (3.3%) versus 23 out of 235 patients (9.8%); p=0.005). In addition, PPC occurrence was associated with the increasing of postoperative pain (5.04 ± 1.62 versus 5.03 ± 1.58; p=0.001) and the increasing of operative time (270.06 ± 51.49 versus 237.37 ± 65.97; p=0.001). Conclusion. Our results are encouraging to consider laparoscopic surgery a safety and effective way to treat rectal cancer in elderly patients, highlighting that laparoscopic surgery reduces the occurrence of postoperative pulmonary complications.

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Effects of an Alveolar Recruitment Maneuver During Lung Protective Ventilation on Postoperative Pulmonary Complications in Elderly Patients Undergoing Laparoscopy

Clinical Interventions in Aging ◽

10.2147/cia.s264987 ◽

2020 ◽

Vol Volume 15 ◽

pp. 1461-1469

Author(s):

Youn Yi Jo ◽

Kyung Cheon Lee ◽

Young Jin Chang ◽

Wol Seon Jung ◽

Jongchul Park ◽

...

Keyword(s):

Elderly Patients ◽

Recruitment Maneuver ◽

Pulmonary Complications ◽

Protective Ventilation ◽

Alveolar Recruitment ◽

Lung Protective Ventilation ◽

Postoperative Pulmonary Complications ◽

Alveolar Recruitment Maneuver

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Short-Physical Performance Battery (SPPB) score is associated with postoperative pulmonary complications in elderly patients undergoing lung resection surgery: A prospective multicenter cohort study

Chronic Respiratory Disease ◽

10.1177/1479973120961846 ◽

2020 ◽

Vol 17 ◽

pp. 147997312096184

Author(s):

Masatoshi Hanada ◽

Kota Yamauchi ◽

Shinjiro Miyazaki ◽

Yohei Oyama ◽

Yorihide Yanagita ◽

...

Keyword(s):

Cohort Study ◽

Elderly Patients ◽

Physical Performance ◽

Lung Resection ◽

Pulmonary Complications ◽

Short Physical Performance Battery ◽

Postoperative Pulmonary Complications ◽

Multicenter Cohort Study ◽

Multicenter Cohort ◽

The Impact

Elderly patients awaiting lung resection surgery often have poor physical function, which puts them at a high risk of postoperative pulmonary complications. The aim of this study was to investigate the impact of preoperative physical performance on postoperative pulmonary complications in patients awaiting lung resection surgery. In this prospective multicenter cohort study, the characteristics of patients and postoperative pulmonary complications were compared between subjects with low (<10) and high (≥10) Short Physical Performance Battery (SPPB) scores. Postoperative pulmonary complications were defined as over grade II in Clavien-Dindo classification system. We estimated the effects of physical performance on postoperative pulmonary complications using multivariable hierarchical logistic regression. The postoperative pulmonary complications were compared between 331 patients in the high and 33 patients in the low SPPB group. Patients in the low SPPB score group had a significantly higher rate of postoperative pulmonary complications (p < 0.001). Low SPPB score was associated with a higher risk of postoperative pulmonary complications (odds ratio, 8.80; p < 0.001). The SPPB is a clinically useful evaluation tool to assess surgical patients’ physical performance. The low physical performance indicated by the SPPB may be predictive of postoperative pulmonary complications after lung resection surgery. Trial registration: Clinical Trials. University hospital Medical Information Network Center (UMIN-CTR) UMIN000021875.

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Do ARISCAT scores help to predict the incidence of postoperative pulmonary complications in elderly patients after upper abdominal surgery? An observational study at a single university hospital

Perioperative Medicine ◽

10.1186/s13741-021-00214-3 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Jitsupa Nithiuthai ◽

Arunotai Siriussawakul ◽

Rangsinee Junkai ◽

Nutthakorn Horugsa ◽

Sunit Jarungjitaree ◽

...

Keyword(s):

Risk Factors ◽

Elderly Patients ◽

Assessment Tool ◽

Area Under The Curve ◽

Pulmonary Complications ◽

University Hospital ◽

Surgical Patients ◽

Postoperative Pulmonary Complications ◽

Duration Of Surgery ◽

Upper Abdominal

Abstract Background The incidence of postoperative pulmonary complications (PPCs) is increasing in line with the rise in the number of surgical procedures performed on geriatric patients. In this study, we determined the incidence and risk factors of PPCs in elderly Thai patients who underwent upper abdominal procedures, and we investigated whether the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score helps to predict PPCs in Thais. Methods A retrospective study was conducted on upper abdominal surgical patients aged over 65 years who had been admitted to the surgical ward of Siriraj Hospital, Mahidol University, Thailand, between January 2016 and December 2019. Data were collected on significant PPCs using the European Perioperative Clinical Outcome definitions. To identify risk factors, evaluations were made of the relationships between the PPCs and various preoperative, intraoperative, and postoperative factors, including ARISCAT scores. Results In all, 1100 elderly postoperative patients were analyzed. Their mean age was 73.6 years, and 48.5% were male. Nearly half of their operations were laparoscopic cholecystectomies. The incidence of PPCs was 7.7%, with the most common being pleural effusion, atelectasis, and pneumonia. The factors associated with PPCs were preoperative oxygen saturation less than 96% (OR = 2.6, 1.2–5.5), albumin level below 3.5 g/dL (OR = 1.7, 1.0–2.8), duration of surgery exceeding 3 h (OR = 2.0, 1.0–4.2), and emergency surgery (OR = 2.8, 1.4–5.8). There was a relationship between ARISCAT score and PPC incidence, with a correlation coefficient of 0.226 (P < 0.001). The area under the curve was 0.72 (95% CI, 0.665–0.774; P < 0.001). Conclusions PPCs are common in elderly patients. They are associated with increased levels of postoperative morbidities and extended ICU and hospital stays. Using the ARISCAT score as an assessment tool facilitates the classification of Thai patients into PPC risk groups. The ARISCAT scoring system might be able to be similarly applied in other Southeast Asian countries.

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To Pack or Not to Pack: Inpatient Management of Epistaxis in the Elderly

American Journal of Rhinology and Allergy ◽

10.1177/1945892418801259 ◽

2018 ◽

Vol 32 (6) ◽

pp. 539-545 ◽

Cited By ~ 4

Author(s):

Albert H. Zhou ◽

Sei Y. Chung ◽

Michael J. Sylvester ◽

Michael Zaki ◽

Peter S. Svider ◽

...

Keyword(s):

Length Of Stay ◽

Elderly Patients ◽

Hospital Mortality ◽

The Elderly ◽

Primary Diagnosis ◽

Pulmonary Complications ◽

Nasal Packing ◽

Hospital Charges ◽

Cardiac Complications ◽

The Impact

Background Epistaxis is common in elderly patients, occasionally necessitating hospitalization for the management of severe bleeds. In this study, we aim to explore the impact of nasal packing versus nonpacking interventions (cauterization, embolization, and ligation) on outcomes and complications of epistaxis hospitalization in the elderly. Methods The 2008–2013 National Inpatient Sample was queried for elderly patients (≥65 years) with a primary diagnosis of epistaxis and accompanying procedure codes for anterior and posterior nasal packing or nonpacking interventions. Results A total of 8449 cases met the inclusion criteria, with 62.4% receiving only nasal packing and 37.6% receiving nonpacking interventions. On average, nonpacking interventions were associated with a 9.9% increase in length of stay and a 54.0% increase in hospital charges. Comorbidity rates did not vary between cohorts, except for diabetes mellitus, which was less common in the nonpacking cohort (26.6% vs 29.0%; P = .014). Nonpacking interventions were associated with an increased rate of blood transfusion (24.5% vs. 21.8%; P = .004), but no significant differences in rates of stroke, blindness, aspiration pneumonia, infectious pneumonia, thromboembolism, urinary/renal complications, pulmonary complications, cardiac complications, or in-hospital mortality. Comparing patients receiving ligation or embolization, no differences in length of stay, complications, or in-hospital mortality were found; however, embolization patients incurred 232.1% greater hospital charges ( P < .001). Conclusion Nonpacking interventions in the elderly do not appear to be associated with increased morbidity or mortality when compared to nasal packing only but appear to be associated with increased hospital charges and length of stay. Embolization in the elderly results in greater hospital charges but no change in outcome when compared to ligation.

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Frailty is an independent risk factor for postoperative pulmonary complications in elderly patients undergoing video-assisted thoracoscopic pulmonary resections

Aging Clinical and Experimental Research ◽

10.1007/s40520-021-01988-8 ◽

2021 ◽

Author(s):

Dandan Chen ◽

Yi Ding ◽

Wenlan Zhu ◽

Tingting Fang ◽

Nan Dong ◽

...

Keyword(s):

Risk Factor ◽

Elderly Patients ◽

Independent Risk Factor ◽

Pulmonary Complications ◽

Postoperative Pulmonary Complications ◽

Video Assisted

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PS02.172: ESOPHAGECTOMY FOR 70 YEARS OF AGE AND OLDER PATIENTS IN FUKUOKA HIGASHI NATIONAL MEDICAL CENTER

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.172 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 170-171

Author(s):

Takefumi Ohga ◽

Sosei Kuma ◽

Takahiro Ezaki

Keyword(s):

Esophageal Cancer ◽

Elderly Patients ◽

Conflicts Of Interest ◽

Medical Center ◽

The Elderly ◽

Pulmonary Complications ◽

Average Hospital ◽

National Medical ◽

Group I ◽

Group Ii

Abstract Background The patients with esophageal cancer tend to be elder and men. The elderly patients have frequently dysfunction of critical organs. Surgical treatment for elderly esophageal cancer patients has been considered to be the most difficult and the operative indications remain controversial. Aim: The purpose of this study was to clarify the indications for an esophagectomy in elderly patients (especially patients over 70 years of age) with esophageal cancer. Methods A total of 27 patients with esophageal cancer who underwent an esophagectomy in the Department of Surgery, National Fukuoka-Higashi Medical Center from 2005 to 2014 were divided into two groups according to age, namely, groups I (< 70 years, n = 18) and II (> or = 70 years, n = 9). In group II, surgery was only done in patients with PS0 or 1, as well as almost normal cardiac and pulmonary functions. Results The morbidity rates of group I and II were 66% and 33%, respectively. Pulmonary complications in each groups occurred in 12% and 0%, respectively. In group II, the mortality and 30-day mortality rates were 0.0% and 0.0%, respectively, and pulmonary complications did not occurred (0.0%). The average hospital stay period after the operation in group I and II were 55.5 days and 50.4 days, respectively. The hospital mortality retes in group I and II were 5.56% and 0.0%, respectively. The number of 3 years above survival persons is three (16.7%) and four (44.0%) in group I and II. Conclusion In the elderly, careful perioperative management is needed while paying special attention to pulmonary complications. However, when the indications for surgery can be strictly determined, an esophagectomy is considered a viable treatment alternative with satisfactory prognosis even in patients 70 years of age and older without any increased morbidity or mortality. Disclosure All authors have declared no conflicts of interest.

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PS02.164: ESOPHAGECTOMY FOR 70 YEARS OF AGE AND OLDER PATIENTS IN FUKUOKA HIGASHI NATIONAL MEDICAL CENTER

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.164 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 168-168

Author(s):

Takefumi Ohga ◽

Sosei Kuma ◽

Takahiro Ezaki

Keyword(s):

Esophageal Cancer ◽

Elderly Patients ◽

Conflicts Of Interest ◽

Medical Center ◽

The Elderly ◽

Pulmonary Complications ◽

Average Hospital ◽

National Medical ◽

Group I ◽

Group Ii

Abstract Background The patients with esophageal cancer tend to be elder and men. The elderly patients have frequently dysfunction of critical organs. Surgical treatment for elderly esophageal cancer patients has been considered to be the most difficult and the operative indications remain controversial. Aim: The purpose of this study was to clarify the indications for an esophagectomy in elderly patients (especially patients over 70 years of age) with esophageal cancer. Methods A total of 27 patients with esophageal cancer who underwent an esophagectomy in the Department of Surgery, National Fukuoka-Higashi Medical Center from 2005 to 2014 were divided into two groups according to age, namely, groups I (< 70 years, n = 18) and II (> or = 70 years, n = 9). In group II, surgery was only done in patients with PS0 or 1, as well as almost normal cardiac and pulmonary functions. Results The morbidity rates of group I and II were 66% and 33%, respectively. Pulmonary complications in each groups occurred in 12% and 0%, respectively. In group II, the mortality and 30-day mortality rates were 0.0% and 0.0%, respectively, and pulmonary complications did not occurred (0.0%). The average hospital stay period after the operation in group I and II were 55.5 days and 50.4 days, respectively. The hospital mortality retes in group I and II were 5.56% and 0.0%, respectively. The number of 3 years above survival persons is three (16.7%) and four (44.0%) in group I and II. Conclusion Discussion: In the elderly, careful perioperative management is needed while paying special attention to pulmonary complications. However, when the indications for surgery can be strictly determined, an esophagectomy is considered a viable treatment alternative with satisfactory prognosis even in patients 70 years of age and older without any increased morbidity or mortality. Disclosure All authors have declared no conflicts of interest.

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