Obesity in the elderly cardiac surgical patient as a risk factor for intra-operative complications

AbstractThe impact of most, but not all, cardiovascular risk factors decline by age. We investigated how the metabolic syndrome (MetS) was related to cardiovascular disease (CVD) during 40 years follow-up in the Uppsala Longitudinal Study of Adult Men (ULSAM, 2,123 men all aged 50 at baseline with reinvestigations at age 60, 70, 77 and 82). The strength of MetS as a risk factor of incident combined end-point of three outcomes (CVD) declined with ageing, as well as for myocardial infarction, ischemic stroke and heart failure when analysed separately. For CVD, the risk ratio declined from 2.77 (95% CI 1.90–4.05) at age 50 to 1.30 (95% CI 1.05–1.60) at age 82. In conclusion, the strength of MetS as a risk factor of incident CVD declined with age. Since MetS was significantly related to incident CVD also at old age, our findings suggest that the occurrence of MetS in the elderly should not be regarded as innocent. However, since our data were derived in an observational study, any impact of MetS in the elderly needs to be verified in a randomized clinical intervention trial.

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Prognosis and risk factors of ERCP pancreatitis in elderly

Scientific Reports ◽

10.1038/s41598-021-95484-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Erhan Ergin ◽

Nevin Oruç ◽

Galip Ersöz ◽

Oktay Tekeşin ◽

Ömer Özütemiz

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Elderly Patients ◽

Biochemical Analysis ◽

Female Gender ◽

The Elderly ◽

Imaging Findings ◽

Endoscopic Retrograde ◽

Sphincter Oddi ◽

Oddi Dysfunction

AbstractPost Endoscopic Retrograde Cholangiopancreatography (ERCP) pancreatitis is one of the most serious complications of ERCP. Our study aims to investigate the risk, predisposing factors and prognosis of pancreatitis after ERCP in elderly patients. Patients referred to the ERCP unit between April 2008 and 2012 and admitted to the hospital at least 1 day after the ERCP procedure were included to the study. Information including patient’s demographics, diagnosis, imaging findings, biochemical analysis, details of the ERCP procedure and complications were recorded. The severity of post ERCP pancreatitis (PEP) was determined by revised Atlanta Criteria as well as APACHE II and Ranson scores. A total of 2902 ERCP patients were evaluated and 988 were included to the study. Patients were divided into two groups as ≥ 65 years old (494 patients, 259 F, 235 M) and < 65 years old (494 patients, 274 F, 220 M). PEP was diagnosed in 4.3% of patients aged 65 years and older. The female gender was risk factors in elderly for PEP. The Sphincter Oddi Dysfunction (SOD) and Juxta papillary diverticula (JPD) were higher in elderly patients with PEP. Age did not increase the risk of PEP development. The most important post ERCP pancreatitis risk factor in the elderly is the female gender, while the risk is enhanced slightly by SOD and JPD.

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Anticoagulant dosing in renal impairment

Phlebologie ◽

10.12687/phleb2290-6-2015 ◽

2015 ◽

Vol 44 (06) ◽

pp. 316-319 ◽

Cited By ~ 2

Author(s):

S. Harder

Keyword(s):

Risk Factor ◽

Venous Thromboembolism ◽

Renal Impairment ◽

Anticoagulant Therapy ◽

Severe Renal Impairment ◽

Dabigatran Etexilate ◽

The Elderly ◽

Thrombin Inhibitor ◽

Safety And Efficacy ◽

Direct Acting

SummaryAnticoagulants are widely used for prophylaxis and treatment of venous thromboembolism in the elderly, who commonly have renal impairment and other comorbidities. Renal impairment is a risk factor for bleeding and thrombosis during anticoagulant therapy and can influence the balance between the safety and efficacy of such agents. Some anticoagulants, such as fondaparinux and the direct acting oral thrombin inhibitor dabigatran etexilate are contraindicated for use in patients with severe renal impairment (eGFR <30 ml/min). However, also the direct acting oral FXa-inhibitors rivaroxaban, edoxaban and apixaban need caution regarding dosing advice or contraindications when used in patients with renal impairment.

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