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Wu XD, Wang Q, Song YX, Chen XY, Xue T, Ma LB, Luo YG, Li H, Lou JS, Liu YH, Wang DF, Wu QP, Peng YM, Mi WD, Cao JB. Risk factors prediction of 6-month mortality after noncardiac surgery of older patients in China: a multicentre retrospective cohort study. Int J Surg 2024; 110:219-228. [PMID: 37738004 PMCID: PMC10793791 DOI: 10.1097/js9.0000000000000791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/09/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Identifying the risk factors associated with perioperative mortality is crucial, particularly in older patients. Predicting 6-month mortality risk in older patients based on large datasets can assist patients and surgeons in perioperative clinical decision-making. This study aimed to develop a risk prediction model of mortality within 6 months after noncardiac surgery using the clinical data from 11 894 older patients in China. MATERIALS AND METHODS A multicentre, retrospective cohort study was conducted in 20 tertiary hospitals. The authors retrospectively included 11 894 patients (aged ≥65 years) who underwent noncardiac surgery between April 2020 and April 2022. The least absolute shrinkage and selection operator model based on linear regression was used to analyse and select risk factors, and various machine learning methods were used to build predictive models of 6-month mortality. RESULTS The authors predicted 12 preoperative risk factors associated with 6-month mortality in older patients after noncardiac surgery. Including laboratory-associated risk factors such as mononuclear cell ratio and total blood cholesterol level, etc. Also including medical history associated risk factors such as stroke, history of chronic diseases, etc. By using a random forest model, the authors constructed a predictive model with a satisfactory accuracy (area under the receiver operating characteristic curve=0.97). CONCLUSION The authors identified 12 preoperative risk factors associated with 6-month mortality in noncardiac surgery older patients. These preoperative risk factors may provide evidence for a comprehensive preoperative anaesthesia assessment as well as necessary information for clinical decision-making by anaesthesiologists.
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Affiliation(s)
- Xiao-Dong Wu
- Department of Anaesthesiology, The First Medical Centre of Chinese PLA General Hospital
| | - Qian Wang
- Department of Anaesthesiology, The First Medical Centre of Chinese PLA General Hospital
- Medical School of Chinese People's Liberation Army
| | - Yu-Xiang Song
- Department of Anaesthesiology, The First Medical Centre of Chinese PLA General Hospital
| | - Xian-Yang Chen
- Zhong Guan Cun Biological and Medical Big Data Centre
- Bao Feng Key Laboratory of Genetics and Metabolism
| | - Teng Xue
- Zhong Guan Cun Biological and Medical Big Data Centre
- Bao Feng Key Laboratory of Genetics and Metabolism
| | - Li-Bin Ma
- Department of Anaesthesiology, The First Medical Centre of Chinese PLA General Hospital
| | - Yun-Gen Luo
- Department of Anaesthesiology, The First Medical Centre of Chinese PLA General Hospital
- Medical School of Chinese People's Liberation Army
| | - Hao Li
- Department of Anaesthesiology, The First Medical Centre of Chinese PLA General Hospital
| | - Jing-Sheng Lou
- Department of Anaesthesiology, The First Medical Centre of Chinese PLA General Hospital
| | - Yan-Hong Liu
- Department of Anaesthesiology, The First Medical Centre of Chinese PLA General Hospital
| | - Di-Fen Wang
- Department of Intensive Care Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, People's Republic of China
| | - Qing-Ping Wu
- Department of Anaesthesiology, Union hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan
| | - Yu-Ming Peng
- Department of Anaesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing
| | - Wei-Dong Mi
- Department of Anaesthesiology, The First Medical Centre of Chinese PLA General Hospital
- National Clinical Research Centre for Geriatric Diseases, People's Liberation Army General Hospital
| | - Jiang-Bei Cao
- Department of Anaesthesiology, The First Medical Centre of Chinese PLA General Hospital
- National Clinical Research Centre for Geriatric Diseases, People's Liberation Army General Hospital
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Laurent A, Marechal R, Farinella E, Bouazza F, Charaf Y, Gay F, Van Laethem JL, Gonsette K, El Nakadi I. Esophageal cancer: Outcome and potential benefit of esophagectomy in elderly patients. Thorac Cancer 2022; 13:2699-2710. [PMID: 36000335 PMCID: PMC9527164 DOI: 10.1111/1759-7714.14596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 12/04/2022] Open
Abstract
Background This analysis evaluated the morbimortality and the potential benefit of esophagectomy for cancer in elderly patients. Methods Patients who underwent esophagectomy for EC were divided into elderly (≥70 years) and nonelderly (<70 years) groups. The groups were compared regarding patient and tumor characteristics, postoperative morbimortality, and disease‐free, overall and cancer‐specific survival. Results Sixty‐one patients were classified into elderly, and 187 into nonelderly groups. The elderly were characterized by a higher rate of WHO score (p < 0.0001), higher cardiac (p < 0.004) and renal (p < 0.023) comorbidities. The rate of neoadjuvant therapy and especially of neoadjuvant CRT was significantly lower in elderly patients (p < 0.018 and p < 0.007). Operative morbidity was also higher in this group (p < 0.024). The 30‐ and 90‐day mortality was 8.2 and 11.5%, respectively in elderly patients and 0.5 and 3.2% in nonelderly patients (p < 0.004 and p < 0.012). This 90‐day mortality decreased when specific surgery‐related deaths were taken into consideration. OS and DFS were significantly better in the nonelderly group (p < 0.003 and p < 0.005) while no difference was observed for cancer‐specific survival (CSS). Conclusion No difference in CSS was observed. Although elderly patients with EC had higher postoperative morbimortality, the age should not be a criterion whether to perform, or not to perform, esophagectomy. This decision must be based on the balance between the patient's general condition and aggressive disease.
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Affiliation(s)
- Adeline Laurent
- Department of Digestive Surgery, Faculty of Medicine (ULB), Erasme University Hospital Center, Brussels, Belgium
| | - Raphael Marechal
- Department of Gastroenterology, University Hospital Center of Tivoli, La louvière, Belgium
| | - Eleonora Farinella
- Department of Digestive Surgery, Faculty of Medicine (ULB), Erasme University Hospital Center, Brussels, Belgium
| | - Fikri Bouazza
- Department of Digestive Surgical Oncology, Faculty of Medicine (ULB), Institut Jules Bordet, Brussels, Belgium
| | - Yassine Charaf
- Department of Digestive Surgery, Faculty of Medicine (ULB), Erasme University Hospital Center, Brussels, Belgium
| | - France Gay
- Department of Gastroenterology and Digestive Oncology, Faculty of Medicine (ULB), Erasme University Hospital Center, Brussels, Belgium
| | - Jean-Luc Van Laethem
- Department of Gastroenterology and Digestive Oncology, Faculty of Medicine (ULB), Erasme University Hospital Center, Brussels, Belgium
| | - Kimberly Gonsette
- Department of Anesthesiology, Faculty of Medicine (ULB), Erasme University Hospital Center, Brussels, Belgium
| | - Issam El Nakadi
- Department of Digestive Surgery, Faculty of Medicine (ULB), Erasme University Hospital Center, Brussels, Belgium
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Tirotta F, Fadel MG, Hodson J, Parente A, Wilkerson H, Almond LM, Ford SJ, Hayes AJ, Desai A, Strauss DC. Association Between Ageing and Short-Term Survival Outcomes in Patients Undergoing Surgery for Primary Retroperitoneal Sarcoma. Ann Surg Oncol 2022; 29:7320-7330. [PMID: 35854029 DOI: 10.1245/s10434-022-12231-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/25/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND As the population ages, more elderly patients are receiving surgery for retroperitoneal sarcoma (RPS). However, high-quality data investigating associations between ageing and prognosis are lacking. Our study aimed to investigate whether ageing is associated with inferior short-term survival outcomes after RPS surgery. PATIENTS AND METHODS Patients undergoing surgery for primary RPS between 2008 and 2019 at two tertiary sarcoma centres were analysed. The primary outcome was 1-year mortality, and the primary explanatory variable was patient age, classified as: < 55, 55-64, 65-74 or 75+ years. RESULTS The 692 patients undergoing surgery (mean age 60.8 ± 13.8 years) had a 1-year mortality rate of 9.4%, which differed significantly by age (p < 0.001), with rates of 7.2%, 6.9%, 8.7% and 22.8% for the < 55, 55-64, 65-74 and 75+ years groups, respectively. The distribution of causes of death also differed significantly by age (p = 0.023), with 22% and 28% of deaths in the 65-74 and 75+ years groups caused by post-operative complications, versus none in the < 55 and 55-64 years groups. On multivariable analysis, age of 75+ years (versus < 55 years) was a significant independent predictor of 1-year mortality [odds ratio (OR) 7.05, 95% confidence interval (CI) 2.63-18.9, p < 0.001]; no significant increase in risk was observed in the 55-64 (OR 0.72, 95% CI 0.28-1.87) or 65-74 (OR 0.89, 95% CI 0.37-2.15) years groups. CONCLUSIONS Post-operative complications are an important cause of deaths in elderly patients. These findings are relevant to decision-making and counselling when surgery is considered for patients with RPS.
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Affiliation(s)
- Fabio Tirotta
- Department of Academic Surgery, Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK. .,Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TH, UK.
| | - Michael G Fadel
- Department of Academic Surgery, Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - James Hodson
- Institute of Translational Medicine, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.,Research Development and Innovation, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alessandro Parente
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - Helene Wilkerson
- Department of Academic Surgery, Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - L Max Almond
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - Samuel J Ford
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - Andrew J Hayes
- Department of Academic Surgery, Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Anant Desai
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - Dirk C Strauss
- Department of Academic Surgery, Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
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Cai Y, Lin J, Wei W, Chen P, Yao K. Burden of esophageal cancer and its attributable risk factors in 204 countries and territories from 1990 to 2019. Front Public Health 2022; 10:952087. [PMID: 36148334 PMCID: PMC9485842 DOI: 10.3389/fpubh.2022.952087] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/15/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Esophageal cancer is a global health concern. Regularly updated data about the burden of esophageal cancer are essential for formulating specific public policies. We aimed to estimate the global, regional, and national burden and trends of esophageal cancer and its attributable risk factors from 1990 to 2019, by age, sex and socio-demographic index (SDI). METHODS Data about the incidence, death, disability-adjusted life-years (DALYs), and age-standardized rates were collected from Global Burden of Disease study 2019. Estimated annual percentage changes were used to quantify the temporal trends of age-standardized rates. Moreover, the risk factors attributable to esophageal cancer deaths were also presented. RESULTS There were 534,563 incident cases and 498,067 deaths in 2019, contributing to 11,666,017 DALYs. The absolute numbers of incidence, death, and DALYs had increased from 1990 to 2019, contrasting with declined changes in their corresponding age-standardized rates. The burden of esophageal cancer varied across different regions and countries, and the age-standardized rates were negative with SDI. Almost half of the esophageal cancer was concentrated in China. Males accounted for most of the burden of esophageal cancer, and the onset age tended to be older. The death of esophageal cancer was primarily attributable to smoking, followed by alcohol use, high body mass index, diet low in fruits and diet low in vegetables. CONCLUSION The burden of esophageal cancer was heterogeneous across regions and countries by sex, age, and SDI, providing information for governments that may help to formulate more targeted policies.
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Affiliation(s)
- Yanqing Cai
- Department of Medical Oncology, Jieyang People's Hospital, Jieyang, China
| | - Jianxiong Lin
- Department of Medical Oncology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Wenbo Wei
- Department of General Surgery, Jieyang People's Hospital, Jieyang, China
| | - Peixing Chen
- Department of Medical Oncology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Kaitao Yao
- Department of Medical Oncology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
- *Correspondence: Kaitao Yao
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Increased perioperative morbidity and mortality following oesophagectomy in older patients: Time for a patient-centered conversation. Eur J Surg Oncol 2021; 47:2690-2691. [PMID: 34039474 DOI: 10.1016/j.ejso.2021.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/14/2021] [Indexed: 11/21/2022] Open
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Kamarajah SK, Elhadi M, Umar H, Subramanya MS, Evans RP, Powell SL, Griffiths EA. Age or frailty: What matters in oesophagectomy for cancer in the elderly? Eur J Surg Oncol 2021; 47:2692-2693. [PMID: 34020807 DOI: 10.1016/j.ejso.2021.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/14/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Sivesh K Kamarajah
- Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Trust, Birmingham, United Kingdom; Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | | | - Hamza Umar
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Manjunath S Subramanya
- Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Trust, Birmingham, United Kingdom
| | - Richard Pt Evans
- Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Trust, Birmingham, United Kingdom; Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Susan L Powell
- Department of Geriatric Medicine, Worcestershire Acute Hospitals NHS Foundation Trust, Worcestershire, United Kingdom
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Trust, Birmingham, United Kingdom; Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.
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