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Zhou X, Jiang Y, Xu H, Lin S, Xu T, Bai X, Liu S. Modified Frailty Index Predicts Prognosis in Patients With Gastric Cancer After Gastrectomy: A Systematic Review and Meta-Analysis. J Surg Oncol 2025. [PMID: 40365878 DOI: 10.1002/jso.28136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Revised: 02/25/2025] [Accepted: 03/12/2025] [Indexed: 05/15/2025]
Abstract
BACKGROUND The predictive ability of the modified frailty index (mFI) for postoperative outcomes and survival in patients with gastric cancer (GC) remains uncertain. METHODS Studies were retrieved from 11 electronic databases. Odds ratio (OR) and 95% confidence intervals (CIs) were used to report surgical outcomes, including overall survival (OS), complications, mortality, readmission, and nonhome discharge. The fixed or random effects model was used depending on the heterogeneity. Subgroup and meta-regression analyses were performed to determine the source of heterogeneity. RESULTS This meta-analysis of 13 studies, including 15 359 GC patients, showed that high mFI scores were associated with reduced OS (OR = 1.35) and increased risk of poor postoperative outcomes (OR = 2.61). The older patients with higher mFI scores had a higher risk of worse OS after gastrectomy (OR = 1.69). CONCLUSIONS This study demonstrated that high mFI scores were strongly associated with reduced OS and increased risk of poor outcomes following surgery in patients with GC, with a more than two-fold increase in the overall risk of poor outcomes. Compared to other tools, the mFI is easy to operate, making it an effective tool for prognosis assessment and personalized treatment and care planning. TRIAL REGISTRATION PROSPERO (Registration Number: CRD42024613727).
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Affiliation(s)
- Xinyao Zhou
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yunlan Jiang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Heyao Xu
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Siyu Lin
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Ting Xu
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xiaodi Bai
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Shulan Liu
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Shi H, Guo X, Su C, Huang H, Chen Y, Zhang J, Zhang B, Feng X, Shen Z. Transcarotid Artery Approach for Endovascular Aortic Repair in Treating Complex Descending Thoracic Aortic Pseudoaneurysm With Aortoiliac Occlusion: A Case Report. Vasc Endovascular Surg 2025:15385744251339956. [PMID: 40347086 DOI: 10.1177/15385744251339956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2025]
Abstract
BackgroundEndovascular aortic repair has emerged as the preferred treatment modality over open surgery for aortic diseases, primarily because of its association with lower perioperative morbidity and mortality rates. Current diagnostic and treatment guidelines generally advocate for endovascular aortic repair in most cases, with the femoral artery serving as the conventional access route. However, this approach may not be feasible for all patients, particularly those with aortoiliac artery occlusion, necessitating alternative access strategies.Case SummaryThis paper presents a complex case study of a patient with aortoiliac artery occlusion who underwent endovascular aortic repair via the left carotid artery approach for a pseudoaneurysm at the anastomotic site of a descending aortic prosthetic graft. This case underscores the potential value of utilizing the carotid artery as an alternative access route in anatomically challenging situations.ConclusionResearch on transcarotid artery approach endovascular aortic repair is limited and predominantly consists of case reports, with a notable absence of randomized controlled trials. This case report suggests that endovascular aortic repair via the carotid artery approach may be a viable alternative for selecting patient groups when the conventional femoral artery approach is not feasible. While our single case demonstrated successful management with minimal complications, larger studies are needed to fully establish the safety profile and determine if perioperative complications and mortality rates are indeed manageable across diverse patient populations.Clinical ImpactThis study provides valuable insights into the feasibility of the carotid artery as an alternative access route for endovascular aortic repair in patients with aortoiliac artery occlusion. It offers clinicians a potential strategy for cases where the conventional femoral artery route is not feasible. The findings presented herein aim to demonstrate the practicality and relative safety of utilizing the carotid artery for endovascular procedures in anatomically challenging scenarios, contributing to the broader understanding of access alternatives in aortic repair interventions.
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Affiliation(s)
- Haofan Shi
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xingyou Guo
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Vascular Surgery, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, China
| | - Chengkai Su
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haoyue Huang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yihuan Chen
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jinlong Zhang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bowen Zhang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiang Feng
- Department of Urology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhenya Shen
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
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3
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Luo LL, Xiao R, Zhang JP, Xi WF, Xu GH, Yuan H. Opioid-Free Anesthesia with Esketamine Combined with Iliac Fascia Block in Elderly Patients Undergoing Hip Surgery. Drug Des Devel Ther 2025; 19:3337-3349. [PMID: 40322035 PMCID: PMC12048711 DOI: 10.2147/dddt.s508805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Accepted: 04/14/2025] [Indexed: 05/08/2025] Open
Abstract
Background Most patients with hip fractures are elderly people with relatively high risks of cardiovascular and cerebrovascular accidents. Esketamine has little effect on haemodynamics and has an exact analgesic effect, which is beneficial for patients with intolerance to surgery and anaesthesia. Therefore, we conducted this study to compare the efficacy and safety of esketamine with those of opioids in elderly patients who underwent surgery for hip fractures. Methods Seventy-two patients were included in the study, but data from only 68 were analysed. Patients were randomly assigned to either the EKT group (esketamine combined with iliac fascia block) or the OP group (opioids combined with iliac fascia block). Esketamine was used for anaesthesia induction and maintenance in the EKT group, and sufentanil and remifentanil were used in the OP group. The primary endpoint was the area under the curve numeric rating scale (AUCNRS). Results The AUCNRS in the EKT group was significantly lower than that in the OP group (6.6±3.6 vs 9.5±3.0, P =0.001). The postoperative numeric rating scale (NRS) scores for pain and the number of rescue analgesia were significantly lower in the EKT group than in the OP group (all P <0.05). The mean blood pressure in the EKT group was significantly greater than those in the OP group after anaesthesia induction (all P <0.05). The incidence of postoperative nausea and vomiting (PONV) in the OP group was significantly higher than that in the EKT group (P =0.033). Conclusion Elderly patients receiving esketamine-based opioid-free anaesthesia had more stable hemodynamics, better postoperative analgesia, and reduced PONV incidence compared to those undergoing opioid-balanced anaesthesia. Clinical Trial Registration The trial was registered at the Chinese Clinical Trial Registry on September 1, 2023 (identifier: ChiCTR2300075324).
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Affiliation(s)
- Lai-Lin Luo
- Department of Anesthesiology, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui, 236000, People’s Republic of China
| | - Rui Xiao
- Department of Anesthesiology, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui, 236000, People’s Republic of China
| | - Jin-Peng Zhang
- Department of Anesthesiology, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui, 236000, People’s Republic of China
| | - Wen-Feng Xi
- Department of Anesthesiology, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui, 236000, People’s Republic of China
| | - Guang-Hong Xu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of China
| | - Hao Yuan
- Department of Anesthesiology, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui, 236000, People’s Republic of China
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Shi H, Guo X, Su C, Huang H, Chen Y, Zhang J, Zhang B, Feng X, Shen Z. A Systematic Review of Transcarotid Approach for Endovascular Aortic Repair in Treating Aortic Disease. Vasc Endovascular Surg 2025:15385744251335775. [PMID: 40278166 DOI: 10.1177/15385744251335775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2025]
Abstract
PurposeThe purpose of this study is to evaluate the feasibility, efficacy, and safety of transcarotid approach endovascular aortic repair (EVAR) in patients where conventional femoral access is not possible.Materials and MethodsA systematic review of all articles discussing transcarotid approach EVAR published in the PubMed, Embase, Ovid, Web of Science, and Cochrane Library databases were conducted. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsIn accordance with the inclusion criteria, 17 articles discussing transcarotid approach EVAR were retrieved, encompassing 18 patients. Among these patients, 6 patients were related to ascending aortic disease, including 4 cases of pseudoaneurysms, 1 case of penetrating ulcer, and 1 case of dissection. 9 patients had descending aortic disease, comprising 6 aneurysms, 2 penetrating ulcers, and 1 pseudoaneurysm. There were 3 cases of abdominal aortic disease, including 2 aneurysms and 1 endoleak. Among these patients, 10 cases had access through the left common carotid artery, and 8 cases had access through the right common carotid artery. One patient experienced spinal cord ischemia and subsequently died of multi-organ failure caused by acute pancreatitis. Additionally, there was one case of minor embolization in the nonsurgical carotid supply area. No cerebral infarctions were observed in the vascular territory of the ipsilateral carotid artery at the surgical approach site.ConclusionsResearch on transcarotid approach EVAR is limited and predominantly consists of case reports, with a notable absence of randomized controlled trials. This systematic review suggests that transcarotid approach EVAR may be a viable alternative for selecting patient groups when the conventional femoral artery approach is not feasible. These findings indicate that this method is associated with a relatively manageable perioperative complications and mortality rates.
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Affiliation(s)
- Haofan Shi
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xingyou Guo
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Vascular Surgery, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, China
| | - Chengkai Su
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haoyue Huang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yihuan Chen
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jinlong Zhang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bowen Zhang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiang Feng
- Department of Urology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhenya Shen
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
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5
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Hicks MH, Edwards AF. Updates in Cardiopulmonary Care: Highlights of Recent Guidelines. Int Anesthesiol Clin 2025:00004311-990000000-00093. [PMID: 40266889 DOI: 10.1097/aia.0000000000000480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2025]
Affiliation(s)
- Megan H Hicks
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Ishizawa Y. Preoperative Cognitive Optimization and Postoperative Cognitive Outcomes: A Narrative Review. Clin Interv Aging 2025; 20:395-402. [PMID: 40166756 PMCID: PMC11956728 DOI: 10.2147/cia.s505388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Accepted: 03/18/2025] [Indexed: 04/02/2025] Open
Abstract
Background Perioperative neurocognitive disorder (PND) is a growing concern and affects millions of older adult surgical patients each year in the United States. However, the effective prevention of PND has yet to be established. Recently, preoperative brain exercise has been suggested to decrease postoperative delirium incidence in older patients. This review aims to interpret existing preoperative cognitive optimization research, determine if the research supports preoperative cognitive optimization, and identify gaps in the knowledge of the older surgical population. Methods A literature search was performed in Pub Med (1995-2024) using the keywords (Older Surgical Patients, Presurgical Assessment, Cognitive Optimization, Neurocognitive Disorder, Postoperative Cognitive Impairment, Postoperative Delirium, Dementia, Frailty Syndrome, Prehabilitation, and Brain Plasticity). The type of literature included clinical trials, case series, cohort studies, and reviews. Among these articles, I included the one in which full text is available in Pub Med and is identified that specifically investigates cognitive function in older adults. Results and Conclusion Evidence of the effect of preoperative cognitive optimization on postoperative cognitive functions in older adult surgical patients is still limited. Postoperative delirium was reduced by preoperative cognitive training. A limited number of clinical studies suggest the beneficial effect of preoperative cognitive training, but others show no effects. Further studies are needed on the cognitive training dosage, duration, and platform type. Studies are also required in presurgical patients with preexisting cognitive impairment or dementia.
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Affiliation(s)
- Yumiko Ishizawa
- Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Klimitz FJ, Diatta F, Freeman J, Schaschinger T, Brown S, Knoedler S, Hundeshagen G, Kauke-Navarro M, Pomahac B, Panayi AC. The Five-Item Modified Frailty Index (mFI-5) Predicts Adverse Short-term Outcomes in Patients Undergoing Mastectomy: A Propensity Score-Matched Analysis of 252,054 Cases. Clin Breast Cancer 2025:S1526-8209(25)00084-9. [PMID: 40253274 DOI: 10.1016/j.clbc.2025.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2025] [Accepted: 03/21/2025] [Indexed: 04/21/2025]
Abstract
BACKGROUND Frailty has emerged as a critical predictor of postoperative outcomes, particularly in older surgical patients. However, its role in mastectomy patients remains underexplored. This study evaluates the utility of the 5-item Modified Frailty Index (mFI-5) in predicting 30-day postoperative complications in mastectomy patients, aiming to improve risk stratification and inform clinical decision-making. METHODS A retrospective analysis using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was conducted from 2008 to 2022. Patients were categorized into high-risk (mFI-5 ≥ 2) and low-risk (mFI-5 < 2) groups. Propensity score matching (PSM) was applied to create balanced cohorts and multivariate logistic regression was used to evaluate associations between frailty and postoperative outcomes. RESULTS Of the 252,054 adult female patients who underwent mastectomy, 1.2 % were identified as high-risk frail. High-risk patients were older (70 ± 9.9 vs. 60 ± 14 years, P < .001) and had a higher BMI (35 ± 9.1 vs. 29 ± 7.1 kg/m², P < .001) compared to low-risk patients. After PSM, high-risk patients had significantly higher odds of any complication (OR: 2.05, 95 % CI: 1.70-2.47, P < .001), surgical complications (OR: 1.70, 95 % CI: 1.38-2.10, P < .001), and medical complications (OR: 3.81, 95 % CI: 2.64-5.50, P < .001). Key complications included infections, bleeding requiring transfusion, and unplanned readmissions. CONCLUSION The mFI-5 effectively identifies mastectomy patients at higher risk of postoperative complications, including medical complications and unplanned reoperation or readmission, underscoring its value in preoperative risk stratification. Incorporating frailty assessments into clinical practice could enhance surgical decision-making, optimize resource allocation, and improve patient outcomes.
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Affiliation(s)
- Felix J Klimitz
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT; Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Fortunay Diatta
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Joshua Freeman
- Department of Computer Science, ETH Zurich, Zurich, Switzerland
| | - Thomas Schaschinger
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Stav Brown
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Samuel Knoedler
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Gabriel Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Martin Kauke-Navarro
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Bohdan Pomahac
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Adriana C Panayi
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
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Li Y, Peng C, Zou B. Relationship of frailty and postoperative complications in older people who underwent radical surgery for a gastrointestinal tumour. Australas J Ageing 2025; 44:e70012. [PMID: 40084587 DOI: 10.1111/ajag.70012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Revised: 02/19/2025] [Accepted: 02/19/2025] [Indexed: 03/16/2025]
Abstract
OBJECTIVE Frailty is associated with postoperative complications in older people with gastrointestinal malignancies. However, the relationship between frailty and complication severity, as well as the risk factors for complications after radical surgery, is still unclear. METHODS Frailty was assessed using a modified Frailty Index (mFI) score, and the correlation between frailty and postoperative complications was compared between frail and non-frail groups. Complication severity was evaluated using the Clavien-Dindo (C-D) system, and independent risk factors for postoperative complications were identified through odds ratios (OR) using multivariate logistic analysis. The participants were divided into non-frailty and frailty groups based on the mFI. RESULTS The frailty group had fewer patients aged 60-69 years (19% vs. 31%, p = .03) and a higher incidence of moderate CCI (52% vs. 69%, p = .001). Frailty was strongly linked to postoperative complications, including pulmonary infections (16% vs. 8%, p = .009), pulmonary embolism (8% vs. 3%, p = .02) and acute kidney injury (14% vs. 6%, p = .005). Older frail patients experienced more severe complications, with higher rates of C-D grade III (23% vs. 10%, p = .004) and grade V (6% vs. 1%, p = .004). Multivariate analysis found that frailty (OR: 1.492, p = .02), age greater than 70 years (OR: 1.239, p = .04) and severe comorbidities increased the OR of severe complications. Additionally, frail patients had poorer recovery, with higher in-hospital mortality (4% vs. 0%, p = .01), more ICU readmissions (11% vs. 3%, p = .005), longer stays (9 vs. 8 days, p < .001) and higher costs (48,035 RMB vs. 43,792 RMB, p < .001). CONCLUSIONS Older frail adults experienced more severe complications and had worse postoperative recovery.
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Affiliation(s)
- Yunsong Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Chunwei Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Bingbing Zou
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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Xu JY, Madden HE, Martínez-Camblor P, Deiner SG. Frailty as an independent risk factor for prolonged postoperative length of stay: A retrospective analysis of 2015-2019 ACS NSQIP data. J Clin Anesth 2025; 101:111730. [PMID: 39708560 DOI: 10.1016/j.jclinane.2024.111730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 11/08/2024] [Accepted: 12/12/2024] [Indexed: 12/23/2024]
Abstract
BACKGROUND Frailty, a syndrome of decreased resilience to physiologic stress, has been associated with increased postoperative length of stay (LOS) for specific procedures. Yet, the literature lacks large-scale analyses examining the relationship between frailty and LOS across surgical procedure. STUDY DESIGN We conducted a retrospective cohort study of patients aged 65+ undergoing inpatient surgery including emergency procedures between 2015 and 2019 using American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) data. Frailty, measured by the modified 5-item frailty index (mFI-5), was categorized as non-frail (mFI-5 < 2) or frail (mFI-5 ≥ 2). We modeled LOS, adjusting for demographic variables, comorbidities, and surgical factors, and conducted a subgroup analysis based on emergency surgery status and surgical procedure type. MAIN RESULTS Among 1,254,809 patients, 29.0 % were frail. A higher proportion of frail patients were Black (10 % vs. 5.5 %), Hispanic (6.1 % vs. 3.8 %), of ASA class IV/V (23.3 % vs. 9.1 %), malnourished (2.7 % vs. 1.9 %), and underwent vascular surgery (16.5 % vs. 8.3 %). They experienced longer median LOS across all surgical procedures, except bariatric surgery. Unadjusted analysis revealed that mFI-5 scores of 4 and 5 were associated with increased median LOS by 3.5 days (95 % CI 3.36-3.64) and 4.64 days (95 % CI 3.96-5.32), respectively, compared to mFI-5 scores of 0. In adjusted analysis, frailty remained a significant risk factor for increased median LOS, with an mFI-5 score of 5 associated with a 3-day longer increase (95 % CI 2.79-3.22) compared to an mFI-5 score of 0. Subgroup analysis showed that each one-point increase in mFI-5 score had the strongest association with increased median LOS in emergency surgery (0.5 days, 95 % CI 0.48-0.52) and lower extremity bypass surgery (0.53 days, 95 % CI 0.47-0.59). CONCLUSIONS Frailty is an independent risk factor for prolonged postoperative LOS among older surgical patients, even after adjustment for patient and procedure covariates. Other independent risk factors for increased LOS include emergent surgery, malnutrition, and higher ASA class.
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Affiliation(s)
- Jane Y Xu
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Hannah E Madden
- University of New England College of Osteopathic Medicine, Biddeford, ME, United States of America
| | - Pablo Martínez-Camblor
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States of America; Department of Biomedical Data Science, Geisel School of Medicine, Hanover, NH, United States of America
| | - Stacie G Deiner
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America; Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States of America.
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Isand KG, Aim A, Bahhir A, Uuetoa M, Kolk H, Saar S, Lepner U, Talving P. Impact of preoperative frailty on outcomes in patients subjected to emergency laparotomy: a prospective study. Eur J Trauma Emerg Surg 2025; 51:34. [PMID: 39853423 DOI: 10.1007/s00068-024-02752-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2024] [Accepted: 12/25/2024] [Indexed: 01/26/2025]
Abstract
PURPOSE Emergency laparotomy (EL) is a high-risk procedure, especially in frail patients. This study investigates the prevalence of frailty in referral facilities, evaluates the impact of frailty on postoperative morbidity and mortality, and assesses the long-term effect of EL on patients' functional status. METHODS This prospective multicentre cohort study included patients aged 50 years and older who underwent EL. Frailty was assessed using the Clinical Frailty Scale (CFS). The primary outcome measure was the prevalence of frailty and its impact on the 180-day mortality rate after EL. Secondary outcomes were 30- and 90-day mortality, complications requiring invasive procedures, length of hospital stay (LOS), and changes in CFS and in living arrangement at six months post-operation. RESULTS The study enrolled 251 patients with a median age of 73 years. Frailty was prevalent, with 57.8% of patients classified as frail (CFS 5-9). In Cox regression analysis, the hazard ratios of 180-day mortality with 95% confidence intervals were 2.4 (0.8-7.1) for CFS 4, 7.5 (2.8-20.0) for CFS 5, 14.4 (5.5-37.8) for CFS 6-8, and 28.7 (9.7-84.6) for CFS 9, compared to non-frail patients. Increasing frailty was also associated with higher 30 and 90- day mortality, increased risk of complications, and prolonged LOS. Additionally, at six months post-EL, patients experienced a further decline in functional status compared to their preoperative state. CONCLUSION The 180-day mortality after EL is significantly higher for patients on higher levels of frailty. Likewise, the preoperative frailty has a significant negative impact on postoperative outcomes both short- and long-term.
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Affiliation(s)
- Karl G Isand
- North Estonia Medical Centre, Sütiste tee 19, Tallinn, 13419, Estonia.
| | - Allan Aim
- East Tallinn Central Hospital, Tallinn, Estonia
| | - Artjom Bahhir
- North Estonia Medical Centre, Sütiste tee 19, Tallinn, 13419, Estonia
| | | | - Helgi Kolk
- Faculty of Medicine, Tartu University, Tartu, Estonia
| | - Sten Saar
- North Estonia Medical Centre, Sütiste tee 19, Tallinn, 13419, Estonia
| | - Urmas Lepner
- Faculty of Medicine, Tartu University, Tartu, Estonia
| | - Peep Talving
- North Estonia Medical Centre, Sütiste tee 19, Tallinn, 13419, Estonia
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11
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Chen J, Li W, Chen Q, Zhou Z, Chen C, Hu Y, Si Y, Zou J. Optimizing anesthesia management based on early identification of electroencephalogram burst suppression risk in non-cardiac surgery patients: a visualized dynamic nomogram. Ann Med 2024; 56:2407067. [PMID: 39317392 PMCID: PMC11423528 DOI: 10.1080/07853890.2024.2407067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 04/22/2024] [Accepted: 08/12/2024] [Indexed: 09/26/2024] Open
Abstract
BACKGROUND Burst suppression (BS) is a specific electroencephalogram (EEG) pattern that may contribute to postoperative delirium and negative outcomes. Few prediction models of BS are available and some factors such as frailty and intraoperative hypotension (IOH) which have been reported to promote the occurrence of BS were not included. Therefore, we look forward to creating a straightforward, precise, and clinically useful prediction model by incorporating new factors, such as frailty and IOH. MATERIALS AND METHODS We retrospectively collected 540 patients and analyzed the data from 418 patients. Univariate analysis and backward stepwise logistic regression were used to select risk factors to develop a dynamic nomogram model, and then we developed a web calculator to visualize the process of prediction. The performance of the nomogram was evaluated in terms of discrimination, calibration, and clinical utility. RESULTS According to the receiver operating characteristic (ROC) analysis, the nomogram showed good discriminative ability (AUC = 0.933) and the Hosmer-Lemeshow goodness-of-fit test demonstrated the nomogram had good calibration (p = 0.0718). Age, Clinical Frailty Scale (CFS) score, midazolam dose, propofol induction dose, total area under the hypotensive threshold of mean arterial pressure (MAP_AUT), and cerebrovascular diseases were the independent risk predictors of BS and used to construct nomogram. The web-based dynamic nomogram calculator was accessible by clicking on the URL: https://eegbsnomogram.shinyapps.io/dynnomapp/ or scanning a converted Quick Response (QR) code. CONCLUSIONS Incorporating two distinctive new risk factors, frailty and IOH, we firstly developed a visualized nomogram for accurately predicting BS in non-cardiac surgery patients. The model is expected to guide clinical decision-making and optimize anesthesia management.
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Affiliation(s)
- Jian Chen
- Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Anesthesiology, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wanxia Li
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Qianping Chen
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhou Zhou
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Chen Chen
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University, Nanjing, China
| | - Yuping Hu
- Department of Anesthesiology, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yanna Si
- Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jianjun Zou
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University, Nanjing, China
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12
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Thompson A, Fleischmann KE, Smilowitz NR, de Las Fuentes L, Mukherjee D, Aggarwal NR, Ahmad FS, Allen RB, Altin SE, Auerbach A, Berger JS, Chow B, Dakik HA, Eisenstein EL, Gerhard-Herman M, Ghadimi K, Kachulis B, Leclerc J, Lee CS, Macaulay TE, Mates G, Merli GJ, Parwani P, Poole JE, Rich MW, Ruetzler K, Stain SC, Sweitzer B, Talbot AW, Vallabhajosyula S, Whittle J, Williams KA. 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2024; 150:e351-e442. [PMID: 39316661 DOI: 10.1161/cir.0000000000001285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2024]
Abstract
AIM The "2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery" provides recommendations to guide clinicians in the perioperative cardiovascular evaluation and management of adult patients undergoing noncardiac surgery. METHODS A comprehensive literature search was conducted from August 2022 to March 2023 to identify clinical studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE Recommendations from the "2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery" have been updated with new evidence consolidated to guide clinicians; clinicians should be advised this guideline supersedes the previously published 2014 guideline. In addition, evidence-based management strategies, including pharmacological therapies, perioperative monitoring, and devices, for cardiovascular disease and associated medical conditions, have been developed.
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Affiliation(s)
| | | | | | - Lisa de Las Fuentes
- Former ACC/AHA Joint Committee on Clinical Practice Guidelines member; current member during the writing effort
| | | | | | | | | | | | | | | | - Benjamin Chow
- Society of Cardiovascular Computed Tomography representative
| | | | | | | | | | | | | | | | | | | | | | - Purvi Parwani
- Society for Cardiovascular Magnetic Resonance representative
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13
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Thompson A, Fleischmann KE, Smilowitz NR, de Las Fuentes L, Mukherjee D, Aggarwal NR, Ahmad FS, Allen RB, Altin SE, Auerbach A, Berger JS, Chow B, Dakik HA, Eisenstein EL, Gerhard-Herman M, Ghadimi K, Kachulis B, Leclerc J, Lee CS, Macaulay TE, Mates G, Merli GJ, Parwani P, Poole JE, Rich MW, Ruetzler K, Stain SC, Sweitzer B, Talbot AW, Vallabhajosyula S, Whittle J, Williams KA. 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024; 84:1869-1969. [PMID: 39320289 DOI: 10.1016/j.jacc.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2024]
Abstract
AIM The "2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery" provides recommendations to guide clinicians in the perioperative cardiovascular evaluation and management of adult patients undergoing noncardiac surgery. METHODS A comprehensive literature search was conducted from August 2022 to March 2023 to identify clinical studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE Recommendations from the "2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery" have been updated with new evidence consolidated to guide clinicians; clinicians should be advised this guideline supersedes the previously published 2014 guideline. In addition, evidence-based management strategies, including pharmacological therapies, perioperative monitoring, and devices, for cardiovascular disease and associated medical conditions, have been developed.
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14
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Soares MR, Mahanna Gabrielli E, Manjarrez EC. The Geriatric Patient: Frailty, Prehabilitation, and Postoperative Delirium. Med Clin North Am 2024; 108:1101-1117. [PMID: 39341616 DOI: 10.1016/j.mcna.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
Historically and for ease of classification, the geriatric patient has received a chronologic definition of a person 65 years and older. Chronologic age remains an independent risk of postoperative complications and adverse surgical outcomes. Frailty is an expression of an individual's biological age and as such a more reliable determination of their vulnerabilities or resilience to stress. The concept of prehabilitation has shown promise as a proactive approach to optimize a patient's functional, cognitive, nutritional, and emotional in preparation for surgical interventions. Postoperative delirium is the most common neuropsychological complication after surgery.
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Affiliation(s)
| | - Elizabeth Mahanna Gabrielli
- Division Neuroanesthesiology, Critical Care Medicine, Neurocritical Care and Geriatric Anesthesiology, University of Miami Miller School of Medicine
| | - Efrén C Manjarrez
- Division of Hospital Medicine, University of Miami Miller School of Medicine. https://twitter.com/drefrenm
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15
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Gualandro DM, Fornari LS, Caramelli B, Abizaid AAC, Gomes BR, Tavares CDAM, Fernandes CJCDS, Polanczyk CA, Jardim C, Vieira CLZ, Pinho C, Calderaro D, Schreen D, Marcondes-Braga FG, Souza FD, Cardozo FAM, Tarasoutchi F, Carmo GAL, Kanhouche G, Lima JJGD, Bichuette LD, Sacilotto L, Drager LF, Vacanti LJ, Gowdak LHW, Vieira MLC, Martins MLFM, Lima MSM, Lottenberg MP, Aliberti MJR, Marchi MFDS, Paixão MR, Oliveira Junior MTD, Yu PC, Cury PR, Farsky PS, Pessoa RS, Siciliano RF, Accorsi TAD, Correia VM, Mathias Junior W. Guideline for Perioperative Cardiovascular Evaluation of the Brazilian Society of Cardiology - 2024. Arq Bras Cardiol 2024; 121:e20240590. [PMID: 39442131 DOI: 10.36660/abc.20240590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2024] Open
Affiliation(s)
- Danielle Menosi Gualandro
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
- University Hospital Basel, Basel - Suíça
| | - Luciana Savoy Fornari
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
- Fundação Zerbini, São Paulo, SP - Brasil
| | - Bruno Caramelli
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | - Alexandre Antonio Cunha Abizaid
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | - Carisi Anne Polanczyk
- Hospital de Clínicas da Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre, RS - Brasil
| | - Carlos Jardim
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Claudio Pinho
- Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP - Brasil
- Clinica Pinho, Campinas, SP - Brasil
| | - Daniela Calderaro
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | - Dirk Schreen
- Hospital São Carlos, Rede D'Or, Fortaleza, CE - Brasil
- Hospital Universitário Walter Cantidio da Universidade Federal do Ceará (UFC), Fortaleza, CE - Brasil
- Instituto de Medicina Nuclear, Fortaleza, CE - Brasil
| | - Fabiana Goulart Marcondes-Braga
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | - Fábio de Souza
- Escola de Medicina e Cirurgia da Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ - Brasil
| | - Francisco Akira Malta Cardozo
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | - Flavio Tarasoutchi
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | - Gabriel Assis Lopes Carmo
- Universidade Federal de Minas Gerais, Belo Horizonte, MG - Brasil
- Hospital Evangélico de Belo Horizonte, Belo Horizonte, MG - Brasil
- Hospital Orizonti, Belo Horizonte, MG - Brasil
| | | | - José Jayme Galvão de Lima
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | - Luciana Dornfeld Bichuette
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | - Luciana Sacilotto
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
- Fundação Zerbini, São Paulo, SP - Brasil
| | - Luciano Ferreira Drager
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | | | - Luis Henrique Wolff Gowdak
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | | | | | - Márcio Silva Miguel Lima
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | - Marcos Pita Lottenberg
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | | | - Mauricio Felippi de Sá Marchi
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | - Milena Ribeiro Paixão
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | - Mucio Tavares de Oliveira Junior
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | - Pai Ching Yu
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | - Rinaldo Focaccia Siciliano
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | - Tarso Augusto Duenhas Accorsi
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | - Vinícius Machado Correia
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
| | - Wilson Mathias Junior
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo(HCFMUSP), São Paulo, SP - Brasil
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16
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Li R, Quintana MT, Lee J, Sarani B, Kartiko S. Timing to surgery in elderly patients with small bowel obstruction: An insight on frailty. J Trauma Acute Care Surg 2024; 97:623-630. [PMID: 38787701 DOI: 10.1097/ta.0000000000004410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
BACKGROUND Small bowel obstruction (SBO) frequently necessitates emergency surgical intervention. The impact of frailty and age on operative outcomes is uncertain. This study evaluated postoperative outcomes of SBO surgery based on patient's age and frailty and explore the optimal timing to operation in elderly and/or frail patients. METHODS Patients who underwent SBO surgery were identified in American College of Surgeons National Surgical Quality Improvement Program database 2005 to 2021. Patients aged ≥65 years were defined as elderly. Patients with 5-Factor Modified Frailty Index≥2 were defined as frail. Multivariable logistic regression was used to compare 30-day postoperative outcomes between elderly frail versus nonfrail patients, as well as between nonfrail young versus elderly patients. RESULTS There were 49,344 patients who had SBO surgery, with 7,089 (14.37%) patients classified as elderly frail, 17,821 (36.12%) as elderly nonfrail, and 21,849 (44.28%) as young nonfrail. Elderly frail patients had higher mortality (adjusted odds ratio, 1.541; p < 0.01) and postoperative complications compared with their elderly nonfrail counterparts; these patients also had longer wait until definitive operation ( p < 0.01). Among nonfrail patients, when compared with young patients, the elderly had higher mortality (adjusted odds ratio, 2.388; p < 0.01) and complications, and longer time to operation ( p < 0.01). In elderly nonfrail patients, a higher mortality was observed when surgery was postponed after 2 days. Mortality risk for frail elderly patients is heightened from their already higher baseline when surgery is delayed after 4 days. CONCLUSION When SBO surgery is postponed for more than 2 days, elderly nonfrail patients have an increased mortality risk. Consequently, upon admission, these patients should be placed under a nasogastric tube and undergo an initial gastrograffin challenge. If there is no contrast in colon, they should be operated on within 2 days. Conversely, elderly frail patients with SBO have a higher mortality risk when surgery is delayed beyond 4 days. Thus, following the same scheme, they should be operated on before 4 days if gastrograffin challenge fails. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Renxi Li
- From the George Washington University School of Medicine and Health Sciences (R.L.); and Department of Surgery (M.T.Q., J.L., B.S., S.K.), The George Washington University Hospital, Washington, District of Columbia
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17
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Khalid A, Pasha SA, Demyan L, Standring O, Newman E, King DA, DePeralta D, Gholami S, Weiss MJ, Melis M. Modified 5-Item Frailty Index (mFI-5) may predict postoperative outcomes after pancreatoduodenectomy for pancreatic Cancer. Langenbecks Arch Surg 2024; 409:286. [PMID: 39305322 DOI: 10.1007/s00423-024-03483-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Accepted: 09/17/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND Pancreatic Ductal Adenocarcinoma (PDAC) primarily affects older individuals with diminished physiological reserves. The Modified 5-Item Frailty Index (mFI-5) is a novel risk stratification tool proposed to predict postoperative morbidity and mortality. This study aimed to validate the mFI-5 for predicting surgical outcomes in patients undergoing pancreatoduodenectomy (PD) for PDAC. METHODS Our retrospective PDAC database included patients who underwent PD between 2014 and 2023. Patients were stratified by mFI-5 scores (0 best - 5 worst), which assess preoperative CHF, diabetes mellitus, history of COPD or pneumonia, functional health status, and hypertension requiring medication. Associations between mFI-5 scores and outcomes, including postoperative complications and mortality, were analyzed using logistic regression, Cox proportional hazards models, and Kaplan-Meier survival analysis. RESULTS Among 250 PDAC patients undergoing PD, 142 (56.8%) had mFI-5 scores ≤ 1, and 25 (10%) had scores ≥ 3. No patients had scores > 4. Higher mFI-5 scores correlated with older age (p < 0.001) and tobacco use (p = 0.036). Multivariate analysis identified age (RR 1.02, p = 0.038), ASA class (ASA III; RR 2.61, p < 0.001; ASA IV; RR 2.63, p = 0.026), and moderate alcohol consumption (RR 0.56, p = 0.038) as frailty predictors. An mFI-5 score > 2 independently associated with higher mortality (HR 2.08, p = 0.026). Median overall survival was significantly lower for patients with mFI-5 scores > 2 than for those with scores ≤ 2 (21.3 vs. 42.1 months, p = 0.022). CONCLUSIONS The mFI-5 is a valuable tool for predicting postoperative morbidity and mortality in PDAC patients undergoing PD. Integrating frailty assessment into preoperative evaluations can enhance patient selection and surgical outcomes. Future research should focus on incorporating frailty assessments into surgical planning and patient management to improve outcomes in this vulnerable population.
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Affiliation(s)
- Abdullah Khalid
- North Shore/Long Island Jewish General Surgery, Northwell Health, 300 Community Dr. Manhasset, Manhasset, NY, USA.
| | - Shamsher A Pasha
- Department of Surgery, UT Health San Antonio, San Antonio, TX, USA
| | - Lyudmyla Demyan
- North Shore/Long Island Jewish General Surgery, Northwell Health, 300 Community Dr. Manhasset, Manhasset, NY, USA
| | - Oliver Standring
- North Shore/Long Island Jewish General Surgery, Northwell Health, 300 Community Dr. Manhasset, Manhasset, NY, USA
| | - Elliot Newman
- Northwell Health Lenox Hill Hospital, 100 E 77th St, New York, NY, USA
| | - Daniel A King
- Northwell Health Cancer Institute, 1111 Marcus Ave, New Hyde Park, NY, USA
| | - Danielle DePeralta
- Northwell Health Cancer Institute, 1111 Marcus Ave, New Hyde Park, NY, USA
| | - Sepideh Gholami
- Northwell Health Cancer Institute, 1111 Marcus Ave, New Hyde Park, NY, USA
| | - Matthew J Weiss
- Northwell Health Cancer Institute, 1111 Marcus Ave, New Hyde Park, NY, USA
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18
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Huggins A, Casson C, Holden T, Majumder A, Blatnik J, Holden SE. Classifying frailty in the ventral hernia population. Surg Endosc 2024:10.1007/s00464-024-11250-7. [PMID: 39294314 DOI: 10.1007/s00464-024-11250-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 08/31/2024] [Indexed: 09/20/2024]
Abstract
INTRODUCTION Frailty is increasingly recognized as a preoperative predictor of adverse outcomes following various surgical procedures. Our study aims to compare validated frailty measures in the ventral hernia population, as this is a common elective procedure with a paucity of data regarding frailty prevalence. METHODS Patients aged 18 years or older with planned ventral hernia repairs were prospectively enrolled in our single-institution study from January 2023 through June 2023. After obtaining informed consent, patients completed the Fried Frailty Index (FFI), the FRAIL Scale, and the Strength, Assistance walking, Rising from a chair, Climbing stairs, and Falls (SARC-F) questionnaires, as well as the standard completion of the Patient-Reported Outcomes Measurement Information System (PROMIS) measures at their preoperative clinic appointment. Chart review was performed for baseline demographics and comorbidities. The Modified Frailty Index (mFI-11) and the Charleston Comorbidity Index (CCI) were calculated. RESULTS A total of 63 patients were enrolled in our study. On average, the population was 60 years old, with a BMI of 32.4 kg/m2, a CCI of 3, and on 10.5 medications preoperatively. Overall, 12 patients (19%) screened positive for frailty by the mFI-11, 17 patients (27%) by the FFI, 15 patients (23.8%) by the FRAIL Scale, and 15 patients (23.8%) screened positive for sarcopenia by SARC-F. The FFI and the FRAIL Scale were strongly correlated with the other measures by Spearman's rank-order correlation (p < 0.05). On multivariate regression analysis, a longer Timed Up and Go test was associated with screening positive for frailty or sarcopenia (OR 1.896, p = 0.016). CONCLUSION In this study, we find that frailty is more prevalent than previously reported in the literature by any measure used. Both the FRAIL Scale and FFI strongly correlate with the other tools investigated. Surgeons should consider using these assessments preoperatively to estimate frailty and guide operative planning as well as shared decision-making.
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Affiliation(s)
- Ashley Huggins
- Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA.
| | - Cameron Casson
- Division of Minimally Invasive Surgery, Department of Surgery, Washington University in St. Louis, Saint Louis, USA
| | - Tim Holden
- Division of Geriatrics and Nutritional Science, Department of Medicine, Washington University in St. Louis, Saint Louis, USA
| | - Arnab Majumder
- Division of Minimally Invasive Surgery, Department of Surgery, Washington University in St. Louis, Saint Louis, USA
| | - Jeffrey Blatnik
- Division of Minimally Invasive Surgery, Department of Surgery, Washington University in St. Louis, Saint Louis, USA
| | - Sara E Holden
- Division of Minimally Invasive Surgery, Department of Surgery, Washington University in St. Louis, Saint Louis, USA
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Park CM, Lie JJ, Yang L, Cooper Z, Kim DH. Impact of peri-operative frailty and operative stress on post-discharge mortality, readmission and days at home in Medicare beneficiaries. Anaesthesia 2024; 79:829-838. [PMID: 38775305 PMCID: PMC11246804 DOI: 10.1111/anae.16301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Understanding how patients' frailty and the physiological stress of surgical procedures affect postoperative outcomes may inform risk stratification of older patients undergoing surgery. The objective of the study was to examine the association of peri-operative frailty with mortality, 30-day readmission and days at home after non-cardiac surgical procedures of different physiological stress. METHODS This retrospective study used Medicare claims data from a 7.125% random sample of Medicare fee-for-service beneficiaries from 2015 to 2019 who were aged ≥ 65 years and underwent non-cardiac surgical procedure listed in the Operative Stress Score categories. The exposure of the study was claims-based frailty index (robust, < 0.15; pre-frail, 0.15 to < 0.25; mildly frail, 0.25 to < 0.35; and moderate-to-severely frail, ≥ 0.35) with Operative Stress Score categories being 1, very low stress to 5, very high stress. The primary outcome was all-cause mortality at 30 days and 365 days after the surgical procedure. RESULTS In total, 1,019,938 patients (mean (SD) age of 76.1 (7.3) years; 52.3% female; 16.8% frail) were included. The cumulative incidence of mortality generally increased with Operative Stress Score category, ranging from 5.0% (Operative Stress Score 2) to 24.9% (Operative Stress Score 4) at 365 days. Within each category, increasing frailty was associated with mortality at 30 days (hazard ratio comparing moderate-to-severe frailty vs. robust ranged from 1.59-3.91) and at 365 days (hazard ratio 1.30-4.04). The variation in postoperative outcomes by patients' frailty level was much greater than the variation by the operative stress category. CONCLUSIONS These results emphasise routine frailty screening before major and minor non-cardiac procedures and the need for greater clinician awareness of postoperative outcomes beyond 30 days in shared decision-making with older adults with frailty.
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Affiliation(s)
- Chan Mi Park
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jessica J. Lie
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Laiji Yang
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Zara Cooper
- Harvard Medical School, Boston, MA, USA
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA
| | - Dae Hyun Kim
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Chen L, Liu C, Deng A, Zhang A, Zhu M, Xi H. Association between nutritional risk and fatigue in frailty conditions for older adult patients: a multicentre cross-sectional survey study. BMJ Open 2024; 14:e079139. [PMID: 38851231 PMCID: PMC11163610 DOI: 10.1136/bmjopen-2023-079139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 05/27/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND AND AIMS Frailty is widespread in the elderly, while there is a bi-directional relationship between frailty and malnutrition. The objectives of this study were to investigate the prevalence and correlation of frailty and nutritional risk in older adult patients and to analyse the factors associated with fatigue which is one indicator of frailty. METHODS This cross-sectional multicentre survey study was conducted in five hospitals in the same city from 01 January 2021 to 01 December 2021. We collected information on gender, age, diseases, medication and dietary status. Frailty status was diagnosed using the FRAIL scale, and Nutritional Risk Screening-2002 was used to screen the nutritional risk. Spearman rank correlation was used to analyse the correlation between frailty and nutritional risk. Univariate and multivariate logistic regression analyses were used to analyse the risk factors related to fatigue in all patients and inpatients. RESULTS Among 2016 older adult patients, the prevalence of frailty was 15.1% (305/2016), the prevalence of nutritional risk was 16.2% (327/2016) and the overlap prevalence of frailty and nutritional risk was 7.3% (147/2016). Multivariate analysis showed that nutritional risk (OR 3.109, 95% CI 2.384 to 4.056, p<0.001) was an independent risk factor for fatigue in all patients; similar results were found for nutritional risk (OR 2.717, 95% CI 2.068 to 3.571, p<0.001) in hospitalised patients. CONCLUSIONS Frailty and nutritional risk are prevalent among older adult patients, and nutritional risk is associated with the occurrence of fatigue in older adult patients and older adult inpatients. TRIAL REGISTRATION NUMBER China Clinical Trial Registry (Registered No. ChiCTR-EPC-14005253).
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Affiliation(s)
- Liru Chen
- Department of Nutrition, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Chengyu Liu
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - An Deng
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia, USA
| | - Anqi Zhang
- Department of Nutrition, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingwei Zhu
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Huan Xi
- Department of Geriatric, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Mishra M, Wu J, Kane AE, Howlett SE. The intersection of frailty and metabolism. Cell Metab 2024; 36:893-911. [PMID: 38614092 PMCID: PMC11123589 DOI: 10.1016/j.cmet.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/11/2024] [Accepted: 03/21/2024] [Indexed: 04/15/2024]
Abstract
On average, aging is associated with unfavorable changes in cellular metabolism, which are the processes involved in the storage and expenditure of energy. However, metabolic dysregulation may not occur to the same extent in all older individuals as people age at different rates. Those who are aging rapidly are at increased risk of adverse health outcomes and are said to be "frail." Here, we explore the links between frailty and metabolism, including metabolic contributors and consequences of frailty. We examine how metabolic diseases may modify the degree of frailty in old age and suggest that frailty may predispose toward metabolic disease. Metabolic interventions that can mitigate the degree of frailty in people are reviewed. New treatment strategies developed in animal models that are poised for translation to humans are also considered. We suggest that maintaining a youthful metabolism into older age may be protective against frailty.
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Affiliation(s)
- Manish Mishra
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Judy Wu
- Institute for Systems Biology, Seattle, WA, USA
| | - Alice E Kane
- Institute for Systems Biology, Seattle, WA, USA; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Susan E Howlett
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada; Department of Medicine (Geriatric Medicine), Dalhousie University, Halifax, NS, Canada.
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Darden N, Sharma S, Wu X, Mancini B, Karamchandani K, Bonavia AS. Long-term clinical outcomes in critically ill patients with sepsis and pre-existing low muscle mass: a retrospective cohort study. BMC Anesthesiol 2023; 23:313. [PMID: 37715183 PMCID: PMC10503077 DOI: 10.1186/s12871-023-02274-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/10/2023] [Indexed: 09/17/2023] Open
Abstract
PURPOSE Critically ill patients with sepsis account for significant disease morbidity and healthcare costs. Low muscle mass has been proposed as an independent risk factor for poor short-term outcomes, although its effect on long-term outcomes remains unclear. METHODS Retrospective cohort analysis of patients treated at a quaternary care medical center over 6 years (09/2014 - 12/2020). Critically ill patients meeting Sepsis-3 criteria were included, with low muscle mass defined by [Formula: see text] 5th percentile skeletal muscle index, measured at the L3 lumbar level (L3SMI) on Computed-Tomography (CT) scan ([Formula: see text] 41.6 cm2/m2 for males and [Formula: see text] 32.0 cm2/m2 for females). L3SMI was calculated by normalizing the CT-measured skeletal muscle area to the square of the patient's height (in meters). Measurements were taken from abdominal/pelvic CT scan obtained within 7 days of sepsis onset. The prevalence of low muscle mass and its association with clinical outcomes, including in-hospital and one-year mortality, and post-hospitalization discharge disposition in survivors, was analyzed. Unfavorable post-hospitalization disposition was defined as discharge to a location other than the patient's home. RESULTS Low muscle mass was present in 34 (23%) of 150 patients, with mean skeletal muscle indices of 28.0 ± 2.9 cm2/m2 and 36.8 ± 3.3 cm2/m2 in females and males, respectively. While low muscle mass was not a significant risk factor for in-hospital mortality (hazard ratio 1.33; 95% CI 0.64 - 2.76; p = 0.437), it significantly increased one-year mortality after adjusting for age and illness severity using Cox multivariate regression (hazard ratio 1.9; 95% CI 1.1 - 3.2; p = 0.014). Unfavorable post-hospitalization discharge disposition was not associated with low muscle mass, after adjusting for age and illness severity in a single, multivariate model. CONCLUSION Low muscle mass independently predicts one-year mortality but is not associated with in-hospital mortality or unfavorable hospital discharge disposition in critically ill patients with sepsis.
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Affiliation(s)
- Nola Darden
- Department of Anesthesiology and Perioperative Medicine, Penn State Milton S Hershey Medical Center, 500 University Dr, Mailbox H-187, Hershey, PA, 17033, USA
| | | | - Xue Wu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | | | - Kunal Karamchandani
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Anthony S Bonavia
- Department of Anesthesiology and Perioperative Medicine, Penn State Milton S Hershey Medical Center, 500 University Dr, Mailbox H-187, Hershey, PA, 17033, USA.
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, Penn State Milton S Hershey Medical Center, 500 University Dr, Mailbox H-187, Hershey, PA, 17033, USA.
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Darden N, Sharma S, Wu X, Mancini B, Karamchandani K, Bonavia AS. Long-Term Clinical Outcomes in Critically Ill Patients with Sepsis and Pre-existing Sarcopenia: A Retrospective Cohort Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.12.23288490. [PMID: 37131776 PMCID: PMC10153350 DOI: 10.1101/2023.04.12.23288490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Purpose Critically ill patients with sepsis account for significant disease morbidity and healthcare costs. Sarcopenia has been proposed as an independent risk factor for poor short-term outcomes, although its effect on long-term outcomes remains unclear. Methods Retrospective cohort analysis of patients treated at a tertiary care medical center over 6 years (09/2014 - 12/2020). Critically ill patients meeting Sepsis-3 criteria were included, with sarcopenia defined by skeletal muscle index at the L3 lumbar area on abdominal Computed-Tomography scan. The prevalence of sarcopenia and its association with clinical outcomes was analyzed. Results Sarcopenia was present in 34 (23%) of 150 patients, with median skeletal muscle indices of 28.1 cm 2 /m 2 and 37.3 cm 2 /m 2 in sarcopenic females and males, respectively. In-hospital mortality was not associated with sarcopenia when adjusted for age and illness severity. One year mortality was increased in sarcopenic patients, after adjustment for illness severity (HR 1.9, p = 0.02) and age (HR 2.4, p = 0.001). However, it was not associated with increased likelihood for discharge to long-term rehabilitation or hospice care in adjusted analyses. Conclusion Sarcopenia independently predicts one year mortality but is not associated with unfavorable hospital discharge disposition in critically ill patients with sepsis.
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The Role of Surgical Prehabilitation During the COVID-19 Pandemic and Beyond. Phys Med Rehabil Clin N Am 2023. [PMCID: PMC10070767 DOI: 10.1016/j.pmr.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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25
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Cardiac assessment and management in older surgical patients. Int Anesthesiol Clin 2023; 61:1-7. [PMID: 36892982 DOI: 10.1097/aia.0000000000000393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Siddiqui E, Banco D, Berger JS, Smilowitz NR. Frailty Assessment and Perioperative Major Adverse Cardiovascular Events After Noncardiac Surgery. Am J Med 2023; 136:372-379.e5. [PMID: 36657557 PMCID: PMC10038881 DOI: 10.1016/j.amjmed.2022.12.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 12/14/2022] [Accepted: 12/18/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Frailty is an emerging risk factor for adverse outcomes. However, perioperative frailty assessments derived from electronic health records have not been studied on a large scale. We aim to estimate the prevalence of frailty and the associated incidence of major adverse cardiovascular events (MACE) among adults hospitalized for noncardiac surgery. METHODS Adults aged ≥45 years hospitalized for noncardiac surgery from 2004-2014 were identified from the National Inpatient Sample. The validated Hospital Frailty Risk Score (HFRS) derived from International Classification of Diseases codes was used to classify patients as low (HFRS <5), medium (5-10), or high (>10) frailty risk. The primary outcome was MACE, defined as myocardial infarction, cardiac arrest, and in-hospital mortality. Multivariable logistic regression was used to estimate the adjusted odds of MACE stratified by age and HFRS. RESULTS A total of 55,349,978 hospitalizations were identified, of which 81.0%, 14.4%, and 4.6% had low, medium, and high HFRS, respectively. Patients with higher HFRS had more cardiovascular risk factors and comorbidities. MACE occurred during 2.5% of surgical hospitalizations and was common among patients with high frailty scores (high HFRS: 9.1%, medium: 6.9%, low: 1.3%, P < .001). Medium (adjusted odds ratio [aOR] 2.05; 95% confidence interval [CI], 2.02-2.08) and high (aOR 2.75; 95% CI, 2.70-2.79) HFRS were associated with greater odds of MACE vs low HFRS, with the greatest odds of MACE observed in younger individuals 45-64 years (interaction P value < .001). CONCLUSIONS The HFRS may identify frail surgical inpatients at risk for adverse perioperative cardiovascular outcomes.
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Affiliation(s)
- Emaad Siddiqui
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Darcy Banco
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Jeffrey S Berger
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Nathaniel R Smilowitz
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY; Veterans Affairs New York Harbor Health Care System, New York, NY.
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Bonavina G, Zackova M, Bet L, Bonavina L. Comment on the Need to Fill a Gap in the Assessment of Neurological Status Before Elective Surgery. ANNALS OF SURGERY OPEN 2023; 4:e252. [PMID: 37600891 PMCID: PMC10431550 DOI: 10.1097/as9.0000000000000252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/05/2022] [Indexed: 03/19/2023] Open
Affiliation(s)
- Giuseppe Bonavina
- From the Division of Intensive Care and Neurology Unit, Montecatone Rehabilitation Institute, Imola, Italy
| | - Monika Zackova
- From the Division of Intensive Care and Neurology Unit, Montecatone Rehabilitation Institute, Imola, Italy
| | - Luciano Bet
- Division of General and Foregut Surgery and Neurology Unit, University of Milan, IRCCS Policlinico San Donato, Milan, Italy
| | - Luigi Bonavina
- Division of General and Foregut Surgery and Neurology Unit, University of Milan, IRCCS Policlinico San Donato, Milan, Italy
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Fabbro S, Piccolo D, Vescovi MC, Bagatto D, Tereshko Y, Belgrado E, Maieron M, De Colle MC, Skrap M, Tuniz F. Resting-state functional-MRI in iNPH: can default mode and motor networks changes improve patient selection and outcome? Preliminary report. Fluids Barriers CNS 2023; 20:7. [PMID: 36703181 PMCID: PMC9878781 DOI: 10.1186/s12987-023-00407-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/16/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Idiopathic normal pressure hydrocephalus (iNPH) is a progressive and partially reversible form of dementia, characterized by impaired interactions between multiple brain regions. Because of the presence of comorbidities and a lack of accurate diagnostic and prognostic biomarkers, only a minority of patients receives disease-specific treatment. Recently, resting-state functional-magnetic resonance imaging (rs-fMRI) has demonstrated functional connectivity alterations in inter-hemispheric, frontal, occipital, default-mode (DMN) and motor network (MN) circuits. Herein, we report our experience in a cohort of iNPH patients that underwent cerebrospinal fluid (CSF) dynamics evaluation and rs-fMRI. The study aimed to identify functional circuits related to iNPH and explore the relationship between DMN and MN recordings and clinical modifications before and after infusion and tap test, trying to understand iNPH pathophysiology and to predict the best responders to ventriculoperitoneal shunt (VPS) implant. METHODS We prospectively collected data regarding clinical assessment, neuroradiological findings, lumbar infusion and tap test of thirty-two iNPH patients who underwent VPS implant. Rs-fMRI was performed using MELODIC-ICA both before and after the tap test. Rs-fMRI data of thirty healthy subjects were also recorded. RESULTS At the baseline, reduced z-DMN and z-MN scores were recorded in the iNPH cohort compared with controls. Higher z-scores were recorded in more impaired patients. Both z-scores significantly improved after the tap test except in subjects with a low resistance to outflow value and without a significant clinical improvement after the test. A statistically significant difference in mean MN connectivity scores for tap test responders and non-responders was demonstrated both before (p = 0.0236) and after the test (p = 0.00137). A statistically significant main effect of the tap test on DMN connectivity after CSF subtraction was recorded (p = 0.038). CONCLUSIONS Our results suggest the presence of a partially reversible plasticity functional mechanism in DMN and MN. Low values compensate for the initial stages of the disease, while higher values of z-DMN were recorded in older patients with a longer duration of symptoms, suggesting an exhausted plasticity compensation. The standardization of this technique could play a role as a non-invasive biomarker in iNPH disease, suggesting the right time for surgery. Trial Registration Prot. IRB 090/2021.
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Affiliation(s)
- Sara Fabbro
- Department of Neurosurgery, ASUFC “Santa Maria Della Misericordia”, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy
| | - Daniele Piccolo
- Department of Neurosurgery, ASUFC “Santa Maria Della Misericordia”, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy ,grid.8982.b0000 0004 1762 5736Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla 74, 27100 Pavia, Italy
| | - Maria Caterina Vescovi
- Department of Neurosurgery, ASUFC “Santa Maria Della Misericordia”, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy
| | - Daniele Bagatto
- Department of Neuroradiology, ASUFC “Santa Maria Della Misericordia”, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy
| | - Yan Tereshko
- Department of Neurology, ASUFC “Santa Maria Della Misericordia”, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy
| | - Enrico Belgrado
- Department of Neurology, ASUFC “Santa Maria Della Misericordia”, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy
| | - Marta Maieron
- Department of Physics, ASUFC “Santa Maria Della Misericordia”, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy
| | - Maria Cristina De Colle
- Department of Neuroradiology, ASUFC “Santa Maria Della Misericordia”, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy
| | - Miran Skrap
- Department of Neurosurgery, ASUFC “Santa Maria Della Misericordia”, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy
| | - Francesco Tuniz
- Department of Neurosurgery, ASUFC “Santa Maria Della Misericordia”, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy
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Kraiss LW, Al-Dulaimi R, Allen CM, Mell MW, Arya S, Presson AP, Brooke BS. A Vascular Quality Initiative frailty assessment predicts postdischarge mortality in patients undergoing arterial reconstruction. J Vasc Surg 2022; 76:1325-1334.e3. [PMID: 35709866 PMCID: PMC9613536 DOI: 10.1016/j.jvs.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 05/18/2022] [Accepted: 05/28/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Frailty assessment adds important prognostic information during preoperative decision-making but can be cumbersome to implement into routine clinical care. We developed and tested an abbreviated method of frailty assessment using variables routinely collected by the Vascular Quality Initiative (VQI) registry. METHODS An abbreviated frailty score (the simple Vascular Quality Initiative-Frailty Score [VQI-FS]) was developed using 11 or fewer VQI variables (hypertension, congestive heart failure, coronary artery disease, peripheral vascular disease, diabetes, chronic obstructive pulmonary disease, renal impairment, anemia, underweight, nonhome residence, and nonambulatory status) that map to recognized frailty domains in the Comprehensive Geriatric Assessment and the literature. Nonemergent cases registered in the VQI from 2010 to 2017 (n = 265,632) in seven registries (carotid endarterectomy, n = 77,111; carotid artery stenting, n = 13,215; endovascular abdominal aortic aneurysm repair, n = 29,607; open abdominal aortic aneurysm repair, n = 7442; infrainguinal bypass, n = 33,128; suprainguinal bypass, n = 10,661; and peripheral vascular intervention, n = 94,468) were analyzed using logistic regression models to determine the predictive power of the VQI-FS for perioperative and longer term (9-month) mortality. Nomograms were created using weighted regression coefficients to assist in individualized frailty assessment and estimation of 9-month mortality. RESULTS The VQI-FS, using equal weighting of these 11 VQI variables, effectively predicted 9-month mortality with an area under the curve of 0.724 by receiver operating characteristic curve analysis. However, differential weighting of the variables allowed simplification of the model to only seven variables (congestive heart failure, renal impairment, chronic obstructive pulmonary disease, not living at home, not ambulatory, anemia, and underweight status); hypertension, coronary artery disease, peripheral vascular disease, and diabetes had relatively low predictive power. Adding procedure-specific risk further improved performance of the model with a final area under the curve on receiver operating characteristic curve analysis of 0.758. Model calibration was excellent with predicted/observed regression line slope of 0.991 and intercept of 5.449e-04. CONCLUSIONS A differentially weighted abbreviated VQI-FS using seven variables in addition to procedure-specific risk has strong correlation with 9-month mortality. Nomograms incorporating patient- and procedure-adjusted risk can effectively predict 9-month mortality. Reliable estimates of longer term mortality should assist in preoperative decision-making for vascular procedures that often carry substantial risk of mortality.
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Affiliation(s)
- Larry W Kraiss
- Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City, UT.
| | - Ragheed Al-Dulaimi
- Study Design & Biostatistics Center, Center for Clinical & Translational Science, University of Utah School of Medicine, Salt Lake City, UT
| | - Chelsea M Allen
- Study Design & Biostatistics Center, Center for Clinical & Translational Science, University of Utah School of Medicine, Salt Lake City, UT
| | - Matthew W Mell
- Division of Vascular Surgery, University of California-Davis, Sacramento, CA
| | - Shipra Arya
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA
| | - Angela P Presson
- Study Design & Biostatistics Center, Center for Clinical & Translational Science, University of Utah School of Medicine, Salt Lake City, UT
| | - Benjamin S Brooke
- Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City, UT
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Halvorsen S, Mehilli J, Cassese S, Hall TS, Abdelhamid M, Barbato E, De Hert S, de Laval I, Geisler T, Hinterbuchner L, Ibanez B, Lenarczyk R, Mansmann UR, McGreavy P, Mueller C, Muneretto C, Niessner A, Potpara TS, Ristić A, Sade LE, Schirmer H, Schüpke S, Sillesen H, Skulstad H, Torracca L, Tutarel O, Van Der Meer P, Wojakowski W, Zacharowski K. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J 2022; 43:3826-3924. [PMID: 36017553 DOI: 10.1093/eurheartj/ehac270] [Citation(s) in RCA: 441] [Impact Index Per Article: 147.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Liu C, Xu H, Chen L, Zhu M. Exercise and Nutritional Intervention for Physical Function of the Prefrail: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2022; 23:1431.e1-1431.e19. [PMID: 35697124 DOI: 10.1016/j.jamda.2022.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim is to inspect the effects of exercise and nutritional intervention on prefrail older adults' physical function. DESIGN Systematic review and meta-analysis registered with PROSPERO (registration number: CRD42021261197). SETTING AND PARTICIPANTS Randomized controlled trials involving prefrail older adults who received exercise and/or nutritional interventions. METHODS Ovid MEDLINE, EMBASE, Cochrane Central Registry of Controlled Trials (CENTRAL), Web of Science, Clinical Trials, and PubMed were searched from inception to September 1, 2021. Primary outcomes were physical function, including physical performance, mobility, and grip strength. The short physical performance battery score and chair sit-to-stand test were used to assess the physical performance. Timed up and go and gait speed were applied to assess the mobility. Secondary outcomes were frailty status, weight, body mass index, Barthel index, and quality of life (Euro quality of life 5 dimension index values). RESULTS We included 16 randomized controlled trials comprising 1199 prefrail older adults (intervention group, n = 593; control group, n = 606). Exercise and nutritional interventions significantly improved the short physical performance battery score [n = 5, mean difference 0.81, 95% confidence interval (CI) 0.21‒1.42, I2 = 62%], handgrip strength (n = 7, mean difference 1.52, 95% CI 0.70‒2.34, I2 = 6%), and gait speed (n = 4, standard weighted mean difference -1.06, 95% CI -1.87 to -0.25, I2 = 89%). There were no significant differences among the chair sit-to-stand test, timed up and go, weight, body mass index, and Barthel index. CONCLUSIONS AND IMPLICATIONS Our systematic review and meta-analysis shows that the receipt of exercise and nutritional intervention significantly improved physical function in prefrail older adults.
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Affiliation(s)
- Chengyu Liu
- Department of General Surgery, Department of Hepatobiliopancreatic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Hongxuan Xu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Liru Chen
- Department of Nutrition, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Mingwei Zhu
- Department of General Surgery, Department of Hepatobiliopancreatic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China; Department of Nutrition, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China.
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32
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Song Y, Wu Z, Huo H, Zhao P. The Impact of Frailty on Adverse Outcomes in Geriatric Hip Fracture Patients: A Systematic Review and Meta-Analysis. Front Public Health 2022; 10:890652. [PMID: 35844855 PMCID: PMC9280195 DOI: 10.3389/fpubh.2022.890652] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/13/2022] [Indexed: 01/10/2023] Open
Abstract
ObjectiveWith an aging population and advances in medicine, more research focuses on health and longevity in geriatric adults. Recently, frailty has gradually emerged to assess physical conditions. Frailty can be generally described as a multi-dimensional situation of increased vulnerabilities to both endogenous and exogenous stressors. The objective of the review was to evaluate the predictive value of frailty on adverse outcomes in geriatric hip fracture patients.Materials and MethodsWe searched PubMed, Embase, Web of Science, and the Cochrane library for relevant literature about the connection between frailty and poor outcomes in hip fracture elders.ResultsEleven studies involving a total of 45,979 participants were selected in our study. Our results indicated that frailty could significantly predict postoperative and in-patient complications (OR, 1.46; 95% CI, 1.13–1.90; I2 = 77.4%). Frail elders had higher risk of inpatient mortality (OR, 1.68; 95% CI, 1.26–2.25; I2 = 0.0%), 6-month mortality (OR, 1.46; 95% CI, 1.25–1.72; I2 = 0.0%) and ≥1-year mortality (OR, 2.24; 95% CI, 1.66–3.04; I2 = 91.3%). Furthermore, the risk of prolonged hospital stays was 1.15 times more likely in frail patients (95% CI, 1.03–1.28; I2 = 14.8%).ConclusionFrailty can predict adverse outcomes effectively in geriatric hip fracture patients.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/#recordDetails.
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Affiliation(s)
- Yanhong Song
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ziyi Wu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Huihui Huo
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ping Zhao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Ping Zhao
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Ida M, Naito Y, Tanaka Y, Inoue S, Kawaguchi M. Factors associated with functional disability or mortality after elective noncardiac surgery: a prospective cohort study. Can J Anaesth 2022; 69:704-714. [PMID: 35396651 DOI: 10.1007/s12630-022-02247-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 12/19/2021] [Accepted: 12/22/2021] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Preoperative prediction of functional status after surgery is essential when practicing patient-centered medicine. We aimed to evaluate the incidence and factors associated with postoperative functional disability or all-cause mortality. Secondarily, we sought to describe the trajectory of disability in this population. METHODS Adults aged ≥ 55 yr who underwent elective noncardiac surgery under general anesthesia in a tertiary care hospital were followed up one year after surgery. Pre- and intraoperative factors associated with a composite outcome of postoperative functional disability or all-cause mortality were assessed using a multiple logistic regression. The sequential changes in the 12-item World Health Organization Disability Assessment Schedule (WHODAS) 2.0 score were described and stratified by surgical invasiveness. RESULTS Of the 2,921 patients included, 293 experienced postoperative functional disability (10.0%; 95% confidence interval [CI], 8.9 to 11.1) and 124 died (4.2%; 95% CI, 3.5 to 5.0). In a multiple regression model, the potentially modifiable risk factors, body mass index ≥ 30 kg·m-2 and poor preoperative nutritional status, were significantly associated with the primary composite outcome, as well as nonmodifiable factors such as age, preoperative comorbidities, and blood loss volume. Changes in the 12-item WHODAS 2.0 disability score varied between different levels of surgical invasiveness and types of surgery. CONCLUSION Within one year after surgery, one in ten patients experienced postoperative functional disability and one in 20 died. We identified potentially modifiable factors (obesity, poor nutritional status) associated with these adverse outcomes. STUDY REGISTRATION University Hospital Medical Information Network (UMIN000021671); registered 31 December 2015.
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Affiliation(s)
- Mitsuru Ida
- Department of Anaesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Yusuke Naito
- Department of Anaesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Yuu Tanaka
- Department of Anaesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Satoki Inoue
- Department of Anaesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Masahiko Kawaguchi
- Department of Anaesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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Ishizawa Y. Does Preoperative Cognitive Optimization Improve Postoperative Outcomes in the Elderly? J Clin Med 2022; 11:jcm11020445. [PMID: 35054139 PMCID: PMC8778093 DOI: 10.3390/jcm11020445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/13/2022] [Accepted: 01/13/2022] [Indexed: 12/29/2022] Open
Abstract
Perioperative neurocognitive disorder (PND) is a growing concern, affecting several million elderly patients each year in the United States, but strategies for its effective prevention have not yet been established. Humeidan et al. recently demonstrated that preoperative brain exercise resulted in a decrease in postoperative delirium incidence in elderly surgical patients, suggesting the potential of presurgical cognitive optimization to improve postoperative cognitive outcomes. This brief review summarizes the current knowledge regarding preoperative cognitive optimization and highlights landmark studies, as well as current ongoing studies, as the field is rapidly growing. This review further discusses the benefit of cognitive training in non-surgical elderly populations and the role of cognitive training in patients with preexisting cognitive impairment or dementia. The review also examines preclinical evidence in support of cognitive training, which can facilitate understanding of brain plasticity and the pathophysiology of PND. The literature suggests positive impacts of presurgical cognitive optimization, but further studies are encouraged to establish effective cognitive training programs for elderly presurgical patients.
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Affiliation(s)
- Yumiko Ishizawa
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Association between frailty and postoperative delirium: a meta-analysis of cohort study. Aging Clin Exp Res 2022; 34:25-37. [PMID: 33834367 DOI: 10.1007/s40520-021-01828-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/04/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Frailty has been suggested as a possible risk factor for postoperative delirium (POD). However, results of previous studies were not consistent. We performed a meta-analysis of cohort study to evaluate the above association. METHODS Relevant studies were obtained via systematic search of PubMed, Embase, SCOPUS, and Web of Science databases. Only studies with multivariate analysis were included. A random-effect model incorporating the potential heterogeneity was used to combine the results. RESULTS Fifteen cohort studies including 3250 adult patients who underwent surgery were included, and the prevalence of frailty was 27.1% (880/3250) before surgeries. Overall, POD occurred in 513 patients (15.8%). Pooled results showed that frailty was associated with a higher risk of POD (adjusted odds ratio [OR]: 3.23, 95% confidence interval [CI]: 2.56-4.07, P < 0.001) without significant heterogeneity (P for Cochrane's Q test = 0.25, I2 = 18%). Subgroup analyses showed a more remarkable association between frailty and POD in prospective cohort studies (OR: 3.64, 95% CI: 2.95-4.49, P < 0.001) than that in retrospective cohort studies (OR: 2.32, 95% CI: 1.60-3.35, P < 0.001; P for subgroup difference = 0.04). Moreover, the association was not affected by country of the study, age group of the patient, elective or emergency surgeries, cardiac and non-cardiac surgeries, evaluation instruments for frailty, diagnostic methods for POD, or quality score of the study (P for subgroup difference all > 0.05). CONCLUSIONS Frailty may be associated with a higher risk of POD in adult population.
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He YY, Chang J, Wang XJ. Frailty as a predictor of all-cause mortality in elderly patients undergoing percutaneous coronary intervention: A systematic review and meta-analysis. Arch Gerontol Geriatr 2022; 98:104544. [DOI: 10.1016/j.archger.2021.104544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/27/2021] [Accepted: 09/30/2021] [Indexed: 12/14/2022]
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Gouda P, Wang X, Youngson E, McGillion M, Mamas MA, Graham MM. Beyond the revised cardiac risk index: Validation of the hospital frailty risk score in non-cardiac surgery. PLoS One 2022; 17:e0262322. [PMID: 35045122 PMCID: PMC8769314 DOI: 10.1371/journal.pone.0262322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/22/2021] [Indexed: 12/12/2022] Open
Abstract
Frailty is an established risk factor for adverse outcomes following non-cardiac surgery. The Hospital Frailty Risk Score (HFRS) is a recently described frailty assessment tool that harnesses administrative data and is composed of 109 International Classification of Disease variables. We aimed to examine the incremental prognostic utility of the HFRS in a generalizable surgical population. Using linked administrative databases, a retrospective cohort of patients admitted for non-cardiac surgery between October 1st, 2008 and September 30th, 2019 in Alberta, Canada was created. Our primary outcome was a composite of death, myocardial infarction or cardiac arrest at 30-days. Multivariable logistic regression was undertaken to assess the impact of HFRS on outcomes after adjusting for age, sex, components of the Charlson Comorbidity Index (CCI), Revised Cardiac Risk Index (RCRI) and peri-operative biomarkers. The final cohort consisted of 712,808 non-cardiac surgeries, of which 55·1% were female and the average age was 53·4 +/- 22·4 years. Using the HFRS, 86.3% were considered low risk, 10·7% were considered intermediate risk and 3·1% were considered high risk for frailty. Intermediate and high HFRS scores were associated with increased risk of the primary outcome with an adjusted odds ratio of 1·61 (95% CI 1·50-1.74) and 1·55 (95% CI 1·38-1·73). Intermediate and high HFRS were also associated with increased adjusted odds of prolonged hospital stay, in-hospital mortality, and 1-year mortality. The HFRS is a minimally onerous frailty assessment tool that can complement perioperative risk stratification in identifying patients at high risk of short- and long-term adverse events.
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Affiliation(s)
- Pishoy Gouda
- University of Alberta, Division of Cardiology and Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Xiaoming Wang
- Research Facilitation, Alberta Health Services, Edmonton, Alberta, Canada
| | - Erik Youngson
- Research Facilitation, Alberta Health Services, Edmonton, Alberta, Canada
| | - Michael McGillion
- School of Nursing, Faculty of Health Sciences and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, Newcastle, United Kingdom
| | - Michelle M. Graham
- University of Alberta, Division of Cardiology and Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
- * E-mail:
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Hamilton J, Kushner B, Holden S, Holden T. Age-Related Risk Factors in Ventral Hernia Repairs: A Review and Call to Action. J Surg Res 2021; 266:180-191. [PMID: 34015515 PMCID: PMC8338875 DOI: 10.1016/j.jss.2021.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/29/2021] [Accepted: 04/02/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND As the population ages, the incidence of ventral hernias in older adults is increasing. Ventral hernia repairs (VHR) should not be considered low risk operations, particularly in older adults who are disproportionately affected by multiple age-related factors that can complicate surgery and adversely affect outcomes. Although age-related risk factors have been well established in other surgical fields, there is currently little data describing their impact on VHR. METHODS We performed a systematic review of the literature to identify studies that examine the effects of age-related risk factors on VHR outcomes. This was conducted using Cochrane Library, Embase, PubMed (Medline), and Google Scholar databases, all updated through June 2020. We selected relevant studies using the keywords, multimorbidity, comorbidities, polypharmacy, functional dependence, functional status, frailty, cognitive impairment, dementia, sarcopenia, and malnutrition. Primary outcomes include mortality and overall complications following VHR. RESULTS We summarize the evidence basis for the significance of age-related risk factors in elective surgery and discuss how these factors increase the risk of adverse outcomes following VHR. In particular, we explore the impact of the following risk factors: multimorbidity, polypharmacy, functional dependence, frailty, cognitive impairment, sarcopenia, and malnutrition. As opposed to chronological age itself, age-related risk factors are more clinically relevant in determining VHR outcomes. CONCLUSIONS Given the increasing complexity of VHR, addressing age-related risk factors pre-operatively has the potential to improve surgical outcomes in older adults. Preoperative risk assessment and individualized prehabilitation programs aimed at improving patient-centered outcomes may be particularly useful in this population.
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Affiliation(s)
- Julia Hamilton
- Department of Surgery, Washington University School of Medicine. St. Louis, Missouri.
| | - Bradley Kushner
- Department of Surgery, Washington University School of Medicine. St. Louis, Missouri
| | - Sara Holden
- Department of Surgery, Washington University School of Medicine. St. Louis, Missouri
| | - Timothy Holden
- Department of Medicine, Division of Geriatrics and Nutritional Science, Washington University School of Medicine, St. Louis, Missouri
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Shi J, Tao Y, Meng L, Zhou B, Duan C, Xi H, Yu P. Frailty Status Among the Elderly of Different Genders and the Death Risk: A Follow-Up Study. Front Med (Lausanne) 2021; 8:715659. [PMID: 34485346 PMCID: PMC8414880 DOI: 10.3389/fmed.2021.715659] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/09/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Frailty in the elderly population is currently a frontier and focus in the field of health and aging. The goal of this study was to explore the frailty status among the elderly of different genders and its influence on the risk of death during 11 years. Methods: Frailty index (FI) was used to evaluate the frailty status in the elderly based on the baseline data conducted in 2009; and death as outcome variables collected in 2020 were analyzed. The difference of the frailty level and mortality of different genders was compared. Cox regression and Kaplan–Meier curves were applied to evaluate the influence on the risk of death and the 11-year survival of the elderly at different level of frailty, respectively. Results: Totally, 1,246 elderly people were recruited. The mortality in men (43.7%, 227/519) was statistically higher than that in women (34.3%, 249/727) (x2 = 11.546, P = 0.001). Deficits accumulated exponentially with age, and at all ages, women accumulated more deficits than do men on average (B = 0.030 vs. 0.028, t = 4.137, P = 0.023). For any given level of frailty, the mortality rate is higher in men than in women, and the difference in mortality between genders reached the peak when FI value was 0.26. Cox regression analysis showed that FI value had a greater impact on the risk of death in older men (HR = 1.171, 95%CI: 1.139~1.249)than that in older women (HR = 1.119, 95%CI: 1.039~1.137). Survival analysis showed that the median 11-year survival time in women was longer than that in men (95.26 vs. 89.52 months, Log rank = 9.249, P = 0.002). Kaplan–Meier curves showed that the survival rate decreased with the increase of frailty, and at the same level of frailty, survival time in older women was longer than that in older men, except for severe frailty (FI ≥ 0.5). Conclusion: The frailty status and its influence on mortality are different among the older people of different genders; therefore, specific interventions for frailty should be conducted in the elderly population of different genders, as well as of different degrees of frailty.
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Affiliation(s)
- Jing Shi
- Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Chinese Academy of Medical Sciences, Beijing, China
| | - Yongkang Tao
- Department of Gastroenterology, China-Japan Friendship Hospital, Beijing, China
| | - Li Meng
- Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Chinese Academy of Medical Sciences, Beijing, China
| | - Baiyu Zhou
- Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Chinese Academy of Medical Sciences, Beijing, China
| | - Chunbo Duan
- Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Chinese Academy of Medical Sciences, Beijing, China
| | - Huan Xi
- Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Chinese Academy of Medical Sciences, Beijing, China
| | - Pulin Yu
- Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Chinese Academy of Medical Sciences, Beijing, China
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Venianaki M, Andreou A, Nikolouzakis TK, Chrysos E, Chalkiadakis G, Lasithiotakis K. Factors Associated with Malnutrition and Its Impact on Postoperative Outcomes in Older Patients. J Clin Med 2021; 10:2550. [PMID: 34207674 PMCID: PMC8229217 DOI: 10.3390/jcm10122550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/29/2021] [Accepted: 06/03/2021] [Indexed: 11/28/2022] Open
Abstract
Malnutrition is associated with dismal treatment outcomes in older patients but its impact in geriatric surgery has not been studied extensively. Herein, we report the prevalence of malnutrition risk, its risk factors and its association with postoperative outcomes in older patients undergoing operations of general surgery. This is a retrospective analysis of a prospectively maintained database including patients older than 65 years who were to undergo general surgery operations between 2012 and 2017. The Malnutrition Universal Screening Tool (MUST) was used for nutritional risk. Demographics, socioeconomic data, site and magnitude of the operation, various measures of comorbidity and functional dependence as well as postoperative complications based on Clavien-Dindo classification and length of stay were recorded. There were 501 patients. A total of 28.6% of them were at intermediate malnutrition risk (MUST = 1) and 14.6% were at high malnutrition risk (MUST ≥ 2). Variables independently associated with malnutrition risk (MUST ≥ 1) were smoking (Odds Ratio, OR:1.6, p = 0.041), upper gastrointestinal (GI) tract surgery (OR:20.4, p < 0.001), hepatobiliary-pancreatic surgery (OR:3.7, p = 0.001), lower GI surgery (OR:5.2, p < 0.001) and American Society of Anesthesiologists (ASA) class III/IV (OR:2.8, p = 0.001). In the multiple regression analysis adjusted for several confounding variables, the MUST score was significantly associated with postoperative death (OR:9.1, p = 0.047 for MUST = 1 and OR:11.9, p = 0.035 for MUST score ≥ 2) and postoperative hospital stay (adjusted incidence rate ratio, 1.3, p = 0.041 for MUST = 1 and 1.7, p < 0.001 for MUST ≥ 2). Malnutrition risk was highly prevalent in this sample, particularly in patients with operations of the gastrointestinal tract, in patients with poor physical status and it was associated with postoperative mortality and length of stay.
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Affiliation(s)
- Maria Venianaki
- Department of General Surgery, University General Hospital of Heraklion, 71110 Heraklion, Crete, Greece; (M.V.); (A.A.); (T.K.N.); (E.C.); (G.C.)
| | - Alexandros Andreou
- Department of General Surgery, University General Hospital of Heraklion, 71110 Heraklion, Crete, Greece; (M.V.); (A.A.); (T.K.N.); (E.C.); (G.C.)
| | - Taxiarchis Konstantinos Nikolouzakis
- Department of General Surgery, University General Hospital of Heraklion, 71110 Heraklion, Crete, Greece; (M.V.); (A.A.); (T.K.N.); (E.C.); (G.C.)
- Department of Anatomy, Medical School, University of Crete, 71110 Heraklion, Crete, Greece
| | - Emmanuel Chrysos
- Department of General Surgery, University General Hospital of Heraklion, 71110 Heraklion, Crete, Greece; (M.V.); (A.A.); (T.K.N.); (E.C.); (G.C.)
| | - George Chalkiadakis
- Department of General Surgery, University General Hospital of Heraklion, 71110 Heraklion, Crete, Greece; (M.V.); (A.A.); (T.K.N.); (E.C.); (G.C.)
| | - Konstantinos Lasithiotakis
- Department of General Surgery, University General Hospital of Heraklion, 71110 Heraklion, Crete, Greece; (M.V.); (A.A.); (T.K.N.); (E.C.); (G.C.)
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Gracie TJ, Caufield-Noll C, Wang NY, Sieber FE. The Association of Preoperative Frailty and Postoperative Delirium: A Meta-analysis. Anesth Analg 2021; 133:314-323. [PMID: 34257192 DOI: 10.1213/ane.0000000000005609] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Both frailty and postoperative delirium (POD) are common in elective surgical patients 65 years of age and older. However, the association between preoperative frailty and POD remains difficult to characterize owing to the large number of frailty and POD assessment tools used in the literature, only a few of which are validated. Furthermore, some validated frailty tools fail to provide clear score cutoffs for distinguishing frail and nonfrail patients. We performed a meta-analysis to estimate the relationship between preoperative frailty and POD. METHODS We searched several major databases for articles that investigated the relationship between preoperative frailty and POD in patients with mean age ≥65 years who were undergoing elective, nonemergent inpatient surgery. Inclusion criteria included articles published in English no earlier than 1999. Both preoperative frailty and POD must have been measured with validated tools using clear cutoff scores for frailty and delirium. Articles were selected and data extracted independently by 2 researchers. Risk of bias (ROBINS-I) and presence of confounders were summarized. Odds ratios (ORs) for POD associated with frailty relative to nonfrailty were computed with adjusted ORs when available. Original estimates were pooled by random effects analysis. Statistical significance was set at 2-sided P < .05. RESULTS Nine studies qualified for meta-analysis. The Fried score or a modified version of it was used in 5 studies. Frailty prevalence ranged from 18.6% to 56%. Delirium was assessed with the Confusion Assessment Method (CAM) or Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) in 7 studies, Delirium Observation Scale in 1 study, and Intensive Care Delirium Screening Checklist in 1 study. The incidence of POD ranged from 7% to 56%. ROBINS-I risk of bias was low in 1 study, moderate in 4 studies, serious in 3 studies, and critical in 1 study. Random effects analysis (n = 794) of the OR for POD in frail versus nonfrail patients based on adjusted OR estimates was significant with an OR of 2.14 and a 95% confidence interval of 1.43-3.19. The I2 value was in the low range at 5.5, suggesting small variability from random effects. Funnel-plot analysis did not definitively support either the presence or absence of publication bias. CONCLUSIONS This meta-analysis provides evidence for a significant association between preoperative frailty and POD in elective surgical patients age 65 years or older.
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Affiliation(s)
- Thomas J Gracie
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christine Caufield-Noll
- Library Services, Harrison Library, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
| | - Nae-Yuh Wang
- Departments of Medicine (General Internal Medicine), Biostatistics, and Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Frederick E Sieber
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Au Yong PSA, Sim EYL, Ho CYX, He Y, Kwa CXW, Teo LM, Abdullah HR. Association of Multimorbidity With Frailty in Older Adults for Elective Non-Cardiac Surgery. Cureus 2021; 13:e15033. [PMID: 34150384 PMCID: PMC8200322 DOI: 10.7759/cureus.15033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Frailty is associated with adverse surgical outcomes. While existing studies describe the prevalence of multimorbidity and frailty in the community, the surgical population may have more severe disease and significant surgical stress. This study aims to describe the distribution of frailty and multimorbidity in the older surgical population and examine if specific comorbidities are more strongly associated with frailty. Methods This is a single-centre retrospective cohort study using an electronic database in the preoperative evaluation clinic, conducted in Singapore General Hospital, Singapore. All patients above 70 years old going for elective non-cardiac surgery were included. Demographics and comorbidities were analysed for their association with frailty according to the Edmonton Frail Scale. Results A total of 1396 out of 1398 patients were analyzed. The overall incidence of frailty was 27.8% and multimorbidity was 63.4%. Factors independently associated with frailty were age (adjusted Odds Ratio [aOR] = 1.07), female gender (aOR = 1.67), type 2 diabetes mellitus (aOR = 1.69), chronic kidney disease (aOR = 1.47), end-stage renal failure (aOR = 3.58), history of cerebrovascular accident or transient ischemic attack (aOR = 1.87), moderate anaemia (aOR = 2.11), dementia (aOR = 6.38), depression (aOR = 3.82), and peptic ulcer disease (aOR = 1.98). The presence of multi-morbidity was significantly associated with frailty, with overall increasing strength of association. Conclusion As the number of comorbidities increases, the odds of frailty increase. Only a small proportion of those with multimorbidity accumulate enough biological deficits to develop frailty, putting them at higher risk than with solely multimorbidity or frailty. Dementia and depression are comorbidities with strong associations that have yet to see coordinated interventional efforts in the preoperative setting.
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Affiliation(s)
- Phui Sze Angie Au Yong
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, SGP
| | - Eileen Yi Lin Sim
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, SGP
| | - Collin Yih Xian Ho
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, SGP
| | - Yingke He
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, SGP
| | - Charlene Xian Wen Kwa
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, SGP
| | - Li Ming Teo
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, SGP
| | - Hairil Rizal Abdullah
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, SGP
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