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Teves J, Holc F, Castro Lalín A, García-Mansilla A, Vildoza S, R B, Carbó L, Costantini J. Are frailty scores superior to the ASA score in predicting complications, hospital stay, and readmissions in total knee replacement? A comparative study between octogenarian and septuagenarian patients. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:128-133. [PMID: 37263578 DOI: 10.1016/j.recot.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/23/2023] [Accepted: 05/11/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Frailty scores have not been standardized for the preoperative assessment of patients undergoing total knee replacement (TKR). The aim of this study was to compare the efficacy of the American Society of Anesthesiology (ASA) score, the Charlson comorbidity index (ICC) and the simple frailty score (SSF) in predicting complications, hospital stay, readmissions and mortality after elective TKR. MATERIALS AND METHODS We retrospectively studied 448 patients who underwent TKR for osteoarthritis at our institution between 2016 and 2019. They were divided into two groups: Group A (263 patients, <80 years) and Group B (185 patients, >80 years).). All were classified by ASA, ICC and SSF scores. RESULTS The ICC was higher in Group B (median 5 [RI: 4-6] vs. 4 [RI: 3-5]; P<.001); however, it was not associated with a higher number of complications. When performing a logistic regression analysis we found, for complications: OR SSF=0.67, ICC=1.11; ASA 3 & 4=0.89 and age=1.04; while for readmissions: OR SSF=2.09; ICC=1.01; ASA 3 & 4=0.79 and age=1. CONCLUSIONS The ICC and SSF scales showed no differences to the ASA scale in the prediction of readmissions, complications and hospital stay. However, the SSF seems to have a better correlation in predicting unplanned readmission.
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Affiliation(s)
- J Teves
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - F Holc
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A Castro Lalín
- Departamento de Anestesiología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A García-Mansilla
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - S Vildoza
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Brandariz R
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - L Carbó
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J Costantini
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Teves J, Holc F, Castro Lalín A, García-Mansilla A, Vildoza S, Brandariz R, Carbó L, Costantini J. [Translated article] Are frailty scores superior to the ASA score in predicting complications, hospital stay, and readmissions in total knee replacement? A comparative study between octogenarian and septuagenarian patients. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T128-T133. [PMID: 38000542 DOI: 10.1016/j.recot.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/11/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Frailty scores have not been standardised for the preoperative assessment of patients undergoing total knee replacement (TKR). The aim of this study was to compare the efficacy of the American Society of Anesthesiology (ASA) score, the Charlson comorbidity index (ICC) and the simple frailty score (SSF) in predicting complications, hospital stay, readmissions and mortality after elective TKR. MATERIALS AND METHODS We retrospectively studied 448 patients who underwent TKR for osteoarthritis at our institution between 2016 and 2019. They were divided into two groups: Group A (263 patients, <80 years) and Group B (185 patients, >80 years).). All were classified by ASA, ICC and SSF scores. RESULTS The ICC was higher in Group B (median 5 [RI: 4-6] vs. 4 [RI: 3-5]; p<.001); however, it was not associated with a higher number of complications. When performing a logistic regression analysis we found, for complications: OR SSF=0.67; ICC=1.11; ASA 3 & 4=0.89 and age=1.04; while for readmissions: OR SSF=2.09; ICC=1.01; ASA 3 & 4=0.79 and age=1. CONCLUSIONS The ICC and SSF scales showed no differences to the ASA scale in the prediction of readmissions, complications and hospital stay. However, the SSF seems to have a better correlation in predicting unplanned readmission.
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Affiliation(s)
- J Teves
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - F Holc
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A Castro Lalín
- Departamento de Anestesiología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A García-Mansilla
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - S Vildoza
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - R Brandariz
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - L Carbó
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J Costantini
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Jiménez Martínez C, Espejo Bares V, Artiaga de la Barrera V, Marco Quirós C, Pérez Fernández E, Luz Martínez Mas M, Botas Rodríguez J. [Role of statins in clinical evolution of octogenarian patients admitted due to COVID-19]. Med Clin (Barc) 2023; 161:147-153. [PMID: 37296046 PMCID: PMC10076509 DOI: 10.1016/j.medcli.2023.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION AND OBJECTIVES coronavirus disease 2019 (COVID-19) causes high mortality in elderly patients. Some studies have shown a benefit of statin treatment in the evolution of this disease. Since there are no similar publications in this population group, the aim of this study is to analyze in-hospital mortality in relation to preadmission treatment with statins in an exclusively elderly population of octogenarian patients. MATERIALS AND METHODS A single-center retrospective cohort study was performed including a total of 258 patients ≥80 years with hospital admission for confirmed COVID-19 between March 1 and May 31, 2020. They were divided into two groups: taking statins prior to admission (n=129) or not (n=129). RESULTS In-hospital mortality due to COVID-19 in patients ≥80 years (86.13±4.40) during the first wave was 35.7% (95% CI: 30.1-41.7%). Mortality in patients previously taking statins was 25.6% while in those not taking statins was 45.7%. Female sex (RR 0.62 [0.44-0.89]; p=0.008), diabetes (RR 0.61 [0.41-0.92]; p=0.017) and pre-admission treatment with statins (RR 0.58 95% CI [0.41-0.83]; p=0.003) were associated with lower in-hospital mortality. Severe lung involvement was associated with increased in-hospital mortality (RR 1.45 95% CI [1.04-2.03]; p=0.028). Hypertension, obesity, age, cardiovascular disease and a higher Charlson index did not, however, show influence on in-hospital mortality. CONCLUSIONS In octogenarian patients treated with statins prior to admission for COVID-19 in the first wave, lower in-hospital mortality was observed.
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Affiliation(s)
| | | | | | - Cecilia Marco Quirós
- Servicio de Cardiología, Hospital Universitario Fundación Alcorcón, Madrid, España
| | - Elia Pérez Fernández
- Unidad de Investigación, Hospital Universitario Fundación Alcorcón, Madrid, España
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De Maria R, Gori M, Marini M, Gonzini L, Benvenuto M, Cassaniti L, Municinò A, Navazio A, Ammirati E, Leonardi G, Pagnoni N, Montagna L, Catalano M, Midi P, Marina Floresta A, Pulignano G, Iacoviello M. Temporal trends in characteristics, treatment, and outcomes of heart failure in octogenarians over two decades. Rev Esp Cardiol (Engl Ed) 2022; 75:883-893. [PMID: 35523670 DOI: 10.1016/j.rec.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/03/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES Octogenarians represent the most rapidly expanding population segment in Europe. The prevalence of heart failure (HF) in this group exceeds 10%. We assessed changes in clinical characteristics, therapy, and 1-year outcomes over 2 decades in chronic HF outpatients aged ≥ 80 years enrolled in a nationwide cardiology registry. METHODS We included 2520 octogenarians with baseline echocardiographic ejection fraction measurements and available 1-year follow-up, who were recruited at 138 HF outpatient clinics (21% of national hospitals with cardiology units), across 3 enrolment periods (1999-2005, 2006-2011, 2012-2018). RESULTS At recruitment, over the 3 study periods, there was an increase in age, body mass index, ejection fraction, the prevalence of obesity, diabetes, dyslipidemia, pre-existing hypertension, and atrial fibrillation history. The proportion of patients with preserved ejection fraction rose from 19.4% to 32.7% (P for trend <.0001). Markers of advanced disease became less prevalent. Prescription of beta-blockers and mineralocorticoid receptor antagonists increased over time. During the 1-year follow-up, 308 patients died (12.2%) and 360 (14.3%) were admitted for cardiovascular causes; overall, 591 (23.5%) met the combined primary endpoint of all-cause mortality or cardiovascular hospitalization. On adjusted multivariable analysis, enrolment in 2006 to 2011 (HR, 0.70; 95%CI, 0.55-0.90; P=.004) and 2012 to 2018 (HR, 0.61; 95%CI, 0.47-0.79; P=.0002) carried a lower risk of the primary outcome than recruitment in 1999 to 2005. CONCLUSIONS Among octogenarians, over 2 decades, risk factor prevalence increased, management strategies improved, and survival remained stable, but the proportion hospitalized for cardiovascular causes declined. Despite increasing clinical complexity, in cardiology settings the burden of hospitalizations in the oldest old with chronic HF is declining.
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Affiliation(s)
- Renata De Maria
- Heart Failure Working Group, Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Florence, Italy.
| | - Mauro Gori
- Cardiology Division, Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Marco Marini
- Department of Cardiovascular Sciences Cardiology, Ospedali Riuniti, Ancona, Italy
| | - Lucio Gonzini
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Manuela Benvenuto
- Intensive Cardiac Care Unit Cardiology and Hemodynamics, Giuseppe Mazzini Hospital, Teramo, Italy
| | - Leonarda Cassaniti
- Cardiology Division, Hospital of National Importance and High Specialization "Garibaldi", "Garibaldi-Nesima" Hospital, Catania, Italy
| | | | - Alessandro Navazio
- Cardiology Division, Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale (AUSL) di Reggio Emilia - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
| | - Enrico Ammirati
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy
| | - Giuseppe Leonardi
- Severe Heart Failure Unit, Policlinico Catania, Rodolico Hospital, Catania, Italy
| | - Nicoletta Pagnoni
- Cardiology and Cardiac Rehabilitation, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - Laura Montagna
- Heart Failure Unit, Cardiology Division, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Mariarosaria Catalano
- Cardiology Department with Intensive Cardiac Care Unit and Hemodynamics, Azienda Ospedaliera Cannizzaro, Catania, Italy
| | - Paolo Midi
- Heart Failure and Cardiomyopathies Department, Cardiology Division, Castelli Hospital, Ariccia, Italy
| | - Agata Marina Floresta
- Cardiology Division Villa Sofia-Regional reference Center for the Diagnosis and Treatment of Heart Failure, Azienda Ospedaliera Villa Sofia-Cervello, Palermo, Italy
| | - Giovanni Pulignano
- Heart Failure Unit, Cardiology Department, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Massimo Iacoviello
- Cardiology Unit, University Hospital Policlinico Riuniti, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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García Rey E, Cruz Pardos A, Ortega Chamarro J. Mortality as a competition risk factor in the survival analysis of the results of the type of fixation of the total hip prosthesis in octogenarian patients. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 65:99-107. [PMID: 33172799 DOI: 10.1016/j.recot.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/01/2020] [Accepted: 07/12/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Total hip replacement (THR) is challenging in octogenarians due to associated comorbidities and controversy regarding fixation type. We ask whether cemented THR is superior to uncemented THR in patients above the age of 80 years. MATERIAL AND METHODS A total of 382 patients (441 hips) aged 80 years or older who underwent THR between 2004 and 2015 were analysed. A cemented THR was implanted in 196 hips (group 1), an uncemented THR with a grit-blasted stem in 121 (group 2), or with a porous-coated stem in 124 (group 3). Patients in group 1 had a higher mean age, more comorbidities and osteoporotic bone. Survival analysis was calculated using cumulative incidence function to account for the competing risk of death. RESULTS Medical complications rate was similar. There were 3post-operative fractures: one in group 2 and 2in group 3. Competing risk analysis showed that the cumulative incidence of revision for any cause was 2.3 in group 1, 6.0 in group 2 and 4.1 in group 3 at 10years, and the cumulative incidence of revision for aseptic loosening was 1.2 in group 1, 3.7 in group 2 and 0 in group 3 at the same period. CONCLUSIONS THR presents an acceptable number of adverse events for octogenarian patients. Despite uncemented fixation was satisfactory, the higher peri-prosthetic fracture rate worsens results in this group.
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Affiliation(s)
- E García Rey
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz-Idi Paz, Madrid, España.
| | - A Cruz Pardos
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz-Idi Paz, Madrid, España
| | - J Ortega Chamarro
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz-Idi Paz, Madrid, España
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Pérez-Díaz P, Jiménez-Díaz J, Higuera-Sobrino F, Piqueras-Flores J, Frías-García R, Mazoteras-Muñoz V, Maseda-Uriza R, Arenas-Cambronero V. Medium-long-term mortality and change in functional status in elderly patients with pacemaker. Arch Cardiol Mex 2020; 89:212-220. [PMID: 31967592 DOI: 10.24875/acme.m19000052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Nowadays, 49% of patients with pacemakers are older than 80 years old. Nevertheless, mortality and change in functional status after pacemaker implantation are not well documented in elderly patients. Objective We designed a prospective study to analyze the cardiovascular mortality and change in functional status of elderly patients, medium-long term after pacemaker implantation. Methods An observational study including pacemaker implants in individual older than 70 years old in a single-center university hospital between 2012 and 2014. Analysis testing for an association between pacemaker system, medium-long-term mortality, and functional status after implantation was undertaken. Results About 60% of patients were older than 80 years old. The third-degree atrioventricular blockage (44.3%) and slow ventricular response atrial fibrillation (16.7%) were the most frequent electrocardiogram abnormalities, while bicameral DDD was the sort of pacing our department used the most (38.6%) (VVI in octogenarian patients, 38.7%). Long-term mortality was significantly higher in ventricular devices, especially in octogenarian patients (p = 0.001). Single-chamber VVI pacing acted as independent predictors of all-cause mortality in these individuals (p = 0.001). We found no significant improvement in Barthel Index and functional status in this subgroup of patients, 3 years after pacing. Conclusions Long-term mortality in individuals older than 80 years old with pacemaker implantation was significantly higher comparing with general population, especially in ventricular devices. No significant improvement in functional status was detected in this subgroup of patients.
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Affiliation(s)
- Pedro Pérez-Díaz
- Department of Cardiology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Javier Jiménez-Díaz
- Department of Cardiology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Felipe Higuera-Sobrino
- Department of Cardiology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Jesús Piqueras-Flores
- Department of Cardiology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Raquel Frías-García
- Department of Cardiology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | - Ramón Maseda-Uriza
- Department of Cardiology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Violeta Arenas-Cambronero
- Family and Community Medical Care Teaching Unit (UDMAFYC), Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
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Bryan YF, Johnson KN. Procedural difficulties during successful intubation in octogenarians: A prospective observational study. Rev Esp Anestesiol Reanim 2017; 64:499-505. [PMID: 28366293 DOI: 10.1016/j.redar.2017.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/27/2017] [Accepted: 01/31/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Octogenarians undergo anatomic and physiopathologic degradation, making airway management problematic, specific to intubation, bag mask ventilation, leading to desaturation and aspiration. Our study's aim was to examine the process of airway management regarding the steps involved in intubation and any deviations or delays in the tasks. MATERIALS AND METHODS An institutional review board-approved difficult airway prospective observational study in older adults was conducted. Inclusion criteria included airway features indicative of difficult airway, history of failed intubation, the planned use of specialized airway devices, and/or expected airway complications due to comorbidities. Patients 80 years and older were analyzed. Demographic data collected were age, weight, BMI, gender, ASA classification, airway indices, diagnosis, and procedures. Problems with intubation (INT) (≥3 intubation attempts), laborious assisted ventilation (VEN) (2-person and/or application of CPAP>20cmH2O), and complications with oxygenation (OXY) (SpO2<95%) were analyzed. RESULTS Of the 41 patients enrolled in the study, 3 (7.3%) had all 3: problematic (INT), laborious (VEN), and desaturated (OXY); 8 (19.5%) patients experienced problematic (INT), 20 (48.8%) were described as laborious (VEN), and 14 (34.1%) experienced complications with (OXY). CONCLUSION In octogenarians, we found a low incidence of difficulty with INT-VEN-OXY together. However, bag mask ventilation was found to be laborious with a high incidence of desaturation. Success rate of INT as a sole metric may not accurately describe the process of the intubation. We recommend alternative airway devices and techniques and the establishment of protocols for airway management in the elderly.
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Affiliation(s)
- Y F Bryan
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, Estados Unidos.
| | - K N Johnson
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, Estados Unidos
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Golpe R, Suárez-Valor M, Veres-Racamonde A, Cano-Jiménez E, Martín-Robles I, Sanjuán-López P, Pérez-de-Llano L. Octogenarian patients with chronic obstructive pulmonary disease: Characteristics and usefulness of prognostic indexes. Med Clin (Barc) 2017; 151:53-58. [PMID: 29096969 DOI: 10.1016/j.medcli.2017.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/04/2017] [Accepted: 09/07/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Most studies on chronic obstructive pulmonary disease (COPD) exclude octogenarian patients. Therefore, the disease is not well characterized in this age group. The objective of this study is to analyze the clinical characteristics of octogenarian patients with COPD and the usefulness of the prognostic indexes used most frequently in this age group. PATIENTS AND METHOD Retrospective study of consecutive patients seen at a clinic between 2009 and 2017. The following variables were analyzed: lung function parameters, distribution of clinical phenotypes, income history, mortality, comorbidities and usefulness of the Charlson, BODEX, COTE and CODEX indexes to predict mortality. RESULTS The sample comprised 698 patients, 82 aged (11.7%)≥80 years old. Mean follow-up time was 47.9±21.8 months. In octogenarian patients, the severity of the COPD, assessed by means of the FEV1% or BODEX index, was similar to that of younger patients, but dyspnea was worse in the elderly group. In these patients, the chronic bronchitis and frequent exacerbator phenotypes were the most frequent, whilst the emphysema phenotype was the least common. Octogenarians had a greater prevalence of cardiovascular comorbidities and renal diseases. Moreover, hospital admissions were more frequent and mortality was higher in these elderly patients. Most prognostic indexes were useful in predicting mortality in elderly patients. CODEX was the most useful index to predict mortality, both in octogenarian and younger patients. CONCLUSION Octogenarian patients with COPD have differential characteristics which could imply the need for different therapeutic approaches. Prognostic indexes are useful for predicting mortality in this population.
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Affiliation(s)
- Rafael Golpe
- Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, España.
| | - María Suárez-Valor
- Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, España
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Arango Tomás E, Cerezo Madueño F, Algar Algar FJ, Salvatierra Velázquez A. Is lung surgery a good option for octogenarians? Cir Esp 2013; 92:615-8. [PMID: 24094925 DOI: 10.1016/j.ciresp.2013.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 06/06/2013] [Accepted: 06/17/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The number of geriatric patients with lung cancer is expected to increase in the next few years, especially patients over 80, and therefore it is important to know where the therapeutic limits should be drawn. Is surgery a good option in patients over 80? OBJECTIVE To show the results of lung resection in patients over 80 years of age to evaluate the safety and short-term results. MATERIAL AND METHODS Retrospective study of 21 patients who underwent lung resection between October 1999 and October 2011. RESULTS The mean age of the patients was 82 ± 2; 13 lobectomies were performed,5 transegmental resections, 2 segmentectomies, and 1 pneumonectomy. Postoperative complications (28.6%) were: respiratory 66.6%, cardiological 16.7% and digestive 16,7%. Perioperative mortality was 9,5% (2). There was a significant association between mortality and age (P=.023), or pneumonectomy (P=.002). We studied COPD as a risk factor for mortality and found a statistically significant relation with the need for ICU (P<.007), and the appearance of complications (P<.044). CONCLUSIONS Resective lung surgery is feasible and safe in selected patients over 80 years of age. In our experience, squamous cell carcinoma was the most frequent tumor. The most common procedure was lobectomy which is a safe technique with a low complication rate in elderly patients. Pneumonectomy should be avoided, as we have found a significant association with perioperative mortality.
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Affiliation(s)
- Elisabet Arango Tomás
- Unidad de Gestión Clínica de Cirugía Torácica y Trasplante Pulmonar, Hospital Universitario Reina Sofía, Córdoba, España.
| | - Francisco Cerezo Madueño
- Unidad de Gestión Clínica de Cirugía Torácica y Trasplante Pulmonar, Hospital Universitario Reina Sofía, Córdoba, España
| | - Francisco Javier Algar Algar
- Unidad de Gestión Clínica de Cirugía Torácica y Trasplante Pulmonar, Hospital Universitario Reina Sofía, Córdoba, España
| | - Angel Salvatierra Velázquez
- Unidad de Gestión Clínica de Cirugía Torácica y Trasplante Pulmonar, Hospital Universitario Reina Sofía, Córdoba, España
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Sarró-Maluquer M, Ferrer-Feliu A, Rando-Matos Y, Formiga F, Rojas-Farreras S. [Depression in the elderly: prevalence and associated factors]. Semergen 2013; 39:354-60. [PMID: 24095164 DOI: 10.1016/j.semerg.2013.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 01/09/2013] [Accepted: 01/23/2013] [Indexed: 11/17/2022]
Abstract
AIM To determine the prevalence of depression, and to study the factors associated with it among community-dwelling 85-year-olds. MATERIAL AND METHODS A cross-sectional study was conducted within the framework of a randomized clinical trial in elderly people, all born in 1924, from seven urban and rural primary health care centers. Sociodemographic data and geriatric assessment were performed. Functional status was measured with Barthel index and Lawton index, cognitive impairment with Mini-mental Status Examination, social risk with Gijon test, and comorbidity by Charlson index. The presence of exhaustion and physical activity were recorded along with the chronic prescription of psycothropic drugs, and the presence of depression in clinical registers. Depression was evaluated using the Yesavage Geriatric Depression Scale (GDS) of 5 items (depression ≥ 2). The statistical program used was the R project: (version 2.12.2) Foundation for Statistical Computing, Vienna. RESULTS The sample was consisted of 220 subjects, 129 women (58.6%), 76 (34.5% were depressed using the GDS, 46 (20.9%) subjects had depression in the clinical records, and 60 (35.5%) patients were taking antidepressant drugs, 66 (36,8%) benzodiazepine, and 10 (4%) antipsychotic drugs. Depression was associated with poorer functional status according to basic and instrumental activities of daily living, cognitive impairment, exhaustion, low physical activity, and psychotropic drugs. Finally, the factors significantly associated with depression were low physical activity and increased exhaustion. CONCLUSIONS The present study found a high prevalence of depression in subjects older than 85 years. Physical activity and having a good self-perception of energy are associated to a lower prevalence of depression.
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Affiliation(s)
- M Sarró-Maluquer
- Medicina de Familia y Comunitaria, Centro de Atención Primaria Florida Norte, L'Hospitalet de Llobregat, Barcelona, España.
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