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Caturano A, Galiero R, Vetrano E, Medicamento G, Alfano M, Beccia D, Brin C, Colantuoni S, Di Salvo J, Epifani R, Nevola R, Marfella R, Sardu C, Coppola C, Scarano F, Maggi P, Calabrese C, De Lucia Sposito P, Rescigno C, Sbreglia C, Fraganza F, Parrella R, Romano A, Calabria G, Polverino B, Pagano A, Numis FG, Bologna C, Nunziata M, Esposito V, Coppola N, Maturo N, Nasti R, Di Micco P, Perrella A, Adinolfi LE, Di Domenico M, Monda M, Russo V, Ruggiero R, Docimo G, Rinaldi L, Sasso FC. Impact of Acute Kidney Injury on the COVID-19 In-Hospital Mortality in Octogenarian Patients: Insights from the COVOCA Study. Life (Basel) 2024; 14:86. [PMID: 38255701 PMCID: PMC10817510 DOI: 10.3390/life14010086] [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: 12/11/2023] [Revised: 01/01/2024] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND AND AIMS The COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, has fundamentally reshaped the landscape of global public health, with some people suffering more adverse clinical outcomes than others. The aim of this study is to deepen our understanding of the specific impact of acute kidney injury (AKI) on the in-hospital mortality in octogenarian patients with COVID-19. METHODS This is a prospective observational cohort study, which involved 23 COVID-19 hospital units in the Campania Region, Italy. Exposure variables were collected during hospital admission and at discharge. Only patients aged ≥80 years were deemed eligible for the study. RESULTS 197 patients were included in the study (median age 83.0 [82.0-87.0] years; 51.5% men), with a median duration of hospitalization of 15.0 [8.0-25.0] days. From the multivariable Cox regression analysis, after the application of Šidák correction, only the respiratory rate (HR 1.09, 95% CI: 1.04 to 1.14; p < 0.001) and AKI development (HR: 3.40, 95% CI: 1.80 to 6.40; p < 0.001) were independently associated with the primary outcome. Moreover, the Kaplan-Meier analysis showed a significantly different risk of in-hospital mortality between patients with and without AKI (log-rank: <0.0001). CONCLUSIONS In our investigation, we identified a significant association between AKI and mortality rates among octogenarian patients admitted for COVID-19. These findings raise notable concerns and emphasize the imperative for vigilant monitoring of this demographic cohort.
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Affiliation(s)
- Alfredo Caturano
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Raffaele Galiero
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
| | - Erica Vetrano
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
| | - Giulia Medicamento
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
| | - Maria Alfano
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
| | - Domenico Beccia
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
| | - Chiara Brin
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
| | - Sara Colantuoni
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
| | - Jessica Di Salvo
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
| | - Raffaella Epifani
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
| | - Riccardo Nevola
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
- Ospedale Evangelico Betania, 80147 Naples, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
| | - Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
| | - Carmine Coppola
- Hepatology Unit, Internal Medicine, Area Stabiese Hospital, 80053 Naples, Italy;
| | - Ferdinando Scarano
- COVID Center “S. Anna e SS. Madonna della Neve” Hospital, 80042 Boscotrecase, Italy;
| | - Paolo Maggi
- U.O.C. Infectious and Tropical Diseases, S. Anna e S. Sebastiano Hospital, 81100 Caserta, Italy;
| | - Cecilia Calabrese
- U.O.C. Pneumologia Vanvitelli, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Ospedali dei Colli, Via Leonardo Bianchi, 80131 Naples, Italy;
| | | | - Carolina Rescigno
- U.O.C. Infectious Diseases and Neurology, Cotugno Hospital, 80131 Naples, Italy;
| | - Costanza Sbreglia
- U.O.C. Infectious Diseases of the Elderly, Cotugno Hospital, 80131 Naples, Italy;
| | - Fiorentino Fraganza
- U.O.C. Anestesia and Intensive Care Unit, Cotugno Hospital, 80131 Naples, Italy;
| | - Roberto Parrella
- U.O.C. Respiratory Infectious Diseases, Cotugno Hospital, 80131 Naples, Italy;
| | | | - Giosuele Calabria
- IXth Division of Infectious Diseases and Interventional Ultrasound, Cotugno Hospital, 80131 Naples, Italy;
| | | | - Antonio Pagano
- Emergency and Acceptance Unit, “Santa Maria delle Grazie” Hospital, 80078 Pozzuoli, Italy; (A.P.); (F.G.N.)
| | - Fabio Giuliano Numis
- Emergency and Acceptance Unit, “Santa Maria delle Grazie” Hospital, 80078 Pozzuoli, Italy; (A.P.); (F.G.N.)
| | | | | | - Vincenzo Esposito
- IVth Division of Immunodeficiency and Gender Infectious Diseases, Cotugno Hospital, 80131 Naples, Italy;
| | - Nicola Coppola
- COVID Center, Department of Mental Health and Public Medicine, A.O.U. Vanvitelli, 80131 Naples, Italy;
| | - Nicola Maturo
- U.O.S.D. Infectious Diseases Emergency and Acceptance, Cotugno Hospital, 80131 Naples, Italy;
| | - Rodolfo Nasti
- Emergency Division, A.O.R.N. “Antonio Cardarelli”, 80131 Naples, Italy;
| | - Pierpaolo Di Micco
- Department of Internal Medicine, Fatebenefratelli Hospital of Naples, 80123 Naples, Italy;
| | | | - Luigi Elio Adinolfi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
| | - Marina Di Domenico
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Marcellino Monda
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Vincenzo Russo
- Department of Biology, College of Science and Technology, Sbarro Institute for Cancer Research and Molecular Medicine, Temple University, Philadelphia, PA 19122, USA;
- Division of Cardiology, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Roberto Ruggiero
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Giovanni Docimo
- Unit of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Luca Rinaldi
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy;
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy; (R.G.); (E.V.); (G.M.); (M.A.); (D.B.); (C.B.); (S.C.); (J.D.S.); (R.E.); (R.N.); (R.M.); (C.S.); (L.E.A.); (F.C.S.)
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Karimi AH, Grits D, Shah AK, Burkhart RJ, Kamath AF. Is Discharge Within a Day Following Total Hip Arthroplasty Safe in the Septuagenarian and Octogenarian Population? A Propensity-Matched Cohort Study. J Arthroplasty 2024; 39:13-18. [PMID: 37625466 DOI: 10.1016/j.arth.2023.08.065] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Limited data exists on whether patients older than 70 can safely be discharged within a day (rapid discharge (RD)) following primary total hip arthroplasty (THA). The purpose of this study was to compare perioperative complications and readmission rates associated with RD in patients ≥70 years compared to longer lengths of stay following THA. METHODS A retrospective, propensity-matched cohort study was conducted using the National Surgical Quality Improvement Program database from 2006 to 2020. Patients ≥70 years undergoing RD following THA were propensity matched to patients ≥70 years who had longer hospital stays (nonrapid discharge). Sub-analyses were performed for septuagenarians and octogenarians. Following 1:1 matching, multivariate analyses were performed to compare perioperative complications and readmissions. Following propensity matching, both groups contained 2,192 patients. RESULTS The RD patients were found to have shorter operative times (P < .001), less bleeding complications (P < .001), and were more likely to have home discharges (P < .001). The 2 cohorts did not differ in the remaining complications or 30-day postoperative period readmissions among all patients and when evaluating septuagenarians and octogenarians. CONCLUSION Patients ≥70 years undergoing RD following THA had comparable complication and readmission rates to patients older than 70 undergoing nonrapid discharge. Furthermore, RD patients were more likely to have home discharges and have shorter operations with less bleeding complications. Septuagenarians receiving RD were more likely to have an unplanned readmission. These data suggest that RD following THA can be performed safely in select patients older than 70.
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Affiliation(s)
- Amir H Karimi
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Daniel Grits
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Aakash K Shah
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Robert J Burkhart
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Atul F Kamath
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Katano A, Kasuga Y, Ohira S, Minamitani M, Yamashita H. Hypofractionated Radiotherapy as a Standalone Treatment Modality for Locally Advanced Type B2 Thymoma in an Octogenarian Patient: 45 Gy in 15 Fractions. Cureus 2024; 16:e51528. [PMID: 38304685 PMCID: PMC10833057 DOI: 10.7759/cureus.51528] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2024] [Indexed: 02/03/2024] Open
Abstract
Thymic epithelial tumors (TETs), particularly type B2 thymomas, are rare neoplasms primarily found in the anterior mediastinum. The current therapeutic approach includes surgery, chemotherapy, and radiotherapy, but there is limited research on radiotherapy as a standalone treatment. This case report aims to elucidate the clinical outcomes of hypofractionated radiotherapy as a standalone treatment for locally advanced type B2 thymoma, offering insights into its potential efficacy and role in clinical practice.
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Affiliation(s)
- Atsuto Katano
- Radiology, The University of Tokyo Hospital, Tokyo, JPN
| | - Yuki Kasuga
- Radiology, The University of Tokyo Hospital, Tokyo, JPN
| | - Shingo Ohira
- Comprehensive Radiation Oncology, The University of Tokyo, Tokyo, JPN
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Teraishi F, Shigeyasu K, Kondo Y, Kagawa S, Tamura R, Matsuoka Y, Morimatsu H, Fujiwara T. Clinical Impact of Prehabilitation on Elective Laparoscopic Surgery in Frail Octogenarians With Colorectal Cancer. Anticancer Res 2023; 43:5597-5604. [PMID: 38030178 DOI: 10.21873/anticanres.16762] [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: 10/11/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND/AIM The aim of the present study was to clarify the clinical impact of prehabilitation by the perioperative management center (PERIO) at our hospital in severely frail octogenarians with colorectal cancer. PATIENTS AND METHODS We compared the clinicopathological characteristics of octogenarians who underwent surgery for colorectal cancer before the establishment of PERIO intervention (Control group) with those who received prehabilitation (PERIO group). All patients were classified as American Society of Anesthesiologists (ASA) class 3 or higher. The primary outcome was the incidence of postoperative complications. RESULTS There were 21 patients in the Control group and 19 patients in the PERIO group. Operative time was significantly longer in the PERIO group (Control group, 200 min vs. PERIO group, 230 min; p=0.03) and blood loss was significantly higher in the PERIO group (Control group, 5 ml vs. PERIO group, 30 ml; p=0.02). Postoperative complications occurred in 10 patients (47.6%) in the Control group and 3 patients (15.8%) in the PERIO group and were significantly lower in the PERIO group (p=0.03). Postoperative hospital stay was 13 days (range=7-31 days) in the Control group and 11 days (range=8-70 days) in the PERIO group (p=0.39). The rate of discharge directly to home was 81% in the Control group and 93.3% in the PERIO group (p=0.29). CONCLUSION In frail octogenarians with colorectal cancer of ASA class 3 or higher, the incidence of postoperative complications was significantly lower after PERIO intervention.
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Affiliation(s)
- Fuminori Teraishi
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan;
- Department of Minimally Invasive Therapy Center, Okayama University Hospital, Okayama, Japan
| | - Kunitoshi Shigeyasu
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Minimally Invasive Therapy Center, Okayama University Hospital, Okayama, Japan
| | - Yoshitaka Kondo
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shunsuke Kagawa
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Rie Tamura
- Perioperative Management Center, Okayama University Hospital, Okayama, Japan
| | - Yoshikazu Matsuoka
- Perioperative Management Center, Okayama University Hospital, Okayama, Japan
| | - Hiroshi Morimatsu
- Perioperative Management Center, Okayama University Hospital, Okayama, Japan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Minimally Invasive Therapy Center, Okayama University Hospital, Okayama, Japan
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Ahmed N, Tankel J, Asselah J, Alcindor T, Alfieri J, David M, Najmeh S, Spicer J, Cools-Lartigue J, Mueller C, Ferri L. Survival and perioperative outcomes of octo- and nonagenarians with resectable esophageal carcinoma. Dis Esophagus 2023; 36:doad043. [PMID: 37448141 DOI: 10.1093/dote/doad043] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Indexed: 07/15/2023]
Abstract
The outcomes of different treatment modalities for patients aged 80 and above with locally advanced and resectable esophageal carcinoma are not well described. The aim of this study was to explore survival and perioperative outcomes among this specific group of patients. A retrospective, cohort analysis was performed on a prospectively maintained esophageal cancer database from the McGill regional upper gastroinestinal cancer network. Between 2010 and 2020, all patients ≥80 years with cT2-4a, Nany, M0 esophageal carcinoma were identified and stratified according to the treatment modality: Neoadjuvant chemotherapy (nCT) or chemoradiotherapy (nCRT); definitive CRT (dCRT); upfront surgery; palliative CT/RT; or best supportive care (BSC). Of the 162 patients identified, 79 were included in this study. The median age was 83 years (80-97), most were cT3 (73%), cN- (56%), and had adenocarcinoma (62%). Treatment included: nCT/nCRT (16/79, 20%); surgery alone (19/79, 24%); dCRT (12/29, 15%); palliative RT/CT (27/79, 34%); and BSC (5/79, 6%). Neoadjuvant treatment was completed in 10/16 (63%). Of the 35/79 who underwent surgery, major complications occurred in 13/35 (37%) and 90-day mortality in 3/35 (9%). Overall survival (OS) for the cohort at 1- and 3-years was 58% and 19%. Among patients treated with nCT/nCRT, this was 94% and 46% respectively. Curative intent treatment (nCT/nCRT/upfront surgery/dCRT) had significantly increased 1- and 3- year OS compared with non-curative treatment (76%/31% vs. 34%/3.3%). Multimodal standard of care treatment is feasible and safe in select octo/nonagenarians, and may be associated with improved OS. Age alone should not bias against treatment with curative intent.
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Affiliation(s)
- Nabeel Ahmed
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - James Tankel
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - Jamil Asselah
- Division of Medical Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Thierry Alcindor
- Division of Medical Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Joanne Alfieri
- Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marc David
- Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sara Najmeh
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - Jonathan Spicer
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - Jonathan Cools-Lartigue
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - Carmen Mueller
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - Lorenzo Ferri
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
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Chen W, Yokoyama M, Waseda Y, Kobayashi M, Fan B, Fukuda S, Tanaka H, Yoshida S, Ai M, Fushimi K, Fujii Y. Surgical outcomes of robot-assisted radical cystectomy in octogenarian or older patients: A Japanese nationwide study. Int J Urol 2023; 30:1014-1019. [PMID: 37470427 DOI: 10.1111/iju.15250] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/15/2023] [Accepted: 06/28/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To evaluate the surgical outcomes of robot-assisted radical cystectomy (RARC) in octogenarian or older patients based on a Japanese nationwide database. METHODS The diagnosis procedure combination database was used to extract the data on radical cystectomy cases. Surgical outcomes of RARC in octogenarian or older patients (older group) were initially compared to those of patients younger than 80 years (younger group). Then, the surgical outcomes of RARC in the older group were compared to those of open radical cystectomy (ORC) and laparoscopic radical cystectomy (LRC) in the same age group. RESULTS Between 2018 and 2021, 478 RARC cases in the older group and 2257 RARC cases in the younger group were identified. In the older group, ileal conduit, neobladder, and other urinary diversions were carried out in 352 (73.6%), 22 (4.6%), and 104 (21.8%) patients, respectively. In the older group, when compared with the younger group, the complication rate (24.9%), blood transfusion rate (41.4%), and in-hospital mortality (1.4%) were equivalent, while significantly shorter anesthesia time and longer length of stay were observed in the older group (521.0 ± 140.4 min vs. 595.1 ± 141.71 min, p < 0.01, and 32.9 ± 16.8 days vs. 30.6 ± 17.8 days, p = 0.01, respectively). In the comparison of the surgical outcomes of older patients receiving RARC to those receiving ORC (n = 746) and LRC (n = 375), the RARC group had the lowest complication rate and the shortest length of stay, while the shortest anesthesia time was noted in the ORC group. CONCLUSION The feasibility of RARC for octogenarian or older patients was demonstrated by the nationwide database study.
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Affiliation(s)
- Wei Chen
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Insured Medical Care Management, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuma Waseda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Insured Medical Care Management, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaki Kobayashi
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Bo Fan
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shohei Fukuda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masumi Ai
- Department of Insured Medical Care Management, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
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Jeong H, Lim SY, Jeon HJ, Yoon SJ, Kim H, Han IW, Heo JS, Shin SH. Prognosis of pancreaticoduodenectomy in octogenarians for pancreatic ductal adenocarcinoma with propensity score matched analysis. ANZ J Surg 2023; 93:2655-2663. [PMID: 37658597 DOI: 10.1111/ans.18679] [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: 03/18/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND This retrospective study investigates factors affecting surgical and oncological outcome after performing pancreaticoduodenectomy in octogenarian patients diagnosed with pancreatic ductal adenocarcinoma. METHODS From January 2009 to December 2018, patients who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma were included. Data were analysed by comparing clinicopathological characteristics, complications, survival, recurrence, adjuvant treatment between octogenarians and the younger group. Propensity score matched analysis was performed due to the small size of the octogenarian group. RESULTS A total of 666 patients were included in this study and 24 (3.6%) were included in the octogenarian group. Short term complication rates (P = 0.119) and hospital stay (P = 0.839) did not differ between two groups. Overall survival between the two groups showed significant difference (<80 median 25 months versus ≥80 median 13 months, P = 0.045). However, after propensity score matched analysis, the two groups did not differ in overall survival (<80 median 18 months versus ≥80 median survival 16 months, P = 0.565) or disease-free survival (P = 0.471). Among the octogenarians, six patients survived longer than 24 months even without satisfying all favourable prognostic factors. CONCLUSION Considering the general condition of octogenarians diagnosed with pancreatic ductal adenocarcinoma, select patients should be treated more aggressively for the best chance of receiving curative treatment.
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Affiliation(s)
- HyeJeong Jeong
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Soo Yeun Lim
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyun Jeong Jeon
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - So Jeong Yoon
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hongbeom Kim
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - In Woong Han
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin Seok Heo
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang Hyun Shin
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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8
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Avudaiappan AP, Prabhakar P, Ganapathi H, VanderVeer-Harris N, Caso J, Garje R, Manoharan M. Propensity score matched survival analysis of octogenarians with muscle-invasive bladder cancer: chemoradiation compared to radical cystectomy. Can J Urol 2023; 30:11686-11691. [PMID: 37838996] [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] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Radical cystectomy (RC) is an effective curative treatment option for muscle-invasive bladder cancer (MIBC). However, chemoradiation (CRT) is an evolving bladder preservation protocol alternative to RC. With the increase in life expectancy, it is essential to understand the survival outcomes among octogenarians treated with RC and CRT. In this study, we use the National Cancer Database (NCDB) to compare the survival outcomes between RC and CRT in octogenarians. MATERIALS AND METHODS We collected the data of patients treated for bladder cancer between 2004 to 2018 from the NCDB. Our primary analytic cohort included patients with MIBC (cT2-T4N0M0). We identified the octogenarians and categorized them into RC and CRT arms. The RC arm included those who received RC. The CRT arm included those who received chemotherapy within 90 days of curative radiation therapy. After 1:1 propensity score matching, overall survival (OS) outcomes were compared between both arms. RESULTS Among the octogenarians, the median OS for patients treated with RC was 26.1 months (95% CI, 23.9-28.2), and CRT was 28.7 months (95% CI, 26.8-30.6). Our covariate analyses showed that academic institutions performed more RC (49% RC and 29.7% CRT) and community programs served more CRT (45.7% CRT and 24.2% RC). A multivariate Cox regression analysis showed that the mortality risk increased as the Charlson-Deyo comorbidity score and T stage increased. CONCLUSION Octogenarians treated with RC and CRT had similar OS. As life expectancy increases, it is essential to individualize the treatment strategy based on risk assessment and its potential benefits.
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Affiliation(s)
- Arjun Pon Avudaiappan
- Department of Urologic Oncology Surgery, Miami Cancer Institute, Miami, Florida, USA
| | - Pushan Prabhakar
- Department of Urologic Oncology Surgery, Miami Cancer Institute, Miami, Florida, USA
| | | | | | - Jorge Caso
- Department of Urologic Oncology Surgery, Miami Cancer Institute, Miami, Florida, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Rohan Garje
- Department of Urologic Oncology Surgery, Miami Cancer Institute, Miami, Florida, USA
| | - Murugesan Manoharan
- Department of Urologic Oncology Surgery, Miami Cancer Institute, Miami, Florida, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
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9
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Succar B, Chou YH, Hsu CH, Rapcsak S, Trouard T, Zhou W. Cognitive effects of carotid revascularization in octogenarians. Surgery 2023; 174:1078-1082. [PMID: 37550167 PMCID: PMC10528540 DOI: 10.1016/j.surg.2023.07.010] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/01/2023] [Accepted: 07/08/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Cognitive impairment is the epitome of cerebrovascular diseases, causing a significant economic burden on our health care system. Growing evidence has indicated the benefits of carotid interventions in patients with severe carotid atherosclerosis. However, the neurocognitive outcome of carotid revascularization in octogenarians is not clearly understood. We aim to evaluate postintervention cognitive changes in seniors older than 80 years. METHODS We prospectively recruited 170 patients undergoing carotid interventions. Neurocognitive testing was performed preoperatively and at 1, 6, and 12 months postoperatively. Episodic memory was assessed with Rey's Auditory Verbal Learning Test. Other executive functions and language measures were also evaluated at individual time points. Raw test scores were converted to z-scores or scaled scores adjusted for age and education. The sample was divided into 2 groups based on age: octogenarian (≥80 years) and nonoctogenarian (<80 years old). Postoperative cognitive scores were compared to baseline within each subcohort. RESULTS A total of 23 subjects (13%) were octogenarians, and 147 (87%) were younger than 80 years. Younger patients demonstrated significant cognitive improvements up to 12 months postop compared to the baseline. However, octogenarians exhibited a lack of improvement in verbal memory, measures of executive function, and language at all 3 postintervention time points. CONCLUSION Carotid interventions improve cognitive functions in younger patients with carotid occlusive atherosclerosis. However, no cognitive benefits were seen in male seniors older than 80 years. Further investigations are warranted to better understand the postinterventional cognitive changes in octogenarians.
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Affiliation(s)
- Bahaa Succar
- Department of Surgery, Division of Vascular Surgery, The University of Arizona, Tucson, AZ
| | - Ying-Hui Chou
- Department of Psychiatry, The University of Arizona, Tucson, AZ
| | - Chiu-Hsieh Hsu
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ
| | - Steven Rapcsak
- Department of Psychiatry, The University of Arizona, Tucson, AZ
| | - Theodore Trouard
- Department of Biomedical Imaging, The University of Arizona, Tucson, AZ
| | - Wei Zhou
- Department of Surgery, Division of Vascular Surgery, The University of Arizona, Tucson, AZ.
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10
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Zhang P, Zhao Y, Sun J, Wang Q, Li W, Zhang R, Chen M, Mo B, Yu Y, Feng X, Liu B, Yu Y, Lu Q, Li Y. Safety and efficacy of ablation for atrial fibrillation in combination with left atrial appendage occlusion in octogenarians. Clin Cardiol 2023; 46:1202-1209. [PMID: 37522390 PMCID: PMC10577539 DOI: 10.1002/clc.24099] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/07/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Catheter ablation (CA) combined with left atrial appendage occlusion (LAAO) is a feasible approach for atrial fibrillation (AF) patients. Its role in octogenarians with AF is unclear. HYPOTHESIS In AF patients over 80 years, CA combined with LAAO is a feasible way in restoring sinus rhythm and preventing stroke. METHODS This is a single-center retrospective study. Patients who underwent CA and LAAO in a single procedure between March 2018 and December 2020 were included. Efficacy endpoints included procedural success rate, AF recurrence rate, and thromboembolic events. Safety endpoints included pericardial effusion/cardiac tamponade, device-related thrombus (DRT), all-cause death, and major bleeding. RESULTS Five hundred and five patients (mean age 69.5 ± 7.7 years; 230 [45.5%] female) were included, with 46 (9.1%) patients aged ≥80 years old (octogenarian group). Prevalence of paroxysmal AF (25 [54.3%] vs. 207 [45.1%], p < 0.001) and CHA2DS2VASc score (4.1 ± 1.3 vs. 3.1 ± 1.4, p < 0.0001) were higher in octogenarian patients. There were six cases (1.2%) of pericardial effusion (all in nonoctogenarian patients). At 3 months postprocedure, 437 patients underwent TEE/CT. Thirty-two (80%) octogenarian patients and 308 (77.6%) nonoctogenarian patients had no peri-device leak. After a mean follow-up of 26.9 ± 9.1 months, AF was documented in 10 (21.7%) patients in octogenarian group and in 103 (22.4%) patients in nonoctogenarian group (p = 0.99). The annual thromboembolic risk was 2.1% and 0.8% in the octogenarian group and nonoctogenarian group, respectively. Death occurred in 16 nonoctogenarian patients. One major bleeding was recorded in the octogenarian group. CONCLUSIONS The combination of CA and LAAO in a single procedure is a feasible treatment option in octogenarians with comparable efficacy and safety profile.
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Affiliation(s)
- Peng‐Pai Zhang
- Department of Cardiology, Xinhua Hospital, Shanghai Jiao Tong UniversitySchool of MedicineShanghaiChina
| | - Yan Zhao
- Department of Cardiology, Xinhua Hospital, Shanghai Jiao Tong UniversitySchool of MedicineShanghaiChina
| | - Jian Sun
- Department of Cardiology, Xinhua Hospital, Shanghai Jiao Tong UniversitySchool of MedicineShanghaiChina
| | - Qun‐Shan Wang
- Department of Cardiology, Xinhua Hospital, Shanghai Jiao Tong UniversitySchool of MedicineShanghaiChina
| | - Wei Li
- Department of Cardiology, Xinhua Hospital, Shanghai Jiao Tong UniversitySchool of MedicineShanghaiChina
| | - Rui Zhang
- Department of Cardiology, Xinhua Hospital, Shanghai Jiao Tong UniversitySchool of MedicineShanghaiChina
| | - Mu Chen
- Department of Cardiology, Xinhua Hospital, Shanghai Jiao Tong UniversitySchool of MedicineShanghaiChina
| | - Bin‐Feng Mo
- Department of Cardiology, Xinhua Hospital, Shanghai Jiao Tong UniversitySchool of MedicineShanghaiChina
| | - Yi Yu
- Department of Cardiology, Xinhua Hospital, Shanghai Jiao Tong UniversitySchool of MedicineShanghaiChina
| | - Xiang‐Fei Feng
- Department of Cardiology, Xinhua Hospital, Shanghai Jiao Tong UniversitySchool of MedicineShanghaiChina
| | - Bo Liu
- Department of Cardiology, Xinhua Hospital, Shanghai Jiao Tong UniversitySchool of MedicineShanghaiChina
| | - Yi‐Chi Yu
- Department of Cardiology, Xinhua Hospital, Shanghai Jiao Tong UniversitySchool of MedicineShanghaiChina
| | - Qiu‐Fen Lu
- Department of Cardiology, Xinhua Hospital, Shanghai Jiao Tong UniversitySchool of MedicineShanghaiChina
| | - Yi‐Gang Li
- Department of Cardiology, Xinhua Hospital, Shanghai Jiao Tong UniversitySchool of MedicineShanghaiChina
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11
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Tang J, Gal JS, Geng E, Duey A, Ferriter P, Sicard R, Zaidat B, Girdler S, Rhee H, Zapolsky I, Al-Attar P, Markowitz J, Kim J, Cho S. An 11-Year-Long Analysis of the Risks Associated With Age in Patients Undergoing Anterior Cervical Discectomy and Fusion in a Large, Urban Academic Hospital. Global Spine J 2023:21925682231202579. [PMID: 37703497 DOI: 10.1177/21925682231202579] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
STUDY DESIGN A retrospective database study of patients at an urban academic medical center undergoing an Anterior Cervical Discectomy and Fusion (ACDF) surgery between 2008 and 2019. OBJECTIVE ACDF is one of the most common spinal procedures. Old age has been found to be a common risk factor for postoperative complications across a plethora of spine procedures. Little is known about how this risk changes among elderly cohorts such as the difference between elderly (60+) and octogenarian (80+) patients. This study seeks to analyze the disparate rates of complications following elective ACDF between patients aged 60-69 or 70-79 and 80+ at an urban academic medical center. METHODS We identified patients who had undergone ACDF procedures using CPT codes 22,551, 22,552, and 22,554. Emergent procedures were excluded, and patients were subdivided on the basis of age. Then each cohort was propensity matched for univariate and univariate logistic regression analysis. RESULTS The propensity matching resulted in 25 pairs in both the 70-79 and 80+ y.o. cohort comparison and 60-69 and 80+ y.o. cohort comparison. None of the cohorts differed significantly in demographic variables. Differences between elderly cohorts were less pronounced: the 80+ y.o. cohort experienced only significantly higher total direct cost (P = .03) compared to the 70-79 y.o. cohort and significantly longer operative time (P = .04) compared to the 60-69 y.o. cohort. CONCLUSIONS Octogenarian patients do not face much riskier outcomes following elective ACDF procedures than do younger elderly patients. Age alone should not be used to screen patients for ACDF.
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Affiliation(s)
- Justin Tang
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan S Gal
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eric Geng
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Akiro Duey
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pierce Ferriter
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ryan Sicard
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bashar Zaidat
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Steven Girdler
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hannah Rhee
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ivan Zapolsky
- Department of Orthopedic Surgery, Penn Medicine at the University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Paul Al-Attar
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan Markowitz
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jun Kim
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel Cho
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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12
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Mahanta D, Gadade SV, Parhi DK, Das D. Primary Percutaneous Coronary Intervention of Acute Thrombotic Occlusion of a Low-Lying Tortuous Right Coronary Artery With a Multipurpose Catheter in an Octogenarian. Cureus 2023; 15:e46048. [PMID: 37900527 PMCID: PMC10603496 DOI: 10.7759/cureus.46048] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Right coronary artery intervention is usually accomplished with a Judkins right (JR) coronary guide catheter. Abnormal right coronary artery take-off from the right coronary sinus poses difficulty in engaging the right coronary artery with a conventional JR guide catheter. We report a rare case of primary percutaneous intervention of the right coronary artery which was performed with a multipurpose catheter as the patient had an extremely low-lying coronary artery from the coronary sinus where conventional catheters could not engage the right coronary artery in an octogenarian with acute inferior wall ST-elevation myocardial infarction in cardiogenic shock.
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Affiliation(s)
| | | | | | - Debasish Das
- Department of Cardiology, All India Institute of Medical Sciences, Bhubaneswar, IND
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13
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Reichert C, Baldini C, Mezghani S, Maubec E, Longvert C, Mortier L, Quereux G, Jannic A, Machet L, de Quatrebarbes J, Nardin C, Beneton N, Amini Adle M, Funck-Brentano E, Descamps V, Hachon L, Malissen N, Baroudjian B, Brunet-Possenti F. Combined Nivolumab and Ipilimumab in Octogenarian and Nonagenarian Melanoma Patients. Cancers (Basel) 2023; 15:4330. [PMID: 37686606 PMCID: PMC10486537 DOI: 10.3390/cancers15174330] [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: 07/16/2023] [Revised: 08/13/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Data regarding elderly melanoma patients treated with anti-PD-1 or anti-CTLA-4 antibodies are in favor of tolerability outcomes that are similar to those of younger counterparts. However, there are very few studies focusing on elderly patients receiving nivolumab combined with ipilimumab (NIVO + IPI). Here, we ask what are the current prescribing patterns of NIVO + IPI in the very elderly population and analyze the tolerance profile. This French multicenter retrospective study was conducted on 60 melanoma patients aged 80 years and older treated with NIVO + IPI between January 2011 and June 2022. The mean age at first NIVO + IPI administration was 83.7 years (range: 79.3-93.3 years). Fifty-five patients (92%) were in good general condition and lived at home. Two dosing regimens were used: NIVO 1 mg/kg + IPI 3 mg/kg Q3W (NIVO1 + IPI3) in 27 patients (45%) and NIVO 3 mg/kg + IPI 1 mg/kg Q3W (NIVO3 + IPI1) in 33 patients (55%). NIVO + IPI was a first-line treatment in 39 patients (65%). The global prevalence of immune-related adverse events was 63% (38/60), with 27% (16/60) being of grade 3 or higher. Grade ≥ 3 adverse events were less frequent in patients treated with NIVO3 + IPI1 compared with those treated with NIVO1 + IPI3 (12% versus 44%, p = 0.04). In conclusion, the prescribing patterns of NIVO + IPI in very elderly patients are heterogeneous in terms of the dosing regimen and line of treatment. The safety profile of NIVO + IPI is reassuring; whether or not the low-dose regimen NIVO3 + IPI1 should be preferred over NIVO1 + IPI3 in patients aged 80 years or older remains an open question.
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Affiliation(s)
- Constance Reichert
- Department of Dermatology, Hôpital Bichat AP-HP, Université Paris Cité, 75018 Paris, France; (C.R.); (V.D.)
| | - Capucine Baldini
- Drug Development Department, Institut Gustave Roussy, CNRS-UMS 3655 and INSERM US23, 94805 Villejuif, France;
| | - Sarah Mezghani
- Department of Imaging, Institut Curie, PSL Research University, 75005 Paris, France;
| | - Eve Maubec
- Department of Dermatology, Hôpital Avicenne AP-HP, Université Sorbonne Paris Nord—Campus de Bobigny, 93000 Bobigny, France;
| | - Christine Longvert
- Department of Dermatology, EA4340-BECCOH, Hôpital Ambroise Paré APHP, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (C.L.); (E.F.-B.)
| | - Laurent Mortier
- Department of Dermatology, Claude Huriez Hospital, Lille University, Inserm U1189, 59000 Lille, France;
| | - Gaëlle Quereux
- Department of Dermatology, Centre Hospitalier Universitaire de Nantes, CIC 1413, INSERM, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302, Nantes University, 44000 Nantes, France;
| | - Arnaud Jannic
- Dermatology Department, Hôpital Henri Mondor AP-HP, 94000 Créteil, France;
| | - Laurent Machet
- Department of Dermatology, Tours University Hospital, 37000 Tours, France;
| | - Julie de Quatrebarbes
- Department of Dermatology, Centre Hospitalier Annecy-Genevois, 74370 Annecy, France;
| | - Charlée Nardin
- Université de Franche-Comté, CHU Besançon, EFS, INSERM, UMR RIGHT, 25000 Besançon, France;
| | - Nathalie Beneton
- Department of Dermatology, Centre Hospitalier du Mans, 72037 Le Mans, France;
| | - Mona Amini Adle
- Oncodermatology Department Centre Léon Bérard, 69008 Lyon, France;
| | - Elisa Funck-Brentano
- Department of Dermatology, EA4340-BECCOH, Hôpital Ambroise Paré APHP, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (C.L.); (E.F.-B.)
| | - Vincent Descamps
- Department of Dermatology, Hôpital Bichat AP-HP, Université Paris Cité, 75018 Paris, France; (C.R.); (V.D.)
| | - Lorry Hachon
- Department of Pharmacy, Hôpital Bichat, AP-HP, 75018 Paris, France;
| | - Nausicaa Malissen
- Dermatology and Skin Cancer Department, APHM, CRCM Inserm U1068, CNRS U7258, CHU Timone, Aix Marseille University, 13007 Marseille, France;
| | - Barouyr Baroudjian
- Department of Dermato-Oncology, Hôpital Saint-Louis AP-HP, Inserm U976, Université Paris Cité, 75010 Paris, France;
| | - Florence Brunet-Possenti
- Department of Dermatology, Hôpital Bichat AP-HP, Université Paris Cité, 75018 Paris, France; (C.R.); (V.D.)
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Shyr BS, Yu JH, Chen SC, Wang SE, Shyr YM, Shyr BU. Surgical Risks and Survival Outcomes in Robotic Pancreaticoduodenectomy for the Aged Over 80: A Retrospective Cohort Study. Clin Interv Aging 2023; 18:1405-1414. [PMID: 37645471 PMCID: PMC10461739 DOI: 10.2147/cia.s411391] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/20/2023] [Indexed: 08/31/2023] Open
Abstract
Aim Whether to execute pancreaticoduodenectomy or not for older people could pose a dilemma. This study clarifies the safety and justification of robotic pancreaticoduodenectomy (RPD) for older individuals over 80. Methods A total of 500 patients undergoing RPD were divided into group O (≥ 80 y/o) and group Y (< 80 y/o) for comparison. Results There were 62 (12.4%) patients in group O. Surgical mortality was 1.6% for overall patients and higher in group O, 6.5% vs 0.9%; p = 0.001. The surgical complication was comparable between groups O and Y. Delayed gastric emptying and bile leakage were higher in group O, 9.7% vs 2.5%; p = 0.004, and 6.5% vs 0.9%; p = 0.001, respectively. Length of stay was also longer in group O, with a median of 26 vs 19 days; p = 0.001. Survival outcome after RPD was poorer in group O for overall periampullary adenocarcinomas, with a 5-year survival of 48.1% vs 51.2%; p = 0.025 and also for the subgroup of pancreatic head adenocarcinoma, with a 3-year survival of 27.4% vs 42.5%; p = 0.030. Conclusion RPD is safe and justified for the selected octogenarians and even nonagenarians, whoever is fit for a major operation. Nevertheless, pancreatic head cancer and higher mortality risk for the aged over 80 with advanced ASA score ≥ 3 should be informed as part of counselling in offering RPD.
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Affiliation(s)
- Bor-Shiuan Shyr
- General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
| | - Jwo-Huey Yu
- General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
| | - Shih-Chin Chen
- General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
| | - Shin-E Wang
- General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
| | - Yi-Ming Shyr
- General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
| | - Bor-Uei Shyr
- General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
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15
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Lin HC, Hung MJ, Wang CH, Chen TH, Chen WS, Cheng CW. Development and Validation of a Novel Risk Score for All-Cause Mortality Risk Stratification Prior to Permanent Pacemaker Implantation in Octogenarians or Older. Medicina (Kaunas) 2023; 59:1499. [PMID: 37629789 PMCID: PMC10456785 DOI: 10.3390/medicina59081499] [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] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/07/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: The demand for permanent pacemaker (PPM) implantation for extremely old patients is increasing. Prior to implanting PPMs, life expectancy evaluation is essential but difficult. We aimed to develop and validate a scoring system for all-cause mortality risk stratification prior to PPM implantation in patients aged ≥80. Materials and Methods: A total of 210 patients aged ≥80 who received PPM implantation were included. Multivariable analysis was performed to assess the effects of different variables on all-cause mortality in a derivation cohort (n = 100). We developed the MELODY score for stratifying all-cause mortality prior to PPM implantation and tested the scoring system in a validation cohort (n = 102). Results: After 4.0 ± 2.7 years of follow-up, 54 patients (54%) had died. The 0.5-, 1- and 2-year all-cause mortality rates were 7%, 10% and 24%, respectively. The MELODY score based on body mass index <21 kg/m2 (HR: 2.21, 95% CI: 1.06-4.61), estimated glomerular filtration rate <30 mL/min/1.73 m2 (3.35, 1.77-6.35), length of hospitalization before PPM implantation >7 days (1.87, 1.02-3.43) and dyspnea as the major presenting symptom (1.90, 1.03-3.50) successfully distinguished patients at high risk of mortality. Patients with MELODY scores ≥3 had a higher risk of mortality compared to those with MELODY scores <3 (8.49, 4.24-17.00). The areas under the receiver operating characteristic curves in predicting 0.5, 1 and 2 years mortality rates were 0.86, 0.81 and 0.74, respectively. The predictive value of the model was confirmed in a validation cohort. Conclusions: The novel scoring system is a simple and effective tool for all-cause mortality risk stratification prior to PPM implantation in patients aged ≥80.
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Affiliation(s)
- Hsuan-Ching Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung 204201, Taiwan
| | - Ming-Jui Hung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung 204201, Taiwan
- Chang Gung University College of Medicine, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333323, Taiwan
| | - Chao-Hung Wang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung 204201, Taiwan
- Chang Gung University College of Medicine, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333323, Taiwan
| | - Tien-Hsing Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung 204201, Taiwan
- Chang Gung University College of Medicine, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333323, Taiwan
| | - Wei-Siang Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung 204201, Taiwan
| | - Chi-Wen Cheng
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung 204201, Taiwan
- Chang Gung University College of Medicine, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333323, Taiwan
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Hussain I, Hartley BR, McLaughlin L, Reiner AS, Laufer I, Bilsky MH, Barzilai O. Surgery for Metastatic Spinal Disease in Octogenarians and Above: Analysis of 78 Patients. Global Spine J 2023; 13:1481-1489. [PMID: 34670413 PMCID: PMC10448094 DOI: 10.1177/21925682211037936] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVE Octogenarians living with spinal metastases are a challenging population to treat. Our objective was to identify the rate, types, management, and predictors of complications and survival in octogenarians following surgery for spinal metastases. METHODS A retrospective review of a prospectively collected cohort of patients aged 80 years or older who underwent surgery for metastatic spinal tumor treatment between 2008 and 2019 were included. Demographic, intraoperative, complications, and postoperative follow-up data was collected. Cox proportional hazards regression and logistic regression were used to associate variables with overall survival and postoperative complications, respectively. RESULTS 78 patients (mean 83.6 years) met inclusion criteria. Average operative time and blood loss were 157 minutes and 615 mL, respectively. The median length of stay was 7 days. The overall complication rate was 31% (N = 24), with 21% considered major and 7% considered life-threatening or fatal. Blood loss was significantly associated with postoperative complications (OR = 1.002; P = 0.02) and mortality (HR = 1.0007; P = 0.04). Significant associations of increased risk of death were also noted with surgeries with decompression, and cervical/cervicothoracic index level of disease. For deceased patients, median time to death was 4.5 months. For living patients, median follow-up was 14.5 months. The Kaplan-Meier based median overall survival for the cohort was 11.6 months (95% CI: 6.2-19.1). CONCLUSIONS In octogenarians undergoing surgery with instrumentation for spinal metastases, the median overall survival is 11.6 months. There is an increased complication rate, but only 7% are life-threatening or fatal. Patients are at increased risk for complications and mortality particularly when performing decompression with stabilization, with increasing intraoperative blood loss, and with cervical/cervicothoracic tumors.
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Affiliation(s)
- Ibrahim Hussain
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Benjamin R. Hartley
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Lily McLaughlin
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anne S. Reiner
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ilya Laufer
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Mark H. Bilsky
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Ori Barzilai
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Zhao Y, Feng D, Wang X, Sun Y, Liu J, Li X, Zhou N, Wang J. Case report: Concurrent pylephlebitis and subarachnoid hemorrhage in an octogenarian patient with Escherichia coli sepsis. Front Med (Lausanne) 2023; 10:1158582. [PMID: 37234250 PMCID: PMC10205978 DOI: 10.3389/fmed.2023.1158582] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/20/2023] [Indexed: 05/27/2023] Open
Abstract
Background Pylephlebitis refers to an infective suppurative thrombosis that occurs in the portal vein and its branches. Concurrent pylephlebitis and subarachnoid hemorrhage (SAH) are rare but fatal for patients with sepsis. This scenario drives the clinicians into a dilemma of how to deal with coagulation and bleeding simultaneously. Case summary An 86-year-old man was admitted to hospital for chills and fever. After admission, he developed headache and abdominal distension. Neck stiffness, Kernig's and Brudzinski's sign were present. Laboratory tests discovered decreased platelet count, elevated inflammatory parameters, aggravated transaminitis, and acute kidney injury. Escherichia coli (E. coli) were identified in blood culture. Computed tomography (CT) revealed thrombosis in the superior mesenteric vein and portal veins. Lumbar puncture and Brain CT indicated SAH. The patient had eaten cooked oysters prior to illness. It was speculated that the debris from oyster shell might have injured his intestinal mucosa and resulted in bacterial embolus and secondary thrombosis in portal veins. The patient was treated with effective antibiotics, fluid resuscitation, and anticoagulation. The dose titration of low molecular weight heparin (LMWH) under close monitoring attributed to diminution of the thrombosis and absorption of SAH. He recovered and was discharged after 33-day treatment. One-year follow-up indicated that the post-discharge course was uneventful. Conclusion This report describes a case of an octogenarian with E. coli septicemia who survived from concurrent pylephlebitis and SAH along with multiple organ dysfunction syndrome. For such patients with life-threatening complications, even in the acute stage of SAH, decisive employment of LMWH is essential to resolve thrombosis and confers a favorable prognosis.
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Affiliation(s)
- Yong Zhao
- Department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Geriatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Dandan Feng
- Department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Geriatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xinyu Wang
- Department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Geriatric Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yuanyuan Sun
- Department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Geriatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Junni Liu
- Department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Geriatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xiaodong Li
- Department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Geriatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Nannan Zhou
- Department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Geriatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jianchun Wang
- Department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Geriatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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Dell'Oglio P, Tappero S, Panunzio A, Antonelli A, Salvador D, Xylinas E, Alvarez-Maestro M, Hurle R, Salas RS, Colomer A, Simone G, Hendricksen K, Peroni A, Lonati C, Olivero A, Rouprêt M, Roumiguié M, Soria F, Umari P, D'Andrea D, Terrone C, Galfano A, Moschini M, Trapani ED. Age represents the main driver of surgical decision making in patients candidate to radical cystectomy. J Surg Oncol 2023. [PMID: 37126407 DOI: 10.1002/jso.27255] [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: 12/20/2022] [Revised: 02/10/2023] [Accepted: 03/13/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Age might influence the choice of surgical approach, type of urinary diversion (UD) and lymph node dissection (LND) in patients candidate to radical cystectomy (RC) for urothelial bladder cancer (UBC). Similarly, age may enhance surgical morbidity and worsen perioperative outcomes. We tested the impact of age (octogenarian vs. younger patients) on surgical decision making and peri- and postoperative outcomes of RC. METHODS Non-metastatic muscle-invasive UBC patients treated with RC at 18 high-volume European institutions between 2006 and 2021 were identified and stratified according to age (≥80 vs. <80 years). Intraoperative Complications Assessment and Reporting with Universal Standards and European Association of Urology guidelines recommendations were accomplished in collection and reporting of, respectively, intraoperative and postoperative complications. Multivariable logistic regression models (MVA) tested the impact of age on outcomes of interest. Sensitivity analyses after 1:3 propensity score matching were performed. RESULTS Of 1955 overall patients, 251 (13%) were ≥80-year-old. Minimally invasive RC was performed in 18% and 40% of octogenarian and younger patients, respectively (p < 0.001). UD without bowel manipulation (ureterocutaneostomy, UCS) was performed in 31% and 7% of octogenarian and younger patients (p < 0.001). LND was delivered to 81% and 93% of octogenarian and younger patients (p < 0.001). At MVA, age ≥80 years independently predicted open approach (odds ratio [OR]: 1.55), UCS (OR: 3.70), and omission of LND (OR: 0.41; all p ≤ 0.02). Compared to their younger counterparts, octogenarian patients experienced higher rates of intraoperative (8% vs. 4%, p = 0.04) but not of postoperative complications (64% vs. 61%, p = 0.07). At MVA, age ≥80 years was not an independent predictor of length of stay, intraoperative or postoperative transfusions and complications, and readmissions (all p values >0.1). These results were replicated in sensitivity analyses. CONCLUSIONS Age ≥80 years does not independently portend worse surgical outcomes for RC. However, octogenarians are unreasonably more likely to receive open approach and UCS diversion, and less likely to undergo LND.
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Affiliation(s)
- Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands
| | - Stefano Tappero
- Department of Urology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Andrea Panunzio
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Daniel Salvador
- Department of Urology, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Evanguelos Xylinas
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology Cochin Hospital, APHP, Paris Descartes University, Paris, France
| | | | - Rodolfo Hurle
- Department of Urology, Istituto Clinico Humanitas Istituto di Ricovero e Cura a Carattere Scientifico-Clinical and Research Hospital, Milan, Italy
| | | | - Anna Colomer
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Giuseppe Simone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Kees Hendricksen
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Angelo Peroni
- Department of Urology, ASST Spedali Civili, Brescia, Italy
| | - Chiara Lonati
- Department of Urology, ASST Spedali Civili, Brescia, Italy
| | - Alberto Olivero
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Morgan Rouprêt
- Department of Urology, Pierre and Marie Curie Medical School, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Sorbonne, Paris, France
| | - Mathieu Roumiguié
- Department of Urology, Institut Universitaire du Cancer, Oncopole, Toulouse, France
| | - Francesco Soria
- Department of Surgical Sciences, Division of Urology, Torino School of Medicine, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Paolo Umari
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - David D'Andrea
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Carlo Terrone
- Department of Urology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Moschini
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ettore Di Trapani
- Division of Urology, IEO-European Institute of Oncology, IRCCS, Milan, Italy
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Ng GSN, Lee LYK, Chu ECP. Undiagnosed Osteoporotic Vertebral Fractures in an Octogenarian During the Coronavirus Disease Pandemic. Cureus 2023; 15:e38585. [PMID: 37153836 PMCID: PMC10162351 DOI: 10.7759/cureus.38585] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 05/10/2023] Open
Abstract
Osteoporotic vertebral fractures are frequently misdiagnosed or under-recognized in the older population, leading to disease progression and reduced quality of life. This case of an 87-year-old woman with acute back pain highlights the importance of early diagnosis and management of fragility fractures. During the coronavirus disease (COVID-19) pandemic, patients with a history of well-managed osteoporosis experienced worsening symptoms of vertebral collapse due to activity limitations and prolonged immobilization. The initial diagnosis of spinal stenosis delayed appropriate treatment for four months. Serial magnetic resonance imaging revealed compression fractures at L1 and L3, and a dual-energy x-ray absorptiometry scan showed osteoporosis with a T-score of -3.2. Pharmacological therapy, including bisphosphonates, was initiated. A comprehensive rehabilitation program with a multidisciplinary approach, with bracing, and lifestyle changes helped stabilize the spine, reduce pain, and maximized function. Her condition improved with close monitoring and guidance during home exercises. This case exemplifies the necessity of a precise and timely diagnosis of osteoporotic vertebral fractures to initiate management and mitigate disease progression.
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Affiliation(s)
- Gabriel Siu Nam Ng
- Chiropractic and Physiotherapy Center, New York Medical Group, Hong Kong, CHN
| | - Linda Yin-King Lee
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Kowloon, HKG
| | - Eric Chun-Pu Chu
- Chiropractic and Physiotherapy Center, New York Medical Group, Hong Kong, CHN
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Chen Z, Chen C, Chong H, Wang J, Zhu X, Zhou Q, Wang D, Xue Y. Safety of open limited surgery for septuagenarian and octogenarian acute type A aortic dissection patients: a retrospective cohort study. Cardiovasc Diagn Ther 2023; 13:326-335. [PMID: 37583688 PMCID: PMC10423737 DOI: 10.21037/cdt-22-533] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/03/2023] [Indexed: 08/17/2023]
Abstract
Background Surgical strategies in older adult patients with acute type A aortic dissection (aTAAD) are crucial. We investigated the safety and efficiency of open limited surgery for septuagenarian and octogenarian patients with aTAAD. Methods Between 2011 and 2019, 1,092 patients diagnosed with aTAAD underwent open surgery in Nanjing Drum Tower Hospital. Patients were divided into two groups based on age: <70 years (n=956) and ≥70 years (n=136). Preoperative baseline characteristics, operative data, and postoperative outcomes were compared between the two groups. To investigate the safety and efficiency of the surgical approach for those aged ≥70 years, we separated these patients into two groups: (I) those who underwent root-sparing surgery and less-invasive arch surgery (Limited group; n=86); and (II) all others (Extensive group; n=50). Results Mortality was significantly higher in those aged ≥70 years than in those <70 years (20.6% vs. 13.2%; P=0.000), with age being a strong risk factor for postoperative mortality [odds ratio (OR) 1.619; 95% confidence interval (CI): 1.015-2.582; P=0.043]. Patients aged ≥70 years tended to receive less invasive surgery, and the rates of root replacement and arch replacement were lower. Patients in the limited surgery group had a higher rate of pericardial tamponade, and the durations of surgery, hypothermic circulation arrest, cardiopulmonary bypass, and aortic clamp were all significantly shorter than in the extensive group. Mortality and postoperative complications were also lower in the limited surgery group. Conclusions Although older age was a risk factor for open surgery for aTAAD, limited surgical techniques could lower the mortality and morbidity regardless of the need for extensive surgery.
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Affiliation(s)
- Zhong Chen
- Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
| | - Cheng Chen
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
| | - Hoshun Chong
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
| | - Junxia Wang
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
| | - Xiyu Zhu
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
| | - Qing Zhou
- Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
| | - Dongjin Wang
- Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
| | - Yunxing Xue
- Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
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21
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Chang S, Yong MS, Stroebel A, Hughes I, Scuffham P, He C. A contemporary evaluation of surgical aortic valve replacement outcomes and temporal trends. ANZ J Surg 2023. [PMID: 37088919 DOI: 10.1111/ans.18486] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Given the ageing population and uptake of transcatheter approaches for treating aortic stenosis (AS), a renewed evaluation of outcomes after surgical aortic valve replacement (SAVR) is warranted. With guidelines recommending age-based indications for surgical and transcatheter approaches, this study critically evaluates outcomes in age-based subgroups, with the aim to refine management of AS in the elderly, where there is often no clear consensus. METHODS Six hundred and thirteen consecutive patients who underwent SAVR in an Australian tertiary cardiac centre between 1 June 2014 and 13 January 2022 were retrospectively analysed. Of these, 70.31% were <75 years (Group 1) and 29.69% were ≥75 years (Group 2). Groups were compared with respect to early and long-term outcomes. Logistic regression, Kaplan-Meier survival estimates and Cox proportional hazards regression were performed for all patients and an AS-specific sub-group. RESULTS Patients aged ≥75 years were more likely to be female and have hypercholesterolemia, hypertension, and pre-existing arrhythmia (P < 0.001). Group 1 experienced a higher incidence of renal failure compared with Group 2, in the overall cohort and AS-specific subgroup (P = 0.02). The incidence of stroke was similar between groups, in the overall cohort (P = 0.22) and the AS-specific subgroup (P = 0.32). Age ≥ 75 was not found to be an independent predictor of 30-day, 1-year or 5-year mortality. Temporal trends revealed low consistently low complication rates. CONCLUSIONS Elderly patients should not be denied surgery based on age, despite guideline-driven age-based recommendations.
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Affiliation(s)
- Shantel Chang
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Matthew S Yong
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Andrie Stroebel
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Ian Hughes
- Office for Research Governance, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Paul Scuffham
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Cheng He
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
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Guertin MP, Lee Y, Stewart SJ, Ramirez J, Nguyen A, Paraliticci G, Pretell-Mazzini JA. Soft Tissue Sarcomas in Octogenarian Patients: Are Treatment Options and Oncological Outcomes Different? A SEER Retrospective Study. Clin Oncol (R Coll Radiol) 2023; 35:269-277. [PMID: 36710153 DOI: 10.1016/j.clon.2023.01.002] [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: 11/09/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023]
Abstract
AIMS As the US population continues to age, oncological strategies and outcomes for soft tissue sarcomas (STSs) should continue to be examined for varying age groups. The aim of this study was analyse and compare treatment strategies and oncological outcomes for octogenarian patients with STSs. MATERIALS AND METHODS Data from the Surveillance, Epidemiology and End Results (SEER) national database were used. Varying treatment modalities were studied when utilised for specific tumour staging with respect to the eighth edition of the American Joint Committee on Cancer. RESULTS In total, 24 666 patients were included for analysis, where 3341 (14%) were 80 years old or older. The octogenarian group was diagnosed with more advanced disease (stages II-IV), relative to their younger counterparts (85% versus 75%, P < 0.001). However, a smaller proportion of the older patients underwent surgical resection (74% versus 86%, P < 0.001). Likewise, the octogenarians received less chemotherapy (4% versus 21%, P < 0.001) and radiotherapy (29% versus 42%, P = 0.010). Surgical resection and chemotherapy significantly improved overall survival for those older patients with stage II STS, whereas surgical resection and radiotherapy improved mortality in this cohort with both stage III and IV STS. Overall survival at 1 and 5 years of follow-up was lower within the octogenarian group compared with the younger group (1 year: 68% versus 88%, P < 0.001 and 5 years: 7% versus 58%, P < 0.001). CONCLUSIONS Octogenarian patients, in most cases, are diagnosed with stage III or metastatic disease. Surgical resection of the primary tumour was beneficial in both age cohorts, with radiotherapy correlating to better overall survival when used in those patients with higher stage STS. Chemotherapy was associated with better mortality in the younger cohort with respect to tumour stage. The octogenarian overall survival at 1 and 5 years was lower than for younger patients.
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Affiliation(s)
- M P Guertin
- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA.
| | - Y Lee
- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - S J Stewart
- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - J Ramirez
- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - A Nguyen
- University of Illinois College of Medicine, Chicago, Illinois, USA
| | - G Paraliticci
- Musculoskeletal Oncology Division, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - J A Pretell-Mazzini
- Musculoskeletal Oncology Division, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
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23
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Sulaiman S, Roy K, Wang H, de Backer O, Alloco D, Reddy VY, Holmes DR, Alkhouli M. Left Atrial Appendage Occlusion in the Elderly: Insights From PROTECT-AF, PREVAIL, and Continuous Access Registries. JACC Clin Electrophysiol 2023; 9:669-676. [PMID: 36890047 DOI: 10.1016/j.jacep.2023.02.007] [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: 01/17/2023] [Revised: 02/17/2023] [Accepted: 02/17/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Data on the safety and efficacy of left atrial appendage occlusion (LAAO) in elderly patients are limited. OBJECTIVES We aimed to compare the outcomes of LAAO between patients ≥80 and <80 years of age. METHODS We included patients enrolled in randomized trials and nonrandomized registries of the Watchman 2.5 device. The primary efficacy endpoint was a composite of cardiovascular/unknown death, stroke, or systemic embolism at 5 years. Secondary endpoints included cardiovascular/unknown death, stroke, systemic embolism, and major and nonprocedural bleeding. Survival analyses were performed using the Kaplan-Meier, Cox proportional hazards, and competing risk analysis methods. Interaction terms were used to compare the 2 age groups. We also estimated the average treatment effect of the device with the use of inverse probability weighting. RESULTS We studied 2,258 patients, of whom 570 (25.2%) were ≥80 years old, and 1,688 (74.8%) were <80 years old. Procedural complications at 7 days were similar in both age groups. The primary endpoint occurred in 12.0% in the device group vs 13.8% in the control group (HR: 0.9; 95% CI: 0.6-1.4) among patients <80 years of age and in 25.3% vs 21.7%, respectively (HR: 1.2; 95% CI: 0.7-2.0) among patients ≥80 (interaction P value = 0.48). There was no interaction between age and treatment effect for any of the secondary outcomes. The average treatment effects of LAAO (compared with warfarin) were similar in the elderly population (compared with younger patients). CONCLUSIONS Despite the higher event rates, octogenarians derive similar benefits from LAAO as their younger counterparts. Age alone should not preclude LAAO in otherwise suitable candidates.
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Affiliation(s)
- Samian Sulaiman
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Kristine Roy
- Boston Scientific Corporation, Marlborough, Massachusetts, USA
| | - Hong Wang
- Boston Scientific Corporation, Marlborough, Massachusetts, USA
| | - Ole de Backer
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Dominic Alloco
- Boston Scientific Corporation, Marlborough, Massachusetts, USA
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David R Holmes
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA.
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24
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Ucci A, de Troia A, D'Ospina RM, Pedrazzi G, Nabulsi B, Azzarone M, Perini P, Massoni CB, Rossi G, Freyrie A. Carotid endarterectomy in asymptomatic octogenarians: Outcomes at 30 days and 5 years. Vascular 2023; 31:98-106. [PMID: 34923864 DOI: 10.1177/17085381211056434] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND The following study investigated the 30-day and 5-year relative survival rate and freedom from neurological events in asymptomatic carotid stenosis (ACS) octogenarians who had undergone elective carotid endarterectomy (CEA). METHODS Between January 2008 and June 2014, a retrospective review was conducted on ACS patients who had undergone elective CEA. The patients' sample was divided into two groups: Group A (GA) included octogenarians and Group B (GB) included younger patients. The GA patients were subjected to a risk-scoring system and follow-up. The two groups were compared analysing the following primary endpoints: 30-day mortality, stroke, stroke/death and acute myocardial infarction (AMI); GA patients' survival rate and freedom from neurological events at 5 years. The 30-day secondary endpoints included carotid shunting, redo surgical, need for general anaesthesia with preserved consciousness (GAPC) conversion and length of hospital stay. RESULTS We identified 620 patients with ACS, of them 144 (23.2%) belonged to the GA and 476 (76.8%) belonged to the GB. No statistical difference between the two groups was found regarding the primary and secondary endpoints. One hundred nineteen of 144 GA patients (82.6%) underwent the follow-up; the median follow-up was 78.3 months. The GA patients' 5-year survival rate was 62%, while freedom from cerebral events was 94.9%. Analysis regarding GA patients' 5-year survival rate revealed a significantly lower percentage among the patients with a severe risk score compared with those with a moderate risk score (respectively, 29.5% vs 67.7%; p = .005). The multivariate analysis showed that chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD) were independently associated with lower survival. CONCLUSIONS The 30-day outcomes of CEA in octogenarians are comparable to those in younger patients. Comprehensive life expectancy and preoperative score, rather than age alone, should be taken into account before performing CEA on octogenarian patients, considering the short- and long-term efficacy in stroke prevention.
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Affiliation(s)
- Alessandro Ucci
- Department of Medicine and Surgery, 9370University of Parma, Parma, Italy
| | - Alessandro de Troia
- Department of Medicine and Surgery, 9370University of Parma, Parma, Italy.,Department Cardio Thoracic and Vascular Surgery, Unit of Vascular Surgery, 18630University Hospital of Parma
| | | | - Giuseppe Pedrazzi
- Department of Medicine and Surgery, 9370University of Parma, Parma, Italy
| | - Bilal Nabulsi
- Department Cardio Thoracic and Vascular Surgery, Unit of Vascular Surgery, 18630University Hospital of Parma
| | - Matteo Azzarone
- Department of Medicine and Surgery, 9370University of Parma, Parma, Italy.,Department Cardio Thoracic and Vascular Surgery, Unit of Vascular Surgery, 18630University Hospital of Parma
| | - Paolo Perini
- Department Cardio Thoracic and Vascular Surgery, Unit of Vascular Surgery, 18630University Hospital of Parma
| | - Claudio Bianchini Massoni
- Department Cardio Thoracic and Vascular Surgery, Unit of Vascular Surgery, 18630University Hospital of Parma
| | - Giulia Rossi
- Department Cardio Thoracic and Vascular Surgery, Unit of Vascular Surgery, 18630University Hospital of Parma
| | - Antonio Freyrie
- Department of Medicine and Surgery, 9370University of Parma, Parma, Italy.,Department Cardio Thoracic and Vascular Surgery, Unit of Vascular Surgery, 18630University Hospital of Parma
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25
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Varady NH, Amen TB, Rudisill SS, Adcock K, Bovonratwet P, Ast MP. Same-Day Discharge Total Knee Arthroplasty in Octogenarians. J Arthroplasty 2023; 38:96-100. [PMID: 35985540 DOI: 10.1016/j.arth.2022.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/03/2022] [Accepted: 08/07/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND One of the most important aspects of the transition to outpatient (OP) arthroplasty is patient selection, with guidance traditionally recommending that OP total knee arthroplasty (TKA) be reserved for patients <80 years old. However, there are limited data as to whether older age should really be considered a contraindication to OP-TKA. The purpose of this study is to assess the risk of complications and readmissions following OP-TKA in patients ≥80 years old. METHODS This is a retrospective, propensity-matched cohort study of the National Surgical Quality Improvement Program database from 2011 to 2019. Patients ≥80 years undergoing OP (same-day discharge) TKA were propensity matched to patients ≥80 years undergoing inpatient (IP) TKA based on age, gender, race, body mass index, American Society of Anesthesiologists classification, functional status, smoking status, anesthetic type, and medical comorbidities. There were 1,418 patients (709 IPs and 709 OPs) included. All baseline factors were successfully matched between IP-TKA versus OP-TKA (P ≥ .18 for all). Thirty-day complications, readmissions, reoperations, and mortality were subsequently analyzed. RESULTS Thirty-day readmission rates were identical between patients undergoing IP-TKA and OP-TKA (3.5% versus 3.5%, P = 1.0). Similarly, there was no significant difference in the incidence of major complications (2.7% versus 2.0%, P = .38), reoperations (1.3% versus 0.8%, P = .44), or mortalities (0.3% versus 0.3%, P = 1.0) within 30 days. CONCLUSION Octogenarians undergoing OP-TKA had comparable complication rates to similar patients undergoing IP-TKA. OP-TKA can be performed safely in select octogenarians and age ≥80 years likely does not need to be a uniform contraindication to OP-TKA.
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Affiliation(s)
- Nathan H Varady
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York; Department of Orthopaedic Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
| | - Troy B Amen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York; Department of Orthopaedic Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
| | | | - Kelson Adcock
- University of Washington Medical Center, Seattle, Washington
| | - Patawut Bovonratwet
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York; Department of Orthopaedic Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
| | - Michael P Ast
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York; Department of Orthopaedic Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
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26
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Shahi P, Song J, Dalal S, Melissaridou D, Shinn DJ, Araghi K, Mai E, Sheha E, Dowdell J, Qureshi SA, Iyer S. Improvement following minimally invasive lumbar decompression in patients 80 years or older compared with younger age groups. J Neurosurg Spine 2022; 37:828-835. [PMID: 35901712 DOI: 10.3171/2022.5.spine22361] [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: 04/01/2022] [Accepted: 05/16/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to assess the outcomes of minimally invasive lumbar decompression in patients ≥ 80 years of age and compare them with those of younger age groups. METHODS This was a retrospective cohort study. Patients who underwent primary unilateral laminotomy for bilateral decompression (ULBD) (any number of levels) and had a minimum of 1 year of follow-up were included and divided into three groups by age: < 60 years, 60-79 years, and ≥ 80 years. The outcome measures were 1) patient-reported outcome measures (PROMs) (visual analog scale [VAS] back and leg, Oswestry Disability Index [ODI], 12-Item Short-Form Health Survey [SF-12] Physical Component Summary [PCS] and Mental Component Summary [MCS] scores, and Patient-Reported Outcomes Measurement Information System Physical Function [PROMIS PF]); 2) percentage of patients achieving the minimal clinically important difference (MCID) and the time taken to do so; and 3) complications and reoperations. Two postoperative time points were defined: early (< 6 months) and late (≥ 6 months). RESULTS A total of 345 patients (< 60 years: n = 94; 60-79 years: n = 208; ≥ 80 years: n = 43) were included in this study. The groups had significantly different average BMIs (least in patients aged ≥ 80 years), age-adjusted Charlson Comorbidity Indices (greatest in the ≥ 80-year age group), and operative times (greatest in 60- to 79-year age group). There was no difference in sex, number of operated levels, and estimated blood loss between groups. Compared with the preoperative values, the < 60-year and 60- to 79-year age groups showed a significant improvement in most PROMs at both the early and late time points. In contrast, the ≥ 80-year age group only showed significant improvement in PROMs at the late time point. Although there were significant differences between the groups in the magnitude of improvement (least improvement in ≥ 80-year age group) at the early time point in VAS back and leg, ODI, and SF-12 MCS, no significant difference was seen at the late time point except in ODI (least improvement in ≥ 80-year group). The overall MCID achievement rate decreased, moving from the < 60-year age group toward the ≥ 80-year age group at both the early (64% vs 51% vs 41% ) and late (72% vs 58% vs 52%) time points. The average time needed to achieve the MCID in pain and disability increased, moving from the < 60-year age group toward the ≥ 80-year age group (2 vs 3 vs 4 months). There was no significant difference seen between the groups in terms of complications and reoperations except in immediate postoperative complications (5.3% vs 4.8% vs 14%). CONCLUSIONS Although in this study minimally invasive decompression led to less and slower improvement in patients ≥ 80 years of age compared with their younger counterparts, there was significant improvement compared with the preoperative baseline.
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Affiliation(s)
- Pratyush Shahi
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and
| | - Junho Song
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and
| | - Sidhant Dalal
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and
| | | | - Daniel J Shinn
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and
| | - Kasra Araghi
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and
| | - Eric Mai
- 2Department of Orthopaedic Surgery, Weill Cornell Medicine, New York, New York
| | - Evan Sheha
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and
| | - James Dowdell
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and
| | - Sheeraz A Qureshi
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and.,2Department of Orthopaedic Surgery, Weill Cornell Medicine, New York, New York
| | - Sravisht Iyer
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and.,2Department of Orthopaedic Surgery, Weill Cornell Medicine, New York, New York
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27
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Burns DJP, Angelini GD, Benedetto U, Caputo M, Ciulli F, Vohra HA. Early mortality and neurologic outcomes following mitral valve surgery in the very elderly. J Card Surg 2022; 37:4510-4516. [PMID: 36335608 DOI: 10.1111/jocs.17098] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/17/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Valve repair is the gold standard for treatment of degenerative mitral valve disease. As the population ages, patients undergoing valve degeneration and therefore considered for mitral valve surgery will naturally be getting older. We sought to evaluate whether mitral repair retained a survival advantage over replacement in patients ≥80 years old. METHODS A retrospective cohort study was performed using data acquired from the United Kingdom National Adult Cardiac Surgery Audit for the outcomes of in-hospital mortality and postoperative cerebrovascular event (CVA). Individual multivariable logistic regression models were created to investigate adjusted associations between these outcomes and type of mitral valve operation, repair or replacement. Additionally, associations between the individual model parameters and in-hospital mortality and CVA were investigated. RESULTS A total of 1140 patients underwent mitral repair (66.4%, median age 82.3), and 577 patients underwent mitral replacement (33.6%, median age 82.1). The overall age range was 80-92. The incidence of in-hospital mortality favored the repair group (4.4% vs. 8.3%, p = .001). Multivariable logistic regression modeling demonstrated an increased adjusted odds of in-hospital mortality for mitral valve replacement (MVR) (odd ratio [OR]: 2.01, 1.15-3.50, p = .01). The only other parameter associated with an increased adjusted odds of in-hospital mortality was postoperative dialysis (OR: 14.2, 7.67-26.5, p < .001). There was not a demonstrated association between MVR and perioperative CVA (OR: 1.11, 0.49-2.4, p = .8). CONCLUSIONS In patients ≥80 years old, mitral valve repair (MVr) was shown to be associated with a decreased adjusted odds of mortality, with a null association with CVA. These results suggest that, if feasible, MVr should remain the preferred management strategy, even in the very elderly.
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Affiliation(s)
- Daniel J P Burns
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Gianni D Angelini
- Department of Cardiac Surgery, Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Umberto Benedetto
- Department of Cardiac Surgery, Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Massimo Caputo
- Department of Cardiac Surgery, Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Franco Ciulli
- Department of Cardiac Surgery, Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Hunaid A Vohra
- Department of Cardiac Surgery, Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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28
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HATTORI SOU, OJIMA EIJI, OKAUCHI SHINICHIRO, SASATANI YUIKA, SHIOZAWA TOSHIHIRO, SATOH HIROAKI, HIZAWA NOBUYUKI. Octogenarians With Anaplastic Lymphoma Kinase-rearranged Non-small-cell Lung Cancer: A Case Series. Cancer Diagn Progn 2022; 2:711-715. [PMID: 36340445 PMCID: PMC9628154 DOI: 10.21873/cdp.10165] [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] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/16/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND/AIM Anaplastic lymphoma kinase (ALK) rearrangements define a distinct group of patients with non-small-cell lung cancer (NSCLC), mainly represented by never-smoking young individuals. However, we also encounter elderly patients with ALK-rearranged NSCLC over the age of 80 years. We report herein three cases of these patients that we have experienced. CASE REPORT Three patients with ALK-rearranged NSCLC aged 80 years or older received therapy with the ALK-tyrosine kinase, alectinib. Of them, one was male and two had a history of smoking. Comorbidities, especially heart diseases, were prominent. Long-term survival was achieved with alectinib treatment in two patients. CONCLUSION ALK-rearranged mutations should be evaluated even in octogenarians with NSCLC, regardless of sex and smoking history. Even if they have comorbid diseases, long-term control might be achieved with alectinib therapy in cooperation with physicians other than chest physicians and medical oncologists.
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Affiliation(s)
- SOU HATTORI
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba, Mito, Japan
| | - EIJI OJIMA
- Division of Cardiology, Mito Medical Center, University of Tsukuba, Mito, Japan
| | - SHINICHIRO OKAUCHI
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba, Mito, Japan
| | - YUIKA SASATANI
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba, Mito, Japan
| | - TOSHIHIRO SHIOZAWA
- Division of Respiratory Medicine, Faculty of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - HIROAKI SATOH
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba, Mito, Japan
| | - NOBUYUKI HIZAWA
- Division of Respiratory Medicine, Faculty of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
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29
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Fleisher I, Ong CB, Chiu YF, Krell E, Cushner FD, Gausden E, Boettner F, Gonzalez Della Valle A. Nonagenarians and Octogenarians Undergoing THA and TKA: A 10-Year Age Difference Increases Rates of In-Hospital Complications But Does Not Affect 90-Day Outcomes. HSS J 2022; 18:478-484. [PMID: 36263271 PMCID: PMC9527538 DOI: 10.1177/15563316221090508] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/01/2022] [Indexed: 02/07/2023]
Abstract
Background The population of nonagenarians undergoing total joint arthroplasty (TJA) of the hip or knee is expected to increase, but this population may be reluctant to consider elective surgery because of their advanced age. Purpose We sought to compare TJA outcomes between nonagenarians and octogenarians with an exact 10-year age difference. Methods We performed a retrospective chart review, including 129 nonagenarians who underwent primary unilateral TJA for osteoarthritis in a 4-year period at a single institution and who were matched with 381 octogenarians based on sex, body mass index, Charlson Comorbidity Index, replaced joint (hip or knee), and a 10-year age difference. Ninety-day outcomes included Centers for Medicare and Medicaid Services (CMS) defined complications, unscheduled outpatient clinic visits, emergency room (ER) visits, and readmissions. No patients were lost to follow-up. Results Nonagenarians and octogenarians had comparable rates of CMS complications (10% vs 6.3%, respectively), but nonagenarians had higher rates of CMS mechanical complications (6.2% vs 1.6%). There was 1 death in each group. Nonagenarians had longer hospital stays than octogenarians (4.1 vs 3.0 days, respectively), and a greater risk of in-hospital events and complications (60.5% vs 37.3%, respectively). The groups showed similar rates of unscheduled outpatient visits (14.7% vs 13.9%, respectively), ER visits (12.4 vs 6.6%, respectively), and readmissions (6.2% vs 7.1%, respectively). Conclusions This retrospective study found higher rates of in-hospital complications in nonagenarians than in matched octogenarians following elective TJA, although the 2 groups showed similar rates of postdischarge complications. Further research in a larger cohort is needed.
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Affiliation(s)
- Ilan Fleisher
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
- New York Medical College, Valhalla, NY, USA
| | - Christian B. Ong
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Yu-Fen Chiu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Ethan Krell
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Fred D. Cushner
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Elizabeth Gausden
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Friedrich Boettner
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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30
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Elsamadicy AA, Koo AB, Reeves BC, Freedman IG, David WB, Ehresman J, Pennington Z, Laurans M, Kolb L, Sciubba DM. Octogenarians Are Independently Associated With Extended LOS and Non-Routine Discharge After Elective ACDF for CSM. Global Spine J 2022; 12:1792-1803. [PMID: 33511889 PMCID: PMC9609534 DOI: 10.1177/2192568221989293] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim of this study was to determine the impact age has on LOS and discharge disposition following elective ACDF for cervical spondylotic myelopathy (CSM). METHODS A retrospective cohort study was performed using the National Inpatient Sample (NIS) database from 2016 and 2017. All adult patients >50 years old undergoing ACDF for CSM were identified using the ICD-10-CM diagnosis and procedural coding system. Patients were then stratified by age: 50 to 64 years-old, 65 to 79 years-old, and greater than or equal to 80 years-old. Weighted patient demographics, comorbidities, perioperative complications, LOS, discharge disposition, and total cost of admission were assessed. RESULTS A total of 14 865 patients were identified. Compared to the 50-64 and 65-79 year-old cohorts, the 80+ years cohort had a significantly higher rate of postoperative complication (50-64 yo:10.2% vs. 65-79 yo:12.6% vs. 80+ yo:18.9%, P = 0.048). The 80+ years cohort experienced significantly longer hospital stays (50-64 yo: 2.0 ± 2.4 days vs. 65-79 yo: 2.2 ± 2.8 days vs. 80+ yo: 2.3 ± 2.1 days, P = 0.028), higher proportion of patients with extended LOS (50-64 yo:18.3% vs. 65-79 yo:21.9% vs. 80+ yo:28.4%, P = 0.009), and increased rates of non-routine discharges (50-64 yo:15.1% vs. 65-79 yo:23.0% vs. 80+ yo:35.8%, P < 0.001). On multivariate analysis, age 80+ years was found to be a significant independent predictor of extended LOS [OR:1.97, 95% CI:(1.10,3.55), P = 0.023] and non-routine discharge [OR:2.46, 95% CI:(1.44,4.21), P = 0.001]. CONCLUSIONS Our study demonstrates that octogenarian age status is a significant independent risk factor for extended LOS and non-routine discharge after elective ACDF for CSM.
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Affiliation(s)
- Aladine A. Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
- Aladine A. Elsamadicy, Department of
Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven,
CT 06520, USA.
| | - Andrew B. Koo
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Benjamin C. Reeves
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Isaac G. Freedman
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Wyatt B. David
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Jeff Ehresman
- Department of Neurosurgery, John Hopkins School of Medicine, Baltimore, MD, USA
| | - Zach Pennington
- Department of Neurosurgery, John Hopkins School of Medicine, Baltimore, MD, USA
| | - Maxwell Laurans
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Luis Kolb
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Daniel M. Sciubba
- Department of Neurosurgery, John Hopkins School of Medicine, Baltimore, MD, USA
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31
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Shen Y, Qi Y, Zhao J, Huang B, Yuan D, Wang T, Wang J. Predictive factors for major adverse cardiac and cerebrovascular events in octogenarians after elective endovascular aneurysm repair. Ann Vasc Surg 2022; 88:363-372. [PMID: 36029948 DOI: 10.1016/j.avsg.2022.07.029] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/03/2022] [Accepted: 07/24/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to identify risk factors of major adverse cardiac and cerebrovascular events (MACCE) in octogenarians who received elective endovascular aneurysm repair (EVAR). METHODS Consecutive patients aged ≥ 80 years undergoing elective EVAR from 2009 to 2020 were retrospectively evaluated. The primary outcome was long-term MACCE. All independent risk factors for outcomes were determined by multivariate logistic analysis or Cox regression analysis. RESULTS A total of 163 patients were enrolled in this study. The median age was 81 (interquartile range, IQR, 80-84) years and 85.9% (140/163) of them were male. MACCE happened in 2.5% (4/163) patients within 30 days. With median follow-up of 28 (IQR, 15-46) months, the incidence of long-term MACCE was 26.4% (43/163). Arrythmia was significantly associated with long-term MACCE (hazard ratio, HR = 2.64, 95% confidence interval, CI, 1.16-6.03, P = .021). Carotid artery disease was found a significant association with 2-year MACCE (odd ratio, OR = 6.50, 95% CI, 1.07-39.51, P = .042). Besides, we found that arrythmia and congestive heart failure (CHF) were predictors for overall survival (arrythmia, HR = 2.56, 95% CI, 1.05-6.28, P = .039; CHF, HR = 8.96, 95% CI, 2.12-37.79, P = .003). CONCLUSIONS EVAR in octogenarians had acceptable perioperative risk and long-term outcome. Considering high risk of 2-year MACCE, intervention strategy should be more cautious for patients with carotid artery disease. Octogenarians with arrythmia and CHF should receive stricter postoperative management in case of MACCE.
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Affiliation(s)
- Yinzhi Shen
- West China School of Medicine, Sichuan University, 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yuhan Qi
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jichun Zhao
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Bin Huang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Ding Yuan
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Tiehao Wang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Jiarong Wang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
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Partan M, Frane N, Iturriaga C, Matai P, Bitterman A. Short-Term Outcomes of Primary Total Ankle Arthroplasty in Octogenarians: A National Database Analysis. Foot Ankle Spec 2022; 15:346-353. [PMID: 33000649 DOI: 10.1177/1938640020960546] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Total ankle arthroplasty (TAA) is an increasingly popular option for end-stage ankle arthritis. Americans over the age of 80 years grew to 16.7 million in 2010, but there are scarce data assessing the outcomes of octogenarians undergoing TAA. This study evaluated (1) perioperative factors, (2) 30-day postoperative complications compared to a nonoctogenarian cohort, and (3) independent risk factors for adverse outcomes. METHODS A national database registry was queried for patients who had undergone primary TAA. This yielded 1113 patients, under (n = 1059) and over (n = 54) age 80 years. Demographics and perioperative data were compared using Fisher's exact, χ2, and independent-samples t tests. Logistic and Poisson regressions were used to calculate odds ratio (OR) of complications and independent risk factors. RESULTS The octogenarian cohort had longer in-hospital length of stay (1.9 vs 2.5 days, P < .0001). Octogenarians were not significantly more likely to develop any complication (OR = 1.32; 95% confidence interval = 0.29-6.04; P = .722), or increased number of complications (OR = 1.18; 95% CI = 0.27-5.18; P = .820). Octogenarians had significantly increased risk of being discharged to rehab/skilled nursing (OR = 6.60; 95% CI = 2.16-20.15; P < .001) instead of home. CONCLUSION Although the elderly population may carry inherent risk factors, octogenarians do not present an increased risk of short-term complications following TAA. LEVELS OF EVIDENCE Therapeutic, Level III: Retrospective cohort study.
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Affiliation(s)
- Matthew Partan
- Department of Orthopaedic Surgery, Northwell Health Plainview Hospital, Plainview, New York (MP, NF, CI, PM).,Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center, New Hyde Park, New York (CI).,Department of Orthopaedic Surgery, Northwell Health Huntington Hospital, Huntington, New York (AB).,Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, New York (AB)
| | - Nicholas Frane
- Department of Orthopaedic Surgery, Northwell Health Plainview Hospital, Plainview, New York (MP, NF, CI, PM).,Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center, New Hyde Park, New York (CI).,Department of Orthopaedic Surgery, Northwell Health Huntington Hospital, Huntington, New York (AB).,Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, New York (AB)
| | - Cesar Iturriaga
- Department of Orthopaedic Surgery, Northwell Health Plainview Hospital, Plainview, New York (MP, NF, CI, PM).,Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center, New Hyde Park, New York (CI).,Department of Orthopaedic Surgery, Northwell Health Huntington Hospital, Huntington, New York (AB).,Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, New York (AB)
| | - Prashant Matai
- Department of Orthopaedic Surgery, Northwell Health Plainview Hospital, Plainview, New York (MP, NF, CI, PM).,Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center, New Hyde Park, New York (CI).,Department of Orthopaedic Surgery, Northwell Health Huntington Hospital, Huntington, New York (AB).,Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, New York (AB)
| | - Adam Bitterman
- Department of Orthopaedic Surgery, Northwell Health Plainview Hospital, Plainview, New York (MP, NF, CI, PM).,Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center, New Hyde Park, New York (CI).,Department of Orthopaedic Surgery, Northwell Health Huntington Hospital, Huntington, New York (AB).,Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, New York (AB)
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Abstract
Background: Decreased length of stay after total joint arthroplasty (TJA) is becoming a more common way to contain healthcare costs and increase patient satisfaction. There is little evidence to support "early" discharge in elderly patients. Purpose: We sought to identify preoperative factors that correlated with early discharge (by postoperative day [POD] 1) in comparison to late discharge (after POD2) in octogenarians after TJA. Methods: In a retrospective cohort study from a single institution, we identified 482 patients ages 80 to 89 who underwent primary TJA from January 2014 to December 2017; 319 had total knee arthroplasty (TKA) and 163 had total hip arthroplasty (THA). Data collected included preoperative knee range of motion (ROM), demographics, and comorbidities; 90-day readmission and mortality rates were also evaluated. P values for continuous data were calculated using student's t test and for categorical data using χ2 testing. Results: Of octogenarian patients, 30.9% were discharged by POD1. Early discharge was associated with being male, married, and nonsmoking, as well as having an American Society of Anesthesiologists (ASA) score of 2, independent preoperative ambulation, and a postoperative caregiver. Type of procedure (TKA vs THA), body mass index, laterality, preoperative range of motion (ROM) for TKA, and single vs multilevel home did not affect the probability of early discharge. Discharge on POD1 was not associated with increased 90-day readmission rates. There were no deaths. Conclusion: Early discharge for octogenarians can be successfully implemented in a select subset of patients without increasing 90-day readmission or death rates. There are multiple factors that predict successful early discharge.
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Affiliation(s)
- Andrew B. Kay
- The Rothman Institute, Egg Harbor
Township, NJ, USA,Andrew B. Kay, MD, The Rothman Institute,
2500 English Creek Ave, Bldg 1300, Egg Harbor Township, NJ 08234, USA.
| | | | | | | | | | - Andres Duque
- The Rothman Institute, Egg Harbor
Township, NJ, USA
| | - Alvin C. Ong
- The Rothman Institute, Egg Harbor
Township, NJ, USA
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Zaini J, Putra AC, Ridwanuloh AM, Saniyyah Z, Haryanto B, Utomo ARH, Dharmayanthi AB, Prasetyoputri A, Andriani A, Hariyatun H, Nuryana I, Iryanto SB, Saputra S, Wardiana A, Ningrum RA. Possible intraindividual evolution of SARS-CoV-2 in nasopharyngeal and anal swab in an octogenarian: a case report. Germs 2022; 12:298-303. [PMID: 36504602 PMCID: PMC9719385 DOI: 10.18683/germs.2022.1332] [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: 11/11/2021] [Revised: 04/30/2022] [Accepted: 05/20/2022] [Indexed: 12/15/2022]
Abstract
Introduction COVID-19 is an emerging infectious disease that remains to be further investigated. Case report Here, we describe a case of COVID-19 in an octogenarian woman with comorbidities who slowly recovered during hospitalization, but died due to sudden cardiac death after 2 weeks of hospitalization. Her nasopharyngeal and anal swabs returned positive for SARS-CoV-2 by RT-PCR on day 7 of hospitalization. The NGS showed possible intraindividual evolution of virus. The sample from the nasopharyngeal swab yielded a B.1470 variant classified as clade GH. This variant showed mutation in the spike gene D614G; N gene; NS3 gene; NSP2 gene and NSP12 gene. The sample from the anal swab showed similar mutation but with additional point mutation in spike gene S12F and was classified as B.1.465 variant. Conclusions The possibility of the gastrointestinal tract that served as reservoir for virus mutation accumulation should also be considered and the potential impact of viral fecal transmission in the environment should be further investigated.
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Affiliation(s)
- Jamal Zaini
- MD, PhD, Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Persahabatan National Respiratory Referral Hospital, 13230, Jakarta Timur, Indonesia,Corresponding author: Jamal Zaini,
| | - Andika Chandra Putra
- MD, PhD, Faculty of Medicine, Universitas Yarsi, 10510, Jakarta Pusat, Indonesia, Persahabatan National Respiratory Referral Hospital, 13230, Jakarta Timur, Indonesia
| | - Asep Muhamad Ridwanuloh
- MSc, National Research and Innovation Agency Republic of Indonesia, Jalan Raya Bogor KM 46 Cibinong, Bogor 16911, Jawa Barat, Indonesia
| | - Zahrah Saniyyah
- MD, Faculty of Medicine, Universitas Yarsi, 10510, Jakarta Pusat, Indonesia
| | - Budi Haryanto
- MD, Department of Microbiology, Persahabatan National Respiratory Referral Hospital, 13230, Jakarta Timur, Indonesia
| | - Ahmad Rusdan Handoyo Utomo
- PhD, Graduate School of Biomedical Science Master Program, Universitas Yarsi, 10510, Jakarta Pusat, Indonesia And Dharmais Hospital National Cancer Center, 11480, Jakarta, Indonesia
| | - Anik Budhi Dharmayanthi
- PhD, National Research and Innovation Agency Republic of Indonesia, Jalan Raya Bogor KM 46 Cibinong, Bogor 16911, Jawa Barat, Indonesia
| | - Anggia Prasetyoputri
- PhD, National Research and Innovation Agency Republic of Indonesia, Jalan Raya Bogor KM 46 Cibinong, Bogor 16911, Jawa Barat, Indonesia
| | - Ade Andriani
- PhD, National Research and Innovation Agency Republic of Indonesia, Jalan Raya Bogor KM 46 Cibinong, Bogor 16911, Jawa Barat, Indonesia
| | - Hariyatun Hariyatun
- MSc, National Research and Innovation Agency Republic of Indonesia, Jalan Raya Bogor KM 46 Cibinong, Bogor 16911, Jawa Barat, Indonesia
| | - Isa Nuryana
- MSc, National Research and Innovation Agency Republic of Indonesia, Jalan Raya Bogor KM 46 Cibinong, Bogor 16911, Jawa Barat, Indonesia
| | - Syam Budi Iryanto
- MSc, National Research and Innovation Agency Republic of Indonesia, Jalan Raya Bogor KM 46 Cibinong, Bogor 16911, Jawa Barat, Indonesia
| | - Sugiyono Saputra
- PhD, National Research and Innovation Agency Republic of Indonesia, Jalan Raya Bogor KM 46 Cibinong, Bogor 16911, Jawa Barat, Indonesia
| | - Andri Wardiana
- PhD, National Research and Innovation Agency Republic of Indonesia, Jalan Raya Bogor KM 46 Cibinong, Bogor 16911, Jawa Barat, Indonesia
| | - Ratih Asmana Ningrum
- PhD, National Research and Innovation Agency Republic of Indonesia, Jalan Raya Bogor KM 46 Cibinong, Bogor 16911, Jawa Barat, Indonesia
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D’Ambrosi R, Menon PH, Salunke A, Mariani I, Palminteri G, Basile G, Ursino N, Mangiavini L, Hantes M. Octogenarians Are the New Sexagenarians: Cruciate-Retaining Total Knee Arthroplasty Is Not Inferior to Posterior-Stabilized Arthroplasty in Octogenarian Patients. J Clin Med 2022; 11:jcm11133795. [PMID: 35807083 PMCID: PMC9267517 DOI: 10.3390/jcm11133795] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/20/2022] [Accepted: 06/29/2022] [Indexed: 12/22/2022] Open
Abstract
Purpose: The primary goal of this study was to compare survivorship and functional results in individuals aged 80 and over who underwent total knee arthroplasty (TKA) with cruciate-retaining (CR) or posterior-stabilized (PS) implants. Methods: We prospectively analyzed the clinical records of two consecutive cohorts for a total of 96 implants in patients aged 80 years or over. The first cohort consisted of 59 consecutive cemented PS cases, while the second cohort comprised 37 consecutive cemented CR cases. The decision to either perform a PS or CR arthroplasty was taken based on preoperative magnetic resonance imaging and intraoperative findings. The clinical evaluation entailed evaluating each patient’s visual analogue scale for pain (VAS), range of motion (flexion and extension), Knee Society Score (KSS), and Oxford Knee Score (OKS). Each patient was clinically evaluated the day before surgery (T0) and at two consecutive follow-ups at least 1 (T1) and 2 (T2) years after surgery. Implant survival was calculated using the Kaplan−Meier method. Results: Both groups showed statistically significant improvements at each follow-up compared with the preoperative values (p < 0.05). The CR group showed a higher flexion degree at T1 than the PS group (116.14 ± 5.57° versus 113.16 ± 7.66°; p = 0.048). No differences were found between the two groups regarding survival rate (chi-squared test p-value = 0.789). Three failures were noted in the CR group, while there were four in the PS group. Conclusions: This prospective clinical study demonstrates that CR and PS TKA had similar clinical outcomes in octogenarians with regard to knee function, postoperative knee pain, and other complications. Prosthesis survivorship for CR and PS TKA were both satisfactory, and in selected octogenarian patients, CR TKA should always be considered because of the reduced surgical time.
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Affiliation(s)
- Riccardo D’Ambrosi
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (G.P.); (G.B.); (N.U.); (L.M.)
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, 20133 Milan, Italy
- Correspondence: ; Tel.: +39-339-706-6151
| | - Prem Haridas Menon
- Division of Orthopedics and Traumatology, Government Medical College Trivandrum, Kerala University of Health Sciences, Thiruvananthapuram 695011, India;
| | | | - Ilaria Mariani
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, 34137 Trieste, Italy;
| | - Giovanni Palminteri
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (G.P.); (G.B.); (N.U.); (L.M.)
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, 20133 Milan, Italy
| | - Giuseppe Basile
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (G.P.); (G.B.); (N.U.); (L.M.)
| | - Nicola Ursino
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (G.P.); (G.B.); (N.U.); (L.M.)
| | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (G.P.); (G.B.); (N.U.); (L.M.)
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, 20133 Milan, Italy
| | - Michael Hantes
- Department of Orthopaedic Surgery, Faculty of Medicine, University Hospital of Larissa, University of Thessalia, 41110 Larissa, Greece;
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Sebekos K, Guiab K, Stamelos G, Evans T, Siddiqi M, Brigode W, Capron G, Kaminsky M, Bokhari F. Effect of Age Alone on Outcome of Acute Surgical Conditions Among Healthy Patients (Non-smokers, Non-obese, and No Comorbid Conditions). Am Surg 2022:31348221091966. [PMID: 35522891 DOI: 10.1177/00031348221091966] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND The impact of age alone in relation to postoperative outcomes needs to be further elucidated. This study investigated whether increasing age was associated with increased morbidity and mortality for patients with no comorbidities undergoing acute care surgery (ACS). METHODS The 2016-2018 National Surgical Quality Improvement Project database was used to identify adult patients who underwent ACS performed on an urgent/emergent basis. Patients overweight or with pre-existing medical comorbidities were excluded. Patients were divided into age groups in decades. The association between outcomes and the different age groups, other patient characteristics, and perioperative factors was examined by multivariate logistic regression. RESULTS 22,770 patients were identified, of which 73.5% were appendectomies, and 21.6% were open procedures. Increasing age correlated with higher unadjusted complication rates and mortality. Multivariate analyses revealed that compared to patients ≤ 30 years old, mortality was not different for patients 31-60 years old, but it was higher for the age groups > 61 years old. Patients aged 51-60 and from 71 and above were associated with higher risks of complications. Subset analysis on octogenarians revealed a 1.14-fold higher odds of mortality for every year of increasing age. Preoperative risk factors including open procedure, wound class, and American Society of Anesthesiology (ASA) class were also associated with greater risks of mortality in octogenarians. CONCLUSION Patients older than age 50 were at higher risk for postoperative complications, and mortality significantly increased for each decade past 60 years old in healthy individuals.
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Affiliation(s)
| | - Keren Guiab
- 25430John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - George Stamelos
- 25430John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Teresa Evans
- 25430John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Mahwash Siddiqi
- 25430John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - William Brigode
- 25430John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | | | - Matthew Kaminsky
- 25430John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Faran Bokhari
- 25430John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
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Lee HK, Knabl L, Moliva JI, Knabl L, Werner AP, Boyoglu-Barnum S, Kapferer S, Pateter B, Walter M, Sullivan NJ, Furth PA, Hennighausen L. mRNA vaccination in octogenarians 15 and 20 months after recovery from COVID-19 elicits robust immune and antibody responses that include Omicron. Cell Rep 2022; 39:110680. [PMID: 35395191 PMCID: PMC8947943 DOI: 10.1016/j.celrep.2022.110680] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/16/2022] [Accepted: 03/23/2022] [Indexed: 01/20/2023] Open
Abstract
Knowledge about the impact of prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection of the elderly on mRNA vaccination response is needed to appropriately address the demand for additional vaccinations in this vulnerable population. Here, we show that octogenarians, a high-risk population, mount a sustained SARS-CoV-2 spike-specific immunoglobulin G (IgG) antibody response for 15 months following infection. This response boosts antibody levels 35-fold upon receiving a single dose of BNT162b2 mRNA vaccine 15 months after recovery from coronavirus disease 2019 (COVID-19). In contrast, antibody responses in naive individuals boost only 6-fold after a second vaccine. Spike-specific angiotensin-converting enzyme 2 (ACE2) antibody binding responses in the previously infected octogenarians following two vaccine doses exceed those found in a naive cohort after two doses. RNA sequencing (RNA-seq) demonstrates activation of interferon-induced genetic programs, which persist only in the previously infected. A preferential increase of specific immunoglobulin G heavy chain variable (IGHV) clonal transcripts that are the basis of neutralizing antibodies is observed only in the previously infected nuns.
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Affiliation(s)
- Hye Kyung Lee
- National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
| | | | - Juan I Moliva
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | | | - Anne P Werner
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Seyhan Boyoglu-Barnum
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | | | | | - Mary Walter
- Clinical Core, National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, MD 20892, USA
| | - Nancy J Sullivan
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Priscilla A Furth
- Departments of Oncology & Medicine, Georgetown University, Washington, DC, USA.
| | - Lothar Hennighausen
- National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
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Abstract
Aims: With increasing life expectancy and ageing population, more octogenarians would benefit from total knee arthroplasty (TKA). The aim of this study is to evaluate the survivorship of TKA in octogenarian and their long-term outcomes. Methods: This was a retrospective review of 67 patients aged above 80 years who had primary TKA performed between 2005 and 2013 at a single centre. A sex-matched younger cohort of 67 primary TKAs during the same time-period was recruited for control. Five and 10-year survival was calculated. Pre- and peri-operative factors were collected and compared. Post-operative range of motion, Knee Society Score (KSS) and Function Score (KFS) were collected and compared. Rate of revision, infection, aseptic loosening and mortality was collected. Results: The mean follow-up period was 10.39 ± 2.29 years. The 5- and 10-year survival of octogenarian group was 85.1% and 54.6%, respectively. Pre- and peri-operative factors between the octogenarian and control groups were comparable (p > 0.05). Both groups showed improvement in range of motion, KSS and KFS post-operatively. Rate of revision, aseptic loosening and deep infection was 0% in octogenarian and 1.5% in control group. Conclusion: TKA can be performed in patients with age above 80 years old with comparable post-op knee range, complication rate and long-term functional score. Advanced age should not be a limiting factor for TKA.
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Affiliation(s)
- Rex Wang-Fung Mak
- Department of Orthopaedics and Traumatology, 13621Prince of Wales Hospital, Shatin, Hong Kong
| | - Wai-Wang Chau
- Department of Orthopaedics and Traumatology, 26451Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kwong-Yin Chung
- Department of Orthopaedics and Traumatology, 13621Prince of Wales Hospital, Shatin, Hong Kong
| | - Kwok-Hing Chiu
- Department of Orthopaedics and Traumatology, 13621Prince of Wales Hospital, Shatin, Hong Kong
| | - Kevin Ki-Wai Ho
- Department of Orthopaedics and Traumatology, 26451Chinese University of Hong Kong, Shatin, Hong Kong
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Davis KP, Kompelli A, Gardner JR, Mohler S, Gammill S, King D, Vural E, Sunde J, Moreno MA. Postoperative and 1-Year Functional Outcomes After Free Flap Surgery Among Patients 80 Years or Older. Otolaryngol Head Neck Surg 2022; 167:41-47. [PMID: 35290129 DOI: 10.1177/01945998221083592] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the postoperative and 1-year functional outcomes after free flap surgery among patients ≥80 years old. STUDY DESIGN Retrospective chart review. SETTING Single tertiary care center. METHODS We conducted a retrospective review of 596 patients who underwent head and neck ablation and reconstruction with free tissue over a 7-year period. Patients ≥80 years of age were included. RESULTS Fifty patients were ≥80 years old, with an average age of 83.7 years. Ninety-day mortality was 12.0%, and those who died were of older age (87.5 vs 83.1 years, P = .036). Prior radiation therapy (odds ratio, 6.8 [95% CI, 1.1-42.7]) and a Charlson Comorbidity Index ≥3 (odds ratio, 10.0 [95% CI, 1.5-67.0]) were associated with an increased risk of 90-day mortality. Overall 21 (42.0%) patients experienced a 30-day complication; 7 (14.0%) were readmitted within 30 days; and 5 (10.0%) underwent additional flap-related operations. Flap failure occurred in 2 (4.0%) patients. Before surgery, 45 (90%) patients were living independently or within assisted living; among these, 19.5% declined to dependent functional status at 90-day follow-up. At 90 days, 2 (8.3%) of 24 patients remained tracheostomy dependent, and 20 (66.7%) of 30 patients required feeding tube supplementation. Among 42 patients, 36 (85.7%) had unrestricted or modified oral diets at 90 days. Charlson Comorbidity Index ≥2 was associated with an increased risk of 1-year mortality (odds ratio, 5.1 [95% CI, 1.4-18.6]). CONCLUSION The potential for functional decline and risk of 90-day mortality should be discussed with patients aged ≥80 years.
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Affiliation(s)
- Kyle P Davis
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Anvesh Kompelli
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - James Reed Gardner
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Samantha Mohler
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sarah Gammill
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Deanne King
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Emre Vural
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jumin Sunde
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mauricio Alejandro Moreno
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Srinath H, Kim TJ, Mor IJ, Warner RE. Robot-Assisted vs Laparoscopic Right Hemicolectomy in Octogenarians. J Am Med Dir Assoc 2022; 23:690-694. [PMID: 35247356 DOI: 10.1016/j.jamda.2022.01.080] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE With increasing age, there is greater need for right-sided colonic resections than its left-sided counterparts. Older age is associated with limited physical and functional status, which carries greater operative risk. Improvements in robotic surgery questions its role, especially in older adults, compared with laparoscopy. The objective is to investigate whether robotic right hemicolectomy (RRH) is as safe and effective as laparoscopic right hemicolectomy (LHR) in octogenarians (age >80 years). DESIGN Retrospective cross-sectional analysis. SETTINGS AND PARTICIPANTS Octogenarians who underwent elective RRH and LRH by the Tweed Colorectal Group over 5 years. METHODS Complications within 30 days, age, gender, smoking status, immunocompromised status, presence of diabetes, American Society of Anesthesiologists (ASA) physical status score, preoperative Eastern Cooperative Oncology Group (ECOG) performance status, mFI-5 (modified frailty index), operative time, method of anastomosis, postoperative length of stay (LOS), need for rehabilitation, and short-term oncologic data using the TNM criteria were compared using univariate and multivariate analysis. RESULTS Seventy-eight elective patients were included. LRH and RRH groups had similar median ages, gender distribution, and comorbidities. Across the entire cohort, 61.5% had no 30-day complications. RRH had nonsignificantly shorter operative time but significantly shorter LOS (5 vs 8 days) and fewer minor complications (24.5% vs 34.5%). Major complications and overall complications were not significantly different between the groups. Lower ASA and ECOG status were associated with lower complication rates across both groups. Oncologic resection outcomes were similar for both approaches. CONCLUSIONS AND IMPLICATIONS RRH does not confer an increased risk of complications compared to LRH in the octogenarians and may be a viable alternative in the field of minimally invasive surgery for older patients. Future research should focus on intracorporeal anastomoses, as it is a potential confounder leading to the shorter inpatient LOS shown in our robotic group.
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Affiliation(s)
- Havish Srinath
- Department of Colorectal Surgery, The Tweed Hospital, Tweed Heads, New South Wales, Australia; Department of Colorectal Surgery, John Flynn Private Hospital, Tugun, Queensland, Australia.
| | - Tae-Jun Kim
- Department of Colorectal Surgery, The Tweed Hospital, Tweed Heads, New South Wales, Australia
| | - Isabella J Mor
- Department of Colorectal Surgery, The Tweed Hospital, Tweed Heads, New South Wales, Australia; Department of Colorectal Surgery, John Flynn Private Hospital, Tugun, Queensland, Australia
| | - Ross E Warner
- Department of Colorectal Surgery, The Tweed Hospital, Tweed Heads, New South Wales, Australia; Department of Colorectal Surgery, John Flynn Private Hospital, Tugun, Queensland, Australia
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Nakai Y, Yamada T, Ogawa S, Kamiya S, Saitoh Y, Suda H. Surgical outcomes of acute type A aortic dissection in septuagenarians and octogenarians. Asian Cardiovasc Thorac Ann 2022; 30:772-778. [PMID: 35234053 DOI: 10.1177/02184923221083369] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND We studied surgical outcomes of acute type A aortic dissection and compared early and late outcomes between septuagenarians and octogenarians. METHODS From 2010 to 2019, we evaluated 254 consecutive patients with acute type A aortic dissection. We performed emergent operations within 48 h of symptom onset for 188 patients, including 59 septuagenarians and 32 octogenarians. RESULTS The overall 30-day mortality rate was 8.5% in septuagenarians and 9.4% in octogenarians (p = 1.0). The hospital mortality rate was 10.2% in septuagenarians and 12.5% in octogenarians (p = 0.74). Multivariate analysis identified prolonged ventilation (≥ 72 h) as a significant risk factor for hospital mortality. Being an octogenarian was not significantly associated with hospital mortality. The actuarial survival rate at 5 years was 80.1% in septuagenarians and 58.5% in octogenarians (log-rank p = 0.09). The freedom from aortic event rate at 5 years was 91.0% in septuagenarians and 100% in octogenarians (log-rank p = 0.23). CONCLUSION The two groups showed no significant differences in hospital mortality or morbidity. Our tear-oriented strategies might be appropriate for both septuagenarians and octogenarians. Prolonged ventilation (≥ 72 h) was a significant risk predictor for hospital mortality.
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Affiliation(s)
- Yosuke Nakai
- Department of Cardiovascular Surgery, 38386Nagoya City University Graduate School of Medical Sciences, Japan
| | - Toshiyuki Yamada
- Department of Cardiovascular Surgery, 38386Nagoya City University Graduate School of Medical Sciences, Japan
| | - Shinji Ogawa
- Department of Cardiovascular Surgery, 38386Nagoya City University Graduate School of Medical Sciences, Japan
| | - Shinji Kamiya
- Department of Cardiovascular Surgery, 38386Nagoya City University Graduate School of Medical Sciences, Japan
| | - Yuhei Saitoh
- Department of Cardiovascular Surgery, 38386Nagoya City University Graduate School of Medical Sciences, Japan
| | - Hisao Suda
- Department of Cardiovascular Surgery, 38386Nagoya City University Graduate School of Medical Sciences, Japan
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Chen JW, Sainbayar N, Hsu RB. Outcome of emergency surgery for acute type A aortic dissection in octogenarians. J Card Surg 2022; 37:610-615. [PMID: 34996133 DOI: 10.1111/jocs.16219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/04/2021] [Accepted: 11/27/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Emergency surgery for acute type A aortic dissection (AAAD) was usually avoided or denied in octogenarians because of high surgical mortality. Refined surgical techniques and improved postoperative care have led to an improved in-hospital outcome. However, a significant number of operative survivors suffered from postoperative complications and had compromised quality of life. We sought to assess the clinical outcome of emergency surgery using a standard conservative approach in octogenarians with AAAD. METHODS From 2004 to 2021, 123 patients underwent emergency surgery for AAAD by one surgeon using a standard conservative approach with right subclavian artery cannulation, no aortic cross-clamp, selective antegrade cerebral perfusion, moderate systemic hypothermia, reinforced sandwich technique, and a strategy of limited aortic resection. Hospital and late outcomes were assessed in patients with age >80 years. RESULTS Eighteen patients (15%) were octogenarians with seven males (39%) and median age of 82 years (range, 80-89). Hypertension was present in six patients (33%). None had diabetes mellitus, Marfan, or bicuspid aortic valve. Dissection was intramural hematoma in six (33%) and DeBakey type I in 15 patients (83%). Cardiac tamponade with shock was present in seven patients (39%). Ascending aortic grafting was performed in 17 patients, and additional hemiarch replacement in one patient. The hospital mortality rate was 17% (3/18). Fourteen patients (82%) were alive and well at discharge. CONCLUSIONS Emergency surgery for AAAD using a standard conservative approach showed an improved outcome in octogenarians. The majority of patients could return home with an acceptable living.
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Affiliation(s)
- Jeng-Wei Chen
- Department of Surgery, Division of Cardiovascular Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Nyamsuren Sainbayar
- Department of Cardiovascular Surgery, Third State Central Hospital, Ulan Bator, Mongolia
| | - Ron-Bin Hsu
- Department of Surgery, Division of Cardiovascular Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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Fornæss KM, Nome PL, Aakre EK, Hegvik T, Jammer I. Clinical frailty scale: Inter-rater reliability of retrospective scoring in emergency abdominal surgery. Acta Anaesthesiol Scand 2022; 66:25-29. [PMID: 34425015 DOI: 10.1111/aas.13974] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/10/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Frailty is a complex syndrome shown to be an independent predictor of morbidity and mortality after surgery in older patients. Frailty scoring may, therefore, be important, for example, for pre-operative risk assessment and prognosis estimation. The Clinical Frailty Scale (CFS) has been developed to help operationalize frailty in the individual patient. However, the inter-rater reliability of retrospective CFS scoring through patient records by health care personnel is currently unknown in patients over 80 years of age undergoing emergency abdominal surgery. METHODS Retrospective review of electronic patient journal of 112 patients over 80 years of age undergoing emergency abdominal surgery between 2015 and 2016. Three researchers individually assigned each patient a CFS score. The inter-rater reliability was assessed using Cohen's weighted kappa for the comparison of pairs of assessors, as well as Kendall's coefficient of concordance for the comparison of all three raters simultaneously. RESULTS The agreement across raters was strong, with Cohen's kappa values ranging between 0.74 and 0.85 and a Kendall's coefficient of concordance of 0.86. CONCLUSIONS The inter-rater reliability of assigned CFS from patient journals seems acceptable. This could permit retrospective research utilizing CFS measures from several raters and across centers.
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Affiliation(s)
| | - Pia L. Nome
- Department of Clinical Medicine University of Bergen Bergen Norway
| | - Elin Kismul Aakre
- Department of Clinical Medicine University of Bergen Bergen Norway
- Department of Anaesthesia and Intensive Care Haukeland University Hospital Bergen Norway
| | - Tor‐Arne Hegvik
- Department of Biomedicine University of Bergen Bergen Norway
- Department of Breast and Endocrine Surgery Haukeland University Hospital Bergen Norway
| | - Ib Jammer
- Department of Anaesthesia and Intensive Care Haukeland University Hospital Bergen Norway
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Courage O, Strom L, van Rooij F, Lalevée M, Heuzé D, Papin PE, Butnaru M, Müller JH. Higher rates of surgical and medical complications and mortality following TKA in patients aged ≥ 80 years: a systematic review of comparative studies. EFORT Open Rev 2021; 6:1052-1062. [PMID: 34909224 PMCID: PMC8631241 DOI: 10.1302/2058-5241.6.200150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The purpose of this systematic review was to synthesize studies published since the last systematic review in 2015 that compare outcomes of primary total knee arthroplasty (TKA) in older patients (≥ 80 years) and in younger patients (< 80 years), in terms of complication rates and mortality. An electronic literature search was conducted using PubMed, Embase®, and Cochrane Register. Studies were included if they compared outcomes of primary TKA for osteoarthritis in patients aged 80 years and over to patients aged under 80 years, in terms of complication rates, mortality, or patient-reported outcomes (PROs). Thirteen studies were eligible. Surgical complications in older patients ranged from 0.6–21.1%, while in younger patients they ranged from 0.3–14.6%. Wound complications in older patients ranged from 0.5–20%, while in younger patients they ranged from 0.8–22.0%. Medical complications (cardiac, respiratory, thromboembolic) in older patients ranged from 0.4–17.3%, while in younger patients they ranged from 0.2–11.5%. Mortality within 90 days in older patients ranged between 0–2%, while in younger patients it ranged between 0.0–0.03%. Compared to younger patients, older patients have higher rates of surgical and medical complications, as well as higher mortality following TKA. The literature also reports greater length of stay for older patients, but inconsistent findings regarding PROs. The present findings provide surgeons and older patients with clearer updated evidence, to make informed decisions regarding TKA, considering the risks and benefits within this age group. Patients aged over 80 years should therefore not be excluded from consideration for primary TKA based on age alone.
Cite this article: EFORT Open Rev 2021;6:1052-1062. DOI: 10.1302/2058-5241.6.200150
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Affiliation(s)
| | | | | | - Matthieu Lalevée
- Ramsay Santé, Hopital Prive de l'Estuaire, LeHavre, France.,Hôpital Charles Nicolle, CHU de Rouen, Rouen, France
| | - Donatien Heuzé
- Ramsay Santé, Hopital Prive de l'Estuaire, LeHavre, France.,Hôpital Charles Nicolle, CHU de Rouen, Rouen, France
| | - Pierre Emanuel Papin
- Ramsay Santé, Hopital Prive de l'Estuaire, LeHavre, France.,Hôpital Charles Nicolle, CHU de Rouen, Rouen, France
| | - Michael Butnaru
- Ramsay Santé, Hopital Prive de l'Estuaire, LeHavre, France.,Hôpital Charles Nicolle, CHU de Rouen, Rouen, France
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Robinson JN, Davis JMK, Pickens RC, Cochran AR, King L, Salibi P, Iannitti DA, Martinie JB, Baker EH, Ocuin LM, Vrochides D. Enhanced Recovery After Surgery ® in Octogenarians Undergoing Hepatopancreatobiliary Surgery. Am Surg 2021:31348211054063. [PMID: 34866406 DOI: 10.1177/00031348211054063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/16/2022]
Abstract
Advances in perioperative care have increased the frequency of surgical intervention performed on the very elderly (≥80 years). This study aims to investigate the impact of Enhanced Recovery After Surgery (ERAS) on outcomes for octogenarians after major hepatopancreatobiliary (HPB) surgery. Patients ≥80 years old in a single HPB ERAS program (September 2015-July 2018) were prospectively tracked in the ERAS Interactive Audit System (EIAS). Postoperative length of stay (LOS) as well as 30-day major complications, readmissions, and mortality were compared to a pre-ERAS octogenarian control. Since ERAS implementation, octogenarians comprised 7.3% (27 of 370) of patients who underwent pancreaticoduodenectomy (n=17), distal pancreatectomy (n=7), or hepatectomy (n=3). Thirty-day readmissions decreased after ERAS implementation (50% to 15%, P=.037). Thirty-day major complications, mortality, and LOS were similar with 64% median protocol compliance. ERAS for octogenarians in HPB surgery is safe and may contribute to more sustainable recovery resulting in reduced readmissions.
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Affiliation(s)
- Jordan N Robinson
- Division of HPB Surgery, Department of Surgery, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Joshua M K Davis
- Division of HPB Surgery, Department of Surgery, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Ryan C Pickens
- Division of HPB Surgery, Department of Surgery, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Allyson R Cochran
- Carolinas Center for Surgical Outcomes Science, Department of Surgery, 22442Carolinas Medical Center, 2351Atrium Health, Charlotte, NC, USA
| | - Lacey King
- Division of HPB Surgery, Department of Surgery, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Patrick Salibi
- Division of HPB Surgery, Department of Surgery, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - David A Iannitti
- Division of HPB Surgery, Department of Surgery, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - John B Martinie
- Division of HPB Surgery, Department of Surgery, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Erin H Baker
- Division of HPB Surgery, Department of Surgery, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Lee M Ocuin
- Division of HPB Surgery, Department of Surgery, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Dionisios Vrochides
- Division of HPB Surgery, Department of Surgery, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
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Ogawa T, Schermann H, Kobayashi H, Fushimi K, Okawa A, Jinno T. Age and clinical outcomes after hip fracture surgery: do octogenarian, nonagenarian and centenarian classifications matter? Age Ageing 2021; 50:1952-1960. [PMID: 34228781 DOI: 10.1093/ageing/afab137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/12/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND older patients with hip fractures are arbitrarily classified as octogenarians, nonagenarians and centenarians. We have designed this study to quantify in-hospital mortality and complications among each of these groups. We hypothesised that the associations between age and in-hospital mortality and complications are continuously increasing, and that these risks increase rapidly when patients reach a certain age. METHODS this research is a retrospective cohort study using nationwide database between 2010 and 2018. Patients undergoing hip fracture surgery, and aged 60 or older, were included. The associations between patient age, in-hospital mortality and complications were visualised using the restricted cubic spline models, and were analysed employing multivariable regression models. Then, octogenarians, nonagenarians and centenarians were compared. RESULTS among a total of 565,950 patients, 48.7% (n = 275,775) were octogenarians, 23.0% (n = 129,937) were nonagenarians and 0.7% (n = 4,093) were centenarians. The models presented three types of association between age, in-hospital mortality and complications: (i) a continuous increase (mortality and respiratory complications); (ii) a mild increase followed by a steep rise (intensive care unit admission, heart failure, renal failure and surgical site hematoma) and (iii) a steep increase followed by a limited change (coronary heart disease, stroke and pulmonary embolisms). CONCLUSION we identified three types of association between age and clinical outcomes. Patients aged 85-90 may constitute the upper threshold for age categorisations, because the risk of in-hospital complications changed dramatically at that stage. This information can improve clinical awareness of various complications and support collective decision-making.
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Affiliation(s)
- Takahisa Ogawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Haggai Schermann
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Hiroki Kobayashi
- Department of Medicine, Harvard Medical School, Section on Genetics and Epidemiology, Research Division, Joslin Diabetes Center, Boston, USA
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedic Surgery, Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
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Goh GS, Corvi JJ, Grace TR, Eralp I, Small I, Lonner JH. Octogenarians Undergoing Medial Unicompartmental Knee Arthroplasty Have Similar Patient-Reported Outcomes as Their Younger Counterparts. J Arthroplasty 2021; 36:3656-3661. [PMID: 34226083 DOI: 10.1016/j.arth.2021.06.014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/09/2021] [Accepted: 06/16/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND As a procedure with lower surgical morbidity, unicompartmental knee arthroplasty (UKA) may present a practical solution for elderly patients with unicompartmental arthritis. However, few studies have analyzed the results of UKA in the extreme elderly. This study compared the functional and perioperative outcomes between octogenarians and age-appropriate controls undergoing UKA. METHODS Prospectively collected data of 44 patients aged ≥80 years who underwent unilateral UKA were analyzed. Each octogenarian was matched 1:3 with 132 patients aged 65-74 years using propensity scores adjusting for gender, body mass index, Charlson comorbidity index, and preoperative scores. Knee Injury and Osteoarthritis Outcome Score for Joint Replacement and Short Form-12 were collected preoperatively and 2 years postoperatively. Complications, reoperations, readmissions, and unplanned visits were recorded up to 1 year postoperatively. RESULTS The mean age was 70.0 ± 2.7 years in the control group and 83.0 ± 3.0 years in the octogenarian group (P < .001). The percentage of outpatient procedures was comparable (control 50.0%; octogenarian 45.5%; P = .601). With the exception of poorer Short Form-12 physical scores in octogenarians at 2 years (39.4 ± 14.1 vs 44.9 ± 9.2, P = .028), there was no difference in final postoperative scores or improvement in scores between the groups. The rate of complications, reoperations, readmissions, and emergency room visits was also similar. The five-year survivorship was 97% in the control group and 93% in the octogenarian group (P = .148). CONCLUSION Octogenarians undergoing UKA can experience clinical outcomes that are similar to those of their younger counterparts. The clinical trajectory outlined may help clinicians provide valuable prognostic information to elderly patients and guide preoperative counseling.
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Affiliation(s)
- Graham S Goh
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - John J Corvi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Trevor R Grace
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Ipek Eralp
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Ilan Small
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Jess H Lonner
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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Kitamura H, Tamaki M, Kawaguchi Y, Okawa Y. Results of off-pump coronary artery bypass grafting with off-pump first strategy in octogenarian. J Card Surg 2021; 36:4611-4616. [PMID: 34613636 PMCID: PMC9291825 DOI: 10.1111/jocs.16055] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022]
Abstract
Background and Aim Ischemic heart disease is the leading cause of death around the world. Coronary artery bypass grafting offers efficient surgical revascularization for ischemic disease. Both on‐ or off‐pump coronary artery bypass methods provide promising results to octogenarians, once complete vascularization is achieved. However, off‐pump bypass requires a certain level of experience to achieve sufficient results. We have applied an off‐pump coronary artery bypass‐first strategy to all generations since 2008. This study investigated early and long‐term results of surgical revascularization for octogenarians by a team with an off‐pump‐first strategy. Methods All cases of isolated coronary artery bypass grafting performed since 2008 were identified and divided into a young group (age < 80 years) and an old group (age ≥ 80 years). Peri‐operative results were investigated retrospectively in both groups and long‐term results for the old group were assessed. Results Among the 707 patients, 97% underwent off‐pump bypass, and 94 cases were classified to the old group. Distal anastomoses and ventilator time were identical between groups (young vs. old: 3.3 vs. 3.2; 3.7 h vs. 3.7 h). In‐hospital death rates were 0.5% and 0% in the young and old groups, respectively. With a mean follow‐up of 1318 days, actual 1‐, 3‐, and 5‐year survival rates for octogenarians were 92.1%, 81.2%, and 68.3%, respectively. Nearly half of the patients reached their nineties, which was close to the life expectancy of the national general octogenarian. Conclusions An experienced team with an off‐pump‐first strategy could provide valid therapeutic options for octogenarians.
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Affiliation(s)
- Hideki Kitamura
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Mototsugu Tamaki
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Yasuhiko Kawaguchi
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan
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Carney J, Gerlach E, Plantz MA, Cantrell C, Swiatek PR, Marx JS, Marra G. Short-Term Outcomes After Total Shoulder Arthroplasty in Octogenarians: A Matched Analysis. Cureus 2021; 13:e16441. [PMID: 34422472 PMCID: PMC8367019 DOI: 10.7759/cureus.16441] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Studies have shown that the use of total shoulder arthroplasty is increasing every year in the United Stated at a rate higher than that of total hip or total knee arthroplasty. As the population of the United States continues to age, it is becoming more important for surgeons to understand the true impact of age on outcomes and complications following procedures such a total shoulder arthroplasty. The purpose of this study was to determine if octogenarians have poorer outcomes after total shoulder arthroplasty compared to a younger, matched control group. Methods Data was obtained through the American College of Surgeons National Surgical Quality Improvement Program database (ACS NSQIP). Patients who had undergone total shoulder arthroplasty were identified by Current Procedural Terminology code (23472). Indication for arthroplasty was determined by ICD9/10 code (osteoarthritis, fracture, other). Each octogenarian was matched 1:1 to a non-octogenarian based on sex, BMI, ASA class, medical comorbidities, functional status, and surgical indication for arthroplasty by propensity scoring. A subgroup analysis was performed to compare outcomes between only those patients who underwent TSA for osteoarthritis.Outcomes of interest were assessed between the two groups for statistical significance using a chi-squared test or fisher exact test for expected values of less than 5. Statistical significance was set at p<0.05. Results After matching, octogenarians were found to be at higher risk of readmission (4.7% vs. 3.3%, p=0.046), non-home discharge (27.1% vs. 9.4%, p<0.001), and overall surgical (4.4% vs. 2.5%, p=0.006) and medical complications (3.7% vs. 2.4%, p=0.039). In the setting of TSA for osteoarthritis only, however, octogenarians were only at higher risk for non-home discharge (22.4% vs. 7.5%, p<0.001). Conclusions Octogenarians are at higher risk of some complications following total shoulder arthroplasty but fewer than has been previously reported, particularly in the setting of arthroplasty for the treatment of arthritis.
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Affiliation(s)
- John Carney
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Erik Gerlach
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Mark A Plantz
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Colin Cantrell
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Peter R Swiatek
- Department of Orthopaedic Surgery, Northwestern Memorial Hospital, Chicago, USA
| | - Jeremy S Marx
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Guido Marra
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
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50
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Bruno RR, Wernly B, Mamandipoor B, Rezar R, Binnebössel S, Baldia PH, Wolff G, Kelm M, Guidet B, De Lange DW, Dankl D, Koköfer A, Danninger T, Szczeklik W, Sigal S, van Heerden PV, Beil M, Fjølner J, Leaver S, Flaatten H, Osmani V, Jung C. ICU-Mortality in Old and Very Old Patients Suffering From Sepsis and Septic Shock. Front Med (Lausanne) 2021; 8:697884. [PMID: 34307423 PMCID: PMC8299710 DOI: 10.3389/fmed.2021.697884] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/11/2021] [Indexed: 01/09/2023] Open
Abstract
Purpose: Old (>64 years) and very old (>79 years) intensive care patients with sepsis have a high mortality. In the very old, the value of critical care has been questioned. We aimed to compare the mortality, rates of organ support, and the length of stay in old vs. very old patients with sepsis and septic shock in intensive care. Methods: This analysis included 9,385 patients, from the multi-center eICU Collaborative Research Database, with sepsis; 6184 were old (aged 65–79 years), and 3,201 were very old patients (aged 80 years and older). A multi-level logistic regression analysis was used to fit three sequential regression models for the binary primary outcome of ICU mortality. A sensitivity analysis in septic shock patients (n = 1054) was also conducted. Results: In the very old patients, the median length of stay was shorter (50 ± 67 vs. 56 ± 72 h; p < 0.001), and the rate of a prolonged ICU stay was lower (>168 h; 9 vs. 12%; p < 0.001) than the old patients. The mortality from sepsis was higher in very old patients (13 vs. 11%; p = 0.005), and after multi-variable adjustment being very old was associated with higher odds for ICU mortality (aOR 1.32, 95% CI 1.09–1.59; p = 0.004). In patients with septic shock, mortality was also higher in the very old patients (38 vs. 36%; aOR 1.50, 95% CI 1.10–2.06; p = 0.01). Conclusion: Very old ICU-patients suffer from a slightly higher ICU mortality compared with old ICU-patients. However, despite the statistically significant differences in mortality, the clinical relevance of such minor differences seems to be negligible.
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Affiliation(s)
- Raphael Romano Bruno
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Bernhard Wernly
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria.,Center for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, Salzburg, Austria.,Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | | | - Richard Rezar
- Center for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Stephan Binnebössel
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Philipp Heinrich Baldia
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Georg Wolff
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Bertrand Guidet
- Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.,INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, Netherlands
| | - Daniel Dankl
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Andreas Koköfer
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Thomas Danninger
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Wojciech Szczeklik
- Intensive Care and Perioperative Medicine Division, Jagiellonian University Medical College, Kraków, Poland
| | - Sviri Sigal
- Medical Intensive Care Unit, Hadassah University Hospital, Jerusalem, Israel
| | | | - Michael Beil
- Medical Intensive Care Unit, Hadassah University Hospital, Jerusalem, Israel
| | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Susannah Leaver
- Research Lead Critical Care Directorate St George's Hospital, London, United Kingdom
| | - Hans Flaatten
- Department of Intensive Care, Anesthesia and Surgical Services, Haukeland University Hospital Bergen, Bergen, Norway
| | - Venet Osmani
- Fondazione Bruno Kessler Research Institute, Trento, Italy
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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