Age-adjusted Charlson Comorbidity Index Research Articles

Enhancing surgical outcomes in elderly gastric cancer patients: the role of comprehensive preoperative assessment and support

BackgroundAs the prevalence of gastric cancer rises in aging populations, managing surgical risks and comorbidities in elderly patients presents a unique challenge. The Comprehensive Preoperative Assessment and Support (CPAS) program, through comprehensive preoperative assessments, aims to mitigate surgical stress and improve outcomes by enhancing patient awareness and preparation. This study investigates the efficacy of a CPAS program, incorporating frailty and sarcopenia evaluations, to improve short-term outcomes in elderly gastric cancer patients.MethodsA retrospective analysis was conducted on 127 patients aged 75 or older who underwent surgery with CPAS between 2018 and August 2023, compared to 170 historical controls from 2012 to 2017. Propensity score matching balanced both groups based on age-adjusted Charlson Comorbidity Index and surgical details. The primary focus was on the impact of CPAS elements such as rehabilitation, nutrition, psychological support, oral frailty, and social support on short-term surgical outcomes.ResultsAmong 83 matched pairs, the CPAS group, despite 40.4% of patients in the CPAS group and 21.2% in the control group had an ASA-PS score of 3 or higher (P < 0.001), demonstrated significantly reduced blood loss (100 ml vs. 190 ml, P = 0.026) and lower incidence of serious complications (19.3% vs. 33.7%, P = 0.034), especially in infections and respiratory issues. Sarcopenia was identified in 38.6% of CPAS patients who received tailored support. Additionally, the median postoperative hospital stay was notably shorter in the CPAS group (10 days vs. 15 days, P < 0.001), with no in-hospital deaths. These results suggest that personalized preoperative care effectively mitigates operative stress and postoperative complications.ConclusionImplementing CPAS significantly enhances surgical safety and reduces complication rates in elderly gastric cancer patients, emphasizing the critical role of personalized preoperative care in surgical oncology for this demographic.

Proof-of-concept for an automatable mortality prediction scoring in hospitalised older adults

IntroductionIt is challenging to prognosticate hospitalised older adults. Delayed recognition of end-of-life leads to failure in delivering appropriate palliative care and increases healthcare utilisation. Most mortality prediction tools specific for older adults require additional manual input, resulting in poor uptake. By leveraging on electronic health records, we aim to create an automatable mortality prediction tool for hospitalised older adults.MethodsWe retrospectively reviewed electronic records of general medicine patients ≥75 years at a tertiary hospital between April–September 2021. Demographics, comorbidities, ICD-codes, age-adjusted Charlson Comorbidity Index (CCI), Hospital Frailty Risk Score, mortality and resource utilization were collected. We defined early deaths, late deaths and survivors as patients who died within 30 days, 1 year, and lived beyond 1 year of admission, respectively. Multivariate logistic regression analyses were adjusted for age, gender, race, frailty, and CCI. The final prediction model was created using a stepwise logistic regression.ResultsOf 1,224 patients, 168 (13.7%) died early and 370 (30.2%) died late. From adjusted multivariate regression, risk of early death was significantly associated with ≥85 years, intermediate or high frail risk, CCI &amp;gt; 6, cardiovascular risk factors, AMI and pneumonia. For late death, risk factors included ≥85 years, intermediate frail risk, CCI &amp;gt;6, delirium, diabetes, AMI and pneumonia. Our mortality prediction tool which scores 1 point each for age, pneumonia and AMI had an AUC of 0.752 for early death and 0.691 for late death.ConclusionOur mortality prediction model is a proof-of-concept demonstrating the potential for automated medical alerts to guide physicians towards personalised care for hospitalised older adults.

The cementless taper wedge vs. fit-and-fill stem in primary total hip arthroplasty: risk of stem-related complication differs across Dorr types.

The choice between a cementless taper wedge stem and a fit-and-fill stem in total Hip arthroplasty (THA) for various proximal femoral morphological types has not been thoroughly evaluated. This study aimed to compare the risk of stem-related complications between these two stem types in Dorr type A, B, and C femurs. From January 2015 through April 2021, we retrospectively reviewed 1995 cementless THA procedures. We stratified all procedures into three groups: Dorr type A (N = 360, 18.0%), B (N = 1489, 74.7%) and C (N = 146, 7.3%). The primary outcome domain was stem-related complications, including stem subsidence ≥ 3mm, intraoperative fracture, periprosthetic fracture and aseptic stem loosening. We performed multivariate regression analysis to compare the risk of stem-related complication between the two stem types. Other factors included age, sex, body mass index, diagnosis, age-adjusted Charlson comorbidity index, stem alignment and canal fill ratio. The incidence of stem-related complications in the taper wedge and fit-and-fill stem groups was 4.4% (N = 15) and 6.5% (N = 107), respectively. Fit-and-fill stems showed an increased risk of stem-related complications (aOR: 9.903, 95% CI: 1.567-62.597) only in Dorr type C femurs. No significant difference in risk was observed in Dorr type A and B femurs. Furthermore, the canal fill ratio at the lesser trochanter, 2cm and 7cm below the lesser trochanter, did not exhibit an association with stem-related complications in any Dorr type. Concerning the risk of stem-related complications, the taper wedge stem was a better choice in Dorr type C femurs. However, there was no difference in risk between the taper wedge stem and fit-and-fill stem in Dorr type A and B femurs.

Age-adjusted Charlson comorbidity index is associated with the risk of osteoporosis in older fall-prone men: a retrospective cohort study

BackgroundThere is growing evidence linking the age-adjusted Charlson comorbidity index (aCCI), an assessment tool for multimorbidity, to fragility fracture and fracture-related postoperative complications. However, the role of multimorbidity in osteoporosis has not yet been thoroughly evaluated. We aimed to investigate the association between aCCI and the risk of osteoporosis in older adults at moderate to high risk of falling.MethodsA total of 947 men were included from January 2015 to August 2022 in a hospital in Beijing, China. The aCCI was calculated by counting age and each comorbidity according to their weighted scores, and the participants were stratified into two groups by aCCI: low (aCCI < 5), and high (aCCI ≥5). The Kaplan Meier method was used to assess the cumulative incidence of osteoporosis by different levels of aCCI. The Cox proportional hazards regression model was used to estimate the association of aCCI with the risk of osteoporosis. Receiver operating characteristic (ROC) curve was adapted to assess the performance for aCCI in osteoporosis screening.ResultsAt baseline, the mean age of all patients was 75.7 years, the mean BMI was 24.8 kg/m2, and 531 (56.1%) patients had high aCCI while 416 (43.9%) were having low aCCI. During a median follow-up of 6.6 years, 296 participants developed osteoporosis. Kaplan–Meier survival curves showed that participants with high aCCI had significantly higher cumulative incidence of osteoporosis compared with those had low aCCI (log-rank test: P < 0.001). When aCCI was examined as a continuous variable, the multivariable-adjusted model showed that the osteoporosis risk increased by 12.1% (HR = 1.121, 95% CI 1.041–1.206, P = 0.002) as aCCI increased by one unit. When aCCI was changed to a categorical variable, the multivariable-adjusted hazard ratios associated with different levels of aCCI [low (reference group) and high] were 1.00 and 1.557 (95% CI 1.223–1.983) for osteoporosis (P < 0.001), respectively. The aCCI (cutoff ≥5) revealed an area under ROC curve (AUC) of 0.566 (95%CI 0.527–0.605, P = 0.001) in identifying osteoporosis in older fall-prone men, with sensitivity of 64.9% and specificity of 47.9%.ConclusionsThe current study indicated an association of higher aCCI with an increased risk of osteoporosis among older fall-prone men, supporting the possibility of aCCI as a marker of long-term skeletal-related adverse clinical outcomes.

Effect of MELD-Na score on overall survival of periampullary cancer.

Periampullary cancers have a short overall survival (OS), and many prognostic factors have been studied for this purpose. They usually present with biliary obstruction, which negatively affects the liver, kidney, immune system, and cardiovascular system. This study aimed to investigate the effect of MELD-Na scores on OS in patients undergoing pancreaticoduodenectomy due to periampullary cancer. Patients who underwent pancreaticoduodenectomy due to periampullary cancer between January 2010 and January 2021 were included in the study. After applying the exclusion criteria, 80 of the 124 patients were included in the study. The demographic, laboratory, and pathologic data of the patients were analyzed retrospectively. Univariate analysis showed that MELD-Na score at admission, age-adjusted Charlson Comorbidity Index, adjuvant treatment, portal vein resection, lymphovascular invasion (LVI), T-stage, and tumor location were significantly associated with OS (p < 0.1). In multivariate analysis, MELD-Na score at admission (HR: 1.051, 95% CI [1.004-1.101]; p = 0.033), adjuvant treatment (HR: 4.717, 95% CI [2.371-9.383]; p < 0.001), LVI (HR: 2.473, 95% CI [1.355-4.515]; p = 0.003), and tumor location (HR: 2.380, 95% CI [1.274-4.445]; p = 0.007) were independent risk factors for OS. MELD-Na score, adjuvant treatment, LVI, and tumor location were independent risk factors for the OS of periampullary cancer. The MELD-Na score may be used to predict OS for patients undergoing pancreaticoduodenectomy due to periampullary cancer.

Prognostic value and association of the age-adjusted Charlson Comorbidity Index with sarcopenia within patients with gastric cancer after radical resection

PurposeThe association between the age-adjusted Charlson Comorbidity Index (ACCI) and sarcopenia in patients with gastric cancer (GC) remains ambiguous. This study aimed to investigate the association between the ACCI and sarcopenia and the prognostic value in patients with GC after radical resection. In addition, this study aimed to develop a novel prognostic scoring system based on these factors. MethodsUnivariate and multivariate Cox regression analyses were used to determine prognostic factors in patients undergoing radical GC resection. Based on the ACCI and sarcopenia, a new prognostic score (age-adjusted Charlson Comorbidity Index and Sarcopenia [ACCIS]) was established, and its prognostic value was assessed. ResultsThis study included 1068 patients with GC. Multivariate analysis revealed that the ACCI and sarcopenia were independent risk factors during the prognosis of GC (P = 0.001 and P < 0.001, respectively). A higher ACCI score independently predicted sarcopenia (P = 0.014). A high ACCIS score was associated with a greater American Society of Anesthesiologists score, higher pathologic TNM (pTNM) stage, and larger tumor size (all P < 0.05). Multivariate analysis demonstrated that the ACCIS independently predicted the prognosis for patients with GC (P < 0.001). By incorporating the ACCIS score into a prognostic model with sex, pTNM stage, tumor size, and tumor differentiation, we constructed a nomogram to predict the prognosis accurately (concordance index of 0.741). ConclusionThe ACCI score and sarcopenia are significantly correlated in patients with GC. The integration of the ACCI score and sarcopenia markedly enhances the accuracy of prognostic predictions in patients with GC.

The Impact of Modified Body Mass Index on Clinical Prognosis in the Elderly With Acute Ischemic Stroke.

The modified body mass index (mBMI) combines the body mass index and serum albumin, accurately reflecting the nutritional status. It remains uncertain whether modified body mass index influences neurological function and clinical prognosis in elderly patients with acute ischemic stroke. We divided the cohort into quartiles of mBMI (1 to 4). The primary outcome was analyzed using the percentage of patients with a 90-day modified Rankin scale (mRS) score of 0 to 1. There were 7 secondary outcomes, including the disability level at 90 days and the National Institute of Health Stroke Scale (NIHSS) score at 14 and 90 days. mBMI was negatively associated with clinical prognosis at 90-day mRS score in the primary outcome (β=-0.167; 95% CI -0.311 to 0.023, P=0.023). Moreover, mBMI1 (<896.72) and primary outcomes (β=0.438; 95% CI: -0.018 to 0.894) were positively correlated with higher mBMI. Moreover, the number and percentage of patients completing all the duties and activities are also higher. Age-adjusted Charlson comorbidity index (aCCI) and posterior circulation lesion were positively associated with the clinical prognosis 90-day mRS score in the primary outcome (β=2.218; 95% CI: 1.144-4.300, β=2.771; 95% CI: 1.700-4.516). However, BMI and serum albumin were not associated the with clinical prognosis primary outcome. BMI negatively correlates with secondary outcomes (NIHSS at discharge, β=-0.023; 95% CI: -0.102 to 0.057). Our study revealed that mBMI and not BMI could be a better primary outcome predictor in the elderly with acute ischemic stroke, and lower mBMI showed a worse prognosis.

Survival analysis after stereotactic ablative radiotherapy for early stage non-small cell lung cancer: a single-institution cohort study

BackgroundStereotactic ablative radiotherapy (SABR) is the standard treatment for medically inoperable early-stage non-small cell lung cancer (ES-NSCLC), but which patients benefit from stereotactic radiotherapy is unclear. The aim of this study was to analyze prognostic factors for early mortality.MethodsFrom August 2010 to 2022, 617 patients with medically inoperable, peripheral or central ES-NSCLC were treated with SABR at our institution. We retrospectively evaluated the data from 172 consecutive patients treated from 2018 to 2020 to analyze the prognostic factors associated with overall survival (OS). The biological effective dose was > 100 Gy10 in all patients, and 60 Gy was applied in 3–5 fractions for a gross tumor volume (GTV) + 3 mm margin when the tumor diameter was < 1 cm; 30–33 Gy was delivered in one fraction. Real-time tumor tracking or an internal target volume approach was applied in 96% and 4% of cases, respectively. In uni- and multivariate analysis, a Cox model was used for the following variables: ventilation parameter FEV1, histology, age, T stage, central vs. peripheral site, gender, pretreatment PET, biologically effective dose (BED), and age-adjusted Charlson comorbidity index (AACCI).ResultsThe median OS was 35.3 months. In univariate analysis, no correlation was found between OS and ventilation parameters, histology, PET, or centrality. Tumor diameter, biological effective dose, gender, and AACCI met the criteria for inclusion in the multivariate analysis. The multivariate model showed that males (HR 1.51, 95% CI 1.01–2.28; p = 0.05) and AACCI > 5 (HR 1.56, 95% CI 1.06–2.31; p = 0.026) were significant negative prognostic factors of OS. However, the analysis of OS showed that the significant effect of AACCI > 5 was achieved only after 3 years (3-year OS 37% vs. 56%, p = 0.021), whereas the OS in one year was similar (1-year OS 83% vs. 86%, p = 0.58).ConclusionSABR of ES-NSCLC with precise image guidance is feasible for all medically inoperable patients with reasonable performance status. Early deaths were rare in our real-life cohort, and OS is clearly higher than would have been expected after best supportive care.

Surgical options and survival prognosis in geriatric patients beyond average lifespan with locally advanced gastric cancer: a propensity score-matched analysis.

The appropriateness of laparoscopic gastrectomy (LG) for super-geriatric patients with locally advanced gastric cancer (LAGC) is inconclusive, and the prognostic factors are also yet to be elucidated. Herein, we aimed to investigate the surgical and oncological outcomes of LG versus open gastrectomy (OG) for geriatric patients with LAGC who have outlived the average lifespan of the Chinese population (≥ 78years). This is a monocentric, retrospective, comparative study. A 1:1 propensity score matching (PSM) was performed to minimize selection bias and ensure well-balanced characteristics. The primary endpoint of interest was 3-year overall survival, while secondary endpoints included procedure-related variables, postoperative recovery indices, and complications. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify unfavorable prognostic factors. Of 196 eligible individuals, 107 underwent LG and 89 underwent OG, with a median age (interquartile range [IQR]) of 82 [79, 84] years. PSM yielded 61 matched pairs, with comparable demographic and tumor characteristics. The LG group had a significantly lower overall complication rate than the OG group (31.1% vs. 49.2%, P = 0.042), as well as shorter duration of postoperative hospital stay [12 (11, 13) vs. 13 (12, 15.5) d, P < 0. 001], less intraoperative blood loss [95 (75, 150) vs. 230 (195, 290) mL, P < 0.001], but a longer operative time [228 (210, 255.5) vs. 196 (180, 219.5) min, P < 0.001]. The times to first aerofluxus, defecation, liquid diet, and half-liquid diet were comparable. Kaplan-Meier analyses revealed no significant difference in 3-year overall survival between the groups, either in the entire cohort or in subgroups with different TNM staging. Moreover, Age-adjusted Charlson Comorbidity Index scores of > 6 [hazard ratio (HR) 4.003; P = 0.021] and pathologic TNM stage III (HR 3.816, P = 0.023) were independent unfavorable prognostic factors for long-term survival. LG performed by experienced surgeons offers the benefits of comparable or better surgical and oncological safety profiles than OG for super-geriatric patients with LAGC.

Ten Year Experience With Same Day Discharge Outpatient Total Hip Arthroplasty: Patient Demographics Changed, but Safe Outcomes Were Maintained

BackgroundThis study aimed to characterize changes in patient demographics and outcomes for same-day discharge total hip arthroplasty (THA) over a 10-year period at a single orthopaedic specialty hospital. MethodsA consecutive series of 1,654 patients between 2013 and 2022 who underwent unilateral THA and were discharged on the same calendar day were retrospectively reviewed. Patient demographics, including age, sex, body mass index (BMI), age-adjusted Charlson Comorbidity Index, and American Society of Anesthesiologists (ASA), were collected. Readmissions, complications, and unplanned visits were recorded for 90 days postoperatively. In order to compare the demographics of patients over time, patients were divided into 3 groups: Time Group A (2013 to 2016), Time Group B (2017 to 2019), and Time Group C (2020 to 2022). ResultsThe mean age, BMI, ASA score, and CCI increased significantly across each time group. Age increased from 57 years (range, 23 to 77) to 60 years (range, 20 to 87). The BMI increased from 28.1 (range, 18 to 41) to 29.4 (range, 18 to 47). The percentage of patients aged > 70 years almost doubled over time, as did the percentage of patients who had a BMI > 35. Overall complications increased from 3.44 to 6.82%, reflective of the changing health status of patients. Readmissions increased from 0.57 to 1.70% over time. Despite this, there were no readmissions for any patient within the first 24 hours of surgery. ConclusionsOur study has 3 important findings. We identified a worsening patient demographic over time with an increasing percentage of patients of advanced age and higher BMI, ASA, and age-adjusted Charlson Comorbidity Index. Also, there was also an increase in readmissions, complications, and unplanned visits. In addition, despite this worsening patient demographic, there were no readmissions within 24 hours and a low rate of readmissions or unplanned visits within the first 48 hours across all time periods, suggesting that same-day discharge-THA continues to be safe in properly selected patients.

Correlation Between Anesthesia Methods and Adverse Short-Term Postoperative Outcomes Depending on Frailty: A Prospective Cohort Study.

This study aims to investigate how the type of anesthesia used during major orthopedic surgery may impact adverse short-term postoperative outcomes depending on frailty. To conduct this investigation, we recruited individuals aged 65 years and older who underwent major orthopedic surgery between March 2022 and April 2023 at a single institution. We utilized the FRAIL scale to evaluate frailty. The primary focus was on occurrences of death or the inability to walk 60 days after the surgery. Secondary measures included death within 60 days; inability to walk without human assistance at 60 days; death or the inability to walk without human assistance at 30 days after surgery, the first time out of bed after surgery, postoperative blood transfusion, length of hospital stay, hospital costs, and the occurrence of surgical complications such as dislocation, periprosthetic fracture, infection, reoperation, wound complications/hematoma. In a study of 387 old adult patients who had undergone major orthopedic surgery, 41.3% were found to be in a frail state. Among these patients, 262 had general anesthesia and 125 had neuraxial anesthesia. Multifactorial logistic regression analyses showed that anesthesia type was not linked to complications. Instead, frailty (OR 4.04, 95% CI 1.04 to 8.57, P< 0.001), age (OR 1.05, 95% CI 1.00-1.10, P= 0.017), and aCCI scores, age-adjusted Charlson Comorbidity Index, (OR 1.36, 95% CI 1.12 to 1.66, P= 0.002) were identified as independent risk factors for death or new walking disorders in these patients 60 days after surgery. After adjusting for frailty, anesthesia methods was not associated with the development of death or new walking disorders in these patients (P > 0.05). In different frail populations, neuraxial anesthesia is likely to be comparable to general anesthesia in terms of the incidence of short-term postoperative adverse outcomes.

Optimal dual calcium and cholecalciderol dosages for osteoporotic fracture risk patients

Background: Vitamin D is crucial for musculoskeletal health, promoting calcium absorption, osteoid tissue mineralization, and muscle function. Insufficient levels can lead to bone dystrophy, muscle weakness, and osteoporotic fractures. Aims: This research investigates the correlation between bone mineral density and osteoporotic fracture risk, including positive and negative influences, and aims to determine the optimal vitamin D level. Methods: This retrospective observational study examined 206 Jordanian rehabilitation and rheumatology clinic patients from September to November 2021. The participants were post-menopausal women and men over 60. The Age-adjusted Charlson Co-Morbidity Index and Functionality Grade system was used to assess participants' co-morbidity burden and functionality. DEXA scans assessed participants' proximal femoral hip and anteroposterior spine. Participants were divided into two Vit D groups: those below 30 ng/ml and those above 30. Results were compared using a Chi Square test. The study examined correlations, total variations, and Vit D prediction quality using logistic regression analyses. SPSS 23.0 was used for statistical analysis with a 5% significance level. Results: A binary logistic regression model was employed to simulate the correlation between the vitamin D levels of patients and their bone mineral density. The model indicated a 61.39% likelihood of having a fH_BMD (femoral head bone mineral density) equal to or greater than 0.755 g/cm2 when the vitamin D level is at its optimal value of 27.25 ng/ml. The model indicated a 27.25% likelihood of a fHOPF risk-free tool with a value of ≥3% when the optimal vitamin D level is 27.25 ng/ml. The model indicated a 17.74% likelihood of experiencing a significant osteoporotic fracture within the next 10 years. Conclusion: The findings of our study demonstrated a direct correlation between elevated levels of vitamin D and improved bone mineral quality indices that were examined. The serum 25-OH Cholecalciferol levels are more likely to have a beneficial effect on bone health status.

Prognostic value of geriatric and cardiac parameters for one-year mortality in older heart failure patients. A multicentre, observational, prospective study

ABSTRACT Purpose Heart failure is prevalent among older people and has a poor prognosis. The aim of this study is to identify potential prognostic, geriatric, and cardiac parameters which could help clinicians identify older heart failure patients at high risk for one-year mortality. Methods The multicentre, observational cohort study which included 147 heart failure patients aged ≥75 years, hospitalized in the cardiac or geriatric department in two hospitals. One-year survival was the outcome measure. For univariate analysis Chi-square test and independent sample T-test were used; for multivariate analysis Logistic regression and Cox regression for time-dependent analysis. Results One-year mortality was 28% (41/147). One-year survivors and non-survivors did not differ in the following characteristics: age, gender, sodium level at hospital discharge, ejection fraction, NYHA Class, basic and instrumental activities of daily living, and the presence of a geriatric risk profile. There was a significant lower systolic blood pressure at discharge in non-survivors compared to one-year-survivors (mean 125.26 mmHg vs. 137.59 mmHg). Non-survivors had more severe underlying comorbidities according to the age adjusted Charlson Comorbidity index (CCI) (mean 8.80 vs. 7.40). Both logistic and Cox regression showed a higher risk and rate of mortality with decreasing systolic blood pressure at discharge (OR 0.963, p=0.001 and HR 0.970, p<0.001) and with increasing CCI (OR 1.344, p=0.002 and HR 1.269, p=0.001); the other variables were not significantly related. Conclusion Lower blood pressure and more severe comorbidities, but not functionality nor the presence of a geriatric risk profile, are related to one-year mortality in older, in-hospital heart failure patients.

Characteristics and Prognosis of Type 2 Myocardial Infarction Through Worsening Renal Function and NT-proBNP in Older Adults with Pneumonia.

Type 2 myocardial infarction (MI) is becoming more recognized. This study aimed to assess the factors linked to type 2 MI in older adults with pneumonia and further determine the predictive factors of 90-day adverse events (refractory heart failure, cardiogenic shock, and all-cause mortality). A single-center retrospective analysis was conducted among older adults with pneumonia. The primary outcome was the prevalence of type 2 MI. The secondary objective was to assess the adverse events in these patients with type 2 MI within 90 days. A total of 2618 patients were included. Of these, 361 patients (13.8%) suffered from type 2 MI. Multivariable predictors of type 2 MI were chronic kidney disease (CKD), age-adjusted Charlson comorbidity index (ACCI) score, and NT-proBNP > 4165pg/mL. Moreover, the independent predictive factors of 90-day adverse events included NT-proBNP > 4165pg/mL, age, ACCI score, and CKD. The Kaplan-Meier adverse events curves revealed that the type 2 MI patients with CKD and NT-proBNP > 4165pg/mL had a higher risk than CKD or NT-proBNP > 4165pg/mL alone. Type 2 MI in older pneumonia hospitalization represents a heterogeneous population. Elevated NT-proBNP level and prevalence of CKD are important predictors of type 2 MI and 90-day adverse events in type 2 MI patients.

Factors associated with non-completion of palliative radiotherapy for spinal metastasis in patients with terminal cancer: a retrospective study.

Predictors of non-completion of radiotherapy (RT) should be identified to determine the optimal RT dose. Therefore, this study aimed to explore factors associated with non-completion of palliative RT in patients with terminal cancer. In this retrospective study, patients with terminal cancer who received RT (not including single-fraction RT) for relief of pain caused by spinal metastasis were categorized into complete and incomplete groups. Baseline characteristics, hematologic test data [e.g., total lymphocyte count (TLC)], performance status, palliative performance scale (PPS) score, psoas muscle index (PMI), Charlson comorbidity index, and age-adjusted Charlson comorbidity index of the patients were compared between the two groups. The complete group comprised 58 patients (median age: 68 years; female/male: 17/41; number of irradiation fractions: ≥2 to <10, 20 patients; 10, 34 patients; and >10, 4 patients), and the incomplete group comprised 9 patients (median age: 68 years; female/male: 3/6; number of irradiation fractions: ≥2 to <10, 2 patients; 10, 7 patients; and >10, 0 patient). The proportion of patient death within 1 week or 1 month was higher in the incomplete group than in the complete group. Compared with that in the incomplete group, TLC measured 1 week before RT (pre-TLC) and PMI recorded before RT were significantly higher in the complete group (P=0.013 and P=0.012, respectively). In multivariable analyses, pre-TLC was significantly associated with the incomplete group (P=0.048). Compared with the complete group, the incomplete group included several patients whose PPS scores rapidly decreased. Pre-TLC can predict non-completion of palliative RT in patients with terminal cancer.

Characterizing the “iceberg peak” in valvular heart disease: Outcomes and costs of in-hospital procedures in Spain

Introduction and objectivesThe aim was to describe the burden of disease of valvular heart disease (VHD) in-hospital interventions in Spain. MethodsThe analysis involved all cases between 2016 and 2019 in the Spanish Ministry of Health database under the International Classification of Diseases 10th Revision. Procedure rates by region and year (×106), patient risk profile (comorbidities), health outcomes (death), length of stay (LoS), and costs were examined. ResultsA total of 57878 procedures were analyzed, representing a national rate from 292 in 2016 to 321 in 2019 (×106 inhabitants). Comorbidities measured by the age-adjusted Charlson Comorbidity Index ranged between 3.47 and 3.77 and increased over the period. The in-hospital complications have remained constant over the years with some exceptions. Death rate (×106 inhabitants) was 18.0, and the in-hospital mortality per year range was statistically constant and between 5.23% and 6.20%. The unadjusted LoS ranged from 14.68 to 15.34 days (standard deviations [SD], 16.03 and 15.79) including 2.68 to 3.27 days (SD, 6.57–7.82) in the intensive care unit. VHD procedures costs amounted to €1403.13 million in the period, representing an annual cost of €350.8 million. These costs decreased by 3.17% over the period. Per-procedure mean cost also decreased from €24801.81 (SD, €10231.91) to €24015.50 (SD, €9825.39). ConclusionsVHD entails a large and increasing volume of procedures in Spain. While a decline in the per-procedure mean cost was noted, the overall annual cost increased. This underscores the substantial burden on the national health system, even when considering solely in-hospital procedures.

Importance of bone mineral density and comorbidity index for functionality

Background: Assessing elderly ambulatory patients at risk of osteoporotic fractures is crucial for achieving appropriate functioning, including daily activities, rehabilitation, lifestyle improvements, and dietary optimization. Aim: This study focuses on evaluating bone health and comorbidities in patients to predict osteoporotic fracture functionality, using multiple logistic regression and comparing cohorts for optimal operating points. Methods: A retrospective study was conducted at Prince Rashid bin Al-Hasan Military Hospital, Jordan, to examine the correlations and quality of patients' functionality statuses based on Age-adjusted Charlson Co-Morbidity Index (AACCI) and femoral hip bone mineral density (fH_BMD). The study categorized patients into two cohorts, with functional grades ranging from III-IV to I-II. The results were analyzed using statistical tests and confidence intervals. Results: A Multiple Logistic Regression model was developed to simulate the relationship between patients' Age-adjusted Charlson Co-Morbidity Index (AACCI) and femoral hip bone mineral density (fH_BMD) and their functionality statuses. The model was statistically significant, explaining variation in the dependent variable from 30%-40.2% depending on the reference method. It correctly classified 78.2% of cases, with the explained variation ranging from 30%-40.2% depending on the method used. Conclusion: A small, non-sponsored study found an exponential association between patients' femoral bone mineral density and their functionality status, with this correlation shifting to the right when the Age-adjusted Charlson Co-Morbidity Index is ≥4.

Surgical outcomes and perioperative risk factors of patients with interstitial lung disease after pulmonary resection

BackgroundPatients of interstitial lung disease (ILD) combined with pulmonary lesions are increasingly common in clinical practice. Patients with ILD are at significantly higher risk for complications after pulmonary resection (including lobectomy and sublobar resection), especially acute exacerbations of ILD (AE-ILD). The purpose of this study is to summarize the short-term and long-term outcomes after pulmonary resection in ILD patients and to analyze the clinical factors affecting surgical safety.MethodsFrom January 2004 to January 2022, a total of 78 patients who were diagnosed with ILD and underwent pulmonary resection at our center were enrolled in this study. Clinical data, pathological findings, surgical procedures, and intraoperative safety of these patients were collected retrospectively. Postoperative 90-day complications and mortality, long-term surgical outcomes from postoperative 90 days to 24 months, and changes in ILD condition were investigated. Logistic regression analysis was used to identify the risk factors associated with postoperative complications.ResultsThe median age of patients was 66.5 (range 33–86) years, 82.1% (64/78) of patients were male, and 78.2% (61/78) of patients had comorbidities. Idiopathic ILD and secondary ILD accounted for 86% and 14%, thoracotomy and video-assisted thoracoscopic surgery accounted for 12.8% and 87.2%, and lobectomy and sublobar resection accounted for 37.2% and 62.8%, respectively. Postoperative 90-day complications occurred in 25.6% (20/78) of patients, with pulmonary complications and AE-ILD occurring in 15.4% and 9.0% of patients, respectively. The postoperative 90-day mortality rate was 5.1% (4/78), and the cause of death was AE-ILD. Exacerbation of ILD or other complications occurred in 12.8% (10/78) of patients from postoperative 90 days to 24 months. Univariate logistic regression analysis showed that comorbidity, extent of resection, systemic lymph node dissection, operation time, intraoperative blood loss, and pathology of pulmonary lesion were associated with postoperative 90-day complications. In multivariate logistic regression analysis, age-adjusted Charlson Comorbidity Index and intraoperative blood loss were identified as independent risk factors of postoperative 90-day complications.ConclusionsPatients with ILD have a significantly higher risk of postoperative 90-day complications and mortality after pulmonary resection, especially pulmonary complications and AE-ILD. After postoperative 90 days, the risk of deterioration of pulmonary status remains high, including exacerbation of ILD and complications associated with long-term use of glucocorticoids and immunosuppressant. Age, comorbidity and intraoperative blood loss are high risk factors for postoperative 90-day complications.

Surgical and oncological results after rectal resections with or without previous treatment for prostate cancer.

Previous treatment for prostate cancer (PC) may potentially affect the surgical and oncological outcomes of subsequent rectal cancer surgery, but there are only a few studies regarding this particular group. In this study, we present the 3-year surgical and oncological results of rectal cancer patients who had received previous treatment for PC at a single Finnish tertiary referral centre. Data regarding all male patients diagnosed with rectal cancer and treated at Tampere University Hospital (TAUH) between 1997 and 2016 were gathered from medical records. In total, this study included 553 rectal cancer patients who underwent curative surgery, and 54 of them (9.8%) had a prior history of treatment for prostate cancer. Patients in the PC group were older and had more comorbidities compared with those in the non-PC group. The PC patients had a significantly higher risk of permanent stoma compared with the non-PC patients (61.5% vs. 45.2%, respectively, p = 0.025). The PC patients seemed to have lower tumours than the non-PC patients (87% vs. 75%, respectively, p = 0.05). Overall, the 3-year overall survival (OS) for the PC and non-PC patients was 74.1% and 80.6%, respectively. No significant differences were observed between the study groups even in the age-adjusted comparison [hazard ratio (HR): 1.07, confidence interval (CI) 95%: 0.60-1.89]. In the univariable analysis, radically operated patients without a history of PC exhibited an improved overall survival, (HR: 2.46, 95% CI: 1.34-4.53, p = 0.004). However, only a higher age-adjusted Charlson comorbidity index (CCI) and a low tumour location (<10 cm) were found to have an independent prognostic impact on worse OS in the multivariable analysis (HR: 1.57, 95% CI: 1.36-1.82, p < 0.001 and HR: 2.74, 95% CI: 1.32-5.70, p = 0.007, respectively). No significant differences were observed between the groups in terms of disease-free or local recurrence-free survival. Rectal cancer is more frequently found in the middle or lower part of the rectum in patients who have previously received treatment for prostate cancer. These patients also have a higher likelihood of requiring a permanent stoma. In radically operated rectal cancer, the PC group had a worse OS rate, according to the univariable analysis. However, the only independent prognostic factors for a worse OS that were highlighted in the multivariable analysis included a higher CCI and a low tumour location.

Multivariate analysis of prognostic factors in patients with lip squamous cell carcinoma after surgery

BackgroundLip squamous cell carcinoma (LSCC) was one of the most common cancer types of head and neck tumors. This study aimed to find more predictors of the prognosis in postoperative LSCC patients.MethodsA total of 147 LSCC patients between June 2012 and June 2018 were collected from two tertiary care institutions. There were 21 clinicopathological factors included and analyzed in our study. The univariate and multivariate Cox regression analyses were performed to find the independent prognostic factors for predicting progression-free survival (PFS) and overall survival (OS) in postoperative LSCC patients. The role of adjuvant radiotherapy in various subgroups was displayed by Kaplan–Meier plots.ResultsThe 1-, 3-, and 5-year PFS of postoperative LSCC patients were 88.4%, 70.1%, and 57.8%, respectively. Similarly, the 1-, 3-, and 5-year OS of postoperative LSCC patients were 94.6%, 76.9%, and 69.4%, respectively. The results suggested that postoperative LSCC patients with age at diagnosis ≥ 70 years, grade with moderate or poor differentiate, the American Joint Committee on Cancer (AJCC) stage IV, higher systemic immune-inflammation index (SII), surgical margin < 5, and age-adjusted Charlson Comorbidity Index (ACCI) ≥ 5 tend to have a poorer PFS (all P < 0.05). Besides, postoperative LSCC patients with age at diagnosis ≥ 70 years, AJCC stage IV, higher GPS, higher SII, and ACCI ≥ 5 tend to have a worse OS (all P < 0.05). Additionally, postoperative patients with LSCC in the subgroup of ACCI < 5 and AJCC III–IV stage was more likely to benefit from adjuvant radiotherapy, but not for the other subgroups.ConclusionWe identified a series of significant immune-inflammation-related and comorbidity-related clinicopathological factors associated with the prognosis of postoperative LSCC patients by local data from two tertiary care institutions in China, which can be helpful for patients and surgeons to pay more attention to nutrition, inflammation, and complications and finally obtained a better prognosis.