Complications In Elderly Patients Research Articles

Predictive value of the hospital frailty risk score in perioperative complications of artificial hip and knee arthroplasty in elderly patients

Background Although artificial hip and knee arthroplasty has been widely used, the incidence of perioperative complications remains relatively high due to factors such as long operation time and large surgical incisions. However, the Hospital Frailty Risk Score (HFRS) clinical value for patients undergoing artificial hip and knee arthroplasty in China is not yet clear. This study aims to explore its clinical value in this population. Objective To explore predictive value of the HFRS in perioperative complications of artificial hip and knee arthroplasty in elderly patients. Methods Elderly patients who underwent artificial hip and knee arthroplasty in our hospital from March 2020 to March 2022 were selected as the study subjects. The patients were divided into the non-frail risk group (HFRS <5 points) and the frail risk group (HFRS ≥5 points) on the basis of the literature grading method. 5-factor modified frailty index (mFI-5) and Charlson Comorbidity Index (CCI) scores were assessed. General data including age, sex, ASA classification, preoperative course, and surgical time were collected through the electronic medical record system. The occurrence of postoperative deep venous thrombosis, periprosthetic infection, hematoma, anemia, and overall complications was recorded. Hospitalization days, surgical costs, and total treatment costs were also calculated for all patients. Results There were no significant differences in age, sex, ASA classification, preoperative course, or surgical time between the two groups ( p > 0.05). The frail risk group had significantly higher mFI-5 and CCI scores ( p < 0.05). This group also had a higher incidence of deep venous thrombosis and overall complications ( p < 0.05), but similar rates of periprosthetic infection, hematoma, and anemia ( p > 0.05). ROC analysis showed HFRS had the highest predictive value for postoperative complications (AUC = 0.851) compared to mFI-5 (0.786) and CCI (0.739). Surgical costs were similar ( p > 0.05), but the frail group had longer hospital stays and higher total treatment costs ( p < 0.05). Conclusion HFRS has better predictive value for perioperative complications in elderly patients undergoing artificial hip and knee arthroplasty compared to mFI-5 and CCI scores, and it can be used for predicting perioperative complications in elderly patients with this surgery.

Longitudinal Trends in the Incidence of Hyperactive Delirium and Its Causes of Change After Surgery for Degenerative Lumbar Disease: A Population-Based Study of 7250 Surgical Patients Over 11 Years.

Delirium is one of the common complications in elderly patients after spinal surgery. Severe delirium can lead to a series of adverse consequences such as drainage tube removal, wound rupture, patient falls, and severe adverse effects. The current research on POD is mostly small sample studies. This study aimed to investigate longitudinal changes in the incidence of hyper-postoperative delirium in patients with lumbar degenerative disease at our institution over the past 11 years and to identify the potential causes of these changes. This is a retrospective cohort study included 7250 patients who underwent surgical treatment for lumbar degenerative diseases at a single center from 2011 to 2021. These patients were diagnosed with delirium through the Confusion Assessment Method and then diagnosed with high activity delirium through the Richmond Agitation-Sedation Scale, totaling 130 cases. According to the incidence rate of hyper-postoperative delirium within 11 years, the trend test is divided into three groups: S1 upward trend (2011-2014), S2 downward trend (2015-2016) and S3 upward trend (2016-2021). The study collected variables from patients before, during, and after surgery, including gender, age, laboratory tests, anesthesia risk score, New York Heart Association cardiac function grading, number of surgical segments, surgical time, estimated intraoperative blood loss, anesthesia medication, and supplementary analgesic medication in the ward within 3 days after surgery. Kruskal Wallis one-way ANOVA test, Kruskal-Wallis H test, or chi-square test are used to evaluate inter group differences. p < 0.05 is considered statistically significant. The pooled incidence of hyper-postoperative delirium over the past 11 years was 1.79% (130/7250). The average age of 7250 patients was 54.5 ± 13 years, with a male/female ratio close to 1:1. We statistically analyzed the relevant influencing factors before, during, and after surgery of S1 and S3 in the incidence rate increase group and found no statistical difference between the two groups. Our research results show that the incidence of high activity delirium is correlated with age, number of surgical segments, surgical duration, use of dexmedetomidine, remifentanil, and benzodiazepines, with p < 0.05. The reduced use of dexmedetomidine, increased use of benzodiazepines, and prolonged surgical time are the reasons for the increased incidence of hyper-postoperative delirium. The joint management of orthopedic surgeons and anesthesiologists during the perioperative period is of great significance in reducing the incidence of hyper-postoperative delirium in patients undergoing lumbar spine surgery.

Silent Acute Myocardial Infarction and Anterolateral Papillary Muscle Rupture: A Rare Complication in Elderly Patients

Mitral regurgitation (MR) following acute myocardial infarction (AMI) is a common occurrence, often resolving without significant complications. However, severe MR leading potentially to acute heart failure or cardiogenic shock is rare. It can result from papillary muscle rupture (PMR) which is an extremely uncommon and life-threatening mechanical complication of AMI. We present a case of a 77-year-old male with a late-presenting high-risk acute coronary syndrome (ACS) complicated by acute MR due to anterolateral PMR. The patient exhibited atypical symptoms, including dyspnea and cough, and was diagnosed with a STEMI equivalent. Echocardiography revealed severe MR secondary to papillary muscle rupture. The patient underwent successful coronary artery bypass graft (CABG) and mitral valve replacement surgery. We discuss the risk factors, management and complications of papillary muscle rupture, emphasizing the importance of early recognition and intervention. This case underscores the potential for atypical ACS presentations in the elderly and highlights the significance of specific ECG patterns, such as ST segment elevation in leads aVR and/or V1. Despite advancements in therapy, the mortality associated with papillary muscle rupture remains high, underscoring the critical need for preventive measures and heightened clinical awareness

Preoperative Nutritional Status Screened by MNA-SF Predicts Major Complications in Elderly Patients Undergoing Lumbar Fusion Surgery.

To investigate the role of Mini Nutritional Assessment-Short Form (MNA-SF) in predicting postoperative complications in older patients (≥75 years) undergoing lumbar fusion surgery. Patients who had undergone posterior lumbar fusion surgery between June 2019 and September 2021 were enrolled. Those with an MNA-SF score of 12 or higher were categorized as the Nourished group, while those with a score less than 12 were placed in the Malnutrition-Risk group. Preoperative, intraoperative, and postoperative variables between groups were compared. Patients were then re-classified based on the presence of major complications, univariate analysis and multivariate logistic regression was used to identify risk factors for major complications. A total of 240 patients were enrolled, with 182 in the Nourished group and 58 in the Malnutrition-Risk group. The Malnutrition-Risk group exhibited a higher incidence of major complications (46.6% vs 23.1%, p = 0.001) and comprehensive complications index (18.42 ± 18.00 vs 12.65 ± 15.87, p = 0.021), Oswestry Disability Index (27.52 ± 23.44 vs 20.45 ± 20.42, p = 0.029) and longer recovery times (12.53 days vs 10.15 days, p =0.033). Length of stay (LOS) were also increased in the Malnutrition-Risk group (19.22 ± 10.67 vs 16.04 ± 7.69, p = 0.014). Multiple regression analysis identified nutritional risk and malnutrition, as assessed by MNA-SF, as independent factors associated with postoperative major complications (OR 2.81, 95% CI 1.42-5.53, p = 0.003). Preoperative nutritional risk or malnutrition is an independent risk factor for major complications among older patients undergoing posterior lumbar fusion surgery. The MNS-SF emerges as a convenient and effective tool for promptly screening the nutritional status of older patients, prompting subsequent nutritional evaluation or intervention before surgery.

The relationship between postoperative cognitive dysfunction and cerebral small vessel disease: A comprehensive review.

Postoperative cognitive dysfunction (POCD) is a common complication in elderly patients, and cerebral small vessel disease (CSVD) has been suggested as a potential risk factor. This review examines the relationship between POCD and CSVD from epidemiological, pathophysiological, and clinical perspectives, while also considering the role of Alzheimer's disease (AD) pathology. We conducted a comprehensive literature search of major databases, supplemented by reference list checking, to ensure a thorough review of studies published between 2000 and 2023 on the relationship between POCD and CSVD. Epidemiological studies have shown that POCD and CSVD are associated in terms of common risk factors, including advanced age, vascular comorbidities, impaired baseline cognitive function, and certain population characteristics. Animal studies have revealed that CSVD and POCD share similar neuropathological changes, including abnormal cerebral hypoperfusion, inflammatory responses, and blood-brain barrier disruption. Furthermore, recent research suggests a complex interplay between CSVD, AD pathology, and POCD, with potential synergistic effects on cognitive decline. Neuroimaging studies have further demonstrated that preoperative CSVD burden and postoperative CSVD progression are associated with the development of POCD, and the presence of both CSVD and AD markers may increase the risk of cognitive decline. The association between CSVD and POCD has important implications for the perioperative management of elderly patients, including preoperative assessment, choice of anesthesia and surgical methods, intraoperative management, postoperative care, and long-term follow-up. A better understanding of the relationship between CSVD and POCD will guide evidence-based strategies to prevent and manage this debilitating complication in the aging population.

Development and validation of a risk prediction model for severe postoperative complications in elderly patients with hip fracture.

This study aimed to investigate risk factors associated with severe postoperative complications following hip fracture surgery in elderly patients and to develop a nomogram-based risk prediction model for these complications. A total of 627 elderly patients with hip fractures treated at Yongchuan Hospital of Chongqing Medical University from January 2015 to April 2024 were collected. 439 patients were assigned to the training cohort for model development, and 188 to the validation cohort for model assessment. The training cohort was stratified based on the presence or absence of severe complications. We employed LASSO regression, as well as univariate and multivariate logistic regression analyses, to identify significant factors. A nomogram was constructed based on the outcomes of the multivariate regression. The model's discriminative ability was assessed using the area under the receiver operating characteristic curve (AUC), while calibration plots and decision curve analysis (DCA) evaluated its calibration and stability. Internal validation was performed using the validation cohort. Out of the 627 patients, 118 (18.82%) experienced severe postoperative complications. Both LASSO regression and multivariate logistic analysis identified the modified 5-item frailty index (mFI-5) and the preoperative C-reactive protein to albumin ratio (CAR) as significant predictors of severe complications. The nomogram model, derived from the multivariate analysis, exhibited strong discriminative ability, with an AUC of 0.963 (95% CI: 0.946-0.980) for the training cohort and 0.963 (95% CI: 0.938-0.988) for the validation cohort. Calibration plots demonstrated excellent agreement between the nomogram's predictions and actual outcomes. Decision curve analysis (DCA) indicated that the model provided clinical utility across all patient scenarios. These findings were consistent in the validation cohort. Both the mFI-5 and CAR are predictive factors for severe postoperative complications in elderly patients undergoing hip fracture surgery.

The effect of cardiac rehabilitation prescription on medication complications and ET-1, WMSI in elderly patients with coronary heart disease

ObjectiveTo explore the effects of cardiac rehabilitation prescriptions on medication complications, Endothelin 1 (ET-1), and Wall Motion Score Index (WMSI) in elderly patients with coronary heart disease.Methods98 elderly patients with coronary heart disease admitted to the Department of Cardiology of a hospital from January 2020 to June 2022 are selected. According to the red and blue ball method, 98 research subjects are divided into a control group and an observation group. The control group receives routine treatment and exercise intervention, while the observation group receives cardiac rehabilitation prescriptions. After a follow-up of 6 months, the incidence of medication complications between the two groups is compared. The changes in ET-1 and WMSI levels are compared before treatment, 1 month, 3 months, and 6 months after treatment.ResultsThe two groups had no significant difference in ET-1 and WMSI levels before intervention. After intervention, both groups showed significant reductions in ET-1 and WMSI compared with baseline. The ET-1 of the observation group decreased significantly faster than the control group after 1 month, 3 months, and 6 months of intervention. The WMSI decreased more significantly at 6 months. The repeated measurement variance showed that there was a significant difference in the trend of ET-1 changes between the two groups, while the difference between the WMSI groups was not significant. The incidence of medication complications in the observation group was 10.20%, significantly lower than the 26.53% in the control group.ConclusionCardiac rehabilitation prescriptions can reduce the incidence of medication complications in elderly patients with coronary heart disease. It can reduce ET-1 levels faster, improve myocardial motor function, which has better myocardial function and medication safety than conventional treatment.

Respiratory variation of velocity time integral and peak velocity of left ventricular outflow tract for predicting hypotension after induction of general anesthesia in elderly patients.

Hypotension after induction of general anesthesia may lead to severe complications in elderly patients. This study investigated whether the respiratory variation of velocity time integral (ΔVTI) and peak velocity (ΔVpeak) of left ventricular outflow tract (LVOT) could predict hypotension after induction of general anesthesia in elderly patients. 120 elderly patients undergoing selective operation under general anesthesia were enrolled in this study. ΔVTI and ΔVpeak of LVOT were measured by transthoracic echocardiography before induction of general anesthesia. After induction, mean arterial pressure (MAP) was recorded every 1 minute for 15 min. Hypotension was defined as a decrease of more than 30% in MAP at baseline or MAP below 65 mmHg from the start of induction. Receiver operating characteristic curves with gray zone and multivariate logistic regression analysis were used to assess the ability of ΔVTI and ΔVpeak of LVOT to predict hypotension after induction of general anesthesia. Hypotension occurred in 64 (53.3%) patients after induction of general anesthesia. The area under receiver operating characteristic curves (AUC) for ΔVpeak of LVOT to predict hypotension after induction of general anesthesia was 0.811, and the optimal cutoff value was 13.1% with a gray zone of 9.9% to 13.8%, including 45.0% of patients. The AUC for ΔVTI of LVOT was 0.890, and the optimal cutoff value was 13.8% with a gray zone of 11.1% to 13.9%, including 25.8% of patients. After adjusting for confounders, ΔVTI (Odds ratio = 2.24) and ΔVpeak (Odds ratio = 2.09) of LVOT were two significant independent predictors of hypotension after induction of general anesthesia. ΔVTI of LVOT was a reliable predictor of hypotension after the induction of general anesthesia in elderly patients. ΔVpeak of LVOT should be used cautiously to predict hypotension after induction of general anesthesia due to nearly half of elderly patients in the gray zone.Trial registrationThis study was registered in the Chinese Clinical Trial Registry (registration number: ChiCTR2300077117).

Establishment and validation of a predictive model for postoperative pulmonary complications in elderly patients undergoing non-cardiac surgery

Objective: To develop and validate a predictive model for postoperative pulmonary complications (PPCs) in elderly patients undergoing non-cardiac surgery. Methods: This retrospective study included 51 354 elderly patients over 65 years old who underwent non-cardiac surgery at the First Medical Center of Chinese PLA General Hospital from January 2009 to December 2018. The patients were randomly divided into a modeling group [n=41 084; 21 550 males, 19 534 females; age: 70 (67, 74) years] and an internal validation group [n=10 270; 5 458 males, 4 812 females; age: 70 (67, 74) years] at a ratio of 4∶1. Additionally, an external validation group of 14 378 patients [7 893 males, 6 845 females; age: 70 (67, 75) years] who underwent non-cardiac surgery at Henan Provincial People's Hospital between November 2014 and May 2022 was retrospectively included. Multivariate logistic regression were performed to identify factors associated with PPCs. A nomogram prediction model was constructed based on these factors and validated internally and externally. The model's performance and clinical applicability were assessed using receiver operating characteristic (ROC) curves, calibration curves, and decision curves. Results: Among the 51 354 elderly patients underwent general anesthesia for non-cardiac surgery, the incidence of PPCs was 17.5% (9 008/51 354). Multivariate logistic regression analysis reveals that anesthesia duration 130-<183 min (OR=1.858, 95%CI: 1.529-2.266), anesthesia duration 183-<250 min (OR=2.537, 95%CI: 2.079-3.108), anesthesia duration≥250 min(OR=3.533, 95%CI: 2.868-4.368), crystalloid infusion volume 1 400-<2 000 ml (OR=1.481, 95%CI: 1.204-1.829), crystalloid infusion volume 2 000-<9 000 ml (OR=1.776, 95%CI: 1.426-2.220), upper abdominal surgery (OR=1.658, 95%CI: 1.498-1.835), malignancy (OR=1.796, 95%CI: 1.606-2.012), fentanyl dosage 0.40-<0.55 mg (OR=1.404, 95%CI: 1.203-1.640), fentanyl dosage≥0.55 mg (OR=1.601, 95%CI: 1.386-1.854), prophylactic use of antibiotics (OR=7.897, 95%CI: 5.124-12.983), age (OR=1.039, 95%CI: 1.030-1.049), smoking (OR=1.124, 95%CI: 1.014-1.246), preoperative chest X-ray abnormalities (OR=2.139, 95%CI: 1.820-2.509) and intraoperative hypotension (OR=3.184, 95%CI: 2.120-4.795) were risk factors for PPCs, while elective surgery (OR=0.301, 95%CI: 0.220-0.417) was a protective factor. The nomogram model incorporating these factors had an area under the curve (AUC) of 0.757 (95%CI: 0.748-0.766, P=0.309) in the modeling group, 0.779 (95%CI: 0.760-0.796, P=0.171) in the internal validation group, and 0.778 (95%CI: 0.763-0.792, P<0.001) in the external validation group. Calibration curves and decision curves demonstrated good consistency and benefit of the model. Conclusion: The nomogram model which based on anesthesia duration, crystalloid infusion volume, upper abdominal surgery, malignancy, fentanyl dosage, prophylactic use of antibiotics, age, smoking, preoperative chest X-ray abnormalities, intraoperative hypotension and elective surgery provides strong predictive value and clinical utility for assessing the risk of PPCs in elderly patients undergoing non-cardiac surgery.

Glucose-albumin ratio (GAR) as a novel biomarker for predicting postoperative pneumonia (POP) in older adults with hip fractures

Postoperative pneumonia (POP) is a common complication after hip fracture surgery and is associated with increased mortality and other complications in elderly patients. This study aims to evaluate biomarkers, especially the glucose-albumin ratio (GAR), for predicting POP in elderly hip fracture patients. A total of 1279 elderly patients admitted to our hospital with hip fractures were included. We assessed 29 biomarkers and focused on GAR to determine its prognostic and predictive value for POP. Multivariable logistic regression and propensity score-matched analyses were conducted to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for POP, adjusting for potential confounders. Receiver operating characteristic (ROC) curves were utilized to determine the optimal cut-off of GAR for predicting POP. Among the biomarkers and combinations assessed, GAR demonstrated superior predictive capability for POP in elderly hip fracture patients. ROC analyses showed moderate predictive accuracy of GAR for POP, with an area under the curve of 0.750. Using the optimal cut-off of 0.175, the high GAR group was significantly associated with increased odds of POP (adjusted OR 2.14, 95%, CI 1.50–3.05). These associations remained significant after propensity score matching and subgroup analyses. Dose–response relationships between GAR and POP were observed. In conclusion, GAR may be a promising biomarker to predict POP risk in elderly hip fracture patients. Further studies are warranted to validate its clinical utility. However, this study has certain limitations, including its retrospective design, potential for selection bias due to the exclusion criteria, and the single-center nature of the study, which should be addressed in future prospective, multicenter studies.

Postoperative complications in elderly patients undergoing surgery for ovarian cancer: A NSQIP analysis

Postoperative complications in elderly patients undergoing surgery for ovarian cancer: A NSQIP analysis

Atrioventricular block as a common problem in elderly patients with coronary artery disease: clinical observation

Complete atrioventricular block is a dangerous complication in elderly patients with coronary artery disease that requires surgical treatment. Treatment of elderly patients with coronary artery disease and atrioventricular block is a debatable problem, and at the moment, there are no clear recommendations regarding the sequence of surgical interventions in this age group. In our opinion, in some cases it is advisable to perform epicardial lead placement during revascularization, because the risk of complications during the implantation procedure increases on the background of dual antiplatelet therapy, which is required after coronary artery bypass grafting. In addition, this approach provides a significant socio-economic effect, saving a patient from re-hospitalization and intervention for conduction disorders. This article presents a clinical observation with a step-by-step algorithm of actions in multivessel coronary artery disease with complete symptomatic atrioventricular block.

Comparison of ERCP Outcomes and Complication Risk between Elderly and Younger Patients: A Large Single-Center Study

Objectives: The current study compared potential risks, complications, and the impact on clinical outcomes among elderly and younger patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Methods: Procedure-related complications, risk factors, and clinical outcomes following complications in elderly patients (aged ≥75 years) and younger who underwent biliary ERCP were evaluated. Results: Median age of 63 (48–74) of 1164 patients who underwent biliary ERCP for the first time, and 266 (22.8%) were elderly. Comorbidities were statistically significant (81 [30.5%] versus 78 [8.7%], p &lt; 0.001), and periampullary diverticulum (PAD) was detected more commonly in the elderly group (79 [29.7%] vs. 103 [11.5%], p &lt; 0.001). There was no statistical difference in cannulation technique, cannulation time, and cannulation success in both groups, while the total ERCP procedure time was higher in the elderly group (22 [16–29] vs. 20 [14–29], p = 0.030). Regarding the procedure-related complications, there was no statistically significant difference between the two groups (26 [9.8%] vs. 71 [7.9%], p = 0.292). In the case of complications, the length of hospitalization stay was statistically longer in the elderly group. Moreover, the elderly had a longer length of hospitalization, experiencing pancreatitis and a higher probability of developing moderate/severe pancreatitis. In multivariate and univariate analysis, prolonged cannulation time was found to be an independent risk factor in patients ≥75 years of age. Conclusions: This study showed that while ERCP-related complication rates in elderly patients are comparable to younger patients, it can be associated with worse outcomes following the complication and prolonged length of hospitalization.

Development and validation of a nomogram for predicting pulmonary complications in elderly patients undergoing thoracic surgery

BackgroundPostoperative pulmonary complications (PPCs) remain a prevalent concern among elderly patients undergoing surgery, with a notably higher incidence observed in elderly patients undergoing thoracic surgery. This study aimed to develop a nomogram to predict the risk of PPCs in this population.MethodsA total of 2963 elderly patients who underwent thoracic surgery were enrolled and randomly divided into a training cohort (80%, n = 2369) or a validation cohort (20%, n = 593). Univariate and multivariate logistic regression analyses were conducted to identify risk factors for PPCs, and a nomogram was developed based on the findings from the training cohort. The validation cohort was used to validate the model. The predictive accuracy of the model was evaluated by receiver operating characteristic (ROC) curve, area under ROC (AUC), calibration curve, and decision curve analysis (DCA).ResultsA total of 918 (31.0%) patients reported PPCs. Nine independent risk factors for PPCs were identified: preoperative presence of chronic obstructive pulmonary disease (COPD), elevated leukocyte count, higher partial pressure of arterial carbon dioxide (PaCO2) level, surgical site, thoracotomy, intraoperative hypotension, blood loss > 100 mL, surgery duration > 180 min, and malignant tumor. The AUC value for the training cohort was 0.739 (95% CI: 0.719–0.762), and it was 0.703 for the validation cohort (95% CI: 0.657–0.749). The P-values for the Hosmer-Lemeshow test were 0.633 and 0.144 for the training and validation cohorts, respectively, indicating a notable calibration curve fit. The DCA curve indicated that the nomogram could be applied clinically if the risk threshold was between 12% and 84%, which was found to be between 8% and 82% in the validation cohort.ConclusionThis study highlighted the pressing need for early detection of PPCs in elderly patients undergoing thoracic surgery. The nomogram exhibited promising predictive efficacy for PPCs in elderly patients undergoing thoracic surgery, enabling the identification of high-risk patients and consequently aiding in the implementation of preventive interventions.Graphical

EP.07A.12 Association Between Preoperative Diaphragm Thickness and Postoperative Complications in Elderly Patients with Lung Cancer

EP.07A.12 Association Between Preoperative Diaphragm Thickness and Postoperative Complications in Elderly Patients with Lung Cancer

Risk factor analysis and establishment of a predictive model for complications of elderly advanced gastric cancer with Clavien-Dindo classification ≥ II grade

BackgroundThe occurrence of complications following radical gastrectomy for gastric cancer significantly impacts patients’ quality of life. Elderly patients are susceptible to postoperative complications. This study seeks to investigate the risk factors associated with Clavien-Dindo ≥IIgrade complications following radical gastrectomy for advanced gastric cancer in elderly patients, develop a nomogram risk prediction model, and validate its accuracy.MethodsRetrospective collection of clinical and pathological data was conducted on 442 elderly patients with advanced gastric cancer who underwent radical gastrectomy at Shaanxi Provincial People’s Hospital from January 2015 to December 2020. They were randomly divided into a training set (n = 310) and a validation set (n = 132) in a 7:3 ratio. The severity of postoperative complications was graded using the Clavien-Dindo classification system, resulting in two complication groups: Clavien-Dindo <II group (n = 229) and Clavien-Dindo ≥II group (n = 81). Univariate and multivariate logistic regression analyses were performed to identify independent risk factors affecting the occurrence of Clavien-Dindo ≥II grade complications, and a predictive model was established based on the results. The model was then validated using the validation set.ResultsAmong the 442 patients included in the study, 121 cases (27.38%) experienced postoperative complications, with 111 cases (25.11%) classified as Clavien-Dindo ≥II grade complications. Multivariable logistic analysis revealed that the Prognostic Nutritional Index (PNI), surgical duration, age, and history of Diabetes mellitus were independent risk factors for the occurrence of Clavien-Dindo ≥IIgrade complications in elderly patients with advanced gastric cancer after surgery (P < 0.05). The nomogram model constructed based on these factors demonstrated good discriminative ability, as indicated by the area under the Receiver Operating Characteristic (ROC) curve. Calibration plots showed that the predicted probability of gastric cancer lymph node metastasis using the nomogram model was well aligned with actual outcomes. Decision curve analysis indicated the clinical utility of the nomogram model across a wide range of thresholds, demonstrating its practicality and potential for clinical benefit.ConclusionThis study identified Prognostic Nutritional Index (PNI), surgical duration, age, and history of Diabetes mellitus as risk factors for the occurrence of Clavien-Dindo ≥ II grade complications in elderly patients with advanced gastric cancer after surgery. Based on these four risk factors, a nomogram risk prediction model was constructed. This model can be used to personalize the prediction of the risk of Clavien-Dindo ≥ II grade complications occurring after surgery in elderly patients with advanced gastric cancer.

Effect of parecoxib on postoperative cognitive function and analgesic safety in elderly patients undergoing gastrointestinal tumor resection: A retrospective study.

Neuroinflammation is associated with the development of postoperative cognitive dysfunction (POCD). Parecoxib has powerful anti-inflammatory and analgesic effects, which may reduce the occurrence of POCD. We hypothesized that parecoxib could reduce the incidence of POCD and relieve postoperative pain without increasing postoperative complications in elderly patients with gastrointestinal cancer. The study analyzed the effect of parecoxib on elderly patients undergoing elective radical resection of gastrointestinal tumors. Patients were divided into the NSAIDs group and the non-NSAIDs group according to whether parecoxib was administered. Demographic and clinical data were collected and compared. The incidence of POCD was set as the primary outcome, and postoperative pain as the secondary outcome. Among the 440 enrolled patients, the POCD incidence rates within 7 days after surgery in the NSAIDs and non-NSAIDs groups were 42.60% and 40.30%, respectively, with no statistically significant difference (P > 0.05). Patients in the NSAIDs group experienced significantly less pain on the first and second days after surgery compared to the non-NSAIDs group (P < 0.05). There were no statistically significant differences in postoperative adverse events between the two groups (P > 0.05). Parecoxib had no significant negative effect on early postoperative cognitive function, effectively alleviating early postoperative acute pain without increasing postoperative complications. The findings have implications for the broader use of parecoxib in postoperative pain management in elderly patients undergoing major surgery.

Triglyceride-glucose index—A novel metabolism disorder biomarker as a promising indicator for predicting postoperative 30-day infections in elderly patients undergoing gastrointestinal-related abdominal and pelvic surgery

BackgroundThe triglyceride-glucose index, a reliable surrogate biomarker of insulin resistance, has been reported to be associated with cardiovascular events and atherosclerosis. However, few studies have investigated the association of the triglyceride-glucose index with postoperative infections. This study aimed to study the clinical risk values of the preoperative triglyceride-glucose index in postoperative infection complications in elderly patients undergoing gastrointestinal-related abdominal and pelvic surgery. MethodsThis retrospective cohort study included 3,225 older patients who underwent gastrointestinal-related abdominal and pelvic surgery between 2014 and 2019. The patients were divided into groups of triglyceride-glucose index ≤8.268 and triglyceride-glucose index >8.268 according to the optimal triglyceride-glucose index cut-off value. The outcome of interest was postoperative infections within 30 days after surgery. Primary and subgroup analyses were performed to confirm that preoperative triglyceride-glucose index qualifies as a reliable, independent risk indicator. Propensity score matching analysis was further applied to address covariates' potential residual confounding effect and test the robustness of the results. ResultsIn this study, the median age was 71 years (interquartile range, 67, 75 years), the proportion of male patients was 66.3%, and 1,058 (32.8%) were infected within 30 days after surgery. A triglyceride-glucose index >8.268 was associated with an increased risk of postoperative infections in multivariate regression analysis (odds ratio, 1.37; 95% confidence interval, 1.15–1.64; P < .001). The correlation between the triglyceride-glucose index and postoperative infections remained significantly robust (odds ratio, 1.52; 95% confidence interval, 1.21–1.92; P < .001) in the propensity score matching analysis. ConclusionsThe triglyceride-glucose index elevation determined by the optimal cutoff value of 8.268 was an independent risk factor for developing postoperative infections.

Protocol for systematic review and meta-analysis on the efficacy and safety of acupuncture for residual low back pain after percutaneous kyphoplasty in patients with osteoporotic vertebral compression fracture

IntroductionOsteoporotic vertebral compression fracture (OVCF) is a common complication in elderly patients with osteoporosis. Despite undergoing percutaneous kyphoplasty (PKP) treatment, a significant percentage of OVCF patients (1.8% to 31.9%) continue...

Psoas attenuation is associated with early postoperative complications in geriatric patients undergoing multilevel lumbar fusion surgery for degenerative lumbar spinal stenosis

BackgroundMorphometric analysis of the psoas major muscle has shown utility in predicting postoperative morbidity in various surgical fields, but its usefulness in predicting complications in elderly patients undergoing multilevel lumbar fusion surgery has not been studied. The study aimed to investigate if psoas major parameters are independent risk factors of early postoperative complication among elderly patients.MethodsPatients who underwent multilevel lumbar fusion for degenerative lumbar spinal stenosis (DLSS) were included. The psoas major was measured at the lumbar 3/4 intervertebral disc level in three ways on computed tomography image: psoas muscle mass index, mean muscle attenuation, and morphologic change of the psoas major. Early complications were graded using the Clavien-Dindo classification system and the Comprehensive complication index (CCI). A CCI ≥ 26.2 indicated severe complications. Logistic regression was performed to identify independent risk factors.ResultsThis retrospective study reviewed 108 patients (mean age 70.9 years, female to male ratio 1.8:1). Complications were observed in 72.2% of patients, with allogeneic blood transfusion being the most frequent (66.7%), followed by wound infection, acute heart failure (2.8% each). Severe complications occurred in 13.9% of patients. After multivariable regression analysis, those in the lowest psoas muscle attenuation tertile had higher odds of experiencing early postoperative complications (OR: 3.327, 95% CI 1.134–9.763, p = 0.029) and severe complications (OR: 6.964, 95% CI 1.928–25.160, p = 0.003).ConclusionThe psoas muscle attenuation can be used as a predictor of early postoperative complications in elderly patients undergoing multilevel lumbar fusion surgery for DLSS.