Extremely Elderly Research Articles

The Geriatric Nutrition Risk Index Is Not a Prognostic Predictor for Postoperative Morbidity in Extremely Elderly Patients Undergoing Surgery for Proximal Femur Fractures

Background/Objectives: The geriatric nutrition risk index (GnRI) has been regarded as a useful predictor of morbidity and mortality in elderly patients. This study aimed to determine the use of the GnRI as a prognostic predictor in extremely elderly patients undergoing proximal femur fracture surgery and the usefulness of evaluation tools related to a patient’s underlying disease and functional capacity in predicting the prognosis of extremely elderly patients. Methods: We analyzed 548 patients who had undergone surgery for proximal femur fracture caused by trauma, with an age of ≥80 years, without other accompanying trauma. Results: Body mass index (BMI) (OR, 1.077; 95% CI, 1.010–1.149; p = 0.023), serum albumin levels (0.389; 0.223–0.678; p = 0.001), and Charlson comorbidity index (CCI) (1.170; 1.014–1.349; p = 0.031) were determined to be predictors of morbidity in a multivariable regression analysis. The area under the curve (AUC) in the receiver operating characteristic curve of BMI was 0.565 (95% CI, 0.493–0.637; p = 0.065), and the optimal cut-off value could not be determined. The AUC of serum albumin was 0.647 (0.576–0.717; p < 0.001), and the optimal cut-off value was 3.65 g/dL (sensitivity, 72.2%; specificity, 52.7%). The AUC of the CCI was 0.648 (0.580–0.715; p < 0.001), and the optimal cut-off value was 6.5 (sensitivity, 63.3%; specificity, 61.4%). Conclusions: The GnRI was not a predictive factor for patient prognosis after proximal femur fractures in extreme elderly patients. Rather, serum albumin level and CCI, which reflect the patient’s underlying comorbid conditions, were more useful in predicting in-hospital morbidity after proximal femur surgery in extremely elderly patients.

Comparative Survival Outcomes of Kidney Transplantation vs. Ongoing Dialysis in Extremely Elderly Patients: A Matched-Pair Study

Comparative Survival Outcomes of Kidney Transplantation vs. Ongoing Dialysis in Extremely Elderly Patients: A Matched-Pair Study

Utilizing Leadless Pacemakers in Extremely Elderly Patients With a Conventional Pacemaker System: A Two-Year Follow-Up Case Series Without Generator Extraction in High-Risk Scenarios.

Background and objectives Leadless pacemakers, known for their safer clinical profile, offer significant advantages for elderly patients at a higher risk of complications associated with transvenous pacemaker procedures, particularly those susceptible to high-risk bleeding and infections related to cardiac implantable electronic device interventions. This study explores an alternative use of leadless pacemakers without removing existing transvenous systems, deviating from conventional generator replacement and lead re-interventions. Methods This study was conducted with full approval from the Institutional Review Board, Medical Ethical Committee, Centro Hospitalar Conde São Januário, Macau. Between January 2018 and December 2021, we conducted a retrospective case series involving extremely elderly individuals (aged 85 years or older) at a high risk of complications, necessitating either generator replacement or lead re-implantation. The study considered implanting a leadless pacemaker (Micra; Medtronic,Minneapolis, MN, USA) without removing the transvenous generator. For the primary endpoints, we evaluated procedure-related complications and clinical outcomes during hospitalization. Secondary endpoints included the stability of parameters and any unexpected interference or interactions between the two systems during the two-year follow-up. Results Eleven patients (aged 86-101) were enrolled, most receiving antiplatelet or anticoagulation therapy. Leadless pacemaker implantation proceeded without major complications or adverse clinical outcomes during hospitalization. Regular follow-up was conducted every three to six months for adjusting pacemaker parameters and interrogating each patient. Over two years, three patients died from non-cardiac causes: two from infection and one from spontaneous intracranial hemorrhage, while eight completed regular follow-ups. We didn't detect any episodes of ventricular arrhythmias or intracardiac capture from the transvenous pacemaker system. We observed the stability in both the longevity and the voltage of the conventional generator battery, maintaining similar parameters without significant depletion (mean voltage decline: -0.07V/year). Parameters of the leadless pacemaker remained consistently normal without interference with existing pacing systems. Conclusion Implanting leadless pacemakers without removing transvenous pacemaker generators appears safe and effective for extremely elderly patients who are at high risk of complications. Comprehensive two-year follow-up supports the safety and viability of this approach. Opting for this approach instead of conventional generator replacement, with or without additional lead implantation, may be reasonable in this population. However, further research within this patient cohort, such as exploring long-term outcomes beyond two years or comparing clinical outcomes with conventional strategies, may be necessary.

Abstract 13632: Predictors of Death and/or Readmission in Extremely Elderly Patients Hospitalized for Decompensated Heart Failure

Introduction: Heart Failure (HF) is the final stage of cardiac illness, and it has become highly prevalent with the aging population. The extremely elderly population is underrepresented in HF clinical studies. This study aims to identify predictors of readmission and mortality in extremely elderly patients hospitalized for decompensated heart failure. Research Question: What are the predictors of readmission and mortality in extremely elderly patients hospitalized for decompensated heart failure? Methods: Retrospective cohort study in the model of a single-center registry including data from 2019 to 2022. The study was conducted at a private tertiary institution located in Salvador-BA, Brazil and included patients ≥ 80 years old admitted with a diagnosis of HF. Data was collected from electronic medical records and through follow-up performed 30 days after discharge, analyzed using descriptive statistics and compared by parametric or non-parametric tests, as appropriate. Multivariate analysis with logistic regression was performed to evaluate independent predictors of readmission and death from HF. Results: A total of 221 extremely elderly patients hospitalized for decompensated HF were included. There was a higher prevalence of females (57.4%), mean age of 87.6 ± 4.9 years, and mean Left Ventricular Ejection Fraction (LVEF) of 49.5 ± 17.1%. After 30 days, it was found that 14.9% of this sample had a death outcome and 16.7% were readmitted, totaling 28.1% of combined outcome (death and/or rehospitalization). The outcome group had older age (88.7 ± 4.6 years vs. 87.2 ± 4.9; p = 0.039), lower diastolic blood pressure (DBP) (74.8 ± 18.4 mmHg vs. 81.5 ± 15.6 mmHg; p = 0.007), higher rate of past ischemic stroke (30.6% vs. 13.2%; p = 0.002), and higher palliative care rate (27.4% vs. 3.2%; p = 0.001). In logistic regression, history of ischemic stroke [OR: 3.43 (CI: 1.30 - 9.05); p = 0.013], DBP [OR: 0.96 (CI: 0.93 - 0.99); p = 0.010], and palliative care [OR: 66.71 (CI: 8.18 - 543.66); p < 0.001] were independent risk factors for the combined outcome at 30 days. Conclusion: In extremely elderly patients admitted for heart failure, death or hospitalization at 30 days demonstrated an independent association with a history of ischemic stroke, DBP and palliative care.

Ureteroscopy for Stone Disease in Extremely Elderly Patients (≥85 Years): Outcomes and Lessons Learned.

Introduction: The volume of surgeries including ureteroscopy (URS) performed for urolithiasis is increasing. This includes for the elderly population. The aim of this study was to evaluate the outcomes of URS in extremely elderly patients and identify any lessons that could be learned for clinical practice and treatment planning. Materials and Methods: Retrospective analysis was performed of consecutive patients aged 85 years and older undergoing URS between 2010 and 2022 at our tertiary center. Uni- and multivariable logistic regression analyses were performed to identify possible risk factors for complications. Survival analysis, stratified by age-adjusted Charlson Comorbidity index (ACCI), was performed using the Kaplan-Meier method as well as the log-rank test. Results: Sixty-four URS procedures were performed on 51 patients (mean age 88 years, range 85-97). Mean ACCI score was 7 (range 4-13) and most patients were American Society Anesthesiologists 3 (78%). Mean operative time and hospital stay were 60 minutes (range 15-120) and 2 days (range 0-6), respectively. At 3-month follow-up imaging, 92% were stone free (zero fragments). Intraoperative complication rate was 14% and in three cases (5%), early termination of the procedure was necessary. Eight patients (13%) suffered a complication before discharge. Eighteen patients (28%) had documented late complications after their surgery. The complication rate when combining early and late adverse events was 41%. One year mortality rate was 23%. Multivariable regression analysis revealed that operation time and ACCI >7 were significant predictors of complications after surgery. Survival probability was significantly worse in those patients with ACCI >7 (p = 0.0083). Conclusion: The morbidity burden of URS in the extremely elderly is higher than for other population groups. Risk should be considered carefully and implementation of ACCI can aid this process. High scores should prompt strong consideration of a conservative approach. Operation time should be kept to a minimum wherever possible.

Abstract 9030: Effects of Edoxaban on Clinical Outcomes in Extremely Elderly Patients (aged ≥ 90 Years) With Atrial Fibrillation: A Subanalysis of Data from the ELDERCARE-AF Trial

Introduction: Atrial fibrillation (AF) affects about 10% of the very elderly (≥ 80 years), and its prevalence increases exponentially with age. Data are lacking on the efficacy and safety of anticoagulants in extremely elderly AF patients (≥ 90 years). We tested the hypotheses that such patients are at increased risk of stroke or systemic embolism (SSE) and could benefit from low-dose edoxaban. Methods: This was a subanalysis of ELDERCARE-AF, a multicenter, double-blind, phase 3 study in which very elderly Japanese patients with non-valvular AF (NVAF) considered ineligible for standard anticoagulants were randomly allocated to low-dose edoxaban (15 mg once daily) or placebo. Outcomes were compared between the three prespecified subgroups of age at baseline 80-84, 85-89, and ≥ 90 years. Primary efficacy and safety endpoints were incidence of SSE and ISTH-defined major bleeding, respectively (% per patient-year). Results: A total of 984 patients were randomized. Mean (± SD) age and CHADS 2 score of the patients aged ≥ 90 years were 92.3 (2.1) years and 3.1 (1.1), respectively. SSE occurred in 14/354 (2.8%), 25/374 (5.0%), and 20/256 (6.1%) of patients aged 80-84, 85-89, and ≥ 90 years, respectively; its incidence was significantly higher in the ≥ 90 years vs 80-84 years group (HR = 2.16 [95% CI, 1.09-4.27], P = 0.03). Major bleeding occurred in 6/353 (1.3%), 12/373 (2.6%), and 13/256 (4.3%) of patients aged 80-84, 85-89, and ≥ 90 years, respectively; its incidence was significantly higher in the ≥ 90 years vs 80-84 years (HR = 3.42 [1.30-9.01], P = 0.01). In this patient group ≥ 90 years with higher SSE and major bleeding incidences, edoxaban showed a significantly lower SSE incidence than placebo (4/129 [2.4%] vs 16/127 [10.1%]; HR = 0.23 [0.08-0.68], P = 0.008); however, edoxaban showed a greater tendency toward major bleeding than placebo (10/129 [6.5%] vs 3/127 [2.1%]; HR = 3.02 [0.82-11.21], P = 0.10), and significantly higher incidence of gastrointestinal bleeding (9/129 [5.9%] vs 1/127 [0.7%]; HR = 8.37 [1.04-67.07], P < 0.05). Conclusions: In extremely elderly Japanese NVAF patients, low-dose edoxaban may be an option for preventing SSE. The prophylactic benefit must be balanced against the increased risk of major bleeding, particularly gastrointestinal bleeding.

急性胆囊炎に対する緊急手術例の至適な手術時期と超高齢者での安全性についての検討

急性胆囊炎に対する緊急手術例の至適な手術時期と超高齢者での安全性についての検討

Complex Cervical Spine Surgery Improves Quality of Life in the Extremely Elderly Age Group; Results From an Ambispective Study of 582 Patients Over 75 years Old From a Single Institution

Wilson, Jamie R.F; Badhiwala, Jetan H MD; Joshi, Hetshree; Khan, Omar; Moghaddamjou, Ali; Rampersaud, Raja Y MD; Lewis, Stephen MD; Massicotte, Eric M MD; Fehlings, Michael G MD, PhD Author Information

Complex Spine Surgery is Safe and Effective in the Extremely Elderly Age Group; Results From an Ambispective Study of 722 Patients Over 75 Years Old From a Single Institution

Wilson, Jamie R.F; Badhiwala, Jetan H MD; Moghaddamjou, Ali; Jiang, Fan MD; Rampersaud, Raja Y MD; Lewis, Stephen MS, MD; Massicotte, Eric M MD; Fehlings, Michael G MD, PhD Author Information

Reconstruction of Full Thickness Scalp Defects in Extremely Elderly Patients Using Dermal Regeneration Templates.

The reconstruction of full thickness scalp defects following oncologic resection poses a unique challenge that is further magnified in "extremely elderly" patients, defined as those in at least their ninth decade of life, who are often unsuitable candidates for complex reconstruction. A "simpler" option is two-stage reconstruction: placement of Integra dermal regenerative template (Integra Life Science, Plainsboro, NJ) followed by a split thickness skin graft (STSG). This case series illustrates the success of this technique in the extremely elderly. A retrospective analysis of patients > 80 years at the time of surgery who underwent full thickness scalp reconstruction following tumor extirpation in a two-stage approach under the care of single surgeon from January 2010 to June 2019 was conducted. Variables reviewed were medical history, surgical treatment response, time to split thickness skin graft, follow up, and success of wound coverage. Fourteen patients, with a mean age of 87 years (range: 80 to 101, median: 87), met inclusion criteria. Split thickness skin grafts were placed after an average of 18 days. Twelve patients had successful two-stage reconstruction with 100% take. One patient developed a hematoma under a portion of the template that neither required reoperation nor delayed split thickness skin graft placement. A second suffered from insufficient vascularization of the template with delay to split thickness skin graft and incomplete wound closure. This two-stage approach is a successful primary reconstructive option for definitive management of full thickness scalp defects following oncologic resection in extremely elderly patients.

Rigorous Correction of Sagittal Vertical Axis Is Correlated With Better ODI Outcomes After Extensive Corrective Fusion in Elderly or Extremely Elderly Patients With Spinal Deformity

Study DesignRetrospective analysis of a prospectively collected consecutive case series. ObjectivesTo determine the effect of spinopelvic correction on clinical outcomes and discuss the approach to target alignment in elderly or extremely elderly spinal deformity patients. Summary of Background DataAge-dependent target alignment during corrective fusion surgery in elderly patients remains controversial. Age-related target spinal alignment should be examined based on the outcomes data of patients with fused, nonphysiological spines. MethodsConsecutive adult spinal deformity (ASD) patients aged 45 years or older who underwent thoracolumbar corrective fusion of at least five levels were included. Spinopelvic radiographic parameters, health-related quality of life (Oswestry Disability Index [ODI]), and the scores on a numeric rating scale of low back pain were investigated before and after the operation. The patients were stratified into three groups according to age as follows: Middle-Age, 45–64 years; Elderly, 65–74 years; and Extremely Elderly, ≥75 years. We also stratified the patients into three groups according to lumber lordosis (LL) as follows: ideal (within ±5° of ideal LL), moderate (between −5° and −20° of ideal LL), and under (under ideal LL by −20°). ResultsA total of 149 patients (Middle-Age, 38; Elderly, 68; and Extremely Elderly, 43) were included in this study. No significant difference was observed in any of the radiographic parameters in each age group. The ODI and numeric rating scale scores of the ideal-correction group at two years after surgery were significantly better than those of the undercorrection group across all ages. A significant correlation with ODI was observed between sagittal spinopelvic parameters in the Elderly and Extremely Elderly groups. A stronger correlation was observed in the Extremely Elderly group compared with the Elderly group. ConclusionsRigorous realignment of sagittal vertical axis is correlated with ODI outcomes, especially in very elderly patients. Level of EvidenceLevel 4.

Characterization of Oral Anticoagulant Use Among Extremely Elderly Patients Hospitalized at a Tertiary Academic Medical Center.

Characterization of Oral Anticoagulant Use Among Extremely Elderly Patients Hospitalized at a Tertiary Academic Medical Center.

P2.15-11 Clinical Outcome of Pulmonary Resection for Non–Small Cell Lung Cancer in Extremely Elderly Patients (85-Year-Old or Over)

Surgical resection is considered to be an effective therapy in the elderly patients. In Japan, the number of surgical operations performed in the elderly patients has been increasing. We reviewed the outcome of surgical treatment and the determining indication of pulmonary surgery in patients aged 85 years or over. We performed surgical resection for 27 lung cancer patients aged 85 years or over in our hospital from January 2007 to December 2016. The patients’ operative procedure, histological type, comorbidity, surgery-related complications, prognosis, and recurrence were retrospectively reviewed. We performed pulmonary surgery for elderly patients who have to be able to undergo pulmonary physiotherapy, have good performance status (0-1 in ECOG scale), and be free from psychological disorder such as dementia. There were 19 males and 8 females. Their mean age was 87.0 years (range: 85-93 years). The mean follow-up period after operation was 1585 days (range: 395-3255 days). Operative procedures include lobectomy (N=10), segmentectomy (N=8), and wedge resection (N=9). Histological type include adenocarcinoma (N=18), squamous cell carcinoma (N=7), adenosquamous carcinoma (N=1), and LCNEC (N=1). Pathological stage was ⅠA in 20 patients, ⅠB in 4patients, ⅡB in 2 patients, and ⅢA in 1 patient. 17 patients had comorbidity including coincidence of other malignancy, anti-coagulant therapy, history of the lobectomy, and others. No patients died from surgery or post-surgical complications. Morbidity rate was 14.8% (e.g. refractory pulmonary fistula, Atrial fibrillation, heart failure, atelectasis). 14 patients are alive, whereas 11 patients died from other diseases than lung cancer. 4 patients experienced recurrence, and 2 patients of those died. 5-year survival rate was 71.4%, and 3-year survival rate was 87.5%. Our study indicates that the surgical resection of non-small cell lung cancer benefits patients, even with extremely elder age (85-year-old or older). We consider patients with clinical stage I are good candidates. The long-term prognosis is expected if we chose the patients in elderly people lung cancer definitely.

Safety and Efficacy of Anti-dementia Agents in the Extremely Elderly Patients with Dementia.

BackgroundThere are debates on representation and generalizability of previous randomized controlled trials about anti-dementia agents in the oldest old population. In this context, we aimed to investigate the efficacy and safety of anti-dementia agents in the very elderly patients with dementia.MethodsWe conducted a retrospective study of patients with dementia 1) who were 85 years or older, 2) got started anti-dementia agents, and 3) went through follow-up evaluation about one year thereafter. As a control, patients with dementia who were less than 85 years old with similar inclusion criteria were randomly selected during the same period. The adverse drug effects and discontinuation rates were investigated with self-reported complaint after starting or increasing anti-dementia drugs. For efficacy outcome, we also analyzed the change in neuropsychological results during follow-up period.ResultsA total of 77 dementia patients who were at least 85 years were enrolled. As a control group, 78 patients with dementia who were younger than 85 was analyzed. The adverse drug effects were observed in 26 (33.3%) patients in the younger old and in 26 (33.8%) in the oldest old (P = 0.095). Twenty-one patients (26.9%) in the younger old group and 13 patients (16.9%) in the oldest old group discontinued their medication (P = 0.131). There were no differences between the two groups about changes of Mini-Mental State Examination and Instrumental Activity of Daily Living scores over time.ConclusionThe use of anti-dementia agents in the oldest old dementia patients may be safe and effective as the younger old dementia patients.

Risk Factors for Delirium After Spine Surgery in Extremely Elderly Patients Aged 80 Years or Older and Review of the Literature: Japan Association of Spine Surgeons with Ambition Multicenter Study.

Study Design:Retrospective database analysis.Objective:Spine surgeries in elderly patients have increased in recent years due to aging of society and recent advances in surgical techniques, and postoperative complications have become more of a concern. Postoperative delirium is a common complication in elderly patients that impairs recovery and increases morbidity and mortality. The objective of the study was to analyze postoperative delirium associated with spine surgery in patients aged 80 years or older with cervical, thoracic, and lumbar lesions.Methods:A retrospective multicenter study was performed in 262 patients 80 years of age or older who underwent spine surgeries at 35 facilities. Postoperative complications, incidence of postoperative delirium, and hazard ratios of patient-specific and surgical risk factors were examined.Results:Postoperative complications occurred in 59 of the 262 spine surgeries (23%). Postoperative delirium was the most frequent complication, occurring in 15 of 262 patients (5.7%), and was significantly associated with hypertension, cerebrovascular disease, cervical lesion surgery, and greater estimated blood loss (P < .05). In multivariate logistic regression using perioperative factors, cervical lesion surgery (odds ratio = 4.27, P < .05) and estimated blood loss ≥300 mL (odds ratio = 4.52, P < .05) were significantly associated with postoperative delirium.Conclusions:Cervical lesion surgery and greater blood loss were perioperative risk factors for delirium in extremely elderly patients after spine surgery. Hypertension and cerebrovascular disease were significant risk factors for postoperative delirium, and careful management is required for patients with such risk factors.

Surgery of Intestinal Obstruction in an Extremely Elderly Patient Aged 101 Years

症例は101歳女性．嘔吐を主訴に当院受診．イレウスの診断にて入院となった．イレウスチューブを挿入後症状は改善したが，チューブの先端が進行せず，イレウスチューブ造影検査で先進部に狭窄部位があると診断した．保存的治療の限界であり，手術適応と判断した．手術のリスクを評価すると，合併症発症や死亡のリスクが非常に高いが，ご家族に十分に説明を行い，同意を得たため手術を施行した．大網による索状物によって，回腸末端より約10cmの部位から約50cmにわたりclosed loopを形成し絞扼されていた．腸管の色調は比較的良好であったが，索状物を切離した後も瘢痕狭窄が残存したため，小腸を部分切除した．術後は合併症もなく経過良好にて術後21日目に退院された．今回われわれは超高齢者101歳のイレウスの手術を施行し，良好な経過を得た症例を経験したので報告する．

Sa1508 Long-Term Follow-up of Extremely Elderly Patients With Early Gastric Neoplasms Treated by Endoscopic Submucosal Dissection

groups, respectively (P!0.001). Median follow up period was 32 months (range, 0147.4 months). The five-year overall survival rates were 96.7% and 95.3% for absolute and expanded indication group, respectively (pZ0.940). Local recurrence was observed in five tumors (0.3%) at 2, 2, 6, 19 and 34 months after first ESD (3 en bloc and 2 piecemeal resection). Extragastric recurrence occurred in two EGC cases (0.13%) meeting each AI and EI. The extragastric recurrence interval was 62 months in the AI group and 46 months in the EI group. At that time, endoscopic examination showed no evidence of local recurrence around ER scar area. Metachronous recurrence occurred in 49 EGC cases (2.7%) during follow-up period. The median metachronous recurrence interval was 27.0 months (range, 13-115 months). The cumulative incidence of metachronous recurrence is increased steadily. Conclusions: The expanded indication of ER for EGCs showed acceptable long-term outcomes. Endoscopic examination is required more than 5 years after ER for EGC because the cumulative incidence of metachronous recurrence is increased steadily. Extragatric recurrence occurred at least two years after ESD in most cases unlikely ordinary recurrence pattern of AGC. CT should be performed together with endoscopy for surveillance of recurrence after ER for EGC in the AI group as well as the EI group. Sa1508 Long-Term Follow-up of Extremely Elderly Patients With Early Gastric Neoplasms Treated by Endoscopic Submucosal Dissection Tatsuya Toyokawa*, Tomoki Inaba, Koichi Izumikawa, Isao Fujita, Shigenao Ishikawa, Jun Tomoda Department of Gastroenterology, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan; Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu, Japan Background: Endoscopic submucosal dissection (ESD) has been established as a standard treatment for early gastric neoplasms in Japan. Recently, ESD has gained momentum worldwide. With the increase in the aging population, the number of elderly patients undergoing ESD for the treatment of early gastric neoplasms has steadily increased. This study aimed to investigate the long-term clinical outcomes of early gastric neoplasm in patients aged S 85 years who underwent ESD. Methods: The study subjects were 1123 cases with early gastric neoplasms who underwent ESD from May 2003 to August 2010 at Fukuyama Medical Center, Kagawa Prefectural Centrall Hospital, and Mitoyo General Hospital. The patients were classified into two groups as follows: the elderly group (S 85-years-old) and the nonelderly group (! 85-years-old). We compared the characteristics of patients and lesions, treatment outcomes, procedure-related complications and prognosis between the two groups. Statistical analysis was performed using Mann-Whitney U-test and Chi-square test, p! 0.05 was considered to be statistically significant. Results: The elderly group included 62 cases and the non-elderly group included 1061 cases. The mean follow-up period was approximately 51 months. The female to male ratio was significantly higher in the elderly group than in the non-elderly group. The underlying incidences of hypertension and heart disease were significantly higher in the elderly group. The location, size and types of lesions were not significantly different between the two groups. The mean size of resected specimens from the elderly patients was larger than that from the non-elderly patients (39 mm vs. 35 mm). The en-bloc resection (97% vs. 93%) and curative resection rates (89% vs 84%) were high in both groups. The procedure time was similar between the two groups. No significant procedure-related complications, such as perforation or delayed bleeding, were observed in the two groups. The rates of residual disease or recurrence in both groups were very low (0% vs. 1.1%), and the differences were not significant. The death rate was significantly higher in the elderly group (26% vs. 7.1%) during the follow-up period. However the original disease was not the cause in either of the groups, and there were no significant differences in the reason for death or the period from ESD to death between the two groups. Conclusions: In this study, the treatment of early gastric neoplasms by ESD was equally effective in extremely elderly patients and non-elderly patients. Furthermore, it was elucidated that the death rate because of other diseases is higher in extremely elderly patients and that they have Data and Outcomes for Preand Post-Clipping Phases # of Colonscopies # of Patients # of Polyps Male/ Female Mean Age and Range Polypectomy Duration Mean and Range(minutes) Pre-Clipping 2121 55 65 36/19 69.3 (37-87) 17.47 (2-61)

Instrumental Variable Analysis to Compare Effectiveness of Stents in the Extremely Elderly

Evaluating novel therapies is challenging in the extremely elderly. Instrumental variable methods identify variables associated with treatment allocation to perform adjusted comparisons that may overcome limitations of more traditional approaches. Among all patients aged ≥85 years undergoing percutaneous coronary intervention in nonfederal hospitals in Massachusetts between 2003 and 2009 (n=2690), we identified quarterly drug-eluting stent (DES) use rates as an instrumental variable. We estimated risk-adjusted differences in outcomes for DES versus bare metal stents using a 2-stage least squares instrumental variable analysis method. Quarterly DES use ranged from 15% to 88%. Unadjusted 1-year mortality rates were 14.5% for DES versus 23.0% for bare metal stents (risk difference, -8.5%; P<0.001), an implausible finding compared with randomized trial results. Using instrumental variable analysis, DES were associated with no difference in 1-year mortality (risk difference, -0.8%; P=0.76) or bleeding (risk difference, 2.3%; P=0.33) and with significant reduction in target vessel revascularization (risk difference, -8.3%; P<0.0001). Using an instrumental variable analysis, DES were associated with similar mortality and bleeding and a significant reduction in target vessel revascularization compared with bare metal stents in the extremely elderly. Variation in use rates may be useful as an instrumental variable to facilitate comparative effectiveness in groups underrepresented in randomized trials.

Weekly Four Times Rituximab Consolidation Following Reduced Cycles Of R-CHOP Induction Chemotherapy In Extremely Elderly Patients With Diffuse Large B Cell Lymphoma

▪ PurposePoor outcome of patients with elderly diffuse large B-cell lymphoma (DLBCL) has been linked to their decreased ability to receive full course of R-CHOP, dose-reduction of chemotherapy due to toxicities and their concomitant disease to interrupt the treatment. Recently, several studies suggested that attenuated R-CHOP regimen or reduced cycles of R-CHOP showed the survival benefit along with good tolerability and safety for very elderly patients. The study is aimed to determine objective response, toxicitiy and clinical outcome of weekly four times rituximab augmentation after reduced cycles of R-CHOP in extremely elderly patients with DLBCL. Patients and MethodsProspective, multi-institutional phase II trial was conducted for patients with previously untreated CD20+ diffuse large B cell lymphoma who aged more than 70 years and achieved complete or partial response after 4th R-CHOP chemotherapy (NCT01181999). R-CHOP was infused every 21 days, with initial dose-intensity of CHOP regimen was modulated according to Charlson Comorbidity Index (CCI). If patients were with CCI <1, patients were treated with standard dose of CHOP, however, if patients with CCI °Ã1, patients were with 75% of conventional dose initially. Rituximab consolidation (375mg/m2) was treated weekly four times, at the time of full recovery after 4th R-CHOP. Trimethoprim/sulfamethoxasole (160mg/800mg, 1T orally) was given daily during rituximab consolidation. Response assessment based on Revised International Workshop Criteria was evaluated at the completion of the fourth R-CHOP, after rituximab consolidation and whenever disease progression is suspected. Results51 DLBCL patients were enrolled from 14 institutes between June 2010 and April 2013. Median age was 76 years (range: 70-89) and 35.3% patients had more than 2 concomitant chronic disease. 36 out of 51 patients could be proceeded toward weekly four times rituximab consolidation. High treatment-related mortality (13.7%) during R-CHOP was huddle to proceeding to consolidation treatment. 35 patients (68.6%) presented with high-intermediate or high risk based on IPI and 12 patients (23.5%) were classified with a score of 2 by Glasgow prognostic score (GPS). After a median follow-up of 18.6 months, overall response rate was 70.6% with 66.7% of complete response and 3.9% of partial response. 31 patients (60.8%) were started with decreased dose of CHOP with median 75% reduction of CHOP (range; 50-100%). 2-year probability of progression-free survival (PFS) was 71.5 ±7.9% with 10 relapses. GPS based on systemic inflammatory indicators was a useful prognostic indicator for PFS compared to IPI. The adverse events were mainly related with hematologic toxicities and neutropenic infections during R-CHOP. However, no toxicities were reported associated with rituximab weekly infusion and no adverse events related with delayed infection after rituximab consolidation. ConclusionsRituximab consolidation after reduced cycles of R-CHOP resulted in a favorable response with high tolerability. Debulking R-CHOP and followed by weekly rituximab consolidation could be a good compromise between efficacy and tolerability for extremely elderly DLBCL▪ Disclosures:No relevant conflicts of interest to declare.

Long Term Follow-up of an Extremely Elderly Man Who Underwent Emergency Metallic Stent Placement for Postintubation Tracheal Stenosis

Long Term Follow-up of an Extremely Elderly Man Who Underwent Emergency Metallic Stent Placement for Postintubation Tracheal Stenosis