Long-term Outcomes In Elderly Patients Research Articles

Evaluation of efficacy of physiologic ability and surgical stress score to predict postoperative complications and of long-term outcome in elderly patients with pancreaticoduodenectomy

Evaluation of efficacy of physiologic ability and surgical stress score to predict postoperative complications and of long-term outcome in elderly patients with pancreaticoduodenectomy

Pre-Procedural N-Terminal Pro-B Type Natriuretic Peptide Predicts Contrast-Induced Acute Kidney Injury and Long-Term Outcome in Elderly Patients After Elective Percutaneous Coronary Intervention.

The aim of the study is to evaluate the association of pre-procedural N-terminal pro-B type natriuretic peptide (NT-proBNP) with contrast-induced acute kidney injury (CI-AKI) and long-term outcomes in elderly patients undergoing elective percutaneous coronary intervention (PCI).A total of 540 patients aged ≥ 75 years who had undergone elective PCI between January 2012 and December 2015 were enrolled in this study. Admission NT-proBNP levels were measured before PCI. CI-AKI was defined as a relative increase in serum creatinine (SCr) of ≥50%, or an absolute increase of ≥ 0.3 mg/dL, occurring within 48 hours after contrast medium exposure. The predictive value of NT-proBNP for predicting CI-AKI was assessed by receiver operating characteristic (ROC) and multivariable logistic regression analysis.A total of 54 (10.0%) patients developed CI-AKI. The best cutoff value of NT-pro-BNP for detecting CI-AKI was 1133 pg/mL with 66.7% sensitivity and 70.8% specificity according to the ROC analysis (C statistic = 0.719; 95% CI, 0.679-0.756). Multivariable analysis demonstrated that Lg-NT-proBNP is significantly related to CI-AKI (odds ratio [OR] = 3.892; 95% CI, 1.996-7.590; P < 0.001). Cox regression analysis showed that Lg-NT-proBNP is associated with long-term mortality (adjusted hazard ratio [HR] = 2.158; 95% CI, 1.246-3.740; P = 0.006) during follow-up.Pre-procedural NT-proBNP is a significant and independent predictor of CI-AKI and long-term mortality in elderly patients following elective PCI, and the best cutoff point for predicting CI-AKI was 1133 pg/mL.

THE ROLE OF PATHOPHYSIOLOGY IN BUILDING MEDICAL KNOWLEDGE

Anticoagulation is the primary treatment for pulmonary embolism (PE). Inferior vena cava (IVC) filters are an adjunctive intervention to prevent recurrent pulmonary embolism. Long-term outcomes in elderly patients with contraindications to anticoagulation after IVC filter placement for prevention of recurrent pulmonary embolism have yet to be assessed.Patients ≥ 60 years of age, that had an IVC filter placed between 1 January, 2008 and 2 February, 2013, with a primary diagnosis of pulmonary embolism, were included. Patients that died during index hospitalisation, were discharged to hospice, or had active malignancy were excluded. The primary endpoint was overall survival. Patients were divided depending on whether they were treated with an approved anticoagulant for VTE or had no anticoagulant.Of the 152 patients identified, 55 were not anti-coagulated after IVC filter placement. The incidence of death was 0.4 per 1000 filter days and 0.7 per 1000 filter days in the anti-coagulated and untreated groups respectively (p-value = 0.06). After statistical correction for co-morbid conditions, the effect of anticoagulation was not significant (HR 0.82 CI 0.49–1.37, p-value 0.46). Age was a significant confounder that was associated with death. Increased BMI was protective. Indications for IVC filter placement were numerous, but similar between the two groups.Treatment with an approved anticoagulant is recommended after IVC filter placement for prevention of recurrent PE, however its effect may be attenuated by advanced age. In elderly patients that have undergone IVC filter placement for prevention of recurrent PE, survival may be more dependent on age and co-morbid conditions than exposure to anticoagulation.

Long-term outcomes in elderly patients with resectable large hepatocellular carcinoma undergoing hepatectomy

BackgroundIn contrast to the feasibility of hepatectomy for resectable large hepatocellular carcinoma (HCC, >5 cm) in the younger patients, the concerns of benefits for the elderly patients remain in practice. This study aimed to evaluate the long-term outcomes and safety after hepatectomy in elderly patients with resectable large HCC compared with younger patients. MethodsBetween 2003 and 2014, a total of 2211 HCC patients were reviewed using a prospective database and 257 patients with resectable large HCC undergoing hepatectomy were included: 79 elderly patients with age ≥70 years and 178 younger patients with age <70 years. The last follow-up was assessed in December 2017. The complications, long-term outcomes and risk factors of disease-free and overall survival were analysed. ResultsThe 1-, 3-, 5- and 7-year overall survival rates in the elderly and younger groups were 76%, 55%, 48%, and 42% and 79%, 57%, 51%, and 49%, respectively (P = 0.319). The 1-, 3-, 5-, and 7-year disease-free survival rates in the elderly and younger groups were 60%, 40%, 38%, and 27% and 54%, 36%, 32%, and 32%, respectively (P = 0.633). The analysis of post-operative outcomes of interest, including hospital stay and hospital death and hepatectomy-related complications in both groups revealed no significant difference. Serum albumin and AJCC TNM stage were independent risk factors for survival. Serum alpha-fetoprotein, tumour number and AJCC TNM stage predicted HCC recurrence. ConclusionsOur results suggested that hepatectomy can achieve comparable long-term outcomes in the selected younger and elderly patients with resectable large HCC.

Prognostic factors for short-term and long-term outcomes of gastric cancer surgery for elderly patients: 10 years of experience at a single tertiary care center.

This retrospective study aimed to verify the short-term and long-term outcomes of elderly patients who underwent gastric resection for gastric cancer and to compare the results between younger and elderly patients. 222 Patients, who underwent gastrectomy between January 2005 and December 2014, were divided into 2 groups: ≤ 75years old (group A) and > 75years (group B). The groups were homogeneous except for more advanced pathological stage (p = 0.011) and higher number of comorbidities in group B (p < 0.001) and a higher rate of neoadjuvant or adjuvant complementary therapy in group A (p = 0.029 and p < 0.001). Perioperative morbidity rates were 38.7 and 65.5% (p = 0.001), and mortality rates were 2.5 and 7.9% (p = ns), respectively. The independent negative prognostic factors for morbidity were age older than 75years [odds ratio (OR) 2.7], multiple organ resection (OR 2.4), and male gender (OR 1.8). The 36-month survival rates were 76.1% and 42.1% (p = 0.002) and disease-free survival rates were 85% and 76.3% (p = 0.017), respectively. Surgical indications should not be limited by age.

Endoscopic submucosal dissection for early esophageal cancer in elderly patients with relative indications for endoscopic treatment.

According to the Japanese Esophageal Society (JES) guidelines, early esophageal squamous cell carcinoma (SCC) involving the muscularis mucosae (M3) or upper submucosal (SM1) layers are relative indications for endoscopic submucosal dissection (ESD). Additional esophagectomy or chemoradiotherapy is recommended for patients with relative indications after evaluation. However, elderly patients (≥ 60 years) with relative indications in China often refuse additional treatment because of the debilitating side effects. The aim of this study was to evaluate the long-term outcomes of elderly patients with relative indications who did not undergo additional treatment after ESD. Data from elderly patients with relative indications who underwent ESD for early esophageal SCC between January 2008 and December 2013 were reviewed retrospectively. Stricture and recurrence, and 5-year progression-free survival (PFS) and overall survival rates were compared with patients with absolute indications for ESD. 158 elderly patients were included and analyzed (89 in the absolute indications group and 69 in the relative indications group). The baseline characteristics were balanced between the two groups. During 56 months (range 1 - 108) of follow-up, the postoperative stricture rates were similar in the absolute and relative indications groups (21.3 % vs. 31.9 %; P = 0.13). The hazard ratio (HR) for PFS in the absolute vs. the relative indications groups was 1.025 (95 % confidence interval [CI] 0.36 - 2.95; P = 0.96). The 5-year PFS rates were 90.5 % (95 %CI 83.44 - 97.56) and 90.8 % (95 %CI 83.74 - 97.86) for the absolute and relative indications groups, respectively. The HR for overall survival in the absolute vs. the relative indications groups was 0.564 (95 %CI 0.13 - 2.52; P = 0.45). The 5-year overall survival rates were 96.6 % (95 %CI 92.88 - 100) and 95.6 % (95 %CI 90.70 - 100) for the absolute and relative indications groups, respectively. Based on this study, regular follow-up without additional treatment may be considered as another choice for elderly patients with early esophageal SCC and relative indications after ESD.

Outcomes of a percutaneous coronary intervention versus coronary artery bypass grafting in octogenarians.

Background.The data on long-term outcomes for elderly patients with coronary artery disease who undergo invasive treatment is limited. This study aimed to assess long-term outcomes and risk factors for patients over 80 years of age who underwent revascularisation.Methods.This single-centre retrospective study included ≥80-year-old patients who underwent coronary angiography between 2012 and 2014. Among 590 study patients, 411 patients had significant angiographic changes and had either a percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) performed. Baseline patient characteristics, including demographics, comorbidities, survival to hospital discharge, and long term mortality were analysed. Three-year mortality was assessed.Results.Three hundred sixty-nine (89.8%) patients underwent PCI and in 42 (10.2%) CABG was performed. Significant differences between groups were detected in heart failure (PCI – 51.2% vs. CABG – 78.6%; p = 0.001), previous CABG (11.4% vs. 0%; p = 0.014), cardiogenic shock (12.2% vs. 0%; p = 0.008). Hospital mortality rate in the PCI group – 10.6%, CABG – 7.1%; p = 0.787. A median 3-year survival rate in the PCI group – 66.1%, CABG – 66.7%; p = 1.000. Chronic heart failure (OR 2.442; 95% CI: 1.530–3.898, p < 0.001), atrial fibrillation (OR 0.425; 95% CI: 0.261–0.692, p < 0.001), cardiogenic shock (OR 0.120; 95% CI: 0.054–0.270, p = 0.001), and LMCA stenosis (OR 2.104; 95% CI: 1.281–3.456, p = 0.003) were identified as independent 3-year all-cause mortality predictors in multivariate regression analysis.Conclusions.There was no significant difference in hospital mortality and survival rates between elderly patients who underwent PCI or CAGB. The majority of elderly patients underwent a PCI and these patients appeared to experience cardiogenic shock more frequently.

Low free triiodothyronine is associated with contrast-induced acute kidney injury and long-term outcome in elderly patients who underwent percutaneous coronary intervention.

Objective:Low free triiodothyronine (fT3) is common in elderly patients with cardiovascular disease. The purpose of this study was to evaluate the relationship between low fT3 and contrast-induced acute kidney injury (CI-AKI), including the long-term outcomes, in elderly patients after a percutaneous coronary intervention (PCI).Methods:A total of 350 patients aged ≥75 years who underwent PCI between January 2012 and December 2015 were consecutively enrolled. The perioperative thyroid function, including fT3, was measured before PCI. A low fT3 was defined as fT3 <3.1 pmol/L with normal thyrotropin and free thyroxine. CI-AKI was defined as an absolute serum creatinine (SCr) increase ≥0.30 mg/dL or a relative increase in SCr ≥50% from the baseline value within 48 hours after contrast media exposure. A multivariate logistic regression analysis was applied to analyze whether low fT3 was an independent risk factor for CI-AKI. The Cox regression analysis was used to evaluate the relationship between low fT3 and long-term prognosis.Results:A total of 46 (13.1%) patients developed CI-AKI. The incidence of CI-AKI was significantly higher in the low fT3 group than in the normal group (26.5% vs. 9.9%, p<0.01). A multivariable logistic analysis demonstrated that a low fT3 level was significantly related to CI-AKI [odds ratio (OR)=2.41; 95% confidence interval (CI), 1.11–5.27; p=0.027]. The Cox regression analysis showed that a low fT3 was associated with long-term mortality [adjusted hazard ratio (HR)=2.00; 95% CI, 1.04–3.83; p=0.037] during the follow-up of mean 1.67 years.Conclusion:A low fT3 concentration was independently associated with CI-AKI and poor prognosis in elderly patients who had undergone PCI.

Significance of Body Mass Index for Postoperative Outcomes after Lung Cancer Surgery in Elderly Patients.

Although the frequency of elderly patients undergoing surgery for lung cancer has been increasing, indications for surgery in elderly patients are still controversial. Low body mass index is a significant predictor of poor prognosis in elderly patients with various medical conditions. Then, we examined the long-term outcome of elderly patients who had undergone thoracic surgery for lung cancer, focusing especially on body mass index. Between January 2004 and March 2011, 1673 patients with lung cancer underwent surgical resection at our institution. Among these patients, we retrospectively examined 158 patients aged 80years or older. Perioperative morbidity and mortality rates were 41.8 and 1.3%, respectively. Among 149 patients who were completely followed up, 80 patients (53.7%) died. The overall postoperative survival rates at 3 and 5years were 66.9 and 49.9%, respectively. Univariate analysis demonstrated that sex (female), smoking index (pack-years <20), histology (non-squamous cell carcinoma), pathological stage (stage I) and BMI (within normal BMI) were statistically significant factors associated with better outcome. Multivariate analysis revealed that patients with a low (<18.5kg/m2) or high (≥25kg/m2) body mass index had a significantly and poorer prognosis than patients with a normal body mass index. Body mass index is a more useful prognostic factor than other clinical factors including pathological stage in elderly patients. Because elderly patients with low and high body mass index have a significant poor prognosis, surgeons and pulmonologist should take this into account when consider surgical indication for such elderly patients.

LO76: Emergency department procedural sedation in elderly patients

Introduction: The use of procedural sedation and analgesia (PSA) for the performance of Emergency Department (ED) procedures has been reported to be safe and effective. However, few studies have evaluated the safety of PSA in the elderly, with conflicting results. Our primary objective was to determine if elderly patients undergoing PSA for the management of an orthopedic injury had an increased risk of adverse events (AEs) during the procedure. Methods: This retrospective review of prospectively recorded data between 2006 and 2016 included patients aged ≥16 years undergoing PSA at a single institution to facilitate treatment of a fracture or dislocation. Patients were separated into 3 age groups for analysis: young (18-40), middle-aged (41-64) and elderly (≥65). Elderly patients were divided into 3 subgroups. The primary AEs studied include hypoxia (SpO2&amp;lt;90 %) and hypotension (systolic blood pressure &amp;lt;100 mmHg, or &amp;gt;15% reduction from baseline if initial &amp;lt;100 mmHg). Logistic regression (LR) models tested for associations between age and outcome measurements. Effect sizes were described as odds ratios (OR) and 95% confidence intervals. Results: 4171 patients were studied, including 1125 patients ≥65 years of age. More than 90% of the time, propofol was used as a single agent sedative. Fentanyl was given as an analgesic adjunct in 88% of patients. Medication dosing declined as patients aged. In the young group, the average total propofol dose was 2.34 mg/kg compared to 1.42 mg/kg in the elderly (≥85 years subgroup: 1.07 mg/kg). Despite this, hypoxia was more likely to occur in elderly patients (2.3%) compared to younger patients (0.4%). LR models demonstrated that hypoxia was more likely to occur in: the elderly [OR 4.29 (1.58,11.70)], patients with an ASA classification score of 3 or higher [OR 4.71 (1.89,11.70)], and higher dosing of fentanyl in the elderly [OR 2.35 (1.21,4.57)]. Oral or nasal airway, assisted ventilation, and suctioning were required in less than 1% of all patients. Endotracheal intubation was never required. Hypotension was more likely in elderly patients (11.6%) than younger patients (8.3%). Conclusion: When performing PSA, clinicians should be aware of the increased risk of AEs in the elderly, particularly hypoxia, and modify selection, dosing, and administration of the PSA medication(s) appropriately. Future study should examine the intermediate and long-term outcomes of elderly patients following ED PSA.

Impact of Anticoagulation in Elderly Patients With Pulmonary Embolism That Undergo IVC Filter Placement: A Retrospective Cohort Study

Anticoagulation is the primary treatment for pulmonary embolism (PE). Inferior vena cava (IVC) filters are an adjunctive intervention to prevent recurrent pulmonary embolism. Long-term outcomes in elderly patients with contraindications to anticoagulation after IVC filter placement for prevention of recurrent pulmonary embolism have yet to be assessed. Patients ≥60years of age, that had an IVC filter placed between 1 January, 2008 and 2 February, 2013, with a primary diagnosis of pulmonary embolism, were included. Patients that died during index hospitalisation, were discharged to hospice, or had active malignancy were excluded. The primary endpoint was overall survival. Patients were divided depending on whether they were treated with an approved anticoagulant for VTE or had no anticoagulant. Of the 152 patients identified, 55 were not anti-coagulated after IVC filter placement. The incidence of death was 0.4 per 1000 filter days and 0.7 per 1000 filter days in the anti-coagulated and untreated groups respectively (p-value=0.06). After statistical correction for co-morbid conditions, the effect of anticoagulation was not significant (HR 0.82 CI 0.49-1.37, p-value 0.46). Age was a significant confounder that was associated with death. Increased BMI was protective. Indications for IVC filter placement were numerous, but similar between the two groups. Treatment with an approved anticoagulant is recommended after IVC filter placement for prevention of recurrent PE, however its effect may be attenuated by advanced age. In elderly patients that have undergone IVC filter placement for prevention of recurrent PE, survival may be more dependent on age and co-morbid conditions than exposure to anticoagulation.

Midterm follow-up of a randomized trial of open surgery versus laparoscopic surgery in elderly patients with colorectal cancer.

Laparoscopic surgery has been widely accepted for the treatment of colorectal cancer; however, long-term outcomes in elderly patients remain controversial. The midterm results of a randomized trial comparing open surgery with laparoscopic surgery in elderly patients with colorectal cancer are presented. This was a randomized trial comparing open surgery with laparoscopic surgery in elderly patients with colorectal cancer. The primary outcome was complication rate, and secondary outcomes included 3-year recurrence-free survival and overall survival. A total of 200 patients were randomly assigned to open surgery or laparoscopic surgery between 2008 and 2012. The main study objective was to compare the midterm outcomes of open surgery with those of laparoscopic surgery in elderly patients with colorectal cancer. This trial is registered with Clinical Trials.gov (NCT01862562). There were no differences between the laparoscopic surgery group and open surgery group in the 3-year overall survival rate (91.5% for laparoscopic surgery vs. 90.6% for open surgery, p = 0.638) or the 3-year recurrence-free survival rate (84.8% for laparoscopic surgery vs. 88.2% for open surgery, p = 0.324). The local recurrence rate was significantly higher in the laparoscopic surgery group than in the open surgery group in rectal cancer (13.8% for laparoscopic surgery vs. 0% for open surgery, p = 0.038). In subgroup analysis according to tumor location, there were no significant differences in the 3-year overall survival rate or 3-year recurrence-free survival rate between the two treatment groups. The midterm outcomes of laparoscopic surgery are similar to those of open surgery in elderly patients with colorectal cancer.

Clinical Features, Surgical Treatment, and Long-Term Outcome in Elderly Patients with Moyamoya Disease.

To elucidate the clinical features, surgical treatment, and long-term outcome in elderly patients with moyamoya disease (MMD). We retrospectively reviewed 87 elderly patients with MMD at Beijing Tiantan Hospital. Clinical features, radiologic findings, and outcomes were analyzed. The mean age at diagnosis was 54.0 ± 3.7 years. Familial occurrence was 2.3%. Underlying vascular risk factors was 74.7%. Infarction was the most common symptom in elderly MMD (40.2%). Most patients presented with Suzuki stage 4 or 5 MMD (51.2%). Posterior cerebral artery involvement was observed in 22 (25.3%) patients. The incidence of postoperative infarction or hemorrhages was 6.9%. Diabetes was identified as a predictor of adverse postoperative events. During the average follow-up of 35.5 ± 22.2 months, rebleeding in patients with hemorrhagic MMD was higher than in those with ischemic MMD (P < 0.05). What's more, the rate of perfusion improvement in surgically treated patients was higher than in conservatively treated patients 3 months after discharge (P < 0.05). Infarction was the most common symptom in elderly MMD. More vascular risk factors, a higher grade of Suzuki stage, fewer familial cases, and posterior cerebral artery involvement were observed in elderly patients with MMD. Diabetes was a risk factor of postoperative events for elderly patients. Hemorrhagic MMD had a higher rate of rebleeding than the ischemic type. Although surgical revascularization procedures can improve cerebral perfusion, further study is needed to determine whether surgical revascularization is effective in elderly patients or with certain techniques.

Short- and long-term outcomes of elderly patients undergoing liver resection for colorectal liver metastasis.

Metastatic colorectal cancer is a disease of advancing age. Increased life expectancy has dramatically increased the number of older patients being assessed for hepatectomy. The objective of the study is to assess the safety and survival of hepatic resection in older patients, with colorectal liver metastases (CLM) and compare that with younger patients. All patients undergoing hepatic resection of CLM were included. Patients were divided in groups, less than 75 and 75 and over. Prospectively collected data on patient demographics and post-operative complications were retrospectively analysed. Overall survival was calculated in both groups. Twenty-nine patients over the age of 75 underwent hepatic resection for CLM. A total of 158 patients under the age of 75 underwent resection. Overall, 66% of patients received neoadjuvant chemotherapy and 64% underwent major resection. Ninety-day mortality was 1 out of 29 and 1 out of 158, respectively (P = 0.15). Overall complication rate was low, 4 out of 29 and 26 out of 158 (P = 0.45). Median length of stay was similar in the older population, 8.5 versus 8 days (P = 0.65). Overall 5-year survival was 58% in the over 75 group and 56% in the under 75 group (P = 0.31). Hepatic resection for CLM can be achieved safely in patients over the age of 75 and with equivalent short- and long-term outcomes.

The Short- and Long-term Outcomes in Elderly Patients with Hepatocellular Carcinoma After Curative Surgery -A Case-controlled Study with Propensity Score Matching

Introduction: The incidence of hepatocellular carcinoma (HCC) has been rising due to an increased life expectancy. Although several studies have examined about the outcomes in elderly patients undergoing hepatectomy for HCC, selection bias still remains in the retrospective analyses. The aim of the present study was to clarify the short- and long-term outcomes of surgical treatment in elderly patients (> 75 years) using propensity score matching. Methods: The present study included 420 patients who underwent hepatectomy as their initial treatment with curative intent. Those patients were divided into elderly (n=111) and the non-elderly (n=309) groups. Propensity score matching was performed to minimize the preoperative effect of potential confounders (the statuses of hepatitis B virus antigen and liver damage and the values of prothrombin time and alanine aminotransferase). In the present study, complications were classified into six grades according to the modified Clavien classification. Results: Before matching, the rate of deaths caused by other diseases in the elderly group was significantly higher than that in the non-elderly group (P = 0.004). Although there were no mortality cases in the elderly group, the morbidity rate (Claivien grade 3 or more) in the elderly group was significantly higher than in the non-elderly group (P = 0.010). The overall survival in the elderly patients was poorly than in non-elderly patients despite of marginal difference (P = 0.056). After matching, 89 patients from each group were matched. The preoperative confounding factors were balanced between the two groups. No significant differences were detected in the recurrence-free or overall survivals between the two groups. However, the rates of morbidity (Clavien grade 3 or more) and death due to other diseases in the elderly group were still significantly higher than in the non-elderly group (P = 0.031 and P = 0.016, respectively). The rate of other cancers and pneumonia as death causes tended to be higher in the elderly group than in the non-elderly group. Conclusion: When assessing the usefulness of treatment for the elderly patients, life expectancy and existing comorbidities should be considered. Several studies considering the confounder-adjusted and time dependent effect of age and comorbidities have shown that hepatectomy in the elderly can be justifi ed and provide a survival benefit at a reasonable cost. The present study showed that hepatectomy for HCC in elderly patients is justified.

Short- and Long-Term Outcomes After Gastrectomy in Elderly Gastric Cancer Patients

The number of elderly patients undergoing gastric cancer surgery has recently increased. We therefore evaluated the short- and long-term outcomes of elderly patients after curative gastrectomy. Overall, 824 patients were included in this retrospective study, which comprised of a non-elderly group (60-64years; n=558), an early-elderly group (75-79years; n=198), and a late-elderly group (≥80years; n=68) who underwent curative gastrectomy for gastric cancer between 2005 and 2009. Postoperative complications, according to the Clavien-Dindo classification, and survival of both elderly groups were compared with the non-elderly group. Postoperative life expectancy of the late-elderly group was compared with the corresponding aged general population. Overall and severe (grade III or higher) complications in the early-elderly group were comparable with the non-elderly group; however, those in the late-elderly group were significantly more common than in the non-elderly group (p=0.013 and p=0.043, respectively). Multivariable analysis revealed that age≥80years was an independent risk factor for severe complications (hazard ratio 3.02, 95% confidence interval 1.12-8.17; p=0.029), and the disease-specific survivals of both elderly groups were comparable with the non-elderly group in all TNM stages. Postoperative life expectancy of late-elderly patients eliminating death from recurrence was comparable with the corresponding aged general population eliminating death from gastric cancer. Gastric cancer surgery in elderly patients aged≥80years achieves reasonable long-term survival despite the increased risk of severe complications.

Low Preoperative Prognostic Nutritional Index Predicts Poor Survival Post-gastrectomy in Elderly Patients with Gastric Cancer.

Preoperative nutritional status may predict short- and long-term outcomes of patients with cancer. The aim of this study was to clarify the impact of preoperative nutritional status on outcomes of elderly patients who have undergone gastrectomy for gastric cancer (GC). A review examining 147 patients treated for GC by gastrectomy at our institution between January 2004 and December 2011 was conducted. Onodera's prognostic nutritional index (PNI) was invoked, using an optimal cutpoint to stratify patients by high (PNI>43.8; n=84) or low (PNI≤43.8; n=63) nutritional status. Clinicopathologic features and short- and long-term outcomes, including the cause of death, were compared. In multivariate analysis, low PNI was identified as an independent correlate of poor 5-year overall survival (OS). In subgroup analysis, 5-year OS rates for patients with stage1 GC were significantly worse in the low PNI (vs. high PNI) patient subset, which also posed a significantly higher risk of death from other disease; however, 5-year cancer-specific survival and PNI were unrelated. Deaths from recurrence in both groups were statistically similar, and morbidity rates did not differ significantly by group. PNI is useful in predicting long-term outcomes of elderly patients surgically treated for GC, helping to identify those at high risk of death from other disease. In an effort to improve patient outcomes, nutritional status and oncologic staging merit attention.

Therapeutic results in elderly patients with prostate cancer: chronological comparison in a single community hospital.

Objective: There are few reports of the long-term outcomes of elderly patients with prostate cancer. We analyzed data from our institution from the past 12 years, including the patient history, treatment methods, and prognosis of patients with prostate cancer aged 80 years or more.Patients and Methods: A total of 179 cases of prostate cancer in patients aged 80 years or more were retrospectively evaluated. We divided them chronologically into groups A, B, C, and D: Group A included 40 cases from 2002–2004; Group B, 48 cases from 2005–2007; Group C, 46 cases from 2008–2010; and Group D, 45 cases from 2011–2013.Results: Sixty-one (30%) patients changed treatment course. Interestingly, no cancer deaths occurred in the patients who changed treatment course. Although 14 (7.8%) cancer deaths occurred (A: B: C: D = 4: 4: 6: 0, respectively), all occurred in 2011 or later.Conclusion: In our study, over 50 patients who underwent treatment survived for 5 years or more. By treating prostate cancer in elderly patients when appropriate, we can lower the mortality rate due to prostate cancer. Our results support the active treatment of prostate cancer in elderly patients.

Abstract 14186: Is Mitral Valve Repair Superior to Mitral Valve Replacement in Elderly Patients? Short and Long-term Outcomes From the Past Two Decades

Background: Due to demographic changes a growing number of elderly patients present with mitral valve (MV) disease. Mitral Valve Repair (MV-repair) is the gold-standard treatment option for patients with MV disease. Nevertheless, in elderly patients there is still controversy if MV-repair improves outcomes of patients compared to mitral valve replacement (MVR). We reviewed results after MV surgery in elderly patients treated at our institution over the past 20 years. Methods: Our in-hospital database was explored for patients who underwent MV surgery between 1994 and 2015. A comparative survival-analysis was performed for MV-repair vs. MVR patients. Cox-regression was applied to adjust for age, valve pathology, ejection fraction (EF) and combined procedures. Results: Of the 1776 patients identified, 356 (20.0%) were aged ≥75 years and received either MV-repair (n=224, 62.9%) or MVR (n=132, 37.1%). Patients with repeat cardiac surgery, endocarditis and concomitant aortic valve replacement were excluded. In 55.8% of MV-repair and 46.2% of MVR procedures were combined (p=0.10). Mean age was 79.3±3.1yrs (MV-repair) vs 78.4±2.9yrs (MVR: p=0.02). Logistic EuroSCORE was 14.8±1.3% (MV-repair) vs. 15.3±16.1% (MVR: p=0.77). Median survival of all patients was 7.4years (95%CI: 6.8-8.1) compared to a survival of 8.5years (95%CI: 8.2-9.4) in the age matched UK population (Ratio 0.87; p=0.01). Thirty-day mortality was 6.3% (MV-repair) vs. 10.6% (MVR, p=0.16). Length of ICU-stay was 1.1±1.6 days vs. 1.0±1.0days (p=0.43). Overall 1-, 2-, 5- and 8-year survival after MV-repair (90.7%, 89.0%, 77.0% and 45.9% vs. 79.5%, 76.5%, 58.9% and 41.4%, p[logrank]=0.02) as well as adjusted survival at 1-, 2-, 5- and 8-years were significantly improved after MV-repair (91.1%, 90.2%, 81.0% and 52.5% vs. 77.7%, 76.1%, 56.2%, 37.0%, p&lt;0.01). After MV-repair, impaired EF was an independent predictor of adverse outcome (p&lt;0.01). Conclusion: Mitral valve surgery is a reliable treatment option with excellent long-term outcomes in elderly patients. Long-term outcomes can be improved in this patient group if mitral valves are repaired.

The significance of diarrhea after cardiac arrest – A retrospective analysis

Introduction: In post Resuscitation care there are just a few parameters that can help physicians in the first 24 h post ROSC (Return of spontaneous circulation) to evaluate the patients prognosis. 1 Nürnberger A. Sterz F. et al. Out of hospital cardiac arrest in Vienna: incidence and outcome. Resuscitation. 2013; 84: 42-47 Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar , 2 Grimaldi et al. Short- and long-term outcome in elderly patients. After out-of-hospital cardiac arrest: a cohort study. Crit Care Med. 2014; 42 Crossref PubMed Scopus (54) Google Scholar