Postoperative Elderly Patients Research Articles

PASSIVE LEG RAISING-INDUCED CHANGES IN PEAK VELOCITY VARIATION OF LEFT VENTRICULAR OUTFLOW TRACT TO PREDICT FLUID RESPONSIVENESS IN POSTOPERATIVE CRITICALLY ILL ELDERLY PATIENTS.

Background : Accurate prediction of fluid responsiveness is important for postoperative critically ill elderly patients. The objective of this study was to evaluate the predictive values of peak velocity variation (ΔVpeak) and passive leg raising (PLR)-induced changes in ΔVpeak (ΔVpeak PLR ) of the left ventricular outflow tract to predict fluid responsiveness in postoperative critically ill elderly patients. Method : Seventy-two postoperative elderly patients with acute circulatory failure who were mechanically ventilated with sinus rhythm were enrolled in our study. Pulse pressure variation (PPV), ΔVpeak, and stroke volume were collected at baseline and after PLR. An increase of >10% in stroke volume after PLR defined fluid responsiveness. Receiver operating characteristic curves and gray zones were constructed to assess the ability of ΔVpeak and ΔVpeak PLR to predict fluid responsiveness. Results : Thirty-two patients were fluid responders. The area under the receiver operating characteristic curves (AUC) for baseline PPV and ΔVpeak to predict fluid responsiveness was 0.768 (95% confidence interval [CI], 0.653-0.859; P < 0.001) and 0.899 (95% CI, 0.805-0.958; P < 0.001) with gray zones of 7.63% to 12.66% that included 41 patients (56.9%) and 9.92% to 13.46% that included 28 patients (38.9%). ΔPPV PLR predicted fluid responsiveness with an AUC of 0.909 (95% CI, 0.818-0.964; P < 0.001), and the gray zone was 1.49% to 2.93% and included 20 patients (27.8%). ΔVpeak PLR predicted fluid responsiveness with an AUC of 0.944 (95% CI, 0.863-0.984; P < 0.001), and the gray zone was 1.48% to 2.46% and included six patients (8.3%). Conclusions : Passive leg raising-induced changes in peak velocity variation of blood flow in the left ventricular outflow tract accurately predicted fluid responsiveness with a small gray zone in postoperative critically ill elderly patients.

Effects of Hochuekkito on Physical Activity and Appetite in Postoperative Elderly Patients with Hip Fractures: A Randomized Controlled Trial.

Hip fracture in the elderly involves two cases of invasive damage to the body within a short period of time: the fracture itself and subsequent surgery. This situation affects physical strength and presents a major challenge during convalescent rehabilitation. This study aimed to evaluate the effects of hochuekkito, a traditional Japanese herbal medicine, on physical activity, appetite, motivation, and quality of life (QOL) during inpatient rehabilitation treatment after hip surgery. Thirty-eight patients with hip fracture who underwent postoperative convalescent rehabilitation were randomly assigned to either the hochuekkito group (n=20, daily hochuekkito administration from day 3 after surgery until discharge from hospital) or the control group (n=18). Physical activity was measured with a small tri-axial accelerometer worn by the patients; appetite was evaluated based on daily dietary calorie consumption; motivation was measured using the vitality index score; and QOL was measured using the European QOL 5-Dimensions 5-Levels questionnaire and its associated EQ-visual analog scale (EQ-VAS). All patients were assessed at day 3 (baseline) and 2, 4, 6, 8, and 10 weeks after surgery and at the time of discharge from hospital. The results for the hochuekkito group were significantly higher than the control group for walking exercise at 10 weeks, vigorous activity time at 8 weeks, dietary calorie consumption at 10 weeks and at discharge, and EQ-VAS score at 6 weeks. In elderly hip fracture patients, a course of hochuekkito administration starting soon after surgery significantly improved QOL, physical activity, and appetite at 6 weeks after surgery.

Home enteral nutrition for postoperative elderly patients with esophageal cancer.

The clinical value of enteral nutrition (EN) after radical resection of esophageal cancer (EC) has been well recognized during hospital stay; however, whether using EN agents should be continued at home after the patient is discharged remains unclear, especially for the elderly postoperative patients. Here we investigated the effects of continued EN on nutrition and immune status in elderly patients who had undergone radical EC surgery. Sixty eligible elderly patients undergoing surgical treatment for EC in our center during the period from October 2016 to October 2018 were randomly divided into EN group and control groups, with 30 patients in each group. Among them, the EN group continued to take an orally administered EN agent (Ensure®) daily in addition to daily routine diets after discharge; however, patients in the control group only received regular diets after discharge. The nutritional status and immune indicators were evaluated at discharge and 4 and 8 weeks after discharge (weeks 4 and 8) and compared between EN and control groups. Body mass index (BMI), Patient-Generated Subjective Global Assessment (PG-SGA) score, hemoglobin, serum albumin, serum prealbumin, CD4 and CD8 T cell counts, CD4/CD8 ratio, IgA, IgG, and IgM showed no significant difference between EN group and control group at discharge (all P>0.05). In week 4, the serum prealbumin level was significantly higher in the EM group than in the control group (P<0.05). In week eight, the EM group had significantly higher BMI, PG-SGA score, serum albumin, serum prealbumin, CD4 and CD8 T cell counts, CD4/CD8 ratio, IgA, IgG, and IgM than the control group (all P<0.05). Home EN helps improve immune function in elderly patients who have undergone radical surgery for EC and is worthy of clinical promotion. To optimize its efficacy, a home EN should last no less than eight weeks after discharge.

&lt;p&gt;Effects of Patient-Directed Interactive Music Therapy on Sleep Quality and Melatonin Levels in Postoperative Elderly Patients: A Randomized Controlled Trial&lt;/p&gt;

&lt;p&gt;Effects of Patient-Directed Interactive Music Therapy on Sleep Quality and Melatonin Levels in Postoperative Elderly Patients: A Randomized Controlled Trial&lt;/p&gt;

The Effect of Live Bedside Music on Pain in Elderly Surgical Patients. A Unique Collaboration

Postoperative pain has a negative influence on physical and mental recovery and may result in a variety of postoperative complications. Listening to recorded music has been revealed to reduce pain, but in addition to that, live bedside music further offers the possibility to interact with the patient, respond to their emotions, and help them in adapting their conditions. It, therefore, seems appropriate for older surgical patients. This study examines the effect of live bedside music on postoperative elderly patients. The study was designed as a prospective clinical pilot study with a control group. During six separate weeks, between September 2016 and May 2017, data were collected using convenience sampling among the postoperative patients aged ≥60 years (n = 35) accounting to 83 sessions. The intervention was live music, person-centred improvisation and existing repertoire, performed by professional musicians of a collaborating conservatoire for 10–15 min, one session a day on three surgical wards of a university hospital. The control group (n = 43; 80 sessions) did not receive the intervention. –The primary endpoint was pain, measured with a visual analog scale (VAS; score 0-10) before the intervention and after 30 minutes and 3 hours of the session. Secondary endpoints were hemodynamic parameters, oxygen saturation, and respiratory rate and anxiety. The Wilcoxon signed-rank test and Mann-Whitney U test were performed to determine differences within and between groups. Perceived pain was decreased in the live bedside music group at the time of the first post-test and continued to be so for up to three hours (p = .004; p = .000). This decrease in pain was not observed in the control group. There was no clinically relevant effect on secondary endpoints. Live bedside music, performed by professional musicians, has a positive effect on the perceived pain of elderly patients after surgery. Further research on the underlying mechanisms as well as possible clinical implications is required.

The Value of Geriatric Nutritional Risk Index in Evaluating Postoperative Complication Risk and Long-Term Prognosis in Elderly Colorectal Cancer Patients.

PurposeThe geriatric nutritional risk index (GNRI) has been reported as a useful tool for predicting the prognosis of many diseases; however, there is currently little research on the relationship between GNRI and outcomes in elderly colorectal cancer (CRC) patients. This study aimed to explore the value of GNRI in evaluating postoperative complication risk and long-term prognosis in elderly CRC patients.Patients and MethodsThe medical records of 230 CRC patients aged≥65 years who underwent surgery between January 2012 and December 2014 were retrospectively analyzed. Patients were divided into abnormal and normal GNRI groups by modified binary classification. Logistic regression analysis was used to evaluate the correlation between GNRI and complication risk. The Kaplan–Meier method with log-rank test was used to construct survival curves. The Cox proportional hazard model was used for univariate, multivariate and subgroup survival analyses to assess the relationship between GNRI and long-term prognosis.ResultsMultivariate logistic regression analysis showed that GNRI (p = 0.009, HR 2.280, 95% CI: 1.224–4.247) was an independent risk factor for postoperative complications in elderly CRC patients. Kaplan–Meier survival curves revealed that the abnormal GNRI group had significantly lower disease-free survival (DFS; p = 0.005) and overall survival (OS; p=0.007) than the normal GNRI group had, especially in TNM I stage. In multivariate survival analysis, GNRI was an independent prognostic factor for DFS (p = 0.003, HR 1.842, 95% CI: 1.229–2.760) and OS (p = 0.003, HR 1.852, 95% CI: 1.231–2.787).ConclusionGNRI is a simple and effective tool for predicting the risk of postoperative complications and the long-term prognosis of postoperative elderly CRC patients and can provide a scientific basis for early nutrition interventions in elderly CRC patients.

Influencing factors of fear of progression among postoperative elderly patients with prostatic cancer

Objective To explore the influencing factors of fear of progression among postoperative elderly patients with prostatic cancer. Methods From December 2016 to December 2017, we selected 404 elderly prostatic cancer patients with surgical treatment of Urinary Surgery in Tangshan People's Hospital as subjects by purposive sampling. All of the patients were investigated with the Fear of Progression Questionnaire-Short Form (FoPQ-SF) , Readiness for Hospital Discharge (RHD) , the Chinese Version of the M. D. Anderson Symptom Inventory and Family Adaptability and Cohesion Scale Ⅱ (FACES Ⅱ) . Binary Logistic regression was used to analyze the influencing factors of fear of progression among postoperative elderly patients with prostatic cancer. Results The total of 404 elderly prostatic cancer patients were divided into two groups according to FoPQ-SF, 202 patients with the score of FoPQ-SF less than or equal to 34 in control group and 202 patients with the score of FoPQ-SF more than 34 in case group. There were statistical differences in ages, family support, clinical stages, scores of Gleason, symptom distress and readiness for hospital discharge of patients between two groups (χ2=10.164, 24.762, 21.083, 21.052, 21.915, 25.783; P<0.05) . Logistic regression analysis showed that the influencing factors of fear of progression among postoperative elderly patients with prostatic cancer included ages, family support, readiness for hospital discharge, symptom distress and scores of Gleason (P<0.05) . Conclusions Fear of progression among postoperative elderly patients with prostatic cancer is affected by many factors. Improving patients' readiness for hospital discharge will help to lower the fear of progression of patients. Key words: Prostatic neoplasms; Readiness for hospital discharge; Fear of progression

Effect of Early Ambulation on Reducing Respiratory Tract Infection among Postoperative Elderly Patients with Abdominal Surgeries

Background: Abdominal surgery is one of the most frequent surgical procedures performed in age 65 and more. postoperative respiratory tract infection (RTIs) is the most common serious complication after this type of surgery with reported incidence between 17-88%. Delayed mobilization was associated with a three-fold increase in RTIs. Aim of the study: To evaluate the effect of early ambulation on reducing RTIs among postoperative elderly patients with abdominal surgeries. Research design: Quasi-experimental research design was utilized in the current study. Subjects: Convenient sample including 80 elderly patients male and female, classified equally into two equal groups; study group (n= 40) and control group (n= 40), were collected through one year. Setting: This study was carried out at the general surgery departments (A and C) at Minia University Hospital. Tools of data collection: three tools were utilized in collecting data. Tool I: patient interview structured questionnaire, Tool II: patient's physical and respiratory assessment; Tool III: early ambulation record. Results: current study findings revealed that the 87.5% of the study group were free from postoperative RTIs. In contrast to, 85% of the control group had postoperative RTIs. Conclusion: The current study findings concluded that, early ambulation had a synergetic positive effect on reducing postoperative RTIs, improving respiratory parameters and decreased length of hospital stay among elderly with laparotomy. Recommendations: Hospitals should recommend implementing protocols for postoperative early ambulation as a routine hospital policy among all general surgical patients in all age groups.

Effect of Dexmedetomidine Hydrochloride on Early Cognitive Function in Postoperative Elderly Patients

Purpose: to explore the effect of dexmedetomidine hydrochloride on early cognitive function in postoperative elderly patients. Methods: during December 2015 to November 2016, 80 elderly patients who received surgical treatment in our hospital were selected as research object. Result: patients were randomly divided into two groups (control group and research group). On the basis of routine anesthetic induction, patients in research group took dexmedetomidine, in comparison, patients in control group took an equal dose of sodium chloride solution. The goal was to evaluate the anesthetic effect of those two methods. One hour before surgery, there was no significant difference in the MMSE score between the two groups (P＞0.05). In research group, the MMSE scores at postoperative 1d and 3d were (23.8 ± 2.4) and (27.1 ± 2.0) respectively. In control group, the MMSE scores at postoperative 1d and 3d were (20.5 ± 3.2) and (24.6 ± 3.4) respectively. The difference was statistically significant (P＜0.05). There was no significant difference in anesthesia time, awake time and extubation time between those two groups (P＞0.05). Conclusion: using dexmedetomidine in elderly patients after surgery can protect early cognitive function and improve the prognosis.

Frequent respiratory events in postoperative patients aged 60 years and above.

There is limited information on the occurrence of respiratory events in postoperative patients after discharge from the postanesthesia care unit. We studied the respiratory rate (RR) of 68 patients aged 60 years and above during the first 6 hours following elective surgery under general anesthesia to assess the frequency of respiratory events in the care unit and on the ward. RR was derived from the continuous RR counter RespiR8, measuring RR by quantifying the humidity of exhaled air. One-minute-averaged RRs were collected and analyzed to assess the frequency of postoperative bradypnea (RR 1–6 breaths/minute) and apnea (cessation of inspiratory flow ≥60 seconds). Values were median (interquartile range) or mean (SD). The median RR was 13 (10–15) breaths/minute. In the 6-hour postoperative period, 78% and 57% of patients experienced at least one bradypnea or apnea event, respectively. A median of ten (3.5–24) bradypnea and three (1–11) apnea events were detected per patient. The occurrence of respiratory events in the postanesthesia care unit (PACU) was a predictor of events on the ward (bradypnea, r2=0.4, P<0.001; apnea, r2=0.2, P<0.001). Morphine consumption correlated weakly with respiratory events in the PACU, but not on the ward. Patients with apnea had significantly larger neck circumference than patients without (39.6 [0.7] versus 37.4 [0.8] cm, P<0.05). Bradypneic or apneic respiratory events are frequent in postoperative elderly patients and even occur relatively late after surgery. Continuous respiratory monitoring on the ward, especially in patients with risk factors, such as early occurrence of events, opioid use, and larger neck circumference, is likely warranted.

Analysis of polysomnography in elderly patients in surgical intensive care unit

Objective To evaluate the sleep quality and architecture of postoperative elderly patients without mechanical ventilation in surgical intensive care unit(SICU). Methods The polysomnography(PSG) were recorded and analyzed from fifty elderly patients in SICU(case group) and forty non-surgical physical examination elderly(control group) by using Australian Compumedics Siesta. Results Compared control group, the case group had less total sleep time[289.5 min(147.5-398.8 min) vs 218.4 min(125.3-345.7 min)](P<0.05), poor sleep efficiency[48.2%(24.6%-66.5%) vs 36.3%(20.8%-57.6%)](P<0.05). PSG showed that stage-1 sleep was dominant in the case group[67.3%(21.6%-78.3%)] and stage-2 sleep was dominant in control group [59.6%(18.2%-73.2%)]. The case group had less deep sleep than control group[18.3%(4.1%-20.9%) vs 7.9%(0-11.4%)](P<0.05). The postoperative sleep of case group were absent rapid eye movement (REM) and seventy-six percent were absent slow wave sleep(SWS). Meanwhile only six elderly patients had no REM and five elderly had no SWS in control group. The postoperative sleep of case group were more broken and more frequently aroused than control group[9.1 bph(4.8-24.3 bph) vs 20.5 bph(8.8-32.2 bph)](P<0.01). Conclusions Postoperative elderly patients are more vulnerable to sleep disorder and disturbance and shows the significant decrease of total sleep time, absence of deep sleep, fragmented sleep and frequently aroused. Key words: Postoperative; Elderly patient; Sleep; Polysomnography

Observation of the postoperative analgesic effect of Lornoxicam preemptive analgesia combined with psychotherapy for elderly cancer patients

Objective: This work aims to identify a more effective and safer comprehensive pain-relief method of preemptive analgesia, which could be combined with psychological support for postoperative elderly cancer patients. Methods: A total of 120 patients with ASA I II selective operation were randomly divided into four groups (n=30). In Group A (lornoxicam plus psychological support), intravenous injection of 16 mg lornoxicam was administered to the patients 30 min before surgery (diluted to 10 mL with normal saline). The perioperative psychological support therapy (PPST) for this group was conducted by a special medical staff in accordance to the standard procedure. In Group B (lornoxicam only), 16 mg lornoxicam (diluted to 10 mL with the saline) was injected intravenously without the PPST 30 min before surgery. In Group C (psychological support only), PPST was implemented, and a 10 mL saline was injected 30 min before surgery. In Group D (traditional intravenous anesthesia), the numeric rating scale (NRS) of pain was used at 2, 4, 8, 24, and 48 h after surgery. The adverse reactions and use of other painkillers were recorded. Results: The NRS was significantly lower in Groups A and B compared with that in Groups C and D at 2, 4, 8, 24, and 48 h after the surgery (P 0.05) between Groups A and B. The NRS was obviously lower in Group C than in Group D at 4 and 8 h after surgery (P<0.05). The initial time required for the use of the analgesics was significantly longer in Groups A and B compared with Groups C and D (P<0.05). Comparing the number of cases that needed the analgesics at various intervals of time among the four groups within 48 h, the number of cases was obviously less in Groups A and B than in Groups C and D (P<0.05). No significant difference was observed between the case number of all the groups (P<0.05). No statistical significance was observed in the comparison of the postoperative adverse reactions among the four groups. Conclusion: The preemptive analgesia of lornoxicam combined with psychological support therapy in postoperative analgesia for elderly cancer patients is more favorable compared with that without PPST. This method is a more effective and safer postoperative analgesia.

Effects of Family Presence Intervention on Anxiety, Delirium, Pain and Length of Time in Recovery Room of Post-operative Elderly Patients in Post-anesthesia Care Units

Purpose: The objectives of this study were to assess the influence of family presence in the PACU (Post Anesthesia Care Unit) on anxiety, emergency delirium, pain and length of stay in the recovery room for elderly patients undergoing surgery for which general anesthesia has been used. Methods: The study was a nonequivalent control group pre-post test design. Eighty elderly patients over 65 years who underwent surgery under general anesthesia were recruited. Forty were assigned to the experiment group, patients together with a family member and 40 to the control group, with no family member present. Patients’ anxiety, emergency delirium, pain and length of time in the recovery room were evaluated at 10 minute and 30 minute after arrival in the PACU. Results: Patients with family members in the PACU showed significantly decreased levels of anxiety at 10 and 30 minutes and significantly lower levels of emergency delirium and pain at 30 minutes. However there was no difference between the 2 groups for length of time in the recovery room. Conclusion: The results of this study indicate that being with family members in the PACU after surgery under general anesthesia is effective for reducing elderly patients’ anxiety, delirium and pain during time in the recovery room. 주요어: ë ¸ì¸, 불안, 섬망, 통증, 회복실 간호 Key words: Aged, Anxiety, Delirium, Pain, Postanesthesia nursing

Prevention of renal dysfunction in postoperative elderly patients.

To describe the effect of ageing on kidney function and to summarize the benefits of advocated measures to prevent perioperative acute kidney injury (AKI) in elderly patients. Given a reduced renal reserve and the burden of comorbidities, the senescent kidney is susceptible to develop perioperative AKI and is less able to recover when injury occurs. Current evidence suggests that preoperative statin therapy, tight glycemic control or urine alkalinization with bicarbonate do not protect the kidneys from harm. The theoretical kidney protective effect of preoperative aspirin therapy or renal vasodilatation with atrial natriuretic peptide or fenoldopam is only supported by low-quality evidence that needs further evaluation. Although questions regarding the amount and timing of fluid resuscitation during surgery are seeking answers in ongoing multicenter studies, the harmful effect of hydroxyethyl starches (HES) and hyperchloremic solutions is now surrounded by strong evidence. The future increase in elderly patients being exposed to surgery calls for improved perioperative management to prevent collaterally increased AKI. Although pharmacological therapies aiming to protect the kidneys from harm are under evaluation, hemodynamic optimization and avoidance of nephrotoxic drugs, including HES and hyperchloremic solutions, are critical for the elderly perioperative patient.

Impact of body mass on outcomes of geriatric postoperative acute kidney injury patients.

Acute kidney injury (AKI) frequently occurs in hospitalized patients, particularly in the elderly. However, studies on outcome-modifying factors in geriatric patients with AKI are absent, especially the influence of body mass index (BMI). We performed a retrospective analysis of a prospectively collected multicenter observational cohort, which enrolled elderly (≥65 years) who developed AKI after major surgery in the intensive care units. We analyzed in-hospital mortality within BMI category utilizing Cox proportional hazard regression analysis and generalized additive modeling. Data of a total of 2,015 postoperative elderly patients were retrieved and analyzed. Generalized additive modeling showed that elderly AKI patients with a BMI between 21 and 31 kg/m(2) ("normal") had a lower mortality risk than those with a BMI of less than 21 kg/m(2) ("underweight") or 31 kg/m(2) or greater ("obese"). Both "underweight" and "obese" individuals had a greater risk of mortality compared with patients with "normal" BMI. The U-shaped association of BMI with hospital mortality in geriatric AKI patients contains a widened base and a shifted nadir comparing with chronic dialysis and other AKI patients. This finding is interesting and warrants our attention.

Clinical presentation and outcome of perioperative myocardial infarction in the very elderly following hip fracture surgery

Patterns of clinical symptoms and outcomes of perioperative myocardial infarction (PMI) in elderly patients after hip fracture repair surgery are not well defined. A retrospective 1:2 case-control study in a cohort of 1212 elderly patients undergoing hip fracture surgery from 1988 to 2002 in Olmsted County, Minnesota. The mean age was 85.3 ± 7.4 years; 76% female. PMI occurred in 167 (13.8%) patients within 7 days, of which 153 (92%) occurred in first 48 hours; 75% of patients were asymptomatic. Among patients with PMI, in-hospital mortality was 14.4%, 30-day mortality was 29 (17.4%), and 1-year mortality was 66 (39.5%). PMI was associated with a higher inpatient mortality rate (odds ratio [OR], 15.1; confidence interval [CI], 4.6-48.8), 30-day mortality (hazard ratio [HR], 4.3; CI, 2.1-8.9), and 1-year mortality (HR, 1.9; CI, 1.4-2.7). Elderly patients, after hip fracture surgery, have a higher incidence of PMI and mortality than what guidelines indicate. The majority of elderly patients with PMI did not experience ischemic symptoms and required cardiac biomarkers for diagnosis. The results of our study support the measurement of troponin in postoperative elderly patients for the diagnosis of PMI, in order to implement in-hospital preventive strategies to reduce PMI-associated mortality.

Hospital Mortality of Septic Acute Kidney Injury Requiring Renal Replacement Therapy in the Postoperative Elderly

Septic acute kidney injury (AKI) is a common complication in intensive care units (ICU), it and portends a higher risk of morbidity and death than nonseptic AKI. However, its outcome and prognostic factors among elderly postoperative patients remain unknown. We aimed to determine the risk factors and predictors of mortality among postoperative elderly patients (≥ 65 years) with septic AKI requiring acute dialysis. The study protocol was based on that of a clinical cohort study of renal failure patients in the database of the National Taiwan University Surgical ICU Acute Renal Failure (NSARF) Study Group. From January 2002 to July 2009, patients (aged > 18 years) with postoperative AKI requiring renal replacement therapy (RRT) were recruited for this study. Each case of septic AKI before operation was identified and patients with end-stage renal disease were excluded. A total of 292 postoperative patients with septic AKI requiring dialysis were identified during the study period. The mean (SD) age was 65.9 (11.9) years and 68.2% were men. Abdominal surgery was the most common type of surgery (42.8%), followed by cardiovascular (28.8%) and chest surgery (15.4%). The most common indications for RRT in this study cohort were azotemia in 223 patients (76.4%) and fluid overload in 62 patients (21.2%); 92 (31.5%) patients had one indication, 170 (58.2%) had two indications, and 30 (10.3%) had more than three indications. The elderly patients (those ≥ 65 years) had anemia, underwent abdominal surgery, and received dialysis for fluid overload more frequently than the young adults. By contrast, the young adults were more likely to present with shock requiring vasopressor use and have abnormal liver functions. In the elderly subgroup, the outcome was found to be associated with mechanical ventilator use, but not with disease severity, comorbidities, types of surgery and the indication for dialysis. The hospital mortality of postoperative elderly patients with septic AKI was more than 60% and was not affected by age. Mechanical ventilator use was the major risk factor and prognostic factor for elderly patients in this clinical setting.

Temozolomide plus rituximab for elderly with relapsed primary central nervous system lymphoma

The aim of our study was to analyze the long-term results of rituximab combined with temozolomide in treatment of elderly patients (> 60 years) with relapsed primary central nervous system lymphoma (PCNSL). Twelve postoperative elderly patients (> 60 years) were treated between August 2004 and October 2009. Temozolomide 100 mg/m2 to 200 mg/m2 days 1 to 7 and 15 to 21 and rituximab 375 mg/m2 days 1, 5, 8, 22. The maximum number of rituximab cycles was two. After one or two cycles of this combination, patients with an objective response and an acceptable level of toxicity continued treatment with single agent temozolomide (days 1 to 5, every 28 days). The overall survival was analyzed by using Kaplan-Meier. The overall survival was 9 months. Toxicity was very mild with no grade 3–4 neurotoxicity toxic events. Rituximab combined with temozolomide seems to yields substantial long-term survival with moderate toxicity for the treatment of elderly relapsed PCNSL.

Comparison of expectoration effect between applying the vest airway clearance system and vibration sputum elimination apparatus for elderly postoperative patients

Objective To compare the expectoration effect between applying the vest airway clearance system and vibration sputum elimination apparatus for elderly postoperative patients.Methods A total of 40 patients were randomly divided into the vest group and control group.Both daily volume of sputum excreting of all patients and the incidence rate of postoperative pulmonary infection were compared.Results Daily sputum excreting volume of patients in the vest group increased obviously(P<0.05).However,there were no significant differences between two groups in the incidence rate of postoperative pulmonary infection.Condusions The effect of using the vest airway clearance system for postoperative elderly patients was superior to that of vibration sputum elimination apparatus for sputum excretion. Key words: Elderly; Sputum elimination; Vibration sputum elimination; Vest airway clearance system

Neurosurgery and elderly: analysis through the years

The aging of the population in westernized countries constitutes an important issue for the health systems struggling with limited resources and increasing costs. Morbidity and mortality rates reported for neurosurgical procedures in the elderly vary widely. The lack of data on risk benefit ratios may result in challenging clinical decisions in this expanding group of patients. The aim of this paper is to analyze the elderly patients cohort undergoing neurosurgical procedures and any trend variations over time. The medical records of elderly patients (defined as an individual of 70 years of age and over) admitted to the Neurosurgical and Neuro-ICU Departments of a major University Hospital in Paris over a 25-year period were retrospectively reviewed. The analysis included: (1) number of admissions, (2) percentage of surgically treated patients, (3) type of procedures performed, (4) length of hospital stay, and (5) mortality. The analysis showed a progressive and significant increase in the proportion of elderly presenting for neurosurgical elective and/or emergency procedures over the last 25 years. The number of procedures on patients over 70 years of age increased significantly whereas the mortality dropped. Though the length of hospital stay was reduced, it remained significantly higher than the average stay. The types of procedures also changed over time with more craniotomies and endovascular procedures being performed. Age should not be considered as a contraindication for complex procedures in neurosurgery. However, downstream structures for postoperative elderly patients must be further developed to reduce the mean hospital stay in neurosurgical departments because this trend is likely to continue to grow.