Surgical Treatment Of Elderly Patients Research Articles

Prognostic value of surgical treatment in elderly patients with ulcerative colitis‐associated colorectal cancer: A subanalysis of a nationwide Japanese multicenter study

AbstractAimOur study aimed to examine the characteristics of elderly patients diagnosed with ulcerative colitis‐associated colorectal cancer (UAC) and evaluate the impact of surgical intervention on prognosis.MethodsA total of 1086 patients diagnosed with UAC between 1980 and 2020 were retrospectively enrolled. Data were collected through the Japanese Society for Cancer of the Colon and Rectum project. The patients were divided into two groups: 248 elderly patients in the E‐UAC group and 838 nonelderly patients in the NE‐UAC group. Patients aged >65 y at cancer diagnosis were considered elderly.ResultsThe recurrence rate did not differ between the two groups. Segmental resection was the only common independent risk factor for recurrence in both the E‐UAC and the NE‐UAC groups. The E‐UAC patients had significantly better 5‐y disease‐specific survival (DSS) than the NE‐UAC patients (94.7% vs 91.0%, p = 0.04). There were no differences in 5‐y recurrence‐free survival (RFS; 89.3% vs 86.6%, respectively, p = 0.24) or overall survival (OS; 88.8% vs 89.6%, p = 0.50). The E‐UAC patients who underwent segmental resection had poorer RFS than those who underwent total proctocolectomy, but there were no significant differences in DSS or OS.ConclusionDespite the elevated risk of cancer recurrence observed in the UAC patients who underwent segmental resection in both the E‐UAC the NE‐UAC groups, our findings suggested that segmental resection may be a viable alternative to total proctocolectomy in terms of survival rate for the E‐UAC patients.

Specifics and results of liver transplantation in elderly patients

Aim. To determine specific features, frequency, and structure of complications, immediate and long-term results of liver transplantation in elderly patients.Materials and methods. Data on 529 liver transplantations performed consecutively in one medical center from 2010 to 2023 were analyzed. In 386 (73%) cases, the right lobe of the liver of related donors was used for transplantation. At the time of surgery, the patient age ranged from 18 years to 71 years, with 57 (11%) patients being over 60 years old, 215 (40%) patients aged 44–59 years, and 257 (49%) patients aged 18–44 years.Results. Prior to operation, elderly patients were statistically significantly more often diagnosed with arterial hypertension (n = 19; 33%), diabetes mellitus (n = 12; 21%), and on average a reduced glomerular filtration rate (82 ml/min/1.73m2 ). The most frequent indication for transplantation in this group was hepatocellular carcinoma in the setting of cirrhosis (n = 19; 33%). No statistically significant differences in other preoperative characteristics, parameters of donors and operations, peculiarities of the course of the early postoperative period, frequency, structure of complications and lethal outcomes were found. The one-, five-, and ten-year survival rates for recipients over 60 years old were 82%, 72%, and 36%; for recipients aged 44–59 years old – 88%, 79%, and 70%; and for recipients aged 18–44 years old – 86%, 80%, and 74%, respectively.Conclusion. In the studied cohort, older age was not associated with excessive risks of complications and early postoperative mortality. Given the higher prevalence of comorbidities in this group, preoperative examination should be aimed at, among other things, diagnostics of possible (hidden) cardiovascular and oncologic diseases. The development and introduction of new cardio-, nephro-, and oncoprotective regimens of immunosuppressive therapy seems to be an important measure not only for the surgical treatment of elderly patients, but also for recipients living with a transplanted liver for a long time.

Efficacy study of neuronavigation-assisted stereotactic drilling of urokinase drainage versus craniotomy in the treatment of massive intracerebral haemorrhage in elderly patientsa

To evaluate the efficacy of neuronavigation-assisted stereotactic drilling drainage compared with that of craniotomy in the treatment of massive intracerebral haemorrhage (ICH) in elderly patients. This was a randomized, controlled, blind endpoint clinical study. Elderly patients with massive ICH treated at our neurosurgery department, without the formation of brain herniation preoperatively, all underwent neurosurgical intervention. Patients were randomly assigned to two groups: the minimally invasive surgery (MIS) group, which received neuronavigation-assisted stereotactic drilling drainage, and the craniotomy haematoma removal surgery (CHRS) group. Patient characteristics, surgical anaesthesia methods, surgery duration, intraoperative bleeding volume, duration of ICU stay duration of hospital stay, complications, and modified Rankin scale (mRS) scores at 90 days posttreatment were compared between the two groups. Statistical analysis was performed on the collected data. A total of 67 patients were randomly assigned, with 33 (49.25%) in the MIS group and 34 (50.75%) in the CHRS group. Compared with the CHRS group, the MIS group had advantages, including the use of local anaesthesia, shorter surgery duration, less intraoperative bleeding, shorter ICU stay, and fewer complications (P < 0.05). The MIS group had a significantly improved patient prognosis at 90 days (mRS 0–3). However, there were no significant differences in hospital stay or 90-day survival rate between the two groups (P > 0.05). For elderly patients with massive ICH without brain herniation, stereotactic drilling drainage is a simple surgical procedure that can be performed under local anaesthesia. Patients treated with this approach seem to have better outcomes than those treated with craniotomy. In clinical practice, neuronavigation-assisted stereotactic drilling drainage is recommended for surgical treatment in elderly patients with massive ICH without brain herniation.Clinical trial registration number: NCT04686877

Clinical characteristics and therapeutic outcomes after endoscopic endonasal surgery for craniopharyngioma in the elderly

OBJECTIVE Craniopharyngiomas (CPs) in adults are rare benign epithelial tumors, and few contemporary studies have explored outcomes after surgical treatment in elderly patients, especially with regard to endoscopic endonasal surgery (EES). METHODS A retrospective cohort study was conducted on patients aged ≥ 18 years with CP who were treated with EES from 2013 to 2022. The cohort was divided into nonelderly (18–64 years) and elderly (≥ 65 years) groups based on age. Various parameters, including patient and tumor characteristics, surgical outcomes, complications, and follow-up, were compared between the two age groups. RESULTS A total of 193 patients met the inclusion criteria, with 161 (83.4%) patients in the nonelderly group and 32 (16.6%) patients in the elderly group. Preoperatively, older patients were more likely to have memory impairment (4.3% vs 18.8%, p = 0.010), fatigue or decreased energy (9.3% vs 34.4%, p = 0.001), hypopituitarism (68.7% vs 90.6%, p = 0.012), or hydrocephalus (18% vs 40.6%, p = 0.005), and they were more likely asymptomatic (1.2% vs 9.4%, p = 0.033) and less likely to experience headache (57.8% vs 31.3%, p = 0.006). Patients in the elderly group had a longer symptom duration (median [IQR] 5 [10] months vs 9.5 [13] months, p = 0.001) and higher comorbidity scores (p &lt; 0.001). Postoperatively, gross-total resection was achieved in 145 (90.1%) and 28 (87.5%) patients in the nonelderly and elderly groups, respectively. Older patients were more likely to develop pneumonia (5% vs 21.9%, p = 0.004). There were no significant differences in the extent of resection (p = 0.541), pathological subtypes (88.2% vs 75.0% adamantinomatous, p = 0.089), operation time (mean ± SD 307.8 ± 68.3 minutes vs 323.5 ± 86.0 minutes, p = 0.257), estimated blood loss (median [IQR] 300 [200] ml vs 300 [238] ml, p = 0.594), length of stay (median [IQR] 15 [8] days vs 15 [22] days, p = 0.964), perioperative mortality (2.5% vs 3.1%, p &gt; 0.99), or postoperative severe hypothalamic dysfunction (37.9% vs 50.0%, p = 0.237) between the groups. Multivariate Cox regression analysis demonstrated that tumor calcification (HR 3.406, 95% CI 1.859–27.233, p = 0.038) and preoperative hydrocephalus (HR 3.688, 95% CI 1.310–10.386, p = 0.013) were independently associated with decreased survival. The median follow-up period in the elderly group was shorter (71 months vs 44 months, p = 0.001), and no recurrence was observed (7.1% vs 0%, p = 0.132). CONCLUSIONS This study demonstrates that EES is a viable treatment option for older CP patients. With appropriate perioperative management, EES does not significantly increase mortality and, in selected populations, is well tolerated by patients.

The Prognostic Significance of Surgical Treatment for Excessive Elderly Soft Tissue Sarcoma Patients over 90 Years Old: A Clinicopathological Study of 16 Cases.

The incidence of soft tissue sarcomas (STSs) among older patients is increasing. Although surgical treatment of elderly patients with STS has been reported to improve their prognosis, most of these studies included patients with STS aged &lt;85 years. This study aimed to analyze the clinical features and prognostic factors of STS in elderly patients aged ≥90 years. We retrospectively identified patients aged ≥90 years with STS who were treated at our two hospitals between 1994 and 2022. Data on clinical information and detailed assessments were collected. We evaluated the features and factors affecting the prognosis of patients with older-extremity STS. In addition, we compared the clinical courses and results of patients treated with surgery and radiotherapy for primary tumors. Among 454 patients with STS, 16 were aged ≥90 years. Kaplan-Meier curves for overall survival showed a significantly poorer prognosis in patients who did not receive surgical treatment (p = 0.0348) and those who received radiotherapy (p = 0.0070). Moreover, we investigated the difference in prognosis between surgical treatment and radiotherapy, excluding two cases with distant metastasis at initial diagnosis and one case with no treatment. Kaplan-Meier curves for overall survival showed a significantly better prognosis in patients who underwent surgical treatment (p = 0.0161). Univariate analysis revealed that only primary tumor size was a significant predictor of poor prognosis (p = 0.0426). In patients with STS aged ≥90 years old, aggressive surgical treatment may improve the prognosis more than radiotherapy.

Gluteal Muscle Fatty Atrophy: An Independent Risk Factor for Surgical Treatment in Elderly Patients Diagnosed with Type-III Fragility Fractures of the Pelvis.

Gluteal muscle fatty atrophy (gMFA) might impair pelvic stability and negatively influence remobilization in patients with fragility fractures of the pelvis (FFP). This study aimed to investigate the association between gMFA and surgical indication in patients with FFP. A retrospective analysis of 429 patients (age ≥80) diagnosed with FFP was performed. gMFA of the gluteus maximus, medius, and minimus was evaluated using a standard scoring system based on computer tomography images. No significant difference was found in gMFA between genders or among FFP types. The severity of gMFA did not correlate with age. The severity of gMFA in the gluteus medius was significantly greater than in the gluteus maximus, whereas the most profound gMFA was found in the gluteus minimus. gMFA was significantly more severe in patients who underwent an operation than in conservatively treated patients with type-III FFP, and an independent correlation to surgical indication was found using logistic regression. Our findings imply that gMFA is an independent factor for surgical treatment in patients with type-III FFP. Besides focusing on the fracture pattern, the further evaluation of gMFA could be a feasible parameter for decision making toward either conservative or surgical treatment of type-III FFP.

Comparative study in vivo of the osseointegration of 3D-printed and plasma-coated titanium implants.

Total hip arthroplasty is a common surgical treatment for elderly patients with osteoporosis, particularly in postmenopausal women. In such cases, highly porous acetabular components are a favorable option in achieving osseointegration. However, further discussion is needed if use of such acetabular components is justified under the condition of normal bone mass. To determine the features of osseointegration of two different types of titanium implants [3-dimensional (3D)-printed and plasma-coated titanium implants] in bone tissue of a distal metaphysis in a rat femur model. This study was performed on 20 white male laboratory rats weighing 300-350 g aged 6 mo. Rats were divided into two groups of 10 animals, which had two different types of implants were inserted into a hole defect (2 × 3 mm) in the distal metaphysis of the femur: Group I: 3D-printed titanium implant (highly porous); Group II: Plasma-coated titanium implant. After 45 and 90 d following surgery, the rats were sacrificed, and their implanted femurs were extracted for histological examination. The relative perimeter (%) of bone trabeculae [bone-implant contact (BIC%)] and bone marrow surrounding the titanium implants was measured. Trabecular bone tissue was formed on the 45th day after implantation around the implants regardless of their type. 45 d after surgery, group I (3D-printed titanium implant) and group II (plasma-coated titanium implant) did not differ in BIC% (83.51 ± 8.5 vs 84.12 ± 1 .73; P = 0.838). After 90 d, the BIC% was higher in group I (87.04 ± 6.99 vs 81.24 ± 7.62; P = 0.049), compared to group II. The relative perimeter of the bone marrow after 45 d did not differ between groups and was 16.49% ± 8.58% for group I, and 15.88% ± 1.73% for group II. Futhermore, after 90 d, in group I the relative perimeter of bone marrow was 1.4 times smaller (12.96 ± 6.99 vs 18.76 ± 7.62; P = 0.049) compared to the relative perimeter of bone marrow in group II. The use of a highly porous titanium implant, manufactured with 3D printing, for acetabular components provides increased osseointegration compared to a plasma-coated titanium implant.

A NEW APPROACH TO THE SURGICAL TREATMENT OF ELDERLY PATIENTS WITH STONE CHOLECYSTITIS WITH A HIGH FRAGILITY INDEX

The artice the aim of study was evaluating of the effectiveness of a new treatment method in improving the results of surgical treatment of elderly patients suffering from cholecystitis with a high fraility index. Studies have shown a decrease in the frequency of complications, acceleration of wound healing, and a reduction in hospital stay as a result of the positive effect of treatment tactics in the main group. The change in the dynamics of the frailty index in the short and longterm postoperative periods was more positive in the main group.

A prospective clinical study evaluating short-term changes in body composition and quality of life after gastrectomy in elderly patients receiving postoperative exercise and nutritional therapies

BackgroundMuscle mass loss after gastrectomy is associated with a negative impact on quality of life (QOL) and long-term prognosis following gastric cancer treatment, especially in elderly patients. We conducted a prospective study to examine short-term changes in body composition and QOL after gastrectomy in elderly patients with gastric cancer who received exercise and nutritional therapies.MethodsPatients over aged 65 years of age who underwent gastrectomies for gastric cancer were enrolled in our study. Patients received exercise and nutritional therapies with branched-chain amino acid (BCAA)-rich supplements during 1 month after surgery. Body composition was evaluated using InBody S10 before surgery, and at 1 week and 1 month postoperatively. Other variables including QOL status (EQ-5D-5 L), serum albumin level, hand grip strength, and gait speed were evaluated at the same time.ResultsEighteen patients were analyzed. The mean loss of skeletal muscle mass index (SMI) was 4.6% (1 week) and 2.1% (1 month) compared to the preoperative period. QOL scores showed almost the same degree of recovery at 1 month after gastrectomy as preoperative scores. Serum albumin levels, hand grip strength, and gait speed decreased at 1 week and then increased at 1 month after surgery, similar to the changes seen in SMI.ConclusionsMultidisciplinary approaches play key role in the surgical treatment of elderly patients. Postoperative exercise and nutritional therapies with BCAA-rich supplements may benefit elderly patients after gastrectomy by reducing loss of SMI and decreases in QOL.Trial registrationUMIN Clinical Trials Registry; UMIN000034374 (registration date: 10/10/2018).

P211 Surgical treatment for elderly patients with ductal carcinoma in situ. Is it still a safety and valid option?

P211 Surgical treatment for elderly patients with ductal carcinoma in situ. Is it still a safety and valid option?

Survival Benefit of Surgical Treatment for Elderly Patients with Intrahepatic Cholangiocarcinoma: A Retrospective Cohort Study in the SEER Database by Propensity Score Matching Analysis.

Despite a rising trend in intrahepatic cholangiocarcinoma (ICC) incidence in the elderly population worldwide, the benefit of surgery for those patients is still controversial. Data from 811 elderly patients diagnosed with non-metastatic ICC were obtained from the US surveillance, epidemiology, and end results (SEER) program database. Propensity score matched (PSM) was conducted for the better balance of baseline. The associations between tumor characteristics and surgery with overall survival (OS) and cancer specific survival (CSS) were estimated using hazard ratios (HR) and 95% confidence intervals (CI). The results showed that ICC patients above 60 years old taking surgery had better OS (hazard ratio [HR], 0.258; 95% CI, 0.205-0.324) and CSS (hazard ratio [HR], 0.239; 95% CI, 0.188-0.303) than patients without surgery. Similar trends in patients above 65 years old, above 70 years old, above 75 years old, and above 80 years old were observed, separately. This benefit was also showed in lymph node-negative (N0) and lymph node-positive (N1) subgroups and N0 patients are more likely to take an advantage from surgery than N1 patients. The different outcomes between surgery and non-surgery suggest that surgical treatment may be recommended for elderly ICC if the tumor is resectable to ensure optimal treatment.

Phenotypes of Chronic Rhinosinusitis and Peripheral Blood Leukocytes Parameters in Elderly Patients.

Background and Objectives: Chronic rhinosinusitis (CRS) is a common disease that can be differentiated into two phenotypes, with or without polyps (CRSwNP) or CRSsNP), which may be unilateral (UNIL) or bilateral (BIL). CRS may have an impact on absolute neutrophils and lymphocytes count in peripheral blood. The aim of the study was to investigate whether the incidence of a specific CRS phenotype changes with age and to compare the values of neutrophils, lymphocytes and neutrophil-to-lymphocyte ratio in the peripheral blood between groups of patients below and above 65 years of age with different CRS phenotypes. Material and Methods: A total of 235 patients aged 65 and over were examined, including 140 (59.6%) males. The group of patients &lt;65 years of age comprised 160 subjects, including 103 (64.4%) males. In both groups, the sequence of frequency of particular phenotypes was similar: the most common phenotype was bilateral CRSwNP followed by CRSsNP BIL, CRSsNP UNIL, and finally, CRSwNP UNIL. Direct comparisons between determined phenotype in both groups of different ages revealed that, in the group ≥65 years, CRSwNP BIL occurred significantly more often than in the group &lt;65 years of age. In fact, in the &lt;65 group, bilateral CRSsNP was more common. The absolute neutrophils and lymphocytes counts were significantly higher in the whole group of patients with CRS ≥65 years of age and absolute number of neutrophils was higher in ≥65 years of age group with bilateral CRSsNP. Conclusions: The higher number of neutrophils in the whole ≥65 years of age group and in older patients with bilateral CRSsNP may indicate that CRS, despite of phenotype, may be an important source of infection that requires surgical treatment in elderly patients as well.

The role of frailty score in early surgical treatment of elderly cholecystitis patients

Objectives: The average life expectancy is increasing all over the world, and as a result, the number of elderly patients is increasing. Acute cholecystitis is one of the most common diseases requiring emergency surgical treatment in the elderly. In the literature, it has been reported that in the treatment of elderly patients with acute cholecystitis, physicians do not fully comply with the current literature recommendations due to some concerns and do not apply surgical treatment in the early period. The concept of frailty, which has come to the fore in geriatric assessment today, provides objective information about the general health status of the patient. In our study, the role of frailty assessment in the decision made regarding the early surgery in elderly patients with acute cholecystitis treated in our hospital was investigated. Methods: In our study, the clinical features, comorbidities, American Society of Anesthesiologists (ASA) scores, Canadian Study of Health and Aging (CSHA) frailty scale, treatment modalities and prognosis of patients over the age of 65 who were treated with the diagnosis of acute cholecystitis between January 2018 and January 2021 were evaluated retrospectively. Results: Of the 182 patients included in the study, 24 (13.2%) were found to be frail. It was observed that the mean age and multi-morbidity were higher in the frail group (p &amp;lt; 0.001). It was observed that the mean C-reactive protein and leukocyte values, which are inflammatory mediators, increased in both groups, both fragile and non-fragile, and complicated cholecystitis accompanied by cholangitis or pancreatitis was observed in a total of 64 (35.16%) patients. There were 57 (31.3%) patients using anticoagulant or antiaggregant agents. The patients were most frequently treated with medical treatment (n = 108; 59.3%), the other treatment methods were early surgery ( (n = 46; 25.3%), endoscopic retrograde cholangiopancreatography (n = 22; 12.1%) and percutaneous cholecystostomy (n = 11; 6.0%). Surgical treatment was more common in ASA I and II patients, and percutaneous cholecystostomy was more common in frail patients (p &amp;lt; 0.001). There were 20 (14.70%) patients who were re-admitted to the hospital and 6 (3.29%) patients ended up with mortality. No statistical relationship could be demonstrated between these conditions and frailty (p &amp;gt; 0.05). Conclusions: In the treatment of the elderly cholecystitis patients, early surgical treatment is the most favorable treatment method in order to reduce re-admission and prevent possible complications. However, we think that a detailed geriatric evaluation should be made in a multidisciplinary manner for the decision making regarding the of surgical treatment of elderly patients, and frailty evaluation should also be made in this context.

Surgical management for elderly patients with pancreatic cancer.

Pancreatic cancer, one of the diseases of the elderly, has dismal prognosis, demanding major surgery with high risk and life quality problems, especially in the elderly. Therefore, treatment selection, whether or not to undergo surgery, preoperative risk assessment, and perioperative management of the elderly are becoming critical issues. Although the elderly are expected to have higher morbidity and mortality and lower long-term survival outcomes, surgery is becoming safer over time. Appropriate surgical indication selection, patient-centered decision-making, adequate prehabilitation and postoperative geriatric care are expected to improve surgical outcomes in the elderly. Surgeons must have the concept of geriatric care, and efforts based on institutional systems and academic societies are required. If well selected and prepared, the same surgical principle as non-elderly patients can be applied to elderly patients. In this paper, the surgical treatment of elderly patients with pancreatic cancer is reviewed.

Results of lumbar interbody fusion in elderly patients with lumbar spinal stenosis associated with cauda equina syndrome

Background: Currently, there are no clear recommendations on the timing of surgical intervention for the slow development of cauda equina syndrome (CES) against the background of lumbar spinal stenosis (LSS) at the lumbar level in elderly patients. The information on the long-term effectiveness of decompressive and stabilizing interventions (DSI) in the lumbar spine in this pathology is also limited.Objective: To conduct a comparative analysis of the results of surgical treatment of elderly patients with LSS associated with CES after open and low-traumatic DSI.Material and methods: The retrospective study included 37 patients operated on between 2000 and 2020 for CES caused by LSS. Two groups were distinguished: in the first group (n = 17), an open DSI was performed with the median approach, in the second group (n = 20) a low-traumatic DSI was performed according to the author’s method. Technical features of interventions and specificity of the postoperative period, preoperative instrumental data, clinical parameters in dynamics, and complications were compared.Results: In a comparative analysis in the group of patients operated on with author’s low-traumatic DSI, smaller parameters were registered: the duration of the operation (p = 0.02), the blood loss (p = 0.003), the duration of inpatient treatment (p = 0.002), and the postoperative need for opioid analgesics (p &lt; 0.05). In catamnesis, statistically significantly better clinical parameters of bladder sphincter control (p = 0.02) and motor function recovery (p = 0.01), Oswestry Disability Index (ODI) (p = 0.03) and the Short Form-36 (SF-36) (p = 0.01) were observed in patients of the group II, compared with the group I. A greater number of complications were noticed in the group of open DSI (p = 0.003), with a comparable frequency of reoperations in the follow-up period (p = 0.79).Conclusion: In elderly patients with CES-associated LSS, the advantages of the author’s low-traumatic DSI in comparison with open DSI were established of less blood loss and duration of hospitalization, low need for postoperative analgesia, the minimum number of complications, and the dynamics of neurological symptoms, better recovery of ODI and SF-36 in catamnesis.

Surgical Stabilization of Rib Fractures Is Not Associated with Increased Morbidity in Elderly Patients

Introduction: There is increasing support in the trauma literature for surgical stabilization of rib fractures (SSRF) in patients with certain injury patterns. Surgical treatment in elderly patients prompts concern from many providers for increased procedure related morbidity and mortality. However, this patient group is also at considerable risk of morbidity and mortality from rib fractures. Our goal was to determine whether SSRF is associated with increased complication in elderly patients. Methods: The 2016-2019 Nationwide Readmission Database of the Healthcare Cost and Use Project was used to identify hospital admissions for rib fractures in those aged 65+. Results: The population estimate-based rib fracture rate in those 65+ was 1,500/100,000 persons and rib fixation rate was 0.12/100,000 persons. 184,120 rib fracture admissions (2.6% flail chest) were identified with 144 including SSRF. The mortality rate at the primary hospitalization was 6.8% vs 7.6% (medical management vs SSRF). Independent predictors of SSRF included younger age, rurality, and injury severity. The unplanned 30 and 90-day readmission rate was 10.5% and 11.8% (medical management vs SSRF) and 18.7% and 17.8% (medical management vs SSRF), respectively. After adjusting for age, gender, injury severity, comorbidity index, insurance, patient home location, and payor, rib fixation was not an independent predictor of unplanned 30 or 90-day readmission. Conclusion: SSRF does not increase risk of readmission related to surgical complication in elderly patients. SSRF can be safely offered to elderly patients with significant chest wall injury.

Implementation of a pneumonia prevention protocol to decrease the incidence of postoperative pneumonia in patients after hip fracture surgery

ObjectivePostoperative pneumonia is among the most common complications in elderly patients after hip fracture surgery. We implemented a proactive postoperative pneumonia prevention protocol and analyzed the incidence of postoperative pneumonia in elderly patients (≥70 years of age) receiving this protocol after hip fracture surgery versus those receiving usual care before the protocol's implementation at our institution. Materials and MethodsFrom November 2018 to October 2019, the proactive postoperative pneumonia prevention protocol was implemented. The treatment included intensified physical therapy, postoperative pulmonary exercises and oral care, in addition to the usual surgical treatment for elderly patients with hip fracture. The intervention cohort data were compared with a historical control cohort treated from July 2017 to June 2018. The primary outcome of this study was the incidence of postoperative pneumonia in both groups, diagnosed according to the presence of two of three of the following: elevated infection parameters, radiologic examination confirmation of pneumonia of the chest or clinical suspicion. ResultsA total of 494 patients (n= 249 in the historical control cohort and n=245 in the intervention cohort) were included. A total of 69 patients developed postoperative pneumonia. The incidence of postoperative pneumonia was significantly lower (6.7 percentage points) in the group receiving the proactive postoperative pneumonia prevention protocol (17.3% in the historical control cohort vs 10.6% in the intervention cohort; p=0.033). Discussion and ConclusionA proactive postoperative pneumonia prevention protocol showed promise in decreasing the occurrence of postoperative pneumonia after hip fracture surgery in elderly patients.

Application of a perioperative nursing strategy in the surgical treatment of elderly patients: a narrative review†

Abstract With the steady increase of older people in society, a progressively greater number of patients belonging to the geriatric group need surgical treatment. Since elderly patients with reduced physiological reserve and organ failure often have chronic diseases, geriatric syndrome, and other clinical problems, the perioperative nursing of elderly patients is more complicated. Therefore, we need to comprehensively consider clinical issues, such as patients’ preoperative status, surgical risks, and postoperative quality of life and life expectancy, and conduct comprehensive evaluations and holistic, individualized, and continuous nursing and therapy through the participation of interdisciplinary teams to achieve better curative effects. Here, the perioperative nursing of elderly patients is reviewed, including preoperative evaluation and nursing, intraoperative management, and postoperative nursing.

Evaluation of risk factors for bariatric surgery in elderly patients with morbid obesity

The objective was to improve the efficiency and safety of surgical treatment in elderly patients with morbid obesity.Methods and materials. The study included 20 patients with morbid obesity aged 60 to 69 years. The following scores and indices were used to assess the comorbidity of patients and the risk of complications from surgery: OS-MRS, Charlson comorbidity index, Caprini score, HAS-BLED score.Results. The course of the postoperative period in elderly patients with morbid obesity was smooth in 17 (85 %) people and did not differ from that in middle-aged patients, subject to careful preoperative examination and preparation. The factors of the initial comorbid background and the duration of the operation had the greatest influence on the result of bariatric surgery.Conclusion. Bariatric surgery in elderly patients with morbid obesity should be carried out taking into account careful selection, examination and assessment of the risk of adverse outcome in a specialized surgical center of a multidisciplinary hospital.

Analysis of injury and pain scores during fusion surgery for multisegmental lumbar spinal stenosis in elderly patients

Lumbar stenosis has become a common disease. Controversies exist regarding fusion surgery. The patients were divided into groups per the method of fusion received: the posterolateral fusion group (group P) and the intervertebral fusion group (group I). The patients were further divided into groups based on the number of fusion segments: the 2-segment group (P2 and I2), the 3-segment group (P3 and I3), and the 4-segment group (P4 and I4). The operative time, intraoperative blood loss, blood transfusion volume, and postoperative drainage volume were summarized. In particular, wound healing appearance and management were observed. The operation time and blood transfusion volume of the P2 and P3 groups were significantly less than those of the I2 and I3 groups (p < 0.05). The postoperative drainage volume of group I4 was less than that of group P4 (p < 0.05). Postoperative numeric rating scale (NRS) scores of P2 and P3 groups were lower than those of I2 and I3 groups (p < 0.05), while the NRS scores of P4 group were higher than those of I4 group (p < 0.05). Posterolateral and intervertebral fusion techniques can be used in the surgical treatment of elderly patients with lumbar spinal stenosis. The posterolateral fusion method should be used when three or fewer segments require surgery. The intervertebral fusion method should be used when four segments require surgery.