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Clin Infect Dis 2019 Mar 13. Epub 2019 Mar 13.

Department of Orthopaedic Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan.

Background: Maintaining perioperative normothermia is recommended by recent guidelines for prevention of surgical site infection (SSI). However, the majority of supporting data originates outside the field of orthopaedic surgery.

Methods: The effect of normothermia was explored using prospectively collected data of consecutive patients who underwent single-site surgery in seven tertiary referral hospitals between November 2013 and July 2016. Read More

Clin Ther 2019 Feb 21. Epub 2019 Feb 21.

Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Geriatric Research Education and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, NY, USA. Electronic address:

Purpose: General surgical procedures are among the most commonly performed operations in the United States. Despite advances in surgical and anesthetic techniques and perioperative care, complications after general surgery in older adults remain a significant cause of increased morbidity, mortality, and health care costs. Frailty, a geriatric syndrome characterized by multisystem physiologic decline and increased vulnerability to stressors and adverse clinical outcomes, has emerged as a plausible predictor of adverse outcomes after surgery in older patients. Read More

J Orthop Trauma 2019 Jan 30. Epub 2019 Jan 30.

Medical University of South Carolina Department of Orthopaedics 96 Jonathan Lucas Dr CSB 708 Charleston, SC 29425.

Introduction: While the 11-factor modified frailty index (mFI-11) has been shown to predict adverse outcomes in elderly patients undergoing surgery for hip fractures, the newer 5-factor index has not been evaluated in this population. The goal of this study is to evaluate the mFI-5 as a predictor of morbidity and mortality in elderly patients undergoing surgical management for hip fractures.

Methods: The NSQIP database was queried for patients aged 60 years and older who underwent surgical management for hip fractures between 2005-2016. Read More

Gynecol Obstet Fertil Senol 2019 02 1;47(2):238-249. Epub 2019 Feb 1.

Institut Gustave-Roussy, 94800 Villejuif, France.

In ovarian, tubal and primary peritoneal cancers, older adults have an over-mortality due to more aggressive disease (NP4), surgical and chemotherapy under treatment (NP4) and co-morbidities (NP4). Older age is at higher risk for postoperative morbidity and mortality (NP4). Surgery is more often incomplete in this elderly population (NP4). Read More

Surgeon 2019 Jan 10. Epub 2019 Jan 10.

Department of Trauma and Orthopaedic Surgery, Tallaght Hospital, Dublin 24, Ireland. Electronic address:

Introduction: The increasing incidence of acetabular fractures in the elderly and the fracture complexity seen in this cohort represents one of the greatest challenges faced by trauma orthopaedic surgeons today. There are no formal guidelines of best practice in the treatment of these patients. Management options vary from non-operative, acute ORIF, and/or total joint replacement. Read More

Arch Bone Jt Surg 2018 Nov;6(6):517-522

Research performed at the University of Rochester School of Medicine & Dentistry, Rochester, NY, USA; University of Texas Health Science Center, Fort Worth, TX, USA; Texas Health Resources Harris Methodist Hospital, Forth Worth, TX, USA; and Dell Medical School, The University of Texas, Austin, TX, USA.

Background: A better understanding of how bone mineral density and vitamin D levels are associated with femoral neck and intertrochanteric hip fractures may help inform healthcare providers. We asked: 1) In patients age ≥ 55 years, is there a difference in quantitative ultrasound of the heel (QUS) t-score between patients with fractures of the femoral neck and those with fractures of the intertrochanteric region, accounting for other factors 2) In patients age ≥ 55 years, is there a difference in vitamin D level between those with fractures of the femoral neck and those with fractures of the intertrochanteric region, accounting for other factors? 3) Is there an association between vitamin D level and QUS t-score?

Methods: In this retrospective cohort study, 1,030 patients were identified using CPT codes for fixation of hip fractures between December 2010 and September 2013. Patients ≥ 55 years of age who underwent operative management for a hip fracture following a fall from standing height were included. Read More

Geriatr Orthop Surg Rehabil 2018 5;9:2151459318814823. Epub 2018 Dec 5.

Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

Introduction: Perioperative delirium in elderly hip fracture patients has been correlated with significant morbidity. The purpose of this study was to determine the preoperative risk factors for and short-term sequelae of postoperative delirium in geriatric hip fracture patients.

Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program to identify geriatric (≥65 years) patients who sustained operative hip fractures in 2016. Read More

Geriatr Gerontol Int 2019 Mar 25;19(3):213-217. Epub 2018 Dec 25.

Second Department of Orthopedics, Tangshan Gongren Hospital, Tangshan, China.

Aim: As we are experiencing the progressive aging of our population, risk management of geriatric orthopedic patients is extremely important. The present study was carried out to identify independent predictors of surgical site infection and to better define the threshold value of serum albumin on postoperative wound infection in older patients.

Methods: This retrospective multicenter study was carried out from January 2015 to June in 2017. Read More

J Am Geriatr Soc 2019 Feb 7;67(2):371-380. Epub 2018 Dec 7.

Cardiovascular Division, Department of Internal Medicine, Washington University, St. Louis, Missouri.

Objectives: To identify the top priority areas for research to optimize pharmacotherapy in older adults with cardiovascular disease (CVD).

Design: Consensus meeting.

Setting: Multidisciplinary workshop supported by the National Institute on Aging, the American College of Cardiology, and the American Geriatrics Society, February 6-7, 2017. Read More

Clin Interv Aging 2018 8;13:2267-2273. Epub 2018 Nov 8.

Department of Surgery, JSS Academy of Higher Education and Research, Mysore, Karnataka, India.

Improving trends in global health care have resulted in a steady increase in the geriatric population. However, as the population ages, surgery is being performed more frequently in progressively older patients and those with higher prevalence of comorbidities. A significant percentage of elderly patients experience transient postoperative delirium following surgery or long-term postoperative cognitive dysfunction (POCD). Read More

Int J Qual Health Care 2018 Nov 17. Epub 2018 Nov 17.

Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.

Objective: The aim of this study was to examine whether anesthetic technique is associated with 30- or 90-day mortality and perioperative length of stay (LOS).

Design: We used a retrospective cohort design using a healthcare insurance claims database.

Setting: The Fukuoka Prefecture's claims database of older patients who underwent hip fracture surgery under general or regional (spinal or epidural) anesthesia from April 2012 to March 2016 was used for analyses. Read More

Clin Podiatr Med Surg 2019 Jan 26;36(1):131-140. Epub 2018 Oct 26.

Department of Podiatric Surgery, St. Vincent Charity Medical Center, 2351 East 22nd Street, Cleveland, OH 44115, USA.

Surgical treatment of the elderly can be a very difficult and complex endeavor. Appropriate and thorough evaluation of this group of patients is essential to identify surgical candidates who may be at increased risk for developing age-related problems, such as cognitive impairment or postoperative delirium. Involvement of family members and ancillary caregivers is ideal. Read More

Am J Case Rep 2018 Nov 6;19:1324-1328. Epub 2018 Nov 6.

Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.

BACKGROUND Delirium is a well-established clinical phenomenon that remains largely underdiagnosed. In light of its association with diminished postoperative outcomes, recent efforts involve implementing preventive strategies and fostering early detection. This report highlights how multidisciplinary interventions can inform risk for delirium and the challenges that accompany identifying at-risk patients. Read More

Clin Geriatr Med 2019 02 11;35(1):65-92. Epub 2018 Oct 11.

Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA. Electronic address:

As more patients live longer, it is probable that an increasing number of geriatric patients will require surgery. An organized, systematic, coordinated, multidisciplinary approach to the perioperative management of these patients will result in fewer complications, improved outcomes, and reduced cost of care. Details are herein provided on the preoperative diagnostic evaluation and assessment as well as perioperative care provided to optimize outcomes. Read More

J Am Acad Orthop Surg 2018 Oct 12. Epub 2018 Oct 12.

From the Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY (Dr. Aneja, Dr. Zuelzer, and Dr. Moghadamian), and the Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA (Dr. Kates).

Alzheimer disease is a neurologic disorder characterized by the progressive cognitive decline. As the population continues to age, orthopaedic surgeons need to become familiar with surgical and nonsurgical treatment considerations in this complex population. Despite the advances in geriatric and dementia care, surgical and postoperative management of both elective and emergent surgery remain complex and controversial in this patient population. Read More

Injury 2018 Dec 22;49(12):2234-2238. Epub 2018 Aug 22.

Emory University, Department of Orthopaedics, 59 Executive Park South, Atlanta, GA 30329, United States; Grady Memorial Hospital, 80 Jesse Hill Jr Dr. SE, Atlanta, GA 30303, United States. Electronic address:

Background: As morbidity and mortality from traumatic orthopaedic injuries continues to rise, increased research is being conducted on how to best predict complications in at risk patients. Recently, frailty indices have been validated in a variety of surgical subspecialties as predictors of morbidity and mortality. However, the vast majority of research has been conducted on geriatric patient populations, with little evidence on patients who are chronologically young. Read More

World J Urol 2018 Sep 25. Epub 2018 Sep 25.

Department of Urology, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, No. 168 Litang Road, Changping District, Beijing, 102218, China.

Purpose: To report our experience with total ultrasound-guided percutaneous nephrolithotomy (PCNL) in the management of patients with solitary kidney, and evaluate the safety and feasibility of this technique.

Materials And Methods: Between October 2014 and December 2016, 48 patients with solitary kidneys underwent total ultrasound-guided PCNL at our institution. Stone-free rate (SFR), auxiliary procedures, and complications were recorded. Read More

J Clin Anesth 2019 Feb 20;52:111-118. Epub 2018 Sep 20.

Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

Study Objective: To assess the effect of different intraoperative blood pressure targets on the development of POCD and test the feasibility of a larger trial.

Design: Randomized controlled pilot trial.

Setting: Perioperative care in a tertiary care teaching hospital with outpatient follow-up. Read More

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2018 Aug;32(8):1038-1046

Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Institute of Traumatic Orthopaedics, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, Southeast University, Nanjing Jiangsu, 210009,

Objective: To summarize the latest developments in the enhanced recovery after surgery (ERAS) in the geriatric hip fractures and its perioperative therapy management.

Methods: The recent original literature on the ERAS in the geriatric hip fractures were extensively reviewed, illustrating the concepts and properties of the ERAS in the geriatric hip fractures.

Results: It has been considered to be associated with the decreased postoperative morbidity, reduced hospital length of stay, and cost savings to implement ERAS protocols, including multimodal analgesia, inflammation control, intravenous fluid therapy, early mobilization, psychological counseling, and so on, in the perioperative (emergency, preoperative, intraoperative, postoperative) management of the geriatric hip fractures. Read More

Arch Gerontol Geriatr 2018 Nov - Dec;79:88-96. Epub 2018 Aug 19.

Department of Medicine, The University of Melbourne, Melbourne, Australia.

Background/objectives: Frail patients are increasingly presenting for both perioperative and intensive care, highlighting the need for simple, valid and scaleable frailty measurement. Frailty indexes comprehensively assess a range of deficits in health, and can incorporate routinely collected data. The purpose of this systematic review was to evaluate the effect of frailty indexes on surgical and intensive care risk stratification and patient outcomes (mortality, complications, length of stay, and discharge location). Read More

Eur J Surg Oncol 2018 11 15;44(11):1685-1702. Epub 2018 Aug 15.

Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden.

With an expanding elderly population and median rectal cancer detection age of 70 years, the prevalence of rectal cancer in elderly patients is increasing. Management is based on evidence from younger patients, resulting in substandard treatments and poor outcomes. Modern management of rectal cancer in the elderly demands patient-centered treatment, assessing frailty rather than chronological age. Read More

Ann Surg 2018 Jul 24. Epub 2018 Jul 24.

Clinical Epidemiology Program, the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.

Objective: To compare the accuracy of the modified Fried Index (mFI) and the Clinical Frailty Scale (CFS) to predict death or patient-reported new disability 90 days after major elective surgery.

Background: The association of frailty with patient-reported outcomes, and comparisons between preoperative frailty instruments are poorly described.

Methods: This was a prospective multicenter cohort study. Read More

Injury 2018 Aug 28;49(8):1451-1457. Epub 2018 Jun 28.

Department of General, Trauma and Reconstructive Surgery, Ludwig-Maximilians-Universität München, Germany.

Introduction: Orthogeriatric ankle fractures seem to play an essential role in terms of quality of life in the elderly. Knowledge of the outcome after orthogeriatric ankle fractures is sparse. The present study investigates the outcome after surgically treated ankle fractures at a certified orthogeriatric trauma center. Read More

Clin Cardiol 2018 Aug 17;41(8):1103-1110. Epub 2018 Aug 17.

Chinese Academy of Medical Sciences, Fuwai Hospital, Beijing, China.

Emerging evidence demonstrates that frailty measures can predict adverse outcomes after cardiac procedures. Our objectives were to examine whether the inclusion of frailty measures adds incremental predictive value to existing surgical risk prediction models in patients undergoing cardiac surgery and to evaluate the reporting and methods of studies that investigated the prediction of frailty measures in cardiology. The inclusion of frailty measures adds incremental predictive value on existing perioperative risk-scoring systems. Read More

Gynecol Oncol 2018 09 29;150(3):451-459. Epub 2018 Jun 29.

The University of Texas MD Anderson Cancer Center, Department of Health Services Research, Houston, TX, United States of America.

Background: Neoadjuvant chemotherapy (NACT) may reduce perioperative morbidity in women undergoing primary treatment for ovarian cancer. We evaluated patterns of use and outcomes in a population-based cohort of elderly women with ovarian cancer (OC).

Methods: A cohort of patients ≥66 years old diagnosed between 2000 and 2013 with stage III-IV epithelial OC who received surgery and platinum/taxane chemotherapy for primary treatment was identified from the SEER-Medicare database. Read More

Hong Kong Med J 2018 02;24 Suppl 2(1):45-47

Physiotherapy Department, Queen Mary Hospital.

Intern Med J 2018 06;48(6):731-735

Internal Medicine Services, The Prince Charles Hospital, Brisbane, Queensland, Australia.

This study aimed to identify the incidence of perioperative acute upper gastrointestinal bleeding (UGIB) in our hip fracture patients; to evaluate the characteristics, management and clinical outcomes of these patients; and to explore risk factors and protective factors. Of the 1691 consecutive patients admitted for surgical management of hip fractures, 11 (0.65%) had UGIB and a further four patients for each case were selected as controls for evaluation of risk factors and protective factors. Read More

Postgrad Med 2018 Aug 22;130(6):523-535. Epub 2018 Jun 22.

a Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, and Department of Medicine and Surgery , University-Hospital of Parma , Parma , Italy.

Background: Hyperuricemia and gout represent important issues in the obese patients. Considering the epidemic trend of overweight and obesity in developed countries, the impact of these conditions is likely to increase. At present, bariatric surgery represents the most effective treatment for the management of severe obesity for reducing weight and the impact of associated comorbidities, but its effects on hyperuricemia and gout have not been fully elucidated. Read More

Transfus Apher Sci 2018 Aug 30;57(4):517-523. Epub 2018 May 30.

Department of Internal Medicine, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain; Clinical Department, School of Health Sciences, Universidad Europea, Madrid, Spain.

Background: Patient blood management (PBM) performs multidisciplinary strategies to optimize red blood cell (RBC) transfusion. Orthogeriatric share care models (surgeon and geriatrician manage the patient together from admission) have the goal of improving outcomes in hip fracture patients.

Material And Methods: A prospective observational study was conducted. Read More

Otolaryngol Clin North Am 2018 Aug 19;51(4):835-846. Epub 2018 May 19.

Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1070 New York, NY 10029, USA. Electronic address:

Because of age, increased rates of multimorbidity, polypharmacy, functional changes, and cognitive impairment, older adults are at higher risk for perioperative complications. Identifying modifiable risk factors and educating patients and families about what to expect can improve surgical outcomes and satisfaction. Comprehensive preoperative evaluation assesses these potential factors and should include recommendations for risk reduction. Read More

J Perianesth Nurs 2018 Jun 5;33(3):275-280. Epub 2017 Apr 5.

Purpose: Delirium is an acute change in cognition and attention. It may affect any age group. It is most common in older patients and is associated with a significant increase in mortality. Read More

Worldviews Evid Based Nurs 2018 Jun 5;15(3):206-216. Epub 2018 May 5.

Associate Professor, College of Nursing, Center of Excellence in Critical and Complex Care, The Ohio State University and Nurse Scientist, The Ohio State University Wexner Medical Center, Columbus, OH, USA.

Background: Patients admitted to intensive care units (ICUs) often experience pain, oversedation, prolonged mechanical ventilation, delirium, and weakness. These conditions are important in that they often lead to protracted physical, neurocognitive, and mental health sequelae now termed postintensive care syndrome. Changing current ICU practice will not only require the adoption of evidence-based interventions but the development of effective and reliable teams to support these new practices. Read More

Res Social Adm Pharm 2019 02 19;15(2):207-213. Epub 2018 Mar 19.

Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Australia. Electronic address:

Objective: Inappropriate use of pain medication has serious consequences for older populations. Experts in the field have noted an increase in opioid prescriptions, and opioid-related hospitalisations and deaths among this vulnerable population. In the pursuit of educating pharmacists, physicians, allied healthcare professionals, researchers, academics and the public facing the challenges of chronic pain medication management, 'The Inaugural Monash University School of Public Health and Preventive Medicine (SPHPM) Best Practice in Chronic Pain Medication Management Day Conference' was held in December 2016 at the Alfred Medical Research and Education Precinct (Melbourne, Australia). Read More

Geriatr Orthop Surg Rehabil 2018 22;9:2151459318764150. Epub 2018 Mar 22.

James Cook University Hospital, Middlesbrough, United Kingdom.

Introduction: Hip fracture remains the biggest single source of morbidity and mortality in the elderly trauma population, and any intervention focused on quality improvement and system efficiency is beneficial for both patients and clinicians. Two of the variables contributory to improving care and efficiency are time to theater and length of stay, with the overall goal being to improve care as reflected within the achievement of best practice tariff. One of the biggest barriers to optimizing these variables is preinjury anticoagulation. Read More

Curr Cardiol Rev 2018 ;14(3):142-152

Chair of Geriatrics, Biomedic Campus University, Via Àlvaro del Portillo 21, Rome, Italy.

Background: Levosimendan is a calcium sensitizer drug causing increased contractility in the myocardium and vasodilation in the vascular system. It is mainly used for the therapy of acute decompensated heart failure. Several studies on animals and humans provided evidence of the cardioprotective properties of levosimendan including preconditioning and anti-apoptotic. Read More

Int Psychogeriatr 2018 Sep 21;30(9):1375-1383. Epub 2018 Mar 21.

Rostock Center for the Study of Demographic Change,Rostock,Germany.

ABSTRACTBackground:Cognitive decline is an important complication of joint replacement surgeries in senior people.

Methods: We determined incidence rates of dementia diagnosis following endoprosthetic joint replacement surgery (upper and lower extremities). The observation period covered up to 28 quarters using German claims data comprising 154,604 cases 65 years and older. Read More

J Clin Anesth 2018 Jun 15;47:33-42. Epub 2018 Mar 15.

Department of Medicine, Division of Aging, Brigham & Women's Hospital, Boston, MA, United States. Electronic address:

Frailty is an age-related, multi-dimensional state of decreased physiologic reserve that results in diminished resiliency and increased vulnerability to stressors. It has proven to be an excellent predictor of unfavorable health outcomes in the older surgical population. There is agreement in recommending that a frailty evaluation should be part of the preoperative assessment in the elderly. Read More

Am J Surg 2018 Sep 10;216(3):624-629. Epub 2018 Feb 10.

Department of Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.

Introduction: Surgical specialists and residents lack knowledge to adequately manage frail older patients. This study aims to evaluate the effects of an interactive online course regarding attitude, self-confidence and knowledge in perioperative management of the elderly patient.

Methods: The six-weeks course consisted of expert videos, literature readings, quizzes and forum discussions. Read More

Aging Clin Exp Res 2018 Mar 14;30(3):229-235. Epub 2018 Feb 14.

Perioperative Geriatric Medicine, University of San Marino, Contrada Omerelli, 20, 47890, San Marino, San Marino.

Universally recognized goals of preoperative anesthesia assessment are the evaluation of patient's health status to define the entity of the surgical risk, and the anticipation of possible complications while optimizing and planning preventive strategies. Data obtained by Comprehensive Geriatric Assessment (CGA) and frailty evaluation are of extreme usefulness in surgical risk evaluation in older patients and in the decision about surgery. It is from the team-based discussion of such results that the most appropriate treatment can be individuated, surgery invasiveness and duration critically analyzed and if needed modified, and the best perioperative strategy carefully tailored. Read More

Updates Surg 2018 Mar 30;70(1):97-104. Epub 2018 Jan 30.

Surgical and Medical Department of Translational Medicine, Sant'Andrea Teaching Hospital, "Sapienza" University, 00189, Rome, Italy.

Improvements in living conditions and progress in medical management have resulted in better quality of life and longer life expectancy. Therefore, the number of older people undergoing surgery is increasing. Frailty is often described as a syndrome in aged patients where there is augmented vulnerability due to progressive loss of functional reserves. Read More

J Gen Intern Med 2018 Apr 26;33(4):500-509. Epub 2018 Jan 26.

Department of Geriatric Medicine, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 1A1, Canada.

Background: Postoperative delirium is a common preventable complication experienced by older adults undergoing elective surgery. In this systematic review and meta-analysis, we identified prognostic factors associated with the risk of postoperative delirium among older adults undergoing elective surgery.

Methods: Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and AgeLine were searched for articles published between inception and April 21, 2016. Read More

Aging Clin Exp Res 2018 Mar 20;30(3):245-248. Epub 2018 Jan 20.

Geriatric Perioperative Medicine, San Marino University, San Marino, Republic of San Marino.

Postoperative delirium (POD) is an adverse clinical outcome characterized by cognitive, affective and behavioral symptoms with typically an acute onset and a fluctuating course. POD is attributed to certain patients' predisposing factors as well as to treatment-related precipitating factors. While there are several single-component interventions for the prevention of POD, evolving evidence suggests the importance of a system approach in the prevention of POD. Read More

Curr Opin Anaesthesiol 2018 Feb;31(1):11-18

Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, USA.

Purpose Of Review: This review discusses the pharmacology of contemporary anesthetic medications in geriatric patients, neurophysiological changes with aging, current recommendations for dosing anesthetic drugs. It also addresses current practice patterns and ongoing studies, which are likely to affect future anesthetic drug management in the elderly.

Recent Findings: Potency of anesthetic drugs is increased in the elderly. Read More

Gen Thorac Cardiovasc Surg 2018 Apr 23;66(4):201-213. Epub 2017 Nov 23.

Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Seiryocho, Aoba-ku, Sendai, 980-8574, Japan.

Given that an increasing number of elderly patients are undergoing surgical procedures for a diversity of indications, the concept of frailty is currently being examined in more depth in clinical medicine. Established surgical risk scores designed to predict mortality are mainly focused on general demographic information and clinical factors; however, these do not account for the frailty condition. With vulnerability and low resiliency in the frail elderly, these conventional scores are unable to accurately predict postoperative outcomes including adverse complications, disability, the need for additional rehabilitation, and prolonged length of hospitalization. Read More

Health Serv Insights 2017 15;10:1178632917735075. Epub 2017 Nov 15.

Division of Geriatric Medicine, North Shore University Hospital/Long Island Jewish Medical Center, Manhasset, NY, USA.

Hyperglycemia has long been recognized to have detrimental effects on postoperative outcomes in patients undergoing surgery. The manifestations of uncontrolled diabetes are manifold and can include risk of hyperglycemic crises, postoperative infection, poor wound healing, and increased mortality. There is substantial literature supporting the role of diligent glucose control in the prevention of adverse surgical outcomes, but considerable debate remains as to the optimal glucose targets. Read More

Anasthesiol Intensivmed Notfallmed Schmerzther 2017 Nov 20;52(11-12):785-797. Epub 2017 Nov 20.

Frail patients are more prone to develop complications during and after surgery. As the syndrome becomes more common, recognition and special management of frail patients in the perioperative setting is becoming crucial to improve short- and long-term outcomes. Based on current literature and guidelines, we present a compilation of strategies that could be employed to reduce postoperative complication rates in frail patients. Read More

J Am Heart Assoc 2017 Nov 16;6(11). Epub 2017 Nov 16.

Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA.

Background: Surgical patients aged 65 and over face a higher risk of cardiac complications from noncardiac surgery. The Revised Cardiac Risk Index (RCRI) and the Gupta Myocardial Infarction or Cardiac Arrest (MICA) calculator are widely used to predict this risk, but they are not specifically designed to predict MICA in geriatric patients. Our hypothesis is that a new geriatric-sensitive index, derived from geriatric data, will capture this population's unique response to risk factors. Read More

Chin Med J (Engl) 2017 Nov;130(22):2738-2749

Department of Anesthesiology and Operating Theatre, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.

Objective: The population of elderly patients and the amount of geriatric anesthesia have been growing rapidly in China. Thus, understanding the morbidity and mortality associated with geriatric anesthesia in China is critical to the improvement of anesthesia quality and outcome. The aim of the review was to discuss the geriatric anesthesia-related morbidity and mortality in China, as well as to point out the future trend. Read More

Curr Opin Anaesthesiol 2018 Feb;31(1):1-5

Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Purpose Of Review: Increasing numbers of geriatric patients will present for thoracic surgery as the population ages. The changes in physiologic reserve as well as the increase in comorbid conditions among this population must be considered in order to optimize patient care in the perioperative period.

Recent Findings: For elderly patients with cancer, the risk-benefit relationship for thoracic surgery remains favorable. Read More

World Neurosurg 2018 Feb 4;110:e287-e295. Epub 2017 Nov 4.

Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.

Objective: The aging population in industrialized countries shifts the age limit for neurosurgical interventions toward increasingly older patients. This study investigates whether octogenarians (≥80 years) stand out in outcome and incidence of perioperative complications.

Methods: Consecutive patients ≥80 years operated on between January 2013 and August 2016 were compared against a control group of patients aged 55-75 years matched by indication for surgery. Read More