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    287 results match your criteria Perioperative Management of the Geriatric Patient

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    Comparison of 3 Different Perioperative Care Models for Patients With Hip Fractures Within 1 Health Service.
    Geriatr Orthop Surg Rehabil 2017 Jun 1;8(2):87-93. Epub 2017 Jan 1.
    Department of Orthopaedic Surgery, Western Health, Melbourne, Victoria, Australia.
    Introduction: Orthogeriatric care models have been introduced within many health-care facilities to improve outcomes for hip fracture patients. This study aims to evaluate differences in care between 3 models, an orthopedic model, a geriatric model, and a comanaged model.

    Materials And Methods: A retrospective analysis was conducted for hip fracture patients treated at Western Health between November 2012 and March 2014. Read More

    Femoral nerve block in a representative sample of elderly people with hip fracture: A randomised controlled trial.
    Injury 2017 Apr 24. Epub 2017 Apr 24.
    Department of Nursing and Department of Surgical and Perioperative Science Orthopaedics, Umeå University, SE-90187, Umeå, Sweden.
    Introduction: The number of elderly people with hip fracture and dementia is increasing, and many of these patients suffer from pain. Opioids are difficult to adjust and side effects are common, especially with increased age and among patients with dementia. Preoperative femoral nerve block is an alternative pain treatment. Read More

    [Anesthesiological care of trauma patients in orthogeriatric co-management].
    Anaesthesist 2017 May;66(5):375-392
    Klinik für Anästhesiologie und Allgemeine Intensivmedizin, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
    Elderly patients increasingly need to undergo surgery under anesthesia, especially following trauma. A timely interdisciplinary approach to the perioperative management of these patients is decisive for the long-term outcome. Orthogeriatric co-management, which includes geriatricians and anesthesiologists from an early stage, is of great benefit for geriatric patients. Read More

    Preoperative Cognitive Performance and Postoperative Delirium Are independently Associated With Future Dementia in Older People Who Have Undergone Cardiac Surgery: A Longitudinal Cohort Study.
    Crit Care Med 2017 May 5. Epub 2017 May 5.
    1Department of Nursing and Department of Surgical and Perioperative Science, Umeå University, Umeå, Sweden. 2Department of Nursing, Umeå University, Umeå, Sweden. 3Department of Public Health and Clinical Medicine, Epidemiology and Global Health and Department of Statistics, USBE, Umeå University, Umeå, Sweden. 4Department of Surgical and Perioperative Science, Umeå University, Umeå, Sweden. 5Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
    Objective: To investigate if postoperative delirium was associated with the development of dementia within 5 years after cardiac surgery.

    Design: Longitudinal cohort study.

    Setting: Cardiothoracic Division, Umeå University Hospital, Sweden. Read More

    Curative Treatment for Muscle Invasive Bladder Cancer in Elderly Patients: A Systematic Review.
    Eur Urol 2017 May 3. Epub 2017 May 3.
    Urology Department, Saint Jean Languedoc Hospital, Toulouse, France.
    Context: The incidence of muscle invasive bladder cancer (MIBC) increases with age. With increased life expectancy the number of elderly MIBC patients is expected to increase. Existing guidelines on management of MIBC do not preclude curative treatments for elderly patients. Read More

    Clinical Practice Guidelines Decrease Unnecessary Echocardiograms Before Hip Fracture Surgery.
    J Bone Joint Surg Am 2017 Apr;99(8):676-680
    1Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina.
    Background: Preoperative assessment of geriatric patients with a hip fracture may include transthoracic echocardiography (TTE), which increases resource utilization and cost and may delay surgery. The purpose of this study was to evaluate preoperative TTE utilization at a single institution in order to determine (1) how often TTE is ordered in accordance with clinical practice guidelines (CPGs), (2) how frequently TTE reveals cardiac disease that may alter medical or anesthesia management, and (3) whether following CPGs reduces unnecessary TTE utilization without potentially missing important disease.

    Methods: A retrospective review of data on 100 geriatric patients with a hip fracture who had undergone preoperative TTE was performed. Read More

    Hospital Standards to Promote Optimal Surgical Care of the Older Adult: A Report From the Coalition for Quality in Geriatric Surgery.
    Ann Surg 2017 Mar 8. Epub 2017 Mar 8.
    *American College of Surgeons, Division of Research and Optimal Patient Care, Chicago, IL †University of Chicago Medical Center, Department of Surgery, Chicago, IL ‡Yale University, Department of Surgery, New Haven, CT §Sinai Hospital, Department of Surgery, Sinai Center for Geriatric Surgery, Baltimore, MD ¶University of California, San Francisco, Department of Surgery, San Francisco, CA ||Duke University, Department of Surgery, Durham, NC **University of California, San Francisco, Department of Medicine, Division of Geriatrics, San Francisco, CA ††University of Colorado, Denver, Department of Surgery, Aurora, CO ‡‡University of California, Los Angeles, Department of Surgery, Los Angeles, CA.
    Objective: The aim of this study was to establish high-quality, valid standards to improve surgical care of the older adult.

    Background: The aging population increases demand for high-quality surgical care. Building upon prior guidelines, quality indicators, and pilot projects, the Coalition for Quality in Geriatric Surgery (CQGS) includes 58 diverse stakeholder organizations committed to improving geriatric surgery. Read More

    Preoperative frailty is predictive of complications after major lower extremity amputation.
    J Vasc Surg 2017 Mar;65(3):804-811
    Division of Vascular and Endovascular Surgery, Department of Surgery, Emory University, Atlanta, Ga.
    Objective: Preoperative clinical frailty is increasingly used as a surrogate for predicting postoperative outcomes. Patients undergoing major lower extremity amputation (LEA) carry a high risk of perioperative morbidity and mortality, including high 30-day mortality and readmission rates. We hypothesized that preoperative frailty would be associated with an increased risk of postoperative mortality and readmission. Read More

    Acetabular Fractures in the Elderly: Midterm Outcomes of Column Stabilisation and Primary Arthroplasty.
    Biomed Res Int 2017 17;2017:4651518. Epub 2017 Jan 17.
    University of Adelaide & Royal Adelaide Hospital, Level 4 Bice Building, North Terrace, Adelaide, SA 5000, Australia.
    Background. Interest in arthroplasty techniques for periarticular or intra-articular fractures in the elderly/osteoporotic patient continues to rise, including for geriatric acetabular fractures. In line with this, many acetabular fracture surgeons are now undertaking acute total hip arthroplasty in elderly/osteoporotic patients. Read More

    Clostridium difficile Infection: An Orthopaedic Surgeon's Guide to Epidemiology, Management, and Prevention.
    J Am Acad Orthop Surg 2017 Mar;25(3):214-223
    From the Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI.
    Clostridium difficile infection is a growing concern in health care and is a worrisome complication in orthopaedics. The incidence and severity of this infection are increasing, although the incidence following orthopaedic surgery is comparatively lower than that seen in patients in most other surgical specialties. The typical geriatric orthopaedic patient may have many risk factors that increase the likelihood of C difficile infection, including advanced age, residence in a long-term care facility, multiple comorbidities, the use of perioperative antibiotics, and a long length of stay. Read More

    Age Nutrition Chirugie (ANC) study: impact of a geriatric intervention on the screening and management of undernutrition in elderly patients operated on for colon cancer, a stepped wedge controlled trial.
    BMC Geriatr 2017 Jan 7;17(1):10. Epub 2017 Jan 7.
    Université Lyon 1, Lyon, France.
    Background: Undernutrition prior to major abdominal surgery is frequent and increases morbidity and mortality, especially in older patients. The management of undernutrition reduces postoperative complications. Nutritional management should be a priority in patient care during the preoperative period. Read More

    [Perioperative patient management in orthogeriatrics].
    Orthopade 2017 Jan;46(1):54-62
    Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen, Deutschland.
    The management of major orthopedic surgery in the elderly prototypically reflects the perioperative risks of geriatric, often very frail patients reflecting an aging population. To improve outcome, the risks of anesthesia and surgery as well as of patient comorbidities must be thoroughly assessed and balanced using a multidisciplinary approach. Particular risks include cardiopulmonary morbidity, anemia, risk of hemorrhage and the management by anticoagulation, cerebral impairments as well as frailty and limited physiological reserves in general. Read More

    Functional Outcomes of Operative Management of Scapula Fractures in a Geriatric Cohort.
    J Orthop Trauma 2017 Jan;31(1):e1-e8
    *University of Miami, Coral Gables, FL; and †Department of Orthopaedic Surgery, Regions Hospital, University of Minnesota, Saint Paul, MN.
    Objectives: To analyze functional outcomes, motion, and strength in patients 65 years of age and older who underwent operative management of a scapula fracture.

    Design: Retrospective review of prospective database.

    Setting: A single level-1 teaching trauma center. Read More

    Patient Function and the Value of Surgical Care for Kidney Cancer.
    J Urol 2017 May 13;197(5):1200-1207. Epub 2016 Dec 13.
    Department of Urology, Weill Cornell School of Medicine, New York, New York.
    Purpose: Frailty and functional status have emerged as significant predictors of morbidity and mortality for patients undergoing cancer surgery. To articulate the impact on value (ie quality per cost), we compared perioperative outcomes and expenditures according to patient function for older adults undergoing kidney cancer surgery.

    Materials And Methods: Using linked SEER (Surveillance, Epidemiology and End Results)-Medicare data, we identified 19,129 elderly patients with kidney cancer treated with nonablative surgery from 2000 to 2009. Read More

    Anterior Versus Posterior Approaches for Odontoid Fracture Stabilization in Patients Older Than 65 Years: 30-day Morbidity and Mortality in a National Database.
    Clin Spine Surg 2016 Dec 13. Epub 2016 Dec 13.
    Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA.
    Study Design: Retrospective cohort analysis.

    Objective: To compare 30-day perioperative clinical outcomes of surgical odontoid stabilization by an anterior or posterior operative approach in elderly patients.

    Summary Of Background Data: Surgical stabilization of odontoid fractures is superior to nonoperative management in geriatric patients. Read More

    How to optimally manage elderly bladder cancer patients?
    Transl Androl Urol 2016 Oct;5(5):683-691
    Department of Urology, Medical University of Vienna, Vienna, Austria; ; Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA; ; Department of Urology, Weill Cornell Medical College, New York, USA.
    Bladder cancer (BCa) is a disease of the elderly and as the population is aging, BCa will become an even bigger public health challenge in the future. Nowadays the correct management of BCa in the elderly remains controversial. The purpose of this article was to review the previous literature to summarize the current knowledge. Read More

    Nutritional intervention in cognitively impaired geriatric trauma patients: a feasibility study.
    Clin Interv Aging 2016;11:1239-1246. Epub 2016 Sep 12.
    Center for Orthopedics and Trauma Surgery.
    Background: Most studies focusing on improving the nutritional status of geriatric trauma patients exclude patients with cognitive impairment. These patients are especially at risk of malnutrition at admission and of worsening during the perioperative fasting period. This study was planned as a feasibility study to identify the difficulties involved in including this high-risk collective of cognitively impaired geriatric trauma patients. Read More

    Relationship of Prolonged Operative Time and Comorbidities With Complications After Geriatric Ankle Fractures.
    Foot Ankle Int 2017 Jan 1;38(1):41-48. Epub 2016 Oct 1.
    1 Center for Orthopaedics and Trauma Surgery, University Hospital of Giessen and Marburg, Marburg, Germany.
    Background: The incidence of geriatric ankle fractures has increased during the last few decades. In contrast to younger patients, increased complication rates have been observed. Thus, the goal of the present study was to identify risk factors for perioperative complications following open reduction and internal fixation of geriatric ankle fractures. Read More

    Total Hip and Knee Arthroplasty in Patients Older Than Age 80 Years.
    J Am Acad Orthop Surg 2016 Oct;24(10):683-90
    From the Warren Alpert Medical School of Brown University, Providence, RI.
    A rapidly aging population is currently reshaping the demographic profile of the United States. Among older patients, the cohort aged >80 years is not only living longer but also is electing to undergo more total hip and knee arthroplasties. To improve perioperative safety, orthopaedic surgeons should understand the risks and clinical outcomes of arthroplasty in patients of advanced age. Read More

    [Aortic valve replacement in the elderly].
    Z Gerontol Geriatr 2016 Oct 12;49(7):639-656. Epub 2016 Aug 12.
    Medizinische Klinik 8, Schwerpunkt Kardiologie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland.
    The treatment of severe symptomatic aortic valve stenosis by conventional aortic valve replacement (AVR) or by transcatheter aortic valve implantation (TAVI) has a good perinterventional prognosis even for patients of advanced age. Having a heart team select the best management strategies based on current guidelines for each individual patient is essential for success. Especially in elderly and increasingly multimorbid patients with sometimes severe preconditions, the detection of functional deficits is relevant not only for the mortality but also for perioperative and postoperative complications as well as the functional outcome. Read More

    The impact of frailty on postoperative outcomes in individuals aged 65 and over undergoing elective surgery for colorectal cancer: A systematic review.
    J Geriatr Oncol 2016 Nov 21;7(6):479-491. Epub 2016 Jun 21.
    Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium.
    Colorectal cancer surgery is frequently performed in the older population. Many older persons have less physiological reserves and are thus more susceptible to adverse postoperative outcomes. Therefore, it seems important to distinguish the fit patients from the more vulnerable or frail. Read More

    Frailty assessment to predict short term outcomes after cardiac surgery.
    Asian Cardiovasc Thorac Ann 2016 Jul;24(6):546-54
    Department of Cardiothoracic Surgery, Princess Alexandra Hospital Woolloongabba, Queensland, Australia.
    Background: Frailty has been used to predict outcome in gerontology but has only recently been applied to measures of perioperative risk stratification. It provides information on physiological reserve not addressed by current scoring systems which are heavily reliant on age.

    Methods: We enrolled 123 patients over 70-years old (mean age 77. Read More

    Surgery in the older person: Training needs for the provision of multidisciplinary care.
    Ann R Coll Surg Engl 2016 Jul 6;98(6):367-70. Epub 2016 Jun 6.
    Cardiff University , Cardiff , UK.
    Introduction Many older surgical patients are exposed to high risks of morbidity and mortality when undergoing both elective and emergency surgery. Methods We provide an overview of perioperative care teams and the educational opportunities available to surgeons who undertake surgery in the older person. Findings The number of older people undergoing surgery is increasing at a rate faster than the proportion of older people in the overall population. Read More

    Narcotic Use and Postoperative Doctor Shopping by Patients with Nephrolithiasis Requiring Operative Intervention: Implications for Patient Safety.
    J Urol 2016 Sep 27;196(3):763-8. Epub 2016 Apr 27.
    Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Tennessee Valley Health Care System, Nashville, Tennessee.
    Purpose: We sought to determine perioperative patterns of narcotic use and the prevalence of postoperative doctor shopping among patients with nephrolithiasis requiring operative management.

    Materials And Methods: We retrospectively reviewed the records of consecutive patients residing in Tennessee who required ureteroscopy with laser lithotripsy for nephrolithiasis at a single institution from January to December 2013. Using the Tennessee CSMD (Controlled Substances Medication Database) patients were categorized by the number of postoperative narcotic providers. Read More

    [Anesthesiological care in orthogeriatric co-management. Perioperative treatment of geriatric trauma patients].
    Z Gerontol Geriatr 2016 Apr 18;49(3):237-55. Epub 2016 Apr 18.
    Klinik für Anästhesiologie und Allgemeine Intensivmedizin, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
    Elderly patients increasingly need to undergo surgery under anesthesia, especially following trauma. A timely interdisciplinary approach to the perioperative management of these patients is decisive for the long-term outcome. Orthogeriatric co-management, which includes geriatricians and anesthesiologists from an early stage, is of great benefit for geriatric patients. Read More

    Self-reported Mobility in Older Patients Predicts Early Postoperative Outcomes after Elective Noncardiac Surgery.
    Anesthesiology 2016 Apr;124(4):815-25
    From the Department of Internal Medicine, Section of General Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.K.); Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, North Carolina (A.P.M., X.I.L., S.B.K., W.J.R., L.G.); Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina (A.P.M., W.J.R.); Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina (L.R., C.R., L.G.); Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina (X.I.L.); Department of Internal Medicine, Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.B.K.); Department of Internal Medicine, Section of Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (L.G.); and Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina (L.G.).
    Background: Specific geriatric assessment tools may complement traditional perioperative risk stratification. The aim of this study was to evaluate whether self-reported mobility is predictive of postoperative outcomes in older patients undergoing elective noncardiac surgery.

    Methods: Patients aged 69 yr or older (n = 197) underwent (1) traditional risk assessments (American Society of Anesthesiologists physical status classification and Revised Cardiac Risk Index), (2) five-point frailty evaluation, (3) self-reported mobility assessment using the Mobility Assessment Tool-short form (range, 30. Read More

    Preoperative Assessment of Geriatric Patients.
    Anesthesiol Clin 2016 Mar;34(1):171-83
    Department of Anesthesiology, Washington University School of Medicine, Campus Box 8054, 660 South Euclid Avenue, St Louis, MO 63110, USA. Electronic address:
    Geriatric patients are over-represented in hospitalizations, surgeries, and perioperative complications. Special consideration is required for this patient group in the perioperative period because of the prevalence of comorbid diseases, functional impairments, and other deficits. A comprehensive preoperative evaluation strategy is recommended to identify and address these issues. Read More

    Validation of a modified Frailty Index to predict mortality in vascular surgery patients.
    J Vasc Surg 2016 Jun 28;63(6):1595-1601.e2. Epub 2016 Feb 28.
    Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins Hospital, Baltimore, Md. Electronic address:
    Background: Patient frailty has been implicated as a predictor of poor patient outcomes; however, there is no consensus on how to define or quantify frailty to assess perioperative risk. A previously described modified Frailty Index (mFI) has been shown to predict adverse outcomes after selected vascular surgical procedures, but no studies to date have compared its utility against other recognized risk indices in specific populations of vascular surgery patients.

    Methods: National Surgical Quality Improvement Program data were reviewed for all patients undergoing carotid revascularization, abdominal aortic aneurysm (AAA) repair, and lower extremity revascularization for peripheral arterial disease (PAD) from 2006 to 2012. Read More

    A 15-year retrospective analysis of the epidemiology and outcomes for elderly emergency general surgical admissions in the North East of England: A case for multidisciplinary geriatric input.
    Int J Surg 2016 Apr 23;28:13-21. Epub 2016 Feb 23.
    Department of Colorectal Surgery, Queen Elizabeth Hospital, Gateshead, NE9 6SX, UK. Electronic address:
    Introduction: Life expectancies in the UK are increasing and with this there is an increasing elderly population with more complex co-morbidity. Emergency surgery in the elderly is challenging in terms of decision making, managing co-morbidity and post-operative rehabilitation with high morbidity and mortality. To optimise service design and development, it is important to understand the changing pattern of emergency surgical care for this group. Read More

    [Anesthesiological management of elderly trauma patients].
    Anaesthesist 2016 Feb;65(2):98-106
    Klinik für Anästhesiologie, Universitätsklinikum RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
    Background: The demographic change is accompanied by an increasing number of elderly trauma patients. Geriatric patients with trauma often show several comorbidities and as a result have a high perioperative risk to develop postoperative morbidity and mortality. The 30-day mortality is high. Read More

    [Cost accounting of a geriatric perioperative unit].
    Sante Publique 2015 Jul-Aug;27(4):529-37
    Aim: Hip fracture management in a dedicated geriatric perioperative unit improves long-term mortality. In this "we report the" health economics evaluation of this geriatric perioperative care unit (UPOG).

    Methods: This study was conducted in 2011. Read More

    New Target-Specific Oral Anticoagulants and Intracranial Bleeding: Management and Outcome in a Single-Center Case Series.
    World Neurosurg 2016 Apr 28;88:132-9. Epub 2015 Dec 28.
    Department of Neurosurgery, Medical School of the Saarland University, Homburg/Saar, Germany.
    Introduction: New target-specific anticoagulants such as the direct thrombin inhibitor dabigatran and the factor Xa inhibitor rivaroxaban are used in an increasing number of patients. Several studies comparing these new oral anticoagulants with vitamin K antagonists revealed a lower risk of severe bleeding complications and reduced thromboembolic events. However, the lack of antidotes is a challenging issue in the treatment of traumatic or spontaneous intracranial hemorrhage. Read More

    [Geriatric aspects in oncocoloproctology (review)].
    Adv Gerontol 2016 ;29(2):269-275
    Chair of Faculty Surgery of the Russian Military Medical Academy, Saint-Petersburg, 194175, Russian Federation;
    Severe comorbidity significantly limits the use of active surgical tactics in patients of older age groups suffering from colorectal cancer (CRC), leading to the abandonment of the necessary operations in 20 % of cases. The low use of radical surgical tactics are not always related to objective difficulties, but often can be due to the stereotypical approach to solving the question of the treatment of the elderly patient, which leads to unreasonable refusal of surgical intervention. Today is not defined by a single concept of surgical treatment of patients with colon cancer in elderly and senile age. Read More

    Controversies in anaesthesia for noncardiac surgery in older adults.
    Br J Anaesth 2015 Dec;115 Suppl 2:ii15-25
    Department of Anesthesiology and Critical Care, The University of Pennsylvania, 6 Dulles, 3400 Spruce Street, Philadelphia, PA 19104, USA.
    As the population of the world is rapidly ageing, the amount of surgery being performed in older patients is also increasing. Special attention is required for the anaesthetic and perioperative management of these patients. The clinical and non-clinical issues specific to older surgical patients are reviewed, with a special emphasis on areas of debate related to anaesthesia care in this group. Read More

    [Management of older patients following solid organ transplantation].
    Z Gerontol Geriatr 2016 Jan 9;49(1):59-68. Epub 2015 Dec 9.
    Universitätsklinik für Innere Medizin/Geriatrie, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich.
    Due to a continuous expansion of transplantation registers, such as the old-for-old program in Europe, the number of older patients treated with transplantation is increasing. At the same time the perioperative survival rates show a clear increase even in this patient collective (older than 65 years); therefore, the probability that the care of older patients after organ transplantation will be undertaken in the routine practice increases. This article describes the medical characteristics of older patients following organ transplantation. Read More

    Current Practices Regarding Perioperative Management of Patients With Fracture on Antiplatelet Therapy: A Survey of Orthopedic Surgeons.
    Geriatr Orthop Surg Rehabil 2015 Dec;6(4):289-94
    Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA ; Department of Orthopaedic Surgery, Jamaica Hospital Medical Center, Queens, NY, USA.
    Objective: There continues to be controversy over whether operative delay is necessary for patients on antiplatelet therapy, particularly for elderly patients with hip fractures. This study sought to assess current clinical practices of orthopedic surgeons regarding perioperative management of these patients.

    Methods: A 12-question, Web-based survey was distributed to orthopedic surgeons via e-mail. Read More

    Do elderly patients have the most to gain from laparoscopic surgery?
    Ann Med Surg (Lond) 2015 Sep 21;4(3):321-3. Epub 2015 Sep 21.
    Institute of Health Policy, Management and Education, University of Toronto, Toronto, Canada.
    Populations are aging worldwide, people are living longer, and the surgical needs of elderly patients are rising. Laparoscopic techniques have become more common with improved training, surgeon skill and evidence of improved outcomes. Benefits of laparoscopy include decreased blood loss, postoperative pain, and hospital length of stay; improved mobilization, quicker return to normal activity; and fewer pulmonary, thrombotic, and abdominal wall complications. Read More

    The effect of anesthesia type on major lower extremity amputation in functionally impaired elderly patients.
    J Vasc Surg 2016 Mar 6;63(3):696-701. Epub 2015 Nov 6.
    Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Mass.
    Objective: Patients undergoing major lower extremity amputations are at risk for a wide variety of perioperative complications. Elderly patients with any functional impairment have been shown to be at high risk for these adverse events. Our goal was to determine the association between the type of anesthesia-general anesthesia (GA) and regional/spinal anesthesia (RA)-on perioperative outcomes after lower extremity amputation in these elderly and functionally impaired patients. Read More

    Treatment of muscle invasive bladder cancer in the elderly: navigating the trade-offs of risk and benefit.
    World J Urol 2016 Jan 23;34(1):3-11. Epub 2015 Oct 23.
    Division of Urologic Oncology, Department of Urology, University of North Carolina at Chapel Hill, 2105 Physicians Office Building, Chapel Hill, NC, 27599, USA.
    Purpose: Despite the fact that bladder cancer patients have the highest median age of any type of cancer, older patients with muscle invasion are often under-treated.

    Methods: In this review, we report the most up to date literature on the patterns of care and treatment of older patients with muscle invasive bladder cancer. Data on under-treatment, geriatric principles, cystectomy, perioperative chemotherapy, and bladder preservation for older patients are presented and analyzed. Read More

    Colorectal Cancer In The Elderly Patient.
    Pol Przegl Chir 2015 Aug;87(8):417-24
    Colorectal neoplasms present a serious diagnostic and therapeutic problem. Continuously increasing morbidity affects the elderly people in particular and considering the aging of the society and enhanced impact of the factors with a proved role in carcinogenesis, this tendency is predicted to remain unchanged in the near future. Therefore, it seems justified to thoroughly analyze the specificity of this patient group accordingly adjust the diagnostic and therapeutic procedures. Read More

    Favorable outcomes of very elderly patients with critical limb ischemia who undergo distal bypass surgery.
    J Vasc Surg 2016 Feb 23;63(2):377-84. Epub 2015 Oct 23.
    Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
    Objective: To determine the midterm outcomes of distal bypass surgery for very elderly patients, and to determine the ideal candidates for this procedure.

    Methods: Of 268 consecutive patients (328 limbs) with critical limb ischemia who were treated between 2006 and 2013, 106 (126 limbs) underwent distal bypass and were retrospectively reviewed. Nineteen patients (22 limbs) were aged ≥80 years (very elderly group) and 87 patients (104 limbs) were aged <80 years (control group). Read More

    Apixaban for the prophylaxis and treatment of deep vein thrombosis and pulmonary embolism: an evidence-based review.
    Ther Clin Risk Manag 2015 26;11:1273-82. Epub 2015 Aug 26.
    Division of Hematology and Oncology, College of Medicine, University of Florida, Gainesville, FL, USA.
    Venous thromboembolism (VTE) results in significant morbidity and mortality. The prevention and treatment of VTE is managed with anticoagulant therapy, historically parenteral anticoagulants such as unfractionated heparin, low molecular weight heparin, and fondaparinux, and oral vitamin K antagonists such as warfarin. In the last few years, several target-specific oral anticoagulants have been developed, including the direct thrombin inhibitor dabigatran and anti-Xa inhibitors rivaroxaban, apixaban, and edoxaban. Read More

    Age as a predictor of rescue opioid administration immediately after the emergence of general anesthesia.
    J Clin Anesth 2015 Nov 3;27(7):537-42. Epub 2015 Sep 3.
    Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston MA.
    Background And Objectives: While previous studies have shown that elderly patients require lower dosages of opioids, the literature suggests that pain is undertreated in the geriatric population, which may lead to postoperative pain and high rescue analgesia requirements. The purpose of this study is to determine whether elderly patients undergoing hip and knee arthroplasty require higher levels of postoperative rescue opioids than their younger counterparts early after emergence from anesthesia.

    Methods: Using a nonconcurrent retrospective cohort study design, patients who underwent hip or knee arthroplasty under general anesthesia at a tertiary academic hospital from 2007 to 2012 were identified. Read More

    Is Scheduled Intravenous Acetaminophen Effective in the Pain Management Protocol of Geriatric Hip Fractures?
    Geriatr Orthop Surg Rehabil 2015 Sep;6(3):202-8
    Michigan State University College of Human Medicine, Grand Rapids, MI, USA ; Orthopaedic Associates of Michigan, Grand Rapids, MI, USA.
    Background: Hip fractures have significant effects on the geriatric population and the health care system. Prior studies have demonstrated both the safety of intravenous (IV) acetaminophen and its efficacy in decreasing perioperative narcotic consumption. The purpose of this study is to evaluate the effect of scheduled IV acetaminophen for perioperative pain control on length of hospital stay, pain level, narcotic use, rate of missed physical therapy (PT) sessions, adverse effects, and discharge disposition in geriatric patients with hip fractures. Read More

    Ophthalmic regional blocks: management, challenges, and solutions.
    Local Reg Anesth 2015 20;8:57-70. Epub 2015 Aug 20.
    Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, FL, USA.
    In the past decade ophthalmic anesthesia has witnessed a major transformation. The sun has set on the landscape of ophthalmic procedures performed under general anesthesia at in-hospital settings. In its place a new dawn has ushered in the panorama of eye surgeries conducted under regional and topical anesthesia at specialty eye care centers. Read More

    Pain Management Issues for the Geriatric Surgical Patient.
    Anesthesiol Clin 2015 Sep 3;33(3):563-76. Epub 2015 Jul 3.
    Department of Anesthesiology and Perioperative Medicine, University of Alabama, Birmingham, 619 19th Street South JT862, Birmingham, AL 35249, USA. Electronic address:
    Adequate treatment of pain is of utmost importance in making uncomplicated the perioperative course for geriatric surgical patients. Effective analgesia reduces morbidity, improves patient and family satisfaction, and is a natural expectation of high-quality care. Pain treatment in older adults is more complicated than in younger counterparts, and great consideration must be given to age-related changes in physiology and pharmacokinetics. Read More

    Postoperative Delirium in the Geriatric Patient.
    Anesthesiol Clin 2015 Sep 7;33(3):505-16. Epub 2015 Jul 7.
    Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1010, New York, NY 10029, USA; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1010, New York, NY 10029, USA; Department of Geriatrics and Palliative Care, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1010, New York, NY 10029, USA.
    Postoperative delirium, a common complication in older surgical patients, is independently associated with increased morbidity and mortality. Patients older than 65 years receive greater than one-third of the more than 40 million anesthetics delivered yearly in the United States. This number is expected to increase with the aging of the population. Read More

    Preoperative Assessment of Geriatric Patients.
    Anesthesiol Clin 2015 Sep 7;33(3):471-80. Epub 2015 Jul 7.
    Department of Anesthesiology, Tufts Medical Center, 800 Washington Street, Box 298, Boston, MA 02111, USA. Electronic address:
    The preoperative assessment of geriatric patients provides an excellent opportunity to evaluate the patient for perioperative risk factors such as frailty, functional status, nutritional status, cardiovascular and pulmonary status, and substance dependence. It also provides an overall clinical picture on which health care providers can base a framework to reduce these risk factors. Read More

    Geriatrics and the Perioperative Surgical Home.
    Anesthesiol Clin 2015 Sep;33(3):439-45
    University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA.
    An ever-changing health care system with a constantly increasing aging surgical population creates both opportunities for providing improved health care as well as significant challenges. Coordinated health care initiatives are needed if one is to adequately balance the need for evidence-based improved patient outcomes and the often-associated increased costs. In this article the authors postulate that a protocol-driven, multidisciplinary approach may be a pathway for implementing an effective triple aim to health care, especially in a frail geriatric population. Read More

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