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Clin Neurol Neurosurg 2022 Jun 2;219:107318. Epub 2022 Jun 2.

Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA.

Objective: To identify perioperative risk factors for postoperative delirium (POD) in patients aged 65 or older undergoing lumbar spinal fusion procedures.

Patients And Methods: A retrospective cohort analysis was performed on patients undergoing lumbar spinal fusion over an approximately three-year period at a single institution. Demographic and perioperative data were obtained from electronic medical records. Read More

BMJ Open 2022 Jun 22;12(6):e062524. Epub 2022 Jun 22.

Department of Anesthesiology and Pain Medicine, Ottawa Hospital, Ottawa, Ontario, Canada.

Introduction: Older adults prioritise surviving surgery, but also preservation of their functional status and quality of life. Current approaches to measure postoperative recovery, which focus on death, complications and length of hospitalisation, may miss key relevant domains. We propose that postoperative disability is an important patient-centred outcome to measure intermediate-to-long recovery after major surgery in older adults. Read More

Front Cardiovasc Med 2022 27;9:890967. Epub 2022 May 27.

Department of Geriatric Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China.

Coronavirus disease 2019 (COVID-19) is a highly contagious disease. Most infected patients manifest mild flu-like symptoms, but in some cases, the patients rapidly develop severe lung infections and pneumonia. It is estimated that about 15-20% of patients with COVID-19 develop hypoxemia and require some form of oxygen therapy and ventilation support. Read More

Appl Bionics Biomech 2022 3;2022:8263986. Epub 2022 Jun 3.

Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai 200032, China.

Objective: Preoperative malnutrition is an independent risk factor for postoperative complications and survival for gastric cancer patients. The study is aimed at investigating the prevalence of malnutrition, perioperative nutritional support, and the risk factors associated with delayed discharge of geriatric patients undergoing gastrectomy.

Methods: A retrospective study of gastric cancer patients (age ≥ 65) who underwent gastrectomy at Zhongshan Hospital from January 2018 to May 2020 was conducted. Read More

Ann Palliat Med 2022 May;11(5):1605-1623

1Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.

Comorbidity of lung cancer and chronic obstructive pulmonary disease (COPD) is very common. Surgical operation is the initial treatment of lung cancer. But surgery operation will aggravate the symptoms of COPD, such as shortness of breath, chest tightness. Read More

BMJ Open 2022 Jun 6;12(6):e059416. Epub 2022 Jun 6.

Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA.

Introduction: Postoperative delirium is a frequent adverse event following elective non-cardiac surgery. The occurrence of delirium increases the risk of functional impairment, placement to facilities other than home after discharge, cognitive impairment at discharge, as well as in-hospital and possibly long-term mortality. Unfortunately, there is a dearth of effective strategies to minimise the risk from modifiable risk factors, including postoperative pain control and the analgesic regimen. Read More

Front Surg 2022 18;9:842978. Epub 2022 May 18.

Department of Orthopedics and Traumatology, Beijing Jishuitan Hospital, Beijing, China.

Background: Geriatric hip fracture is one of the most common end-stage events in older patients with osteoporosis. We aimed to improve the original co-management process by engaging emergency physicians in the preoperative multidisciplinary management team (MDT). We evaluated this intervention in terms of reducing patient waiting time before surgery. Read More

Khirurgiia (Mosk) 2022 (6):48-54

Tomsk Regional Clinical Hospital, Tomsk, Russia.

Objective: To study the immediate results of angio- and bronchoplastic lobectomies for non-small cell lung carcinoma (NSCLC) in patients over 70 years old.

Material And Methods: Thirty-one extended angio- and/or bronchoplastic lobectomies were performed in patients with NSCLC over 70 years old between January 2015 and December 2020. Mean age of patients was 74. Read More

J Surg Educ 2022 May 26. Epub 2022 May 26.

Division of Geriatric, Hospital, Palliative, and General Internal Medicine, Keck School of Medicine of USC, Los Angeles, California.

Objective: To develop a hospital-based perioperative surgical co-management curriculum rotation to provide educational value to fourth year medical students, many of whom are future surgical trainees. We leveraged our Hospitalist service which comanages patients with many surgical subspecialties to teach students about preoperative optimization, postoperative management of both acute medical issues and chronic comorbidities, and the interprofessional team for surgical care.

Design: Medical students were assigned to surgical co-management services on two to four week rotations. Read More

J Clin Med 2022 May 16;11(10). Epub 2022 May 16.

Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France.

Preclinical studies have shown that volatile anesthetics may have beneficial effects on injured lungs, and pilot clinical data support improved arterial oxygenation, attenuated inflammation, and decreased lung epithelial injury in patients with acute respiratory distress syndrome (ARDS) receiving inhaled sevoflurane compared to intravenous midazolam. Whether sevoflurane is effective in improving clinical outcomes among patients with ARDS is unknown, and the benefits and risks of inhaled sedation in ARDS require further evaluation. Here, we describe the SESAR (Sevoflurane for Sedation in ARDS) trial designed to address this question. Read More

J Cancer Res Clin Oncol 2022 May 17. Epub 2022 May 17.

Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.

Objective: Five commonly used global health assessment tools have been evaluated to identify and assess the preoperative frailty status and its relationship with perioperative in-hospital complications and transfusion rates in older women with endometrial cancer (EC).

Methods: Preoperative frailty status was examined by the G8 questionnaire, the Eastern Cooperative Oncology Group performance status, the Charlson Comorbidity Index and the American Society of Anesthesiologists Physical Status System, as well as the Lee-Schonberg prognostic index. The main outcome measures were perioperative laboratory values, intraoperative surgical parameters and immediately postoperative complications. Read More

J Surg Res 2022 Sep 11;277:352-364. Epub 2022 May 11.

Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida. Electronic address:

Introduction: A growing percentage of the US population is over the age of 65, and geriatrics account for a large portion of trauma admissions, expected to reach nearly 40% by 2050. Cognitive status is important for operative management, especially in elderly populations. This study aims to investigate preoperative and postoperative cognitive function assessment tools in geriatric patients following acute trauma and associated outcomes, including functional status, postdischarge disposition, mortality, and hospital length of stay (H-LOS). Read More

SAGE Open Nurs 2022 Jan-Dec;8:23779608221097450. Epub 2022 May 6.

Department of Nursing, Umeå University, Umeå, Sweden.

Introduction: Among older adults, hip fracture is a common and serious consequence of a fall. Preoperative pain is common and often severe among patients with hip fracture. Opioids are usually used but have many side effects. Read More

BMC Surg 2022 May 10;22(1):167. Epub 2022 May 10.

Nursing Department, The People's Hospital of Liuyang, Hunan, People's Republic of China.

Aim: To develop and validate a prediction model to evaluate the perioperative hypoglycemia risk in hospitalized type 2 diabetes mellitus (T2DM) patients undergoing elective surgery.

Methods: We retrospectively analyzed the electronic medical records of 1410 T2DM patients who had been hospitalized and undergone elective surgery. Regression analysis was used to develop a predictive model for perioperative hypoglycemia risk. Read More

Front Cardiovasc Med 2022 13;9:869243. Epub 2022 Apr 13.

Department of Comprehensive Surgery, General Hospital of Chinese People's Liberation Army and National Clinical Research Center for Geriatric Disease, Beijing, China.

Background: Postoperative myocardial injury (PMI) is associated with short- and long-term mortality. The incidence of PMI in very old patients is currently unknown. There is currently neither known effective prophylaxis nor a uniform strategy for the elderly with PMI. Read More

Anesth Analg 2022 Apr 20. Epub 2022 Apr 20.

From the Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan.

Background: Delirium is the most common postoperative complication in older adults, though anesthesiologist awareness of delirium prevention guidelines-and associated practice trends-remains unknown.

Methods: This was a convergent mixed-methods study, which simultaneously analyzed quantitative and qualitative data to determine delirium guideline awareness among anesthesiologists and practice patterns based on guideline recommendations. Quantitative data were abstracted from the Multicenter Perioperative Outcomes Group database for noncardiac surgery patients (2009-2020) aged 65 years and older. Read More

J Cardiothorac Vasc Anesth 2022 Aug 26;36(8 Pt B):2983-2990. Epub 2022 Feb 26.

Department of Anesthesiology, Intensive Care, and Pain Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands.

Objectives: Accurate preoperative transfusion risk stratification may serve to better manage older patients undergoing cardiac surgery. Therefore, the aim of the present study was to externally validate the existing Association of Cardiothoracic Anesthetists perioperative risk of blood transfusion (ACTA-PORT) score in a population ≥70 years of age scheduled for cardiac surgery. Furthermore, the study authors investigated the additional prognostic value of individual frailty variables to this transfusion risk score. Read More

Geriatr Orthop Surg Rehabil 2022 23;13:21514593221083824. Epub 2022 Mar 23.

Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Objectives: To evaluate the incidence and risk factors of postoperative pneumonia (POP) in geriatric patients with a hip fracture after surgery, to design a predictive nomogram, and to validate the accuracy of the nomogram.

Design: Retrospective study.

Setting: A tertiary hospital affiliated to a medical university. Read More

Medicina (Kaunas) 2022 Mar 4;58(3). Epub 2022 Mar 4.

Working Committee on Geriatric Trauma Registry of the German Trauma Society, 80538 München, Germany.

The increased use of direct oral anticoagulants (DOACs) results in an increased prevalence of DOAC treatment in hip fractures patients. However, the impact of DOAC treatment on perioperative management of hip fracture patients is limited. In this study, we describe the prevalence of DOAC treatment in a population of hip fracture patients and compare these patients with patients taking vitamin K antagonists (VKA) and patients not taking anticoagulants. Read More

Pain Res Manag 2022 27;2022:9052246. Epub 2022 Feb 27.

Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China.

Background: Due to the presence of multimorbidity and polypharmacy, patients aged 75 and older are at a higher risk for postoperative adverse events after lumbar fusion surgery. More effective enhanced recovery pathway is needed for these patients. Pain control is a crucial part of perioperative management. Read More

J Res Nurs 2021 Jun 18;26(4):341-351. Epub 2020 Sep 18.

Consultant Anesthetist, Department of Anaesthesia, National Health Service (NHS), UK.

Background: Postoperative delirium is a major complication associated with anaesthesia and surgery, more commonly seen in older people.

Aims: The aims of this study were to explore the knowledge and understanding of anaesthetists and nurses involved in anaesthesia through their responses to two case scenarios of postoperative delirium experienced by older people.

Methods: A 30-item online survey was sent to 500 potential respondents. Read More

Medicine (Baltimore) 2022 Mar;101(9):e28990

Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Abstract: The impact of a physical medicine and rehabilitation (PM&R) consultation on clinical outcomes in critically ill surgical patients remains unclear. The aim of this study is to examine whether the patients who received PM&R consultation will demonstrate better clinical outcomes in terms of the differences in clinical outcomes including muscle mass and strength, intensive care unit (ICU) length of stay (LOS) and functional outcomes between the PM&R consultation and no PM&R consultation and between early PM&R consultation and late PM&R consultation in critically ill surgical patients.A prospective observational cohort study was undergone in 65-year-old or older patients who were admitted > 24 hours in the surgical intensive care unit (SICU) in a tertiary care hospital. Read More

Anesth Analg 2022 Feb 24. Epub 2022 Feb 24.

From the Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina.

Management of acute perioperative pain in the geriatric patient can be challenging as the physiologic and pharmacokinetic changes associated with aging may predispose older patients to opioid-related side effects. Furthermore, elderly adults are more susceptible to postoperative delirium and postoperative cognitive dysfunction, which may be exacerbated by both poorly controlled postoperative pain and commonly used pain medications. This narrative review summarizes the literature published in the past 10 years for several nonopioid analgesics commonly prescribed to the geriatric patient in the perioperative period. Read More

Zhonghua Yi Xue Za Zhi 2022 Mar;102(8):563-568

Department of General Surgery, Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China.

To explore the postoperative clinical characteristics of elderly patients with colorectal cancer at different ages. Retrospective analysis was performed on the clinical data of 720 elderly patients with Colorectal Cancer in Beijing Hospitals from January 2012 to December 2019. There were 411 males and 309 females with a median age of 74 years. Read More

BMC Surg 2022 Feb 16;22(1):57. Epub 2022 Feb 16.

Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China.

Background: Many assessment tools have been used to identify frail surgical patients. This study was designed to explore the prediction value of the frailty index (FI) for postoperative morbidity in older patients undergoing elective gastrointestinal surgery.

Methods: Between January 2019 and September 2020, we conducted a prospective study in our hospital, and patients aged over 65 years were enrolled. Read More

J Obstet Gynaecol 2022 Feb 15:1-7. Epub 2022 Feb 15.

Department of Obstetrics and Gynaecology, University of Florida College of Medicine, Gainesville, FL, USA.

Data are limited in the management of elderly women with endometrial cancer as they are under-represented in clinical trials. The aim of this study was to evaluate the outcomes of women ≥70 years who underwent hysterectomy. One hundred and twenty-one patients met the inclusion criteria. Read More

Age Ageing 2022 02;51(2)

Department of Geriatric Medicine, Concord Hospital, Sydney, Australia.

Older adults undergoing surgery have high perioperative morbidity and mortality. Age-related physiological changes and prevalence of geriatric syndromes such as frailty increase the risk of adverse postoperative outcomes. Geriatricians utilise comprehensive geriatric assessment (CGA) and management to identify and manage geriatric syndromes, and deliver patient-centred perioperative care. Read More

Ann Intensive Care 2022 Feb 4;12(1). Epub 2022 Feb 4.

Intensive Care Unit of the Hospital da Mulher, Rua Barão de Cotegipe, 1153, Roma, Salvador, BA, CEP: 40411-900, Brazil.

Background: Since the publication of the 2018 Clinical Guidelines about sedation, analgesia, delirium, mobilization, and sleep deprivation in critically ill patients, no evaluation and adequacy assessment of these recommendations were studied in an international context. This survey aimed to investigate these current practices and if the COVID-19 pandemic has changed them.

Methods: This study was an open multinational electronic survey directed to physicians working in adult intensive care units (ICUs), which was performed in two steps: before and during the COVID-19 pandemic. Read More

Saudi Med J 2022 Feb;43(2):197-201

From the Department of Geriatrics (Zhang, Li, Yuan, Li, Liu, Fan), and from Department of Orthopaedics and Traumatology (Yang, Wu), Beijing Jishuitan Hospital, Beijing, China.

Objectives: To investigate the risk factors of perioperative in-hospital death in elderly patients with hip fracture and the applicability of risk assessment tools.

Methods: Thirteen in-hospital death cases from 1878 geriatric hip fracture treated in Jishuitan Hospital, China from May 2015 to December 2017 were collected, each dead patient was compared with 4 normal discharged patients with a postoperative survival of more than 90 days at the same admission time (within 2 weeks), gender, age (±5 years), and fracture type. Binary logistic regression was used to analyze the risk factors of in-hospital death; Hosmer-lemeshow goodness of fit test was used to evaluate the goodness of fit of E-PASS (estimation of physical ability and surgical stress) and NHFS (Nottingham hip fracture score). Read More

Aging Clin Exp Res 2022 May 24;34(5):1149-1158. Epub 2022 Jan 24.

Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.

Background: In elderly, hip fracture is often complicated by perioperative heart failure, related to worse prognosis. We aimed to analyze the effects of integrated management bundle incorporating with multidisciplinary measures on in-hospital outcomes and early survival in elderly hip fracture patients with perioperative heart failure.

Methods: In this retrospective cohort study, a total of 421 hip fracture patients aged 65 and over who developed perioperative heart failure were included. Read More