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Aging Clin Exp Res 2020 Jul 10. Epub 2020 Jul 10.

Università degli Studi di Ferrara, Ferrara, Italy.

Background: Surgical outcomes in geriatric patients may be complicated by factors such as multiple comorbidities, low functional performance, frailty, reduced homeostatic capacity, and cognitive impairment. An integrated multidisciplinary approach to management is, therefore, essential in this population, but at present, the use of such an approach is uncommon. The Perioperative Management of Elderly patients (PriME) project has been established to address this issue. Read More

J Cardiovasc Pharmacol 2020 Jul;76(1):4-22

Critical Care Proprietary Products, Orion Pharma, Espoo, Finland.

Levosimendan was first approved for clinical use in 2000, when authorization was granted by Swedish regulatory authorities for the hemodynamic stabilization of patients with acutely decompensated chronic heart failure (HF). In the ensuing 20 years, this distinctive inodilator, which enhances cardiac contractility through calcium sensitization and promotes vasodilatation through the opening of adenosine triphosphate-dependent potassium channels on vascular smooth muscle cells, has been approved in more than 60 jurisdictions, including most of the countries of the European Union and Latin America. Areas of clinical application have expanded considerably and now include cardiogenic shock, takotsubo cardiomyopathy, advanced HF, right ventricular failure, pulmonary hypertension, cardiac surgery, critical care, and emergency medicine. Read More

J Cardiovasc Pharmacol 2020 Jun 22. Epub 2020 Jun 22.

Critical Care Proprietary Products, Orion Pharma, Espoo, Finland.

Levosimendan was first approved for clinic use in 2000, when authorisation was granted by Swedish regulatory authorities for the haemodynamic stabilisation of patients with acutely decompensated chronic heart failure. In the ensuing 20 years, this distinctive inodilator, which enhances cardiac contractility through calcium sensitisation and promotes vasodilatation through the opening of adenosine triphosphate-dependent potassium channels on vascular smooth muscle cells, has been approved in more than 60 jurisdictions, including most of the countries of the European Union and Latin America. Areas of clinical application have expanded considerably and now include cardiogenic shock, takotsubo cardiomyopathy, advanced heart failure, right ventricular failure and pulmonary hypertension, cardiac surgery, critical care and emergency medicine. Read More

World J Urol 2020 Jul 4. Epub 2020 Jul 4.

Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dongdan Dahua Road, Dongcheng District, Beijing, 100730, China.

Purpose: To assess the role of atrial fibrillation (AF) on complicating inpatient outcomes of radical prostatectomy (RP).

Materials And Methods: We identified patients treated with RP during 2012-2014 within National Inpatient Sample (NIS) database. Length of stay, cost of hospitalization, and in-hospital complications were compared between patients with or without diagnosis of AF. Read More

J Oral Maxillofac Surg 2020 May 19. Epub 2020 May 19.

Professor, Section of Geriatric Dentistry and Perioperative Medicine in Dentistry, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Fukuoka, Japan.

Purpose: Individuals with implantable ventricular assist devices (VADs) are at extremely high risk of bleeding, thromboembolism, and infection after undergoing invasive dental procedures. This study aimed to investigate the systemic and local complications of tooth extraction before and after VAD implantation.

Patients And Methods: This retrospective cohort study was conducted at a single center. Read More

Geriatr Orthop Surg Rehabil 2020 22;11:2151459320927383. Epub 2020 May 22.

Department of Orthopedic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.

Introduction: Hip fractures are one of the most common indications for hospitalization and orthopedic intervention. Fragility hip fractures are frequently associated with multiple comorbidities and thus may benefit from a structured multidisciplinary approach for treatment. The purpose of this article was to retrospectively analyze patient outcomes after the implementation of a multidisciplinary hip fracture pathway at a level I trauma center. Read More

BMC Musculoskelet Disord 2020 Jun 11;21(1):371. Epub 2020 Jun 11.

Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.

Background: Proximal femoral fractures are a major socioeconomic burden and they occur mainly in geriatric patients. High mortality and complication rates are reported. To reduce the mortality and morbidity of these patients, co-management with geriatricians has been recommended. Read More

J Int Med Res 2020 Jun;48(6):300060520927207

Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany.

Objective: In this survey, we assessed the current clinical management of postoperative delirium (POD) among Chinese anesthesiologists, after publishing the European POD guideline.

Methods: We administered an electronic survey, designed according to the European POD guideline. The survey was completed using mobile devices. Read More

Colorectal Dis 2020 May 28. Epub 2020 May 28.

Department of Surgery, Royal Alexandra Hospital, Paisley, UK.

Aim: There remains limited knowledge on what patients value and prioritize in their decision to undergo emergency laparotomy (ELap) and during their subsequent recovery. The aim of this study was to explore factors in decision-making and to reach a consensus amongst patients on the 10 most important priorities in decision-making in ELap.

Methods: Patients aged over 65 years who had required an ELap decision within the preceding 12 months (regardless of management) were identified and invited to attend a modified Delphi process focus group. Read More

J Am Geriatr Soc 2020 May 22. Epub 2020 May 22.

Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Background: Geriatric hip fracture patients are susceptible to the adverse effects of opioid-induced analgesia. Fascia iliaca blocks (FIBs) have emerged as an analgesic technique for this population. There are limited data on a preoperative FIB's effect on perioperative opioid intake. Read More

J Am Med Dir Assoc 2020 May 14. Epub 2020 May 14.

Department of Geriatric Medicine, Concord Hospital, Sydney, New South Wales, Australia; Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Centre for Education and Research on Ageing, Sydney, New South Wales, Australia; Ageing and Alzheimer's Institute, Sydney, New South Wales, Australia.

Objectives: Managing older patients with surgical conditions is a major challenge for hospitals. There is therefore a growing interest in providing geriatric perioperative services. The aim of this systematic review and meta-analysis was to characterize and assess the impact of targeted perioperative geriatric interventions on clinical outcomes of older adults admitted to nonorthopedic surgical teams. Read More

Anesth Analg 2020 06;130(6):1493-1503

From the Departments of Medicine.

Perioperative management of older adults is a complex field that is heavily influenced by the clinical heterogeneity of older adults. Frailty-a geriatric syndrome in which a patient is more vulnerable to stressors due to decreases in physical function and reserve-has been indicative of adverse postoperative outcomes. Many tools have been developed to measure frailty that incorporate a variety of factors including physical and cognitive function, comorbidities, self-reported measures of health, and clinical judgment. Read More

Curr Opin Anaesthesiol 2020 Jun;33(3):335-342

Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Children's Health, Dallas, Texas, USA.

Purpose Of Review: The current review focuses on the new development of adult congenital heart disease (ACHD) patients in the areas of imaging, percutaneous interventions, ventricular assist devices and transplantation.

Recent Findings: Since the last ACHD publication in the journal, several advances have been made in the evaluation and treatment of these patients. As CHD patients' longevity increases pregnancy, comorbities and acquired heart disease become a concern. Read More

Injury 2020 Jul 20;51(7):1634-1641. Epub 2020 Apr 20.

Department of Nursing and Department of Surgical and Perioperative Science Orthopedics, Umeå University, Umeå, Sweden.

Introduction: Patients with hip fracture often suffer complications leading to increased mortality and morbidity. Pain management are important, but opioids has many side effects. The aim of this study was to investigate whether Femoral Nerve Block (FNB) can reduce complications during hospital stay, with special focus on delirium compared to conventional pain management with opioids among patients with hip fracture, including those with dementia. Read More

Br J Anaesth 2020 07 10;125(1):e28-e37. Epub 2020 Apr 10.

Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA. Electronic address:

Tracheal intubation in coronavirus disease 2019 (COVID-19) patients creates a risk to physiologically compromised patients and to attending healthcare providers. Clinical information on airway management and expert recommendations in these patients are urgently needed. By analysing a two-centre retrospective observational case series from Wuhan, China, a panel of international airway management experts discussed the results and formulated consensus recommendations for the management of tracheal intubation in COVID-19 patients. Read More

J Pain Res 2020 5;13:709-717. Epub 2020 Apr 5.

Department of Anesthesiology, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China.

Purpose: Erector spinae plane block (ESPB) is a newly reported interfascial plane block in pain management, and it can block the nerves exactly in line with the area of the posterior lumbar surgery. The objective of this research was to determine the effectiveness of pre-operative ESPB in enhancing recovery of posterior lumbar surgery.

Patients And Methods: A total of 60 patients undergoing open posterior lumbar decompression surgery under general anesthesia were randomized into two groups. Read More

Cas Lek Cesk 2020 ;159(1):13-16

As life expectancy increases in economically developed countries, there is an increasing need for medical care for the elderly. In surgical fields, this means that the number and spectrum of surgical interventions in elderly patients is increasing. Because of this special attention should be paid to the preoperative evaluation in these patients. Read More

Wiad Lek 2020 ;73(2):312-315

Vinnytsia National Pirogov Memorial Medical University, Vinnytsia, Ukraine.

Objective: The aim of the study was to find the most rational approach to postoperative pain relief in the complex of intensive care for the acute and early periods of traumatic diseasein elderly patients.

Patients And Methods: Materials and methods: 132 gerontology patients with multiple trauma were included in the study. Respiratory and cardiovascular systems parameters were assessed, coagulogram and inflammatory response markers, pain severity and analgesia quality were assed. Read More

Mayo Clin Proc 2020 Apr;95(4):793-800

Department of Psychiatry, Mayo Clinic, Rochester, MN.

The fact that opioids are valuable tools for the management of pain has been known and used for thousands of years. Currently, millions of Americans are treated annually with opioids, and many of these patients are elderly. Opioids present risks to geriatric patients, some of which are unique to the population, and providers should have a good grasp of those risks. Read More

Anesthesiology 2020 06;132(6):1307-1316

From the Department of Anesthesiology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.C.) the Anesthesia and Operation Center, Chinese People's Liberation Army General Hospital, Beijing, China (Y.L., W.S., H.L., W.M.) the Department of Anesthesiology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China (Y.G., X.X., Y.H.) the Department of Anesthesiology, Peking University Third Hospital, Beijing, China (X.G.) the Department of Anesthesiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China (M.Z.) the Department of Anesthesiology, Sixth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China.

The outbreak of the new Coronavirus disease, COVID-19, has been involved in 77,262 cases in China as well as in 27 other countries as of February 24, 2020. Because the virus is novel to human beings, and there is no vaccine yet available, every individual is susceptible and can become infected. Healthcare workers are at high risk, and unfortunately, more than 3,000 healthcare workers in China have been infected. Read More

BMC Surg 2020 Mar 18;20(1):52. Epub 2020 Mar 18.

Oncological Surgery, San Martino Hospital, Polyclinic and Institute for Research and Care, Genoa, Italy.

Background: As surgery remains the cornerstone of colorectal cancer (CRC) treatment, the number of older patients presented for colorectal resection is rapidly increasing. Nevertheless, the choice to operate an oldest-old patient still remain challenging and requires a careful assessment of risk to benefit ratio in order to guarantee appropriate surgical strategies and perioperative management.

Case Presentation: A centenarian patient, acutely admitted to the emergency department, was diagnosed with an ileus caused by stenosing ascending colon cancer with abnormal distension of the right colon at high risk of perforation. Read More

J Am Geriatr Soc 2020 Apr 3;68(4):835-840. Epub 2020 Mar 3.

Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.

Objectives: Although peripheral nerve blocks are associated with improved pain control and end outcomes among older adults with hip fracture, their current utilization among US hip fracture patients is not well understood. We characterized contemporary use of peripheral nerve blocks after hip fracture over time and identified predictors of nerve block receipt.

Design: Retrospective cohort study of claims data from one large national private US insurer. Read More

Cureus 2020 Feb 21;12(2):e7069. Epub 2020 Feb 21.

Geriatrics, Frimley Health National Health Service (NHS) Foundation Trust, Frimley, GBR.

With the increasing median age of survival in the UK, there is an increased burden on the provision of medical and surgical care to the population. The 2010 National Confidential Enquiry into Patient Outcome and Death report, "An Age Old Problem," emphasizes the early involvement of surgical and geriatric consultant input to improve perioperative care in older patients. This study describes the development of a Geriatric Surgical Liaison Service aimed at providing consultant-led geriatrician support to improve the outcomes of older patients undergoing Emergency Laparotomy (EL). Read More

Z Gerontol Geriatr 2020 May 17;53(3):233-238. Epub 2020 Feb 17.

Klinik für Geriatrie und Rehabilitation, Bonifatius Hospital, Lingen, Deutschland.

Anemia is frequent in older people with one in two geriatric inpatients being affected. Therefore, in elective surgery, such as endoprosthetic treatment it is very likely that anemia is already present in a preoperative setting. So far there are no particular guidelines about perioperative management of anemia in geriatric patients. Read More

Anesth Analg 2020 06;130(6):1572-1590

Department of Anesthesiology, Duke University Medical Center.

Postoperative delirium is a geriatric syndrome that manifests as changes in cognition, attention, and levels of consciousness after surgery. It occurs in up to 50% of patients after major surgery and is associated with adverse outcomes, including increased hospital length of stay, higher cost of care, higher rates of institutionalization after discharge, and higher rates of readmission. Furthermore, it is associated with functional decline and cognitive impairments after surgery. Read More

Hosp Pract (1995) 2020 Mar 28;48(sup1):26-36. Epub 2020 Jan 28.

Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.

The older population is expected to nearly double across the globe by 2050, and the baby boom cohort is expected to represent at least 20% of the US population by 2030. Geriatric patients will increasingly utilize the health-care system, and therefore surgical and perioperative care must be tailored to this sensitive group given the increased risk for perioperative complications. The literature was reviewed to highlight fundamental components of the preoperative evaluation as well as cardiac, pulmonary, and renal complications. Read More

Ann Acad Med Singapore 2019 Nov;48(11):382-385

Department of Geriatric Medicine, Westmead Hospital, New South Wales, Australia.

The elderly patient presenting with an acute surgical abdomen or bowel obstruction has become a common and challenging situation. These patients bring comorbidity and frailty that necessitate appropriate risk assessment and comprehensive perioperative management. Robust communication is required between patients, families and health professions. Read More

Chirurg 2020 Feb;91(2):115-120

Institut für Allgemeinmedizin, Universität Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Deutschland.

The increasing proportion of older and polymorbid people in the population also means an increase in polymedication and its risks. This places new and complex demands on the interdisciplinary and transsectoral collaboration. The preoperative, perioperative and postoperative management of polymedication is described in the article with respect to frequent risks and the chances of a systematic exchange of information. Read More

Hip Int 2020 Jan 8:1120700019897878. Epub 2020 Jan 8.

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

Background: Postoperative blood product transfusions in elderly hip fracture patients cause concern for morbidity and mortality. The purpose of this study was to identify predictors and short-term sequelae of postoperative transfusion following geriatric hip fracture surgery.

Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) to identify geriatric (⩾65 years) patients who sustained operative femoral neck, intertrochanteric, and subtrochanteric hip fractures in 2016. Read More

Clin Interv Aging 2019 16;14:2195-2203. Epub 2019 Dec 16.

Orthopaedic Department, Xuanwu Hospital, National Center for Clinical Research of Geriatric Diseases, Beijing, People's Republic of China.

Study Design: Multivariate analysis of retrospective registry data.

Objective: To report the perioperative complication in a large cohort of surgery for elderly degenerative lumbar scoliosis (DLS) patients and to analyze the risk factors.

Summary Of Background Data: The perioperative complication rate and risk factors for patients with DLS remain unclear, especially in elderly population. Read More

Med Klin Intensivmed Notfmed 2020 Feb 12;115(1):16-21. Epub 2019 Dec 12.

Klinik und Poliklinik für Anästhesiologie, Zentrum für Anästhesiologie und Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 22051, Hamburg, Deutschland.

Background: The share of elderly patients undergoing emergency surgery is constantly increasing. Their postoperative outcome remains poor, even if surgery itself is survived in the short or medium term.

Objectives: Important aspects of anesthesiologic care for older emergency patients based upon recent literature and guideline recommendations are presented. Read More

Chirurg 2020 Feb;91(2):103-108

Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, Jena, Deutschland.

The German population is aging in accordance with the worldwide trend; however, in comparison to most other industrial countries the number of disease-free years of life gained by patients is significantly lower in Germany. Subsequently, the number of hospitalizations and necessary surgical treatment for older and especially frail patients is significantly increasing. Several frailty scoring systems have been published with the aim of improving the assessment of the perioperative risk for these patients; however, these systems for risk assessment have not yet become clinical routine in surgery and therefore this group of frail patients remains underdiagnosed in the field of surgery. Read More

Clin Cardiol 2020 Feb 11;43(2):127-136. Epub 2019 Dec 11.

Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri.

Adults age 65 and over are the fastest growing segment of the population in the United States and around the world. As the size of this population expands, the number of older adults referred for surgical procedures will continue to increase. Due to the physiologic changes of aging and the increased frequency of comorbidities, older adults are at increased risk for adverse outcomes, and perioperative care is inherently more complex than in younger individuals. Read More

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2019 Dec;33(12):1538-1542

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

Objective: To analyze the risk factors for postoperative mortality of elder patients with intertrochanteric fractures.

Methods: Patients with intertrochanteric fractures who underwent proximal femoral interlocking intramedullary nail fixation between January 2014 and December 2015 were enrolled in the study. Among them, 135 patients who met the selection criteria were included in the study, and the clinical data were collected, including gender, age, time from admission to surgery, comorbidities, and preoperative hemoglobin, albumin, and total lymphocyte count (TLC), and nutritional status. Read More

J BUON 2019 Sep-Oct;24(5):1809-1816

Department of General Surgery, Kartal Education and Research Hospital, Istanbul, Turkey.

Purpose: To evaluate the incidence, risk factors and outcomes of conversion from laparoscopic to open surgery in geriatric patients with colorectal cancer (CRC).

Methods: All patients subjected to laparoscopic procedures for CRC between 2006 and 2018 were included. Patients older than 70 were divided into these necessitating or not necessitating conversion to open surgery (Con>70 and Lap>70 groups, respectively), and those younger than 70 requiring conversion were evaluated in Con<70 group. Read More

Prog Urol 2019 Nov;29(14):849-864

Inserm UMR, S1165, service d'urologie, unité de chirurgie et d'anesthésie ambulatoires, hôpital Saint-Louis, université de Paris-7-Denis-Diderot, 1, avenue Claude-Vellefaux, 75010 Paris, France.

Aim: To define and present potential improvements for the management of bladder cancer in older patients.

Method: Bibliographical search was performed from the Medline bibliographic database (NLM Pubmed tool) and Embase focused on: bladder cancer, treatment, BCG, chemotherapy, cystectomy, and elderly.

Results: The oncological principles of medico-surgical management of bladder cancer do not differ according to age. Read More

BMJ Open 2019 11 24;9(11):e031837. Epub 2019 Nov 24.

Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Introduction: Geriatric patients have a pronounced risk to suffer from postoperative complications. While effective risk-specific perioperative measures have been studied in controlled experimental settings, they are rarely found in routine healthcare. This study aims (1) to implement a multicomponent preoperative and intraoperative intervention, and investigate its feasibility, and (2) exploratorily assess the effectiveness of the intervention in routine healthcare. Read More

Clin Orthop Relat Res 2020 02;478(2):231-237

J. R. Falvey, Division of Geriatrics, School of Medicine, Yale University, New Haven, CT, USA J. R. Falvey, M. J. Bade, J. E. Stevens-Lapsley, Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA J. R. Falvey, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA C. Hogan, Department of Orthopedic Surgery, University of Colorado Hospital, Aurora, CO, USA J. E. Forster, Rocky Mountain Regional Veterans Affairs Medical Center, Mental Illness Research, Education, and Clinical Center, Aurora, CO, USA M. J. Bade, J. E. Stevens-Lapsley, Veterans Affairs Eastern Colorado Geriatric Research, Education and Clinical Center, Aurora, CO, USA.

Background: With recent Medicare payment changes, older adults are increasingly likely to be discharged home instead of to extended care facilities after total joint arthroplasty (TJA), and may therefore be at increased risk for readmissions. Identifying risk factors for readmission could help re-align care pathways for vulnerable patients; recent research has suggested preoperative dependency in activities of daily living (ADL) may increase perioperative and postoperative surgical complications. However, the proportion of older surgical patients with ADL dependence before TJA, and the impact of ADL dependency on the frequency and timing of hospital readmissions is unknown. Read More

Korean J Anesthesiol 2020 02 22;73(1):8-29. Epub 2019 Oct 22.

Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.

The number of elderly patients who frequently access health care services is increasing worldwide. While anesthesiologists are developing the expertise to care for these elderly patients, areas of concern remain. We conducted a comprehensive search of major international databases (PubMed, Embase, and Cochrane) and a Korean database (KoreaMed) to review preoperative considerations, intraoperative management, and postoperative problems when anesthetizing elderly patients. Read More

J Clin Med 2019 Oct 3;8(10). Epub 2019 Oct 3.

Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Taipei 114, Taiwan.

Background: Video-assisted thoracoscopic surgery (VATS) is widely used for the treatment of empyema. We evaluated clinical symptoms, laboratory examinations, and thoracentesis to assess patients in the emergency department (ED) with empyema thoracis, undergoing VATS to identify predictors of adverse outcomes.

Methods: This retrospective study was conducted by reviewing records of ED patients with pleural empyema admitted for VATS from January 2007 to June 2014. Read More

F1000Res 2019 23;8:1165. Epub 2019 Jul 23.

Department of Anesthesia, University of Manitoba, Winnipeg, Manitoba, Canada.

  There is some evidence that electroencephalography guidance of general anesthesia can decrease postoperative delirium after non-cardiac surgery.  There is limited evidence in this regard for cardiac surgery.  A suppressed electroencephalogram pattern, occurring with deep anesthesia, is associated with increased incidence of postoperative delirium (POD) and death. Read More

J Reconstr Microsurg 2020 Feb 23;36(2):127-135. Epub 2019 Sep 23.

Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.

Background:  In elderly patients, complex soft tissue defects are increasingly observed due to the prolonged life expectancy and accompanying comorbidities. The aim of this study is to evaluate whether free tissue transfer is safe in very old patients without additional risk and complications.

Methods:  All patients older than 65 years undergoing free tissue transfer between November 2007 and September 2016 were reviewed in a retrospective study. Read More

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2019 Oct;33(10):1283-1286

Department of Geriatric Orthopedics, Traumatic Emergency Center, the Third Hospital of Hebei Medical University, Hebei Provincial Biomechancial Key Laboratory, Hebei Provincial Othopedic Institute, Shijiazhuang Hebei, 050051,

Objective: To investigate the effectiveness of multidisciplinary doctor-nurse collaboration team on the perioperation management of geriatric patients with hip fractures.

Methods: The clinical data of 489 geriatric patients with hip fractures (femoral neck fracture and intertrochanteric fracture) between January 1st 2016 and January 1st 2018 was retrospectively analyzed. Among them, 279 patients were treated with the multidisciplinary doctor-nurse collaboration care (observation group) and 210 patients were treated with the conventional therapeutics and nursing care (control group). Read More

Surgery 2020 02 10;167(2):468-474. Epub 2019 Sep 10.

Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, CA.

Background: Geriatric patients require specialized perioperative care, yet the impact of geriatric surgery proportion (a measure of experience) and geriatric surgery volume, on clinical outcomes is unknown. This study analyzes the association between proportion and volume and clinical outcomes after high-risk geriatric surgery.

Methods: Using the 2014 National Inpatient Sample, hospital encounters for older adults (≥65 years) undergoing high-risk geriatric surgery were identified. Read More

Chirurg 2019 Oct;90(10):806-815

Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie, - Schwerbrandverletztenzentrum -, BG Unfallklinik Ludwigshafen, Ludwigshafen, Deutschland.

The treatment of complex injuries of the lower extremities in geriatric and/or multimorbid patients requires optimized preoperative and perioperative management as well as differentiated and interdisciplinary surgical approaches. Timely and definitive treatment should be strived for to avoid longer periods of immobilization. Temporary external stabilization of complex fractures, when necessary, should be followed by permanent loading stable internal osteosynthesis as soon as possible. Read More

Geriatr Orthop Surg Rehabil 2019 22;10:2151459319870682. Epub 2019 Aug 22.

Department of Trauma and Orthopaedics, James Cook University Hospital, Middlesbrough, United Kingdom.

Introduction: Patients with hip fractures pose a significant burden on health services. Malnutrition, frailty, and cognitive impairment are common, and key to addressing the needs of this vulnerable patient group is nutrition optimization, including reduction in arbitrary nil by mouth (NBM) perioperative regimens. In order to understand current practices, we characterize preoperative nutrition in a regional hip fracture population. Read More

Chirurg 2019 Oct;90(10):795-805

Klinik für Hand, Plastische und Rekonstruktive Chirurgie, - Schwerbrandverletztenzentrum - BG Unfallklinik Ludwigshafen; Klinik für Plastische und Handchirurgie, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland.

Complex injuries of the lower extremities in geriatric patients with multiple pre-existing comorbidities represent an increasing challenge to an interdisciplinary team of surgeons. Functional reconstruction of the extremity through osteosynthesis, revascularization and defect coverage aims to preserve mobility and achieve an early return to activities of daily life at home, while avoiding major amputation and the associated risks regarding morbidity and mortality. An interdisciplinary assessment of geriatric patients regarding dystrophy of soft tissue and skín, cardiovascular and metabolic comorbidities as well as specific geriatric diagnostics are crucial steps in ensuring favorable outcomes. Read More

Unfallchirurg 2019 Oct;122(10):755-761

Klinik für Orthopädie, Unfallchirurgie und Wiederherstellungschirurgie, Vinzenz von Paul Kliniken gGmbH Marienhospital Stuttgart, Stuttgart, Deutschland.

Background: Fragility fractures are fractures in multimorbid, geriatric patients. Currently, their number is already high and is likely to increase in the future.

Objective: This article gives an overview of the principles in the management of patients with fragility fractures. Read More

Eur J Surg Oncol 2020 Mar 26;46(3):310-315. Epub 2019 Jul 26.

Department of Geriatric Medicine, Diakonessenhuis Utrecht-Zeist-Doorn, the Netherlands.

Background: The majority of patients with colorectal cancer are older. For surgeons dealing with older patients, it is important to recognize patients that are frail and have an increased risk of complications and mortality. In this review, we will go through pre-treatment assessment, peri-operative management, as well as discharge planning and rehabilitation. Read More

Urologia 2019 Nov 31;86(4):183-188. Epub 2019 Jul 31.

Department of Urology, Central Hospital of Bolzano, Bolzano, Italy.

Objective: To evaluate preoperative scoring systems and operative management and their relation to complications in patients older than 75 years undergoing cystectomy at two academic institutions.

Methods: In total, 212 patients aged 75-95 years with muscle invasive bladder cancer underwent cystectomy at the University of Utah and Central Hospital of Bolzano, Italy. The rates of Grade 3 Clavien-Dindo complications and above in radical cystectomy patients (n = 199) were compared using Eastern Cooperative Oncology Group Scores and American Society of Anesthesiologists Physical Status Classification. Read More