Hypothesis: Among geriatric patients undergoing abdominal surgery who are at high risk for in-hospital delirium, clinical factors associated with delirium correlate with adverse outcomes. Design: Retrospective case series study. Setting: University-affiliated referral hospital. Patients: Among 228 consecutive patients 70 years or older who underwent major abdominal surgery from September 1, 2002, through December 31, 2003, 89 patients with risk factors for delirium were included in the study. Main Outcome Measures: Preoperative, intraoperative, and postoperative clinical factors known to affect the incidence of in-hospital delirium were tested for correlation with adverse outcomes. Incidence of delirium, mortality, and prolonged length of stay (LOS) of 14 days or longer were evaluated as adverse outcomes. Results: Postoperative delirium occurred in 60%, death in 20%, and prolonged LOS in 32% of patients. Multivariate analysis identified independent predictors of adverse outcomes. Poor preoperative functional and nutritional status correlated with postoperative delirium and mortality. Inadequate postoperative glycemic control also correlated with mortality. Complications in 2 or more organ systems and postoperative hypoalbuminemia (albumin level Ͻ3.0 mg/dL[Ͻ.003 g/dL; to convert to grams per liter, multiply by 10]) correlated with prolonged LOS. Suboptimal care was identified in the following clinical areas: use of precipitative medications, prolonged bedrest, uncontrolled pain, hypoxia, and glycemic control. Conclusions: In a subset of geriatric patients undergoing abdominal surgery who are at high risk for inhospital delirium, adverse outcomes correlated only with key clinical variables, such as hyperglycemia and poor nutritional and functional states. A high incidence of suboptimal care was observed in several clinical areas, suggesting opportunities for intervention.

The LUM Imaging System allows rapid identification of residual tumor in the lumpectomy cavity of breast cancer patients and may reduce rates of positive margins.

Gender differences in glenoid anatomy have not been well studied in the current literature. Previous literature demonstrates a mismatch between glenoid anatomy and glenoid implants for shoulder replacements. This may have clinical implications in that glenoid loosening after shoulder arthroplasty has been cited as a frequent cause of poor performance of shoulder implants, and perhaps the most common indication for revision. The purpose of this study was to determine any gender differences in the size and overall shape of the glenoid. Eleven measurements were taken of 363 human scapular bone specimens (equal proportions of females to males and blacks to whites). Glenoid height and width, glenoid notch location, and depth were measured for each specimen using calipers. In addition, the authors developed a classification system to describe anterior glenoid notch morphology. There was a significant difference between female and male specimens for each dimension measured (P < 0.05). Height to width ratios were also significantly different comparing men to women (P < 0.05). These differences resulted in a rounder male glenoid and more oval female glenoid. Our results showed that 80.4% of females had an anterior glenoid notch compared to only 57.6% of males. There was a significant difference between female and male specimens in the location of the anterior glenoid notch: 36.7% from the top of the glenoid in female specimens, and 28.9% in males (P < 0.0001). The clear difference between male and female glenoid anatomy may be important in various shoulder surgeries.

Hypothesis: Patients with inflammatory bowel disease (IBD) undergoing surgery are at increased risk for postoperative thromboembolism, including deep vein thrombosis (DVT), pulmonary embolism (PE), myocardial infarction, and stroke.