According to the United States census bureau 20% of Americans will be older than 65 years in 2030 and half of them will need an operation - equating to about 36 million older surgical patients. Older adults are prone to complications during gastrointestinal cancer treatment and therefore may need to undergo special pretreatment assessments that incorporate frailty and sarcopenia assessments. A focused, structured literature review on PubMed and Google Scholar was performed to identify primary research articles, review articles, as well as practice guidelines on frailty and sarcopenia among patients undergoing gastrointestinal surgery. The initial search identified 450 articles; after eliminating duplicates, reports that did not include surgical patients, case series, as well as case reports, 42 publications on the impact of frailty and/or sarcopenia on outcome of patients undergoing gastrointestinal surgery were included. Frailty is defined as a clinically recognizable state of increased vulnerability to physiologic stressors resulting from aging. Frailty is associated with a decline in physiologic reserve and function across multiple physiologic systems. Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. Unlike cachexia, which is typically associated with weight loss due to chemotherapy or a general malignancy-related cachexia syndrome, sarcopenia relates to muscle mass rather than simply weight. As such, while weight reflects nutritional status, sarcopenia - the loss of muscle mass - is a more accurate and quantitative global marker of frailty. While chronologic age is an important element in assessing a patient's peri-operative risk, physiologic age is a more important determinant of outcomes. Geriatric assessment tools are important components of the pre-operative work-up and can help identify patients who suffer from frailty. Such data are important, as frailty and sarcopenia have repeatedly been demonstrated among the strongest predictors of both short- and long-term outcome following complicated surgical procedures such as esophageal, gastric, colorectal, and hepato-pancreatico-biliary resections.
Introduction: Some rheumatologic diseases, including rheumatoid arthritis and systemic lupus erythematosusa are associated positively with occurrence of venous thromboembolism (VTE). Chronic inflammation accompanying these rheumatologic diseases is considered to increase the risk of VTE. Gout, which is caused by hyperuricemia, is the most common rheumatologic inflammatory arthritis. In addition, hyperuricemia, itself, has proinflammatory effects on vascular cells. Hyperuricemia and gout therefore may increase the risk of VTE, but, so far there has been no study investigating these associations. Hypothesis: We assessed the hypothesis that hyperuricemia or gout are positively associated with the risk of VTE. Methods: The Atherosclerosis Risk in Communities Study measured serum uric acid (SUA) in 15,063 men or women, aged 45-64, without history of VTE or anticoagulant use and followed them for VTE from 1987 to 2011. Of these participants, 10,982 men or women provided information on gout history. Hazard ratios (HRs) of VTE were estimated using Cox proportional hazards models adjusted for age, sex, race, center, body mass index, diabetes, smoking, eGFR, vonWillebrand factor, factor VIII, and gout medication across levels of SUA [median (range) mg/dL: 4.6 (≤5.2), 5.7 (5.2-6.2), 6.7 (6.2-7.2), 7.7 (7.2-8.2), 8.5 (8.2-8.9), and 9.6 (≥8.9)] or gout history (yes or no). Results: We documented 688 incident VTEs [265 unprovoked and 423 provoked VTEs (232 not cancer related and 191 cancer related VTEs)]. Age, sex, and race-adjusted HRs [95% confidential interval (CI)] for total VTE were 1.00, 1.31 (1.04-1.65), 1.34 (1.05-1.70), 1.81 (1.39-2.35), 1.81 (1.25-2.60), and 2.85 (2.06-3.95) (P for trend<0.001) across levels of SUA. After adjustment for the other VTE risk factors, those in the highest vs. lowest level of SUA had HRs (95% CI; P for trend) of 1.72 (1.22-2.45; 0.006) for total VTE, 1.83 (1.08-3.09; 0.128) for unprovoked VTE, and 1.61 (1.00-2.58; 0.022) for provoked VTE. On the other hand, we observed no significant association between the gout history and the incidence of VTE. Conclusions: In conclusion, elevated SUA was associated with a higher risk of VTE, suggesting that elevated SUA might be a novel risk factor for VTE.
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