Objectives
To understand measures of frailty among preoperative patients and explain how these can predict perioperative outcomes among patients with head and neck cancer.
Study Design
Retrospective cross-sectional case series with chart review.
Setting
Academic tertiary medical center.
Subjects and Methods
A retrospective review was performed of patients presenting to an academic hospital following a surgical procedure for a head and neck cancer diagnosis. Charts were queried for preoperative medical diagnoses to calculate 2 frailty scores: the American College of Surgeons National Surgical Quality Improvement Program modified frailty index and the Johns Hopkins Adjusted Clinical Groups frailty index. The American Society of Anesthesiologists classification system was also analyzed as a predictor. Primary outcomes were mortality, 30-day readmission, and length of stay. Perioperative complications and discharge disposition were also evaluated.
Results
A total of 410 charts were queried between January 2014 and December 2017. Mortality was 11%; mean ± SD length of stay was 7.4 ± 5.5 days; and the readmission rate was 17%. The modified frailty index score significantly increased the odds of mortality (odds ratio = 1.475, P = .012) and readmission (odds ratio = 1.472, P = .004), the length of stay (relative risk = 1.136, P = .001), and the number of perioperative complications. The American Society of Anesthesiologists classification was also significantly associated with poor outcomes, including readmission, length of stay, and perioperative complications. The Adjusted Clinical Groups index was not a significant predictor of outcomes in this study population.
Conclusions
This study demonstrated a significant increase in poor perioperative outcomes and mortality among patients with head and neck cancer and increased frailty, as measured by the modified frailty index.
BackgroundThe purpose of this article was to evaluate the risks and benefits of non-operative treatment versus surgical excision of a fabella causing posterolateral knee pain. We performed a systematic review of literature and also present two case reports.Twelve publications were found in a PubMed literature review searching the word “fabella syndrome”. Non-operative treatment and surgical excision of the fabella has been described.Case presentationTwo patients presented to our outpatient clinic with persisting posterolateral knee pain. In both cases the presence of a fabella was identified, located in close proximity to the posterolateral femoral condyle. All other common causes of intra- and extra articular pathologies possibly causing the posterolateral knee pain were excluded.Following failure to respond to physiotherapy both patients underwent arthroscopy which excluded other possible causes for posterolateral knee pain. The decision was made to undertake surgical excision of the fabella in both cases without complication.Both patients were examined 6 month and one year after surgery with the Tegner activity score, the Visual Analogue Scale (VAS), and International Knee Documentation Committee Score (IKDC).ConclusionConsistent posterolateral pain during exercise might indicate the presence of a fabella syndrome. Resecting the fabella can be indicated and is a minor surgical procedure with minimal risk. Despite good results in the literature posterolateral knee pain can persist and prevent return to a high level of sports. Level of evidence: IV, case reports and analysis of literature.
This study was designed to investigate the effects of a group therapy program utilizing social learning theory, experiential methods, and a sociocultural perspective with 14 bulimarexic women. Bulimarexia was operationally defined as a cyclical eating disorder characterized by bingeing/purging behaviors and abnormally low self-esteem (Boskind-White & White, 1978). Ranging in age from 18-45, these women had been binge-eating and purging via forced vomiting, laxative abuse or habitual fasting and dieting on a daily basis for at least four years. None of the women were significantly underweight, overweight, or in need of medical management at the time of treatment. Dependent measures included responses to the California Psychological Inventory and a modified Body Cathexis Test which were administered pre, post, and one year following the group treatment procedure. Application of repeated measures AN OVA to the CPI yielded significant results on eight of eighteen scales. Furthermore, the Body Cathexis data proved significant atposttest and at one year follow-up. Bingeing behaviors were eliminated or attenuated in ten of fourteen cases. Results are commensurate with the authors' sociocultural perspective and their premise that bulimarexia is related to the struggle to achieve a perfect, stereotypic female image in which women surrender most of their self-defining powers to others.
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