Sarcopenia is a Predictor of Outcomes in Very Elderly Patients Undergoing Emergency Surgery

Du, Yang; Baracos, Vickie E.; Karvellas, Constantine J.; Williams, David C.; Khadaroo, Rachel G.

doi:10.1016/j.jss.2013.11.823

Cited by 26 publications

(54 citation statements)

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“…Low muscle mass is an important feature of both cachexia and sarcopenia . It is associated with adverse clinical outcomes in a number of diverse cohorts, including cancer, elderly trauma, and surgical patients . Future work is needed to better understand the effectiveness of the linear measures method in predicting nutrition, functional, and clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Clinically Practical Approach for Screening of Low Muscularity Using Electronic Linear Measures on Computed Tomography Images in Critically Ill Patients

Avrutin

Moisey

Zhang

et al. 2017

J Parenter Enteral Nutr

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Section: Discussionmentioning

confidence: 99%

Clinically Practical Approach for Screening of Low Muscularity Using Electronic Linear Measures on Computed Tomography Images in Critically Ill Patients

Avrutin

Moisey

Zhang

et al. 2017

J Parenter Enteral Nutr

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“…Improved medical technology, experience and more aggressive surgical treatment criteria have allowed a greater number of elderly and more frail patients to become surgical candidates. 5,6 Patients older than 60 years accounted for more than 58% of Canadian surgical bed utilization in 2005, 7 and this number will only increase as our population ages. Older patients are at highest risk of postoperative complications, prolonged hospital admissions and increased dependency or institutionalization.…”

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confidence: 99%

“…Frailty, defined as a poor physiologic reserve limiting response to acute physiologic insult, and postoperative complications have predicted increased postoperative morbidity and mortality, 5,6,[11][12][13][14][15] in-hospital costs, costs following discharge [15][16][17] and outpatient medical costs over 6 months. 18 However, using the full economic impact following surgery to develop models may have better predictive strength.…”

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confidence: 99%

Analysis of postdischarge costs following emergent general surgery in elderly patients

Eamer

Clement

Pederson

et al. 2018

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Background: As populations age, more elderly patients will undergo surgery. Frailty and complications are considered to increase in-hospital cost in older adults, but little is known on costs following discharge, particularly those borne by the patient. We examined risk factors for increased cost and the type of costs accrued following discharge in elderly surgical patients. Methods:Acute abdominal surgery patients aged 65 years and older were prospectively enrolled. We assessed baseline clinical characteristics, including Clinical Frailty Scale (CFS) scores. We calculated 6-month cost (in Canadian dollars) from patient-reported use following discharge according to the validated Health Resource Utilization Inventory. Primary outcomes were 6-month overall cost and cost for health care services, medical products and lost productive hours. Outcomes were log-transformed and assessed in multivariable generalized linear and zero-inflated negative binomial regressions and can be interpreted as adjusted ratios (AR). Complications were assessed according to Clavien-Dindo classification. Results:We included 150 patients (mean age 75.5 ± 7.6 yr; 54.1% men) in our analysis; 10.8% had major and 43.2% had minor complications postoperatively. The median 6-month overall cost was $496 (interquartile range $140-$1948). Disaggregated by cost type, frailty independently predicted increasing costs of health care services (AR 1.76, 95% confidence interval [CI] 1.43-2.18, p < 0.001) and medical products (AR 1.61, 95% CI 1.15-2.25, p = 0.005), but decreasing costs in lost productive hours (AR 0.39, p = 0.002). Complications did not predict increased cost. Conclusion:Frail patients accrued higher health care services and product costs, but lower costs from lost productive hours. Interventions in elderly surgical patients should consider patient-borne cost in older adults and lost productivity in less frail patients. Trial registration: NCT02233153 (clinicaltrials.gov).Contexte : Avec le vieillissement de la population, les personnes âgées seront plus nombreuses à subir des chirurgies. Il est déjà reconnu que la fragilité et les complications font augmenter les coûts d'hospitalisation chez les adultes âgés, mais on en sait relativement peu sur les coûts posthospitaliers, particulièrement ceux assumés par le patient lui-même. Nous avons analysé les facteurs de risque d'augmentation de ces coûts et les types de dépenses assumées après le congé par les patients âgés opérés.Méthodes : Pour l'étude, nous avons recruté des patients de 65 ans et plus qui allaient subir une chirurgie abdominale d'urgence. Nous avons déterminé leurs caractéristiques cliniques initiales, y compris leur score à l'échelle de fragilité clinique (EFC). Nous avons calculé les coûts échelonnés sur 6 mois (en dollars canadiens) rapportés par les patients après leur congé, selon un inventaire validé de l'utilisation des ressources de santé. Les paramètres principaux étaient le montant total des dépenses et le coût des services de santé, des produits médicaux et des heures...

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“…Recent studies involving patients older than 80 years demonstrated that age and number of comorbidities did not accurately predict poor surgical outcomes, 6 and further studies have suggested that frailty measures are better overall predictors. 7,8 The purpose of the present study was to characterize the subset of patients aged 65-80 years who underwent emergency general surgery and to examine their surgical outcomes, including in-hospital mortality and morbidity. We also examined factors associated with the ability to discharge patients back home without the need for in-patient rehabilitation or transfer to long-term care.…”

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confidence: 99%

Perioperative factors predicting poor outcome in elderly patients following emergency general surgery: a multivariate regression analysis

et al. 2015

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Perioperative factors predicting poor outcome in elderly patients following emergency general surgery: a multivariate regression analysis Background: Older adults (≥ 65 yr) are the fastest growing population and are presenting in increasing numbers for acute surgical care. Emergency surgery is frequently life threatening for older patients. Our objective was to identify predictors of mortality and poor outcome among elderly patients undergoing emergency general surgery. Methods:We conducted a retrospective cohort study of patients aged 65-80 years undergoing emergency general surgery between 2009 and 2010 at a tertiary care centre. Demographics, comorbidities, in-hospital complications, mortality and disposition characteristics of patients were collected. Logistic regression analysis was used to identify covariate-adjusted predictors of in-hospital mortality and discharge of patients home.Results: Our analysis included 257 patients with a mean age of 72 years; 52% were men. In-hospital mortality was 12%. Mortality was associated with patients who had higher American Society of Anesthesiologists (ASA) Conclusion: American Society of Anesthesiologists class and in-hospital complications are perioperative predictors of mortality and disposition in the older surgical population. Understanding the predictors of poor outcome and the importance of preventing in-hospital complications in older patients will have important clinical utility in terms of preoperative counselling, improving health care and discharging patients home.Contexte : La population qui connaît la croissance la plus rapide est celle des adultes âgés (≥ 65 ans). Ces personnes nécessitent un nombre croissant d'interventions chirurgicales urgentes. Or, la chirurgie d'urgence comporte souvent un risque de décès pour les patients âgés. Notre objectif était d'identifier les prédicteurs de la mortalité et d'une issue négative chez les patients âgés soumis à une chirurgie générale d'urgence.Méthodes : Nous avons procédé à une étude de cohorte rétrospective chez des patients de 65 à 80 ans soumis à une chirurgie générale d'urgence entre 2009 et 2010 dans un centre de soins tertiaires. Nous avons recueilli les données démographiques, les comorbidités, les complications perhospitalières, la mortalité et les détails sur l'état général de santé des patients. Nous avons utilisé l'analyse de régression logistique afin de dégager les prédicteurs ajustés en fonction des covariables pour la mortalité perhospitalière et les congés hospitaliers des patients vers leur domicile.Résultats : Notre analyse a regroupé 257 patients âgés en moyenne de 72 ans; 52 % étaient des hommes. La mortalité perhospitalière a été de 12 %. La mortalité a été associée à des patients qui se classaient dans une catégorie ASA (American Society of Anesthesiologists) plus élevée (rapport des cotes [RC]

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Sarcopenia is a Predictor of Outcomes in Very Elderly Patients Undergoing Emergency Surgery

Cited by 26 publications

References 0 publications

Clinically Practical Approach for Screening of Low Muscularity Using Electronic Linear Measures on Computed Tomography Images in Critically Ill Patients

Clinically Practical Approach for Screening of Low Muscularity Using Electronic Linear Measures on Computed Tomography Images in Critically Ill Patients

Analysis of postdischarge costs following emergent general surgery in elderly patients

Perioperative factors predicting poor outcome in elderly patients following emergency general surgery: a multivariate regression analysis

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