Association between frailty, cerebral oxygenation and adverse post-operative outcomes in elderly patients undergoing non-cardiac surgery: An observational pilot study

Khan, Shazia; Chua, Henry Wenjie; Hirubalan, Premila; Karthekeyan, Ranjith Baskar; Kothandan, Harikrishnan

doi:10.4103/0019-5049.176278

Cited by 14 publications

(15 citation statements)

References 17 publications

(27 reference statements)

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“…In Europe alone, almost 30% of the population is predicted to be aged 65 or over by 2050 [ 20 ]. Geriatric patients frequently undergo emergency general surgery and accrue more postoperative complications and fatal outcomes than the general population [ 5 , 13 , 16 ]. It is thus highly relevant to develop and guide evidence-based patient-centered decision-making around emergency surgical care [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Patients over 65 years with Acute Complicated Calculous Biliary Disease are Treated Differently—Results and Insights from the ESTES Snapshot Audit

et al. 2021

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Background Accrued comorbidities are perceived to increase operative risk. Surgeons may offer operative treatments less often to their older patients with acute complicated calculous biliary disease (ACCBD). We set out to capture ACCBD incidence in older patients across Europe and the currently used treatment algorithms. Methods The European Society of Trauma and Emergency Surgery (ESTES) undertook a snapshot audit of patients undergoing emergency hospital admission for ACCBD between October 1 and 31 2018, comparing patients under and ≥ 65 years. Mortality, postoperative complications, time to operative intervention, post-acute disposition, and length of hospital stay (LOS) were compared between groups. Within the ≥ 65 cohort, comorbidity burden, mortality, LOS, and disposition outcomes were further compared between patients undergoing operative and non-operative management. Results The median age of the 338 admitted patients was 67 years; 185 patients (54.7%) of these were the age of 65 or over. Significantly fewer patients ≥ 65 underwent surgical treatment (37.8% vs. 64.7%, p < 0.001). Surgical complications were more frequent in the ≥ 65 cohort than younger patients, and the mean postoperative LOS was significantly longer. Postoperative mortality was seen in 2.2% of patients ≥ 65 (vs. 0.7%, p = 0.253). However, operated elderly patients did not differ from non-operated in terms of comorbidity burden, mortality, LOS, or post-discharge rehabilitation need. Conclusions Few elderly patients receive surgical treatment for ACCBD. Expectedly, postoperative morbidity, LOS, and the requirement for post-discharge rehabilitation are higher in the elderly than younger patients but do not differ from elderly patients managed non-operatively. With multidisciplinary perioperative optimization, elderly patients may be safely offered optimal treatment. Trial Registration ClinicalTrials.gov (Trial # NCT03610308).

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Section: Discussionmentioning

confidence: 99%

Patients over 65 years with Acute Complicated Calculous Biliary Disease are Treated Differently—Results and Insights from the ESTES Snapshot Audit

et al. 2021

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“…Two researchers reviewed the titles, abstracts and the full texts to select articles which met inclusion and exclusion criteria. In the final analysis, there were 12 articles that qualified and were included in the study [14–25]. The process of selection of the publications is depicted in Fig.…”

Section: Resultsmentioning

confidence: 99%

Effects of the frailty phenotype on post-operative complications in older surgical patients: a systematic review and meta-analysis

Han

Chen

2019

BMC Geriatr

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Background Frailty has been generally been associated with adverse events in older patients under surgery. Frailty phenotype is the most widely used instrument in the research literature. However the effect of the frailty phenotype on post-operative events was still unclear. The purpose of this systematic review was to explore the association between frailty phenotype and post-operative complications among surgical patients aged 60 years and over. Methods Relevant studies were identified by systematically searching of PubMed, Embase, the Cochrane Library and the Web of Science databases from their beginning to March 2017. Both random-effects models and fixed-effects models were used to combine the risk ratios (RRs) and 95% confidence intervals (CIs). A subgroup analysis was performed to identify the sources of heterogeneity and a sensitivity analysis to identify the strength of the results. Results Twelve prospective cohort studies involving a total of 2278 patients were included. The risk of post-operative complications in the frail group was higher than the non-frail group (RR: 1.6; 95% CI: 1.60–2.13). Compared with the robust group, geriatric patients with frailty or pre-frailty had a higher risk of post-operative complications. The RRs were 1.77 (95% CI: 1.40–2.25) and 1.45 (95% CI: 1.17–1.80), respectively. Conclusion Frailty phenotype should be considered as a useful risk assessment tool for preoperative evaluations of geriatric patients by medical staff.

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“…In fact, this is a common finding in the scientific literature, and has been related to aging 20 and intraoperative period, although previous studies have not evaluated frailty or pre-frailty. 21 Actually, frailty patients undergoing non-cardiovascular surgery had more intraoperative cerebral desaturation compared with no-frailty patients, 22 and older patients with comorbidities such as hypertension and diabetes might be at increased risk due to changes in autoregulation of cerebral blood flow. 23 Our data are in line with current literature that suggests that pre-frailty patients undergoing a valve replacement present a higher incidence of stroke compared to patients submitted to CAB, this fact can be explained due to the higher cardiopulmonary bypass and anoxia time during surgery.…”

Section: Discussionmentioning

confidence: 99%

Pre-Frailty Increases the Risk of Adverse Events in Older Patients Undergoing Cardiovascular Surgery

Rodrigues¹,

Marques²,

Lobo³

et al. 2017

Arquivos Brasileiros De Cardiologia

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BackgroundFrailty is identified as a major predictor of adverse outcomes in older surgical patients. However, the outcomes in pre-frail patients after cardiovascular surgery remain unknown.ObjectiveTo investigate the main outcomes (length of stay, mechanical ventilation time, stroke and in-hospital death) in pre-frail patients in comparison with no-frail patients after cardiovascular surgery.Methods221 patients over 65 years old, with established diagnosis of myocardial infarction or valve disease were enrolled. Patients were evaluated by Clinical Frailty Score (CFS) before surgery and allocated into 2 groups: no-frailty (CFS 1~3) vs. pre-frailty (CFS 4) and followed up for main outcomes. For all analysis, the statistical significance was set at 5% (p < 0.05).ResultsNo differences were found in anthropometric and demographic data between groups (p > 0.05). Pre-frail patients showed a longer mechanical ventilation time (193 ± 37 vs. 29 ± 7 hours; p<0.05) than no-frail patients; similar results were observed for length of stay at the intensive care unit (5 ± 1 vs. 3 ± 1 days; p < 0.05) and total time of hospitalization (12 ± 5 vs. 9 ± 3 days; p < 0.05). In addition, the pre-frail group had a higher number of adverse events (stroke 8.3% vs. 3.9%; in-hospital death 21.5% vs. 7.8%; p < 0.05) with an increased risk for development stroke (OR: 2.139, 95% CI: 0.622-7.351, p = 0.001; HR: 2.763, 95%CI: 1.206-6.331, p = 0.0001) and in-hospital death (OR: 1.809, 95% CI: 1.286-2.546, p = 0.001; HR: 1.830, 95% CI: 1.476-2.269, p = 0.0001). Moreover, higher number of pre-frail patients required homecare services than no-frail patients (46.5% vs. 0%; p < 0.05).ConclusionPatients with pre-frailty showed longer mechanical ventilation time and hospital stay with an increased risk for cardiovascular events compared with no-frail patients.

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Association between frailty, cerebral oxygenation and adverse post-operative outcomes in elderly patients undergoing non-cardiac surgery: An observational pilot study

Cited by 14 publications

References 17 publications

Patients over 65 years with Acute Complicated Calculous Biliary Disease are Treated Differently—Results and Insights from the ESTES Snapshot Audit

Patients over 65 years with Acute Complicated Calculous Biliary Disease are Treated Differently—Results and Insights from the ESTES Snapshot Audit

Effects of the frailty phenotype on post-operative complications in older surgical patients: a systematic review and meta-analysis

Pre-Frailty Increases the Risk of Adverse Events in Older Patients Undergoing Cardiovascular Surgery

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