Estimating Risk of Postsurgical General and Geriatric Complications Using the VESPA Preoperative Tool

Min, Lillian; Hall, Karen E.; Finlayson, Emily; Englesbe, Michael J.; Palazzolo, William C.; Chan, Chiao Li; Hou, Hechuan; Miller, Ashley L.; Diehl, Kathleen M.

doi:10.1001/jamasurg.2017.2635

Cited by 36 publications

(36 citation statements)

References 40 publications

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“…Screening could be achieved using a test such as the Mini-Cog[56, 57] which requires only 3-minutes for administration and thus would not add excessive burden to the preoperative assessment. The Vulnerable Elders Surgical Pathways and Outcomes Assessment (VESPA) trial includes the Mini-Cog in its preoperative risk assessment tool, and has demonstrated the feasibility of this approach[58]. Second, given the substantial impact of delirium on adverse clinical outcomes, these results suggest the need to redouble efforts for prevention of delirium, and screening for MCI could be beneficial to target high-risk patients for these efforts.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes in older surgical patients with mild cognitive impairment

Racine

Fong

Gou

et al. 2017

Alzheimer's & Dementia

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes in older surgical patients with mild cognitive impairment

Racine

Fong

Gou

et al. 2017

Alzheimer's & Dementia

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“…Patients' physical function has also been associated with surgical outcomes for some conditions. Frailty has been associated with longer hospital lengths of stay, 3 elevated risk of postoperative complications, 4 postoperative delirium 5 and postoperative costs. 6 A review of colorectal surgeries found frailty associated with higher risk of poorer postoperative outcomes.…”

Section: Introductionmentioning

confidence: 99%

Relationship between preoperative patient-reported outcomes and hospital length of stay: a prospective cohort study of general surgery patients in Vancouver, Canada

Sutherland

Liu

Crump

et al. 2018

J Health Serv Res Policy

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Preoperative self-reported assessment of depression and pain can assist with identifying patients at higher risk of longer lengths of stay. Patient's self-reported preoperative measures of depression and pain should be incorporated into patient pathways. They provide opportunities for improving management of general surgery patients and possibly play a role in aligning hospital funding with patients' needs.

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“…Although it has been reported that there is a low likelihood of malignancy of thyroid nodules in old aged patients, these cancers have a more aggressive phenotype (27) with any postsurgical complications, rather, the functional status determined by the Lawton and Katz scales and the self-assessed inability to manage alone after discharge were the leading risk factors for surgical outcomes. They also proved that postoperative sarcopenia is a relatively frequent occurrence (30).…”

Section: Discussionmentioning

confidence: 93%

Comparison of Thyroidectomy and Second Fine-Needle aspiration Biopsy Results of the Old Age Group with Previous Bethesda III. Is the second Biopsy necessary?

Atmış¹

2019

Erciyes Med J

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We aimed to detect if there were any radiologic, demographic, or clinical findings that were valuable for differentiating benign nodules from malignant nodules in old aged patients, when the results of the first fine-needle aspiration biopsy (FNAB) were reported as atypia of undetermined significance (AUS). Materials and Methods: Patients aged 65 years and older who were biopsied from thyroid nodules were analyzed retrospectively in this study. A total of 1264 patients with 1374 nodules were enrolled and of these, 203 patients with 216 nodules were recorded to have diagnosis of AUS in pathological evaluation. We excluded 104 nodules on which FNAB had been performed only once and included 112 nodules, on which FNAB had been performed twice. Out of these included patients, a total of 43 patients were thyroidectomized. Preoperative ultrasonographic nodular findings, echogenicity, marginal [ir]regularity, calcification, exophytic configuration, and halo were recorded. Results: The median patient age was 69 years. There was no statistically significant difference between the results of the first and second FNABs. Hypoechogenicity was the only statistically significant different characteristic found in thyroid nodules that could effectively discriminate between malignant and benign groups. Conclusion: The second FNAB does not increase the likelihood of diagnosing malignancy in old aged patients and there is no need for this procedure when recommending surgery. Suspicious USG findings are more frequent among malignant nodules, as reported in the histopathological evaluation of the old aged patients. A multidisciplinary team should take part in the decision-making process for the treatment of old aged patients after the first FNAB, with due consideration of the history, physical examination, USG, FNAB laboratory findings, and patient preference.

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Estimating Risk of Postsurgical General and Geriatric Complications Using the VESPA Preoperative Tool

Abstract: Preoperative assessment of older geriatric patients is feasible in the general preoperative clinic and can help identify patients at higher risk of postoperative complications.

Cited by 36 publications

References 40 publications

Clinical outcomes in older surgical patients with mild cognitive impairment

Clinical outcomes in older surgical patients with mild cognitive impairment

Relationship between preoperative patient-reported outcomes and hospital length of stay: a prospective cohort study of general surgery patients in Vancouver, Canada

Comparison of Thyroidectomy and Second Fine-Needle aspiration Biopsy Results of the Old Age Group with Previous Bethesda III. Is the second Biopsy necessary?

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