Prehabilitation in elderly patients scheduled for liver resection and protocol for Recovery Of Surgery in Elderly

Mohan, Ramkumar; Huey, Cheong Wei Terence; Junnarkar, Sameer P; Low, Jee Keem; Shelat, Vishal G

doi:10.20517/2394-5079.2019.53

Cited by 9 publications

(10 citation statements)

References 47 publications

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“…In the elderly population where there is an increased prevalence of gallstones in the elderly population, biliary events including AC are also more common. The elderly poses a unique challenge due to underlying comorbidity, frailty, sarcopenia, functional decline, cognitive decline, and diminished reserves to withstand stress[ 4 ]. With diminished physiological reserves, sepsis resulting from AC poses a mortality risk, and our mortality outcomes are acceptable, considering mortality risk of up to 20% in patients with AC[ 1 ].…”

Section: Discussionmentioning

confidence: 99%

“…In AC, age determines the severity stratification, and age ≥ 75 years is a criterion for moderate (Grade II) severity in both the TG13 and TG18 guidelines[ 3 ]. Aging is associated with reduced cardiac output, impaired gas exchange, reduction in vital capacity, decline in lean body mass, creatinine clearance reduction, hepatic drug metabolism impairment, frailty, and sarcopenia[ 4 ]. Due to functional metabolic decline, multiple comorbidities, and atypical presentation with potential diagnostic delays, age contributes to inferior outcomes[ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Elderly patients (≥ 80 years) with acute calculous cholangitis have similar outcomes as non-elderly patients (< 80 years): Propensity score-matched analysis

Chan¹,

Mohan²,

Low³

et al. 2021

WJH

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BACKGROUND Acute cholangitis (AC) is a disease spectrum with varying extent of severity. Age ≥ 75 years forms part of the criteria for moderate (Grade II) severity in both the Tokyo Guidelines (TG13 and TG18). Aging is associated with reduced physiological reserves, frailty, and sarcopenia. However, there is evidence that age itself is not the determinant of inferior outcomes in elective and emergency biliary diseases. There is a paucity of reports comparing clinical outcomes amongst elderly patients vs non-elderly patients with AC. AIM To investigate the effect of age (≥ 80 years) on AC's morbidity and mortality using propensity score matching (PSM). METHODS This is a single-center retrospective cohort study of all patients diagnosed with calculous AC (January 2016 to December 2016) and ≥ 80 years old (January 2012 to December 2016) at a tertiary university-affiliated teaching hospital. Inclusion criteria were patients who were treated for suspected or confirmed AC secondary to biliary stones. Patients with AC on a background of hepatobiliary malignancy, indwelling permanent metallic biliary stents, or concomitant pancreatitis were excluded. Elderly patients were defined as ≥ 80 years old in our study. A 1:1 PSM analysis was performed to reduce selection bias and address confounding factors. Study variables include comorbidities, vital parameters, laboratory and radiological investigations, and type of biliary decompression, including the time for endoscopic retrograde cholangiopancreatography (ERCP). Primary outcomes include in-hospital mortality, 30-d and 90-d mortality. Length of hospital stay (LOS) was the secondary outcome. RESULTS Four hundred fifty-seven patients with AC were included in this study (318 elderly, 139 non-elderly). PSM analysis resulted in a total of 224 patients (112 elderly, 112 non-elderly). The adoption of ERCP between elderly and non-elderly was similar in both the unmatched (elderly 64.8%, non-elderly 61.9%, P = 0.551) and matched cohorts (elderly 68.8% and non-elderly 58%, P = 0.096). The overall in-hospital mortality, 30-d mortality and 90-d mortality was 4.6%, 7.4% and 8.5% respectively, with no statistically significant differences between the elderly and non-elderly in both the unmatched and matched cohorts. LOS was longer in the unmatched cohort [elderly 8 d, interquartile range (IQR) 6-13, vs non-elderly 8 d, IQR 5-11, P = 0.040], but was comparable in the matched cohort (elderly 7.5 d, IQR 5-11, vs non-elderly 8 d, IQR 5-11, P = 0.982). Subgroup analysis of patients who underwent ERCP demonstrated the majority of the patients ( n = 159/292, 54.5%) had delayed ERCP (> 72 h from presentation). There was no significant difference in LOS, 30-d mortality, 90-d mortal...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Elderly patients (≥ 80 years) with acute calculous cholangitis have similar outcomes as non-elderly patients (< 80 years): Propensity score-matched analysis

Chan¹,

Mohan²,

Low³

et al. 2021

WJH

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“…The therapeutic window should take into account that tumour also continues to grow. 38 Prehabilitation or rehabilitation can also be recommended to improve post-hepatectomy outcomes. 39 In addition, the combination of TACE and ablation offers comparable clinical outcomes but reduces peri-operative-related mortality.…”

Section: Discussionmentioning

confidence: 99%

<p>The Significance of Platelet–Albumin–Bilirubin (PALBI) Grade in Hepatocellular Carcinoma Patients Stratified According to Platelet Count</p>

Pang¹,

Liu²,

Wang³

et al. 2020

CMAR

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Background Platelet–albumin–bilirubin (PALBI) has been demonstrated to be superior to conventional Child–Pugh (C-P) grade in evaluating liver function and prognosis of HCC patients. However, both thrombocytosis and thrombocytopenia are unfavorable for HCC survival. The aim of this study was to preliminarily investigate the prognostic value of PALBI in HCC patients with thrombocytopenia and excluding thrombocytopenia. Methods In this retrospective cohort study, we reviewed 465 cases of HCC patients who underwent radical surgery. PALBI grade was calculated based on preoperative serological examinations. The primary outcomes were overall survival (OS) and recurrence-free survival (RFS), which were assessed by Kaplan–Meier method and Cox regression. The prognostic performances of PALBI and other models were estimated by using the concordance index (C-index). Results During a median follow-up time of 28 months, 31.6% (147/465) of patients died and 33.5% (156/465) experienced recurrence. Multivariate analyses revealed that both thrombocytosis and thrombocytopenia were independently associated with poor OS and RFS compared with normal platelet count (PLT) in HCC patients. Stratified analysis further revealed that PALBI was a significant predictor for HCC survival in patients excluding thrombocytopenia but not in patients with thrombocytopenia. In particular, in HCC patients excluding thrombocytopenia, the combination of tumor size with PALBI (C-index = 0.730, 95% CI: 0.674–0.786) may be superior to the classical Barcelona Clinic Liver Cancer (BCLC) and Cancer of Liver Italian Program (CLIP) staging systems in predicting survival. Conclusion In conclusion, PALBI grade, in particular the combination with tumor size, is an effective model for discriminating survival in HCC patients excluding thrombocytopenia but not in thrombocytopenic HCC patients.

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“…Our early data have demonstrated promising results of improving these patients' fitness prior to major surgeries. 9 Across the globe, the implementation of similar prehabilitation programmes represent an unequivocal paradigm shift towards greater emphasis on elderly surgical care, with substantial improvements in volume and clinical outcomes. 10 However, these reasons can only partially explain why surgical procedures are increasingly becoming commonplace for the elderly in the twentieth century.…”

Section: Discussionmentioning

confidence: 99%

The changing landscape of general surgery in the elderly – trends over a decade in a tertiary centre in Singapore

Lee

Dharmawan

Zhang

et al. 2022

ANZ Journal of Surgery

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An ageing population with higher rates of helping seeking behaviour and treatment utilization is a worldwide phenomenon with no exception to Singapore. As elderly patients are fast becoming an increasing large part of our surgical practice, their long term outcomes are particularly important. Objective We take stock of our local experience in a high volume tertiary centre in Singapore, Tan Tock Seng Hospital by reviewing the number of surgical procedures performed for elderly patients (65 years old and above) across a decade and reviewing their post‐operative outcomes. Methods This retrospective cohort study included elderly patients (>= aged 65) who underwent surgical procedures under general anaesthesia from January 2008 to December 2019. Demographic data, nature of operation, preoperative American Society of Anaesthesiologists (ASA) status of patients and surrogate markers of outcome including average length of stay (ALOS), 30 and 90‐day mortality were retrospectively analysed. Results Across a 12‐year period, we observed a nearly overall two‐fold increase in the number of surgical procedures for elderly patients from 1,129 cases in 2008 to 2,118 cases in 2019. The ALOS for elderly surgical patients trended downwards from an average of 12.3 days in 2008 to 9.0 days in 2019. All cause 30‐day mortality rate of elderly patients dropped from 5.8% in 2008 to 2.7% in 2019. Conclusion The landscape for general surgery in the elderly is changing in the context of advances in health care and a paradigm shift in treatment beliefs and perspectives. Ultimately, informed decision making, patient engagement and empowerment by the surgeon are keys to better outcomes and improved patient experience.

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Prehabilitation in elderly patients scheduled for liver resection and protocol for Recovery Of Surgery in Elderly

Cited by 9 publications

References 47 publications

Elderly patients (≥ 80 years) with acute calculous cholangitis have similar outcomes as non-elderly patients (< 80 years): Propensity score-matched analysis

Elderly patients (≥ 80 years) with acute calculous cholangitis have similar outcomes as non-elderly patients (< 80 years): Propensity score-matched analysis

<p>The Significance of Platelet–Albumin–Bilirubin (PALBI) Grade in Hepatocellular Carcinoma Patients Stratified According to Platelet Count</p>

The changing landscape of general surgery in the elderly – trends over a decade in a tertiary centre in Singapore

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