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

Lee, Yao Zong; Dharmawan, Ayliana; Zhang, Xiaojin; Chua, Daniel Yong Chuen; Low, Jee Keem

doi:10.1111/ans.17674

Cited by 8 publications

(7 citation statements)

References 17 publications

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“…Our study population included a reasonable proportion of elective surgical patients. Overall mortality for surgical patients has been improving ( 38 ) and has previously been shown to be lower than that of medical patients ( 39 , 40 ). We analyzed data to assess the effect of the elective surgical subgroup on mortality rates.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Outcomes of Very Elderly Patients Admitted to Intensive Care: A Retrospective Multicenter Cohort Analysis*

Rai

Brace

Ross

et al. 2023

Critical Care Medicine

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OBJECTIVES: To characterize and compare trends in ICU admission, hospital outcomes, and resource utilization for critically ill very elderly patients (≥ 80 yr old) compared with the younger cohort (16–79 yr old). DESIGN: A retrospective multicenter cohort study. SETTING: One-hundred ninety-four ICUs contributing data to the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Adult Patient Database between January 2006 and December 2018. PATIENTS: Adult (≥ 16 yr) patients admitted to Australian and New Zealand ICUs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Very elderly patients with a mean ± sd age of 84.8 ± 3.7 years accounted for 14.8% (232,582/1,568,959) of all adult ICU admissions. They had higher comorbid disease burden and illness severity scores compared with the younger cohort. Hospital (15.4% vs 7.8%, p < 0.001) and ICU mortality (8.5% vs 5.2%, p < 0.001) were higher in the very elderly. They stayed fewer days in ICU, but longer in hospital and had more ICU readmissions. Among survivors, a lower proportion of very elderly was discharged home (65.2% vs 82.4%, p < 0.001), and a higher proportion was discharged to chronic care/nursing home facilities (20.1% vs 7.8%, p < 0.001). Although there was no change in the proportion of very elderly ICU admissions over the study period, they showed a greater decline in risk-adjusted mortality (6.3% [95% CI, 5.9%–6.7%] vs 4.0% [95% CI, 3.7%–4.2%] relative reduction per year, p < 0.001) compared with the younger cohort. The mortality of very elderly unplanned ICU admissions improved faster than the younger cohort (p < 0.001), whereas improvements in mortality among elective surgical ICU admissions were similar in both groups (p = 0.45). CONCLUSIONS: The proportion of ICU admissions greater than or equal to 80 years old did not change over the 13-year study period. Although their mortality was higher, they showed improved survivorship over time, especially in the unplanned ICU admission subgroup. A higher proportion of survivors were discharged to chronic care facilities.

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Section: Discussionmentioning

confidence: 99%

Characteristics and Outcomes of Very Elderly Patients Admitted to Intensive Care: A Retrospective Multicenter Cohort Analysis*

Rai

Brace

Ross

et al. 2023

Critical Care Medicine

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“…We refer to an article in your publication by Lee et al 1 Globally, there is rising demand for geriatric surgery and a need for greater emphasis on this population. 2 Care for geriatric surgical patients during the COVID pandemic is challenging due to resource limitations, with redirection of manpower for pandemic response.…”

Section: Dear Editormentioning

confidence: 99%

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

Tang

Wong

Chan

et al. 2023

ANZ Journal of Surgery

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“…In an aging society, there is a rising demand for elective surgeries due to the changing healthcare needs of older people [1][2][3] . However, this increase in elective surgeries raises concerns about additional adverse outcomes, particularly given the unique challenges posed by aging, such as pre-existing health conditions, disease sequelae, and diminished physiological reserves 4,5 .…”

Section: Introductionmentioning

confidence: 99%

Predicting Postoperative Delirium in Older Patients: a multicenter retrospective cohort study

Wu,

Sharma,

Bauch

et al. 2024

Preprint

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BackgroundThe number of elective surgeries for older individuals is on the rise globally. Machine learning may improve risk assessment with impact on surgical planning and postoperative care. Preoperative cognitive assessment may facilitate early identification of postoperative delirium (POD). This study aim to estimate the predictive ability of machine learning models for POD using pre- and/or perioperative features, with a specific focus on adding neuropsychological assessments prior to surgery.Materials and MethodsThis retrospective cohort study analyzed data from the multicenter PAWEL study and its PAWEL-R substudy, encompassing older patients (≥70 years) undergoing elective surgeries across five medical centers from July 2017 to April 2019. A total of 1624 patients were included, with POD diagnosis made before discharge. Data included demographics, clinical, surgical, and neuropsychological features collected pre- and perioperatively. Machine learning model performance was evaluated using the area under the receiver operating characteristic curve (AUC), with permutation testing for significance and SHapley Additive exPlanations (SHAP) for effective neuropsychological assessments identification.ResultsIn this cohort of 1624 patients, 52.3% (N=850) were male, with a mean [SD] age of 77.9 [4.9] years. Predicting POD before surgery using demographic, clinical, surgical, and neuropsychological features achieved an AUC of 0.79. Incorporating all pre- and perioperative features into the model yielded a slightly higher AUC of 0.82, with no significant difference observed (P= .19). Notably, cognitive factors alone were not strong predictors (AUC=0.61). However, specific tests within neuropsychological assessments, such as the Montreal Cognitive Assessment memory subdomain and Trail Making Test Part B, were found to be crucial for prediction according to SHAP analysis.Conclusion and RelevancePreoperative risk prediction for POD can increase risk awareness in presurgical assessment and improve postoperative management in patients with a high risk for delirium.HighlightsAnalyzed 1624 older patients (≥70 years) undergoing elective surgeries across five medical centers from July 2017 to April 2019.Established machine learning model predicts postoperative delirium before surgery.Preoperative cognition enhances predictive performance, comparable to models incorporating all pre- and perioperative features.Montreal Cognitive Assessment memory subdomain and Trail Making Test Part B drive the cognition-based prediction.Perioperative surgical features, such as the duration of the surgery, are important predictors.

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

Cited by 8 publications

References 17 publications

Characteristics and Outcomes of Very Elderly Patients Admitted to Intensive Care: A Retrospective Multicenter Cohort Analysis*

Characteristics and Outcomes of Very Elderly Patients Admitted to Intensive Care: A Retrospective Multicenter Cohort Analysis*

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

Predicting Postoperative Delirium in Older Patients: a multicenter retrospective cohort study

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