Applying Evidence-based Principles to Guide Emergency Surgery in Older Adults

Tremont, Jaclyn N. Portelli; Sloane, Philip D.

doi:10.1016/j.jamda.2022.02.013

Cited by 3 publications

(2 citation statements)

References 79 publications

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“…This patient group poses a challenge to healthcare professionals, due to the higher rate of comorbidities and influence of conditions, such as sarcopenia and frailty, which have an effect on the occurrence of post operative complications [ 2 , 3 ]. Routine pre-operative discussion about the perioperative risks allows for enhanced shared decision-making with the patient and their relatives, improving communication and understanding of possible outcomes, which is desirable for the elderly surgical patient [ 4 , 5 ]. Documentation of risk estimates can also facilitate better allocation of resources, including higher level of care and post-discharge rehabilitation services, which are essential for a large proportion of geriatric patients [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

External Validation of the American College of Surgeons Surgical Risk Calculator in Elderly Patients Undergoing General Surgery Operations

Kokkinakis

Andreou

Venianaki

et al. 2022

JCM

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Preoperative risk stratification in the elderly surgical patient is an essential part of contemporary perioperative care and can be done with the use of the American College of Surgeons Surgical Risk Calculator (ACS-SRC). However, data on the generalizability of the ACS-SRC in the elderly is scarce. In this study, we report an external validation of the ACS-RC in a geriatric cohort. A retrospective analysis of a prospectively maintained database was performed including patients aged > 65 who underwent general surgery procedures during 2012–2017 in a Greek academic centre. The predictive ability of the ACS-SRC for post-operative outcomes was tested with the use of Brier scores, discrimination, and calibration metrics. 471 patients were included in the analysis. 30-day postoperative mortality was 3.2%. Overall, Brier scores were lower than cut-off values for almost all outcomes. Discrimination was good for serious complications (c-statistic: 0.816; 95% CI: 0.762–0.869) and death (c-statistic: 0.824; 95% CI: 0.719–0.929). The Hosmer-Lemeshow test showed good calibration for all outcomes examined. Predicted and observed length of stay (LOS) presented significant differences for emergency and for elective cases. The ACS-SRC demonstrated good predictive performance in our sample and can aid preoperative estimation of multiple outcomes except for the prediction of post-operative LOS.

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Section: Introductionmentioning

confidence: 99%

External Validation of the American College of Surgeons Surgical Risk Calculator in Elderly Patients Undergoing General Surgery Operations

Kokkinakis

Andreou

Venianaki

et al. 2022

JCM

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“…Surgical therapy is the mainstay of treatment for patients with severe symptoms, such as diminished level of consciousness, hemiparesis or intractable headache [ 4 ]. However, especially in this often frail population, surgery comes with complications and an increased risk of mortality and disability, leaving patients dependent on care [ 5 , 6 ]. Patients with no or relatively mild symptoms, can be managed conservatively by employing a ‘wait-and-watch’ or ‘wait-and-scan’ policy with regular outpatient clinic visits and additional CT-scans if necessary [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with success of conservative therapy in chronic subdural hematoma: a single-center retrospective analysis

Foppen,

Lodewijkx,

Bandral

et al. 2024

J Neurol

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Introduction Conservative therapy is a viable option for patients with chronic subdural hematoma (cSDH) who express no, or only mild symptoms. It is not clear which factors are associated with success of conservative therapy. This study aims to determine conservative therapy's success rate and to identify features possibly associated with success. Methods A monocenter retrospective cohort study, including cSDH patients treated conservatively (wait-and-watch) from 2012 to 2022, was performed. The primary outcome was success of conservative therapy, defined as ‘no crossover to surgery’ during the follow-up period. Secondary outcomes were (1) factors associated with success, analyzed with univariate and multivariable logistic regression analyses, (2) 30-day mortality (3) time to crossover and (4) reasons for crossover. Results We included 159 patients. Conservative therapy was successful in 96 (60%) patients. Hematoma volume (OR 0.79, 95% CI 0.69–0.92) and hypodense hematoma type (OR 3.57, 95% 1.38–9.23) were associated with success. Thirty-day mortality rate was 5% and the median duration between diagnosis and surgery was 19 days (IQR 8–39). Clinical deterioration was the most frequent reason for crossover (in 61/63 patients, 97%) and was accompanied by radiological hematoma progression in 42 patients (67%). Conclusion In this selected group of patients, conservative therapy was successful in 60%. Smaller hematoma volume and hypodense hematoma type were associated with success. As time until crossover was approximately three weeks, deploying conservative therapy as primary treatment seems safe and could be rewarding as surgical complications can be avoided. Improvement in patient selection in future cohorts remains warranted.

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