Frailty and post-operative outcomes in older surgical patients: a systematic review

Lin, Hui-Shan; Watts, Jacqueline N.; Peel, Nancye M.; Hubbard, Ruth E.

doi:10.1186/s12877-016-0329-8

Cited by 799 publications

(596 citation statements)

References 41 publications

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“…These findings were noted, "irrespective of the type of surgery conducted "and were consistent across different frailty measurement techniques [47]. Currently, the literature investigating frailty and surgery has defined 'geriatric' as those above 60 or 65 years old, and studies in this patient population have recognized frailty being more prevalent with increasing age.…”

Section: Discussionsupporting

confidence: 54%

“…A recent systematic study by Lin et al [47] reported that "in patients over 75 years of age, frailty was associated with increased mortality, post-operative complications, prolonged length of stay and discharge to long term care facility. " These findings were noted, "irrespective of the type of surgery conducted "and were consistent across different frailty measurement techniques [47].…”

Section: Discussionmentioning

confidence: 99%

“…A recent systematic review incorporating 31 studies of frailty in persons 65 years or older found a prevalence from 4.0% to 17.0% (mean 9.9%) of physical frailty, with a higher prevalence when psychosocial frailty was also included [47,48]. In our patients, NPWTid using the ROCF-CC dressing was selected, as our patients were not candidates for surgical debridement due to their underlying comorbidities contributing to their perceived frailty risk.…”

Section: Discussionmentioning

confidence: 99%

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Initial Experience Using a Novel Reticulated Open Cell Foam Dressing with Through Holes during Negative Pressure Wound Therapy with Instillation for Management of Pressure Ulcers

Fernández¹,

Ellman²,

Jackson³

2017

J Trauma Treat

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Several published reviews and recommendations exist for the use of negative pressure wound therapy (NPWT) with instillation and a dwell time (NPWTi-d) in acute and chronic wounds. Specific dressings for use with NPWTi-d have also been developed, including a reticulated open cell foam dressing with through holes (ROCF-CC) that assists in removing thick wound exudate and infectious materials. ROCF-CC is especially helpful for wound cleansing when debridement is not possible or appropriate in patients.We report our initial experiences in using NPWTi-d with ROCF-CC in patients with pressure ulcers. An algorithmic approach was used to determine appropriate treatment to reach the goals of therapy (i.e., wound bed preparation, granulation tissue formation, and removal of infectious materials). Previous therapies included honey and gauze soaked in Dakin's solution. All patients received antibiotics and debridement when possible.Five patients (3 females and 2 males) received NPWTi-d with ROCF-CC (instillation of saline or a hypochlorous solution with a dwell time of 10 minutes, followed by 2-3 hours of -125 mmHg NPWT). Patient comorbidities included obesity, diabetes mellitus, hypertension, and peripheral artery disease. Mean age of patients was 65.2 years (range: 50-82 years). After an average of 6 days of therapy (range 2-9 days), all wounds treated with NPWTi-d with ROCF-CC showed rapid granulation tissue formation.We also noted improved removal of devitalized tissue and subsequent granulation tissue formation in patients receiving hypochlorous solution compared to patients receiving saline during NPWTi-d with ROCF-CC. All patients were eventually transferred to a skilled nursing facility. In our clinical practice, NPWTi-d with ROCF-CC provided effective and rapid removal of the thick exudate and infectious materials and promoted excellent development of underlying granulation tissue.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Initial Experience Using a Novel Reticulated Open Cell Foam Dressing with Through Holes during Negative Pressure Wound Therapy with Instillation for Management of Pressure Ulcers

Fernández¹,

Ellman²,

Jackson³

2017

J Trauma Treat

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“…10,11 This biologic syndrome, which results in decreased resistance to stressors and increased vulnerability to morbidity, has been termed frailty. 12 Multiple frailty indices have been developed to scale a patient's AD and predict their operative risk.…”

Section: Introductionmentioning

confidence: 99%

“…13 These scores have consistently been confirmed as independent risk factors for predicting adverse outcomes for surgical patients across a range of specialties including vascular surgery. 10,11,[14][15][16] Both the modified frailty index (mFI), an 11-point index developed in the American College of Surgeon National Surgical Quality Improvement Program (NSQIP) database, and the Risk Analysis Index (RAI), a simplified version of the Porock 6-month mortality index, have been validated in CEA patients in these national data sets demonstrating that an increasing number of AD is associated with increased 30-day adverse events after CEA including stroke, mortality, and length of stay. 11,17,18 The major limitation of the existing analyses using the mFI and RAI is the use of national data sets which specifically lack long-term follow-up data.…”

Section: Introductionmentioning

confidence: 99%

An Accumulated Deficits Model Predicts Perioperative and Long-Term Adverse Events After Carotid Endarterectomy

Sridharan

Chaer

et al. 2017

Annals of Vascular Surgery

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Association of State Certificate of Need Regulation With Procedural Volume, Market Share, and Outcomes Among Medicare Beneficiaries

Yuce

Chung

Barnard

et al. 2020

JAMA

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IMPORTANCE Certificate of need laws provide state-level regulation of health system expenditure. These laws are intended to limit spending and control hospital expansion in order to prevent excess capacity and improve quality of care. Several states have recently introduced legislation to modify or repeal these regulations, as encouraged by executive order 13813, issued in October 2017 by the Trump administration.OBJECTIVE To evaluate the difference in markers of hospital activity and quality by state certificate of need status. These markers include hospital procedural volume, hospital market share, county-level procedures per 10 000 persons, and patient-level postoperative outcomes. DESIGN, SETTING, AND PARTICIPANTSA cross-sectional study involving Medicare beneficiaries aged 65 years or older who underwent 1 of the following 10 procedures from January 1, 2016, through November 30, 2018: total knee or hip arthroplasty, coronary artery bypass grafting, colectomy, ventral hernia repair, lower extremity vascular bypass, lung resection, pancreatic resection, cystectomy, or esophagectomy.EXPOSURES State certificate of need regulation status as determined by data from the National Conference of State Legislatures. MAIN OUTCOMES AND MEASURESOutcomes of interest included hospital procedural volume; hospital market share (range, 0-1; reflecting 0%-100% of market share); county-level procedures per 10 000 persons; and patient-level postoperative 30-day mortality, surgical site infection, and readmission.RESULTS A total of 1 545 952 patients (58.0% women; median age 72 years; interquartile range, 68-77 years) at 3631 hospitals underwent 1 of the 10 operations. Of these patients, 468 236 (30.3%) underwent procedures in the 15 states without certificate of need regulations and 1 077 716 (69.7%) in the 35 states with certificate of need regulations. The total number of procedures ranged between 729 855 total knee arthroplasties (47.21%) and 4558 esophagectomies (0.29%). When comparing states without vs with certificate of need regulations, there were no significant differences in overall hospital procedural volume (median hospital procedure volume, 241 vs 272 operations per hospital for 3 years; absolute difference, 31; 95% CI, −27.64 to 89.64; P = .30). There were no statistically significant differences between states without vs with certificate of need regulations for median hospital market share (median, 28% vs 52%; absolute difference, 24%; 95% CI, −5% to 55%; P = .11); procedure rates per 10 000 Medicare-eligible population (median, 239.23 vs 205.41 operations per Medicare-eligible population in 3 years; absolute difference, 33.82; 95% CI, −84.08 to 16.43; P = .19); or 30-day mortality (1.17% vs 1.33%, odds ratio [OR], 1.04; 95% CI, 0.93 to 1.16; P = .52), surgical site infection (1.24% vs 1.25%; OR, 0.93; 95% CI, 0.83 to 1.04; P = .21), or readmission rate (9.69% vs 8.40%; OR, 0.80; 95% CI, 0.57 to 1.12; P = .19).CONCLUSIONS AND RELEVANCE Among Medicare beneficiaries who underwent a range of surgical procedures from 2...

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Frailty and post-operative outcomes in older surgical patients: a systematic review

Cited by 799 publications

References 41 publications

Initial Experience Using a Novel Reticulated Open Cell Foam Dressing with Through Holes during Negative Pressure Wound Therapy with Instillation for Management of Pressure Ulcers

Initial Experience Using a Novel Reticulated Open Cell Foam Dressing with Through Holes during Negative Pressure Wound Therapy with Instillation for Management of Pressure Ulcers

An Accumulated Deficits Model Predicts Perioperative and Long-Term Adverse Events After Carotid Endarterectomy

Association of State Certificate of Need Regulation With Procedural Volume, Market Share, and Outcomes Among Medicare Beneficiaries

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