Minimizing perioperative adverse events in the elderly

Jin, Fengling; Chung, Frances

doi:10.1093/bja/87.4.608

Cited by 258 publications

(158 citation statements)

References 145 publications

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“…Octogenarians in general have greater comorbid conditions and are at higher risk for complications and readmissions [5]. However, there are currently no risk adjustment models for patients with serious comorbidities undergoing THA.…”

Section: Introductionmentioning

confidence: 99%

High Risk of Readmission in Octogenarians Undergoing Primary Hip Arthroplasty

Malkani

Dilworth

Ong

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background As life expectancy increases, more elderly patients with end-stage hip arthritis are electing to undergo primary THA. Octogenarians undergoing THA have more comorbidities than younger patients, but this is not reflected in risk adjustment models for bundled care programs. The burden of care associated with THA in octogenarians has not been well characterized, and doing so may help these value-based programs make adjustments so that this vulnerable patient population does not risk losing access under accountable care models.Questions/purposes The purpose of this study was to describe care use, comorbidities, and complications among octogenarians undergoing primary THA. Methods Five percent of the Medicare national administrative claims data was queried to identify patients diagnosed with hip osteoarthritis between January 1, 1998, and December 31, 2013. Patients who underwent primary THA were identified and followed longitudinally during the study period using their unique, encrypted Medicare beneficiary identifiers. We compared risk factors and complications between the octogenarian group versus those aged 65 to 69 years. Multivariate Cox regression was used to evaluate the effect of patient/hospital factors on risk of revision, periprosthetic joint infection, dislocation, venous thromboembolism (VTE), and mortality. Patient factors in the model included age, sex, race, region, socioeconomic status, and health status based on Charlson comorbidity score 12 months before replacement surgery. Results There were 11,960 THAs in the octogenarians in 1998, which increased to 21,620 in 2013, an 81% increase during this study period. Octogenarians were more likely to have a Charlson score of 3 or higher than those patients aged 65 to 69 years (30% versus 17%, odds ratio [OR] 2.07 [1.98-2.20]; p \ 0.001), and they were more likely to have coronary artery disease or congestive heart failure (47% versus 29%, OR 2.16 [2.06-2.26]; p \ 0.001). The octogenarian group had a greater risk of dislocation (+12%, p = 0.01), VTE (+14%, p\0.001), and mortality (+150%, p\ 0.001) compared with the younger age cohort. A total of 21% of the octogenarians were readmitted after surgery compared with 12% for patients in the younger group (OR=1.64, 95% confidence interval 1.54-1.75; p \ 0.001). Conclusions Because octogenarians are at increased risk of dislocation, VTE, medical complications, and mortality after THA, value-based care models that penalize hospitals One or more of the authors (KO, DB, EL) are employees of Exponent, Inc. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research1 editors and board members are on file with the publication and can be viewed on request. This work was performed at

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Section: Introductionmentioning

confidence: 99%

High Risk of Readmission in Octogenarians Undergoing Primary Hip Arthroplasty

Malkani

Dilworth

Ong

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“…Vyresnio amžiaus operuotinų žmonių skaičius nuolat auga, ypač vyresnių nei 85 metų (1,2). Vienas iš prognozinių pooperacinio mirštamumo ir komplikacijų rizikos veiksnių yra bendroji ligonio būklė.…”

Section: įVadasunclassified

“…Mirties ir komplikacijų riziką vyresnio amžiaus pacientams didina dauginė patologija, operacijos skubumas, didelė operacijos apimtis, trečia ar ketvirta kategorijos būklė pagal ASA (angl. American Society of Anesthesiologists) klasifikaciją bei nepakankama mityba (1).…”

Section: įVadasunclassified

Nutritional status of elderly surgical patients

2008

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nesiskyrė -75,0, 57,7 ir atitinkamai -46,7 proc. (p>0,05). Išvados. Tarp pagyvenusio amžiaus pacientų nepakankama mityba nustatyta dažniau nei tarp jaunesnio amžiaus. Nutukimo dažnis amžiaus grupėse nesiskyrė, tačiau dažniau nutukusios buvo moterys. Nepakankama pagyvenusio amžiaus operuotinų pacientų mityba buvo susijusi su blogesne funkcine būkle, sutrikusiomis pažinimo funkcijomis ir skubia operacija.Adresas susirašinėti: G. Damulevičienė, KMU Geriatrijos klinika, A. Mickevičiaus 9, 44307 Kaunas El. paštas: gytedamu@one.lt ĮvadasVyresnio amžiaus operuotinų žmonių skaičius nuolat auga, ypač vyresnių nei 85 metų (1, 2). Vienas iš prognozinių pooperacinio mirštamumo ir komplikacijų rizikos veiksnių yra bendroji ligonio būklė. Mirties ir komplikacijų riziką vyresnio amžiaus pacientams didina dauginė patologija, operacijos skubumas, didelė operacijos apimtis, trečia ar ketvirta kategorijos būklė pagal ASA (angl. American Society of Anesthesiologists) klasifikaciją bei nepakankama mityba (1).Mitybos būklė yra svarbus vyresnio amžiaus žmo-gaus sveikatos rodiklis. Nepakankama mityba yra daž-na tarp vyresnių žmonių, tačiau ji gana retai nustatoma (3-5). Literatūros duomenimis, apie 5-12 proc. pagyvenusio amžiaus žmonių, gyvenančių namuose, 26-65 proc. -gydomų ligoninėse, 35-65 proc. -geriatrijos skyrių pacientų, 5-85 proc. -slaugos ir globos įstaigose gyvenančių žmonių nustatoma nepakankama mityba (1, 4-11). Nepakankamos mitybos rizikos veiksniai yra amžius, socialinė atskirtis, sumažėjusios pajamos, bloga dantų būklė, alkoholizmas, psichikos sutrikimai, virš-kinamojo trakto ligos, dauginė patologija ir keleto

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“…에 관한 요인 (Tiruvoipati et al, 2010) (Jin & Chung, 2001). 수술환자의 50-90%는 차가 운 수술실의 환경과 체온 조절에 영향을 미치는 마취제, 대사 율의 저하로 저체온을 경험하게 된다 (Biazzotto, Brundniewski, Schmidt, & Auler, 2006).…”

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Factors Influencing Body Temperature in Elderly Surgical Patients

Kwon¹,

Byeon²

2013

Journal of Korean Academy of Fundamentals of Nursing

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Minimizing perioperative adverse events in the elderly

Cited by 258 publications

References 145 publications

High Risk of Readmission in Octogenarians Undergoing Primary Hip Arthroplasty

High Risk of Readmission in Octogenarians Undergoing Primary Hip Arthroplasty

Nutritional status of elderly surgical patients

Factors Influencing Body Temperature in Elderly Surgical Patients

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