New Developments in Geriatric Surgery

Zenilman, Michael E.; Chow, Warren B.; Ko, Clifford Y.; Ibrahim, Andrew M.; Makary, Martin A.; Lagoo‐Deenadayalan, Sandhya; Dardik, Alan; Boyd, Casey A.; Riall, Taylor S.; Sosa, Julie Ann; Tummel, Evan; Gould, Lisa; Segev, Dorry L.; Berger, Judith

doi:10.1067/j.cpsurg.2011.06.002

Cited by 12 publications

(12 citation statements)

References 178 publications

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“…Although caution is needed when treating very old patients, the morbidity and mortality rates for octogenarians appear within the acceptable range for major abdominal surgery when performed at experienced centers. So, careful selection of patients and surgeons are essential points to make decisions, and pancreatic resection in octogenarians should be referred to specialized centers [31]. When considering long-term results of operation, a reduced benefit from resection of cancer of the head of the pancreas in patients with advanced age was previously reported [32].…”

Section: Discussionmentioning

confidence: 97%

Outcome of pancreaticoduodenectomy in octogenarians: Single institution's experience and review of the literature

Beltrame

Gruppo

Pastorelli

et al. 2015

Journal of Visceral Surgery

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Section: Discussionmentioning

confidence: 97%

Outcome of pancreaticoduodenectomy in octogenarians: Single institution's experience and review of the literature

Beltrame

Gruppo

Pastorelli

et al. 2015

Journal of Visceral Surgery

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“…[4, 5, 19] To combat these risks and address disparate surgical needs, care of the elderly requires expert multidisciplinary teams, specialist surgeons and capacity for palliative care, prolonged hospital stays and rehabilitation services. [5, 19-21] Subsequently, high use of healthcare resources among the aged is common. [21] With LMICs’ limited capacity for surgical care at baseline, the added pressures of elderly needs strain health systems even further.…”

Section: Discussionmentioning

confidence: 99%

“…[5, 19-21] Subsequently, high use of healthcare resources among the aged is common. [21] With LMICs’ limited capacity for surgical care at baseline, the added pressures of elderly needs strain health systems even further. With rapidly aging populations, LMICs are confronted with a significant unmet burden of surgical disease.…”

Section: Discussionmentioning

confidence: 99%

Surgical need in an aging population: A cluster-based household survey in Nepal

Stewart

Wong

Gupta

et al. 2015

Surgery

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Background With an aging global population comes significant non-communicable disease burden, especially in low- and middle-income countries (LMICs). An unknown proportion of this burden is treatable with surgery. For health system planning, this study aimed to estimate the surgical needs of individuals over 50 years in Nepal. Methods A two-stage, cluster randomized, community-based survey was performed in Nepal using the validated Surgeons OverSeas Assessment of Surgical Need (SOSAS) tool. SOSAS collects household demographics, randomly selects household members for verbal head-to-toe examinations for surgical conditions and completes a verbal autopsy for deaths in the preceding year. Only respondents older than 50 years were included in the analysis. Results The survey sampled 1,350 households, totaling 2,695 individuals (97% response rate). Of these, 273 surgical conditions were reported by 507 persons ages ≥50 years. Extrapolating, there are potentially 2.1 million people over age 50 with surgically treatable conditions needing care in Nepal (95%CI 1.8 – 2.4 million; 46,000 – 62,6000 per 100,000 persons). One in five deaths were potentially treatable or palliated by surgery. Though a growth or mass (including hernias and goiters) was the most commonly reported surgical condition (25%), injuries and fractures were also common and associated with the greatest disability. Literacy and distance to secondary and tertiary health facilities were associated with lack of care for surgical conditions (p<0.05). Conclusion There is a large unmet surgical need among the elderly in Nepal. Low literacy and distance from a capable health facility are the greatest barriers to care. As the global population ages, there is an increasing need to improve surgical services and strengthen health systems to care for this group.

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“…Age independently, more frequent emergency presentation, delayed diagnosis, comorbid illness and baseline frailty contribute to much higher rates of peri-operative morbidity and mortality in older patients requiring surgery compared to the younger ones [1,38,39]. Mitigating these risks requires multidisciplinary teams versed in geriatric care, specialist surgeons and capacity for prolonged hospital stays, rehabilitation services and palliative care [38,39,40,41]. Additionally, high health-care resource utilization among the aged is common and will further strain LMICs' already limited surgical capacity [41].…”

Section: Discussionmentioning

confidence: 99%

“…Mitigating these risks requires multidisciplinary teams versed in geriatric care, specialist surgeons and capacity for prolonged hospital stays, rehabilitation services and palliative care [38,39,40,41]. Additionally, high health-care resource utilization among the aged is common and will further strain LMICs' already limited surgical capacity [41]. Studies of unmet surgical need among the aged in Sierra Leone and Nepal demonstrated that >40% of the elderly are currently living with a condition potentially treatable with surgery and 20% of deaths in those ≥50 years of age can be prevented or palliated by surgical care [34,37].…”

Section: Discussionmentioning

confidence: 99%

Changing Epidemiology of Intestinal Obstruction in Ghana: Signs of Increasing Surgical Capacity and an Aging Population

Gyedu

Abantanga²,

Kyei³

et al. 2015

Dig Surg

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Introduction: This study aimed to describe the epidemiology and outcomes of intestinal obstruction at a tertiary hospital in Ghana over time. Methods: Records of all patients admitted to a tertiary hospital from 2007 to 2011 with intestinal obstruction were identified using ICD-9 codes. Sociodemographic and clinical data were compared to a previously published series of intestinal obstructions from 1998 to 2003. Factors contributing to longer than expected hospital stays and death were further examined. Results: Of the 230 records reviewed, 108 patients (47%) had obstructions due to adhesions, 50 (21%) had volvulus, 22 (7%) had an ileus from perforation and 14 (6%) had intussusception. Hernia fell from the 1st to the 8th most common cause of obstruction. Patients with intestinal obstruction were older in 2007-2011 compared to those presenting between 1998 and 2003 (p < 0.001); conditions associated with older age (e.g. volvulus and neoplasia) were more frequently encountered (p < 0.001). Age over 50 years was strong factor of in-hospital death (adjusted OR 14.2, 95% CI 1.41-142.95). Conclusion: Efforts to reduce hernia backlog and expand the surgical workforce may have had an effect on intestinal obstruction epidemiology in Ghana. Increasing aging-related pathology and a higher risk of death in elderly patients suggest that improvement in geriatric surgical care is urgently needed.

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New Developments in Geriatric Surgery

Cited by 12 publications

References 178 publications

Outcome of pancreaticoduodenectomy in octogenarians: Single institution's experience and review of the literature

Outcome of pancreaticoduodenectomy in octogenarians: Single institution's experience and review of the literature

Surgical need in an aging population: A cluster-based household survey in Nepal

Changing Epidemiology of Intestinal Obstruction in Ghana: Signs of Increasing Surgical Capacity and an Aging Population

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