Surgical Decisions in the Elderly: The Importance of Biological Age

Farquharson, S.; Gupta, Ramesh C.; Heald, R. J.; Moran, Brendan

doi:10.1177/014107680109400508

Cited by 21 publications

(12 citation statements)

References 9 publications

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“…The decision for DHC in our patients was made on an individual basis, taking account of the biological age of patients rather than of the date of birth. This approach is in line with findings on the importance of the biological age especially in surgical decisions [16] . Individual clinical decision-making is also reflected in the proportion of patients without impaired consciousness (16.7%) or with a time interval of more than 48 h from the index event (21.7%) at the time the decision for DHC was made.…”

Section: Discussionsupporting

confidence: 85%

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Decompressive Hemicraniectomy in Malignant Middle Cerebral Artery Infarction: The ‘Real World' Beyond Studies

Pledl

Hoyer

Rausch³

et al. 2016

Eur Neurol

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Background: Decompressive hemicraniectomy (DHC) is life-saving in patients with malignant middle cerebral artery infarction (MMI), but outcome, perspectives and complications after DHC in daily practice are largely unknown. Methods: From 2008 until 2014, we extracted patient's characteristics as well as complications from our database for patients with MMI who underwent DHC. Additionally, we analysed medical records from the different rehabilitation steps. Results: We identified 48 consecutive patients (mean 57 years, 21 male, 41.7% >60 years) with MMI who underwent DHC. The decision for DHC was made on an individual basis, including patients without impaired consciousness or stroke onset >48 h. In-hospital patients achieved only marginal clinical improvement. Seventy-five percent attended an early-rehabilitation, 44% achieved post-stroke rehabilitation and 6% carried on late-stage rehabilitation. In all, 45.5% returned home after rehabilitation. In-hospital mortality was 14.6%, overall mortality was 16.7%. Surviving patients (78.9%) had a modified Rankin Scale of 4-5. Frequent neurologic complications were symptomatic epilepsy and delirium. Following DHC/bone-flap-reimplantation, wound-healing disorders, epidural hematoma and wound infections were major surgery-related complications. Pulmonary infections were frequent in the acute-phase and urinary tract infections were predominant in the late-phase. Conclusions: DHC is a life-saving technique in patients with MMI, but complications are frequent, were underestimated in randomized clinical trials and may worsen the functional outcome.

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Section: Discussionsupporting

confidence: 85%

“…The decision for DHC was made on an individual basis, referring to accepted criteria as defined in the DESTINY trial [6] . However, 16.7% of all patients had no impaired consciousness and 21.7% of all patients underwent DHC >48 h after suspected onset ( fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

Decompressive Hemicraniectomy in Malignant Middle Cerebral Artery Infarction: The ‘Real World' Beyond Studies

Pledl

Hoyer

Rausch³

et al. 2016

Eur Neurol

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“…It is our strong view that neither age alone nor subjective rating systems (12,13) can determine the appropriateness of surgical intervention in the individual elderly patient. However, the place of palliative treatment must remain a major consideration for nonagenarians with significant comorbidity and/or severe surgical illness (9).…”

Section: Discussionmentioning

confidence: 99%

Nonagenarian surgical admissions for the acute abdomen: who benefits?

Toumi

Kesterton

Bhowmick

et al. 2010

International Journal of Clinical Practice

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Summary Introduction: Patients 90 years and older form an increasing proportion of the general population. Outcomes of their acute surgical admissions are not well documented. Methods and materials: Surgical management of 49 consecutive nonagenarian admissions (median age: 92 years) with an acute abdomen was compared with the management and outcome of 50 younger patients (median age: 53.5) admitted with a suspected acute abdomen over the same period. Results: Nonagenarian group consisted of mainly women (71% vs. 50%; p = 0.003). The use of laboratory investigations and imaging was similar for the patients aged over 90 and the younger patients, although proportionately fewer nonagenarians were investigated by abdominal CT scan (8% vs. 24%). Of the 49 nonagenarian patients admitted, only 4% (n = 2) were operated on. In contrast, 38% (n = 19) of patients aged 50–59 (p = 0.0001) underwent a surgical intervention. A much greater proportion of nonagenarians died in hospital than patients in the 50–59 comparator group (16% nonagenarians vs. 4% comparator patients; p = 0.04). The very large majority of survivors in both age groups were discharged back to their preadmission domicile [39 (95%) nonagenarians vs. 46 (96%) comparator 50–59 year group]. Conclusions: In this study, when compared with younger patients, very few nonagenarian patients (2%) with a suspected acute abdomen benefited from surgical admission. Instead, the large majority of nonagenarians either died or were discharged back to their home address without surgery.

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“…The opinion is usually that the patient looks well for his age or looks fragile for his age. 3 However, this assessment may not be a sufficient valuation of surgical risk. Instead, the Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (P-POSSUM) score may be calculated.…”

Section: Calculation Of Nutritional Riskmentioning

confidence: 99%

“…2 Because of the above factors, age is considered a nonmodifiable risk factor involving surgical outcome. This statement is modulated by the effect of physiologic age versus chronologic age, 3 which is often expressed in clinical practice as the perceived condition of the patient with respect to what the clinician would expect for their specific biological age. Objective measures exist for biological age, such as the concept of frailty, 4 which has been defined recently as the presence of 4 of 6 of the following factors associated with the prediction of 6-month mortality: Mini-Cog score of 3 or less, albumin level of 3.3 mg/dL or less, more than 1 fall in the last 6 months, hematocrit level less than 35%, dependency with at least one activity of daily living, and the presence of at least 3 comorbidities.…”

Section: Introductionmentioning

confidence: 99%