scholarly journals Reply to: Comment on Predicting In‐Hospital Mortality in COVID ‐19 Older Patients with Specifically Developed Scores

2021 ◽  
Author(s):  
Marcello Covino ◽  
Giuseppe De Matteis ◽  
Maria Livia Burzo ◽  
Francesco Franceschi ◽  
Claudio Sandroni
Keyword(s):  
Hospital Mortality ◽  
Older Patients

scholarly journals Does chronic oral anticoagulation reduce in-hospital mortality among COVID-19 older patients?

2021 ◽  
Author(s):  
Marcello Covino ◽  
Giuseppe De Matteis ◽  
Davide Della Polla ◽  
Maria Livia Burzo ◽  
Marco Maria Pascale ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Oral Anticoagulation ◽  
Older Patients

scholarly journals Emergency laparotomy in the older patient: factors predictive of 12-month mortality—Salford-POPS-GS. An observational study

2020 ◽  
Vol 32 (11) ◽  
pp. 2367-2373 ◽  
Author(s):  
Arturo Vilches-Moraga ◽  
Mollie Rowley ◽  
Jenny Fox ◽  
Haroon Khan ◽  
Areej Paracha ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Observational Study ◽  
Hospital Mortality ◽  
Older Patients ◽  
Care Home ◽  
Emergency Laparotomy ◽  
Older Patient ◽  
Readmission Rates ◽  
Clinical Frailty Scale ◽  
Female Predominance

Abstract Introduction Although high rates of in-hospital mortality have been described in older patients undergoing emergency laparotomy (EL), less is known about longer-term outcomes in this population. We describe factors present at the time of hospital admission that influence 12-month survival in older patients. Methods Observational study of patients aged 75 years and over, who underwent EL at our hospital between 8th September 2014 and 30th March 2017. Results 113 patients were included. Average age was 81.9 ± 4.7 years, female predominance (60/113), 3 (2.6%) lived in a care home, 103 (91.2%) and 79 (69.1%) were independent of personal and instrumental activities of daily living (ADLs) and 8 (7.1%) had cognitive impairment. Median length of stay was 16 days ± 29.9 (0–269); in-hospital mortality 22.1% (25/113), post-operative 30-day, 90-day and 12-month mortality rates 19.5% (22), 24.8% (28) and 38.9% (44). 30-day and 12-month readmission rates 5.7% (5/88) and 40.9% (36). 12-month readmission was higher in frail patients, using the Clinical Frailty Scale (CFS) score (64% 5–8 vs 31.7% 1–4, p = 0.006). Dependency for personal ADLs (6/10 (60%) dependent vs. 38/103 (36.8%) independent, p = 0.119) and cognitive impairment (5/8 (62.5%) impaired vs. 39/105 (37.1%) no impairment, p = 0.116) showed a trend towards higher 12-month mortality. On multivariate analysis, 12-month mortality was strongly associated with CFS 5–9 (HR 5.0403 (95% CI 1.719–16.982) and ASA classes III–V (HR 2.704 95% CI 1.032–7.081). Conclusion Frailty and high ASA class predict increased mortality at 12 months after emergency laparotomy. We advocate early engagement of multi-professional teams experienced in perioperative care of older patients.

scholarly journals In-hospital mortality among incident hemodialysis older patients in Peru

2019 ◽  
Vol 12 (2) ◽  
pp. 142-147
Author(s):  
Percy Herrera-Añazco ◽  
Pedro J Ortiz ◽  
Jesus E Peinado ◽  
Tania Tello ◽  
Fabiola Valero ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Older Patients ◽  
Linear Models ◽  
Venous Catheter ◽  
Ageing Population ◽  
Middle Income ◽  
Middle Income Countries ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Understanding the pattern of mortality linked to end stage renal disease (ESRD) is important given the increasing ageing population in low- and middle-income countries. Methods We analyzed older patients with ESRD with incident hemodialysis, from January 2012 to August 2017 in one large general hospital in Peru. Individual and health system-related variables were analyzed using Generalized Linear Models (GLM) to estimate their association with in-hospital all-cause mortality. Relative risk (RR) with their 95% confidence intervals (95% CI) were calculated. Results We evaluated 312 patients; mean age 69 years, 93.6% started hemodialysis with a transient central venous catheter, 1.7% had previous hemodialysis indication and 24.7% died during hospital stay. The mean length of stay was 16.1 days (SD 13.5). In the adjusted multivariate models, we found higher in-hospital mortality among those with encephalopathy (aRR 1.85, 95% CI 1.21-2.82 vs. without encephalopathy) and a lower in-hospital mortality among those with eGFR ≤7 mL/min (aRR 0.45, 95% CI 0.31-0.67 vs. eGFR>7 mL/min). Conclusions There is a high in-hospital mortality among older hemodialysis patients in Peru. The presence of uremic encephalopathy was associated with higher mortality and a lower estimated glomerular filtration rate with lower mortality.

Safety of microvascular decompression for trigeminal neuralgia in the elderly

2011 ◽  
Vol 115 (2) ◽  
pp. 202-209 ◽  
Author(s):  
Anand I. Rughani ◽  
Travis M. Dumont ◽  
Chih-Ta Lin ◽  
Bruce I. Tranmer ◽  
Michael A. Horgan
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
Microvascular Decompression ◽  
Older Patients ◽  
The Elderly ◽  
Hospital Charges ◽  
National Database ◽  
Wound Complications ◽  
Total Hospital ◽  
Large National Database

Object Microvascular decompression (MVD) offers an effective and durable treatment for patients suffering from trigeminal neuralgia (TN). Because the disorder has a tendency to occur in older persons, the risks of surgical treatment in the elderly have been a topic of recent interest. To date, evidence derived from several small retrospective and a single prospective case series has suggested that age does not increase the complication rate associated with surgery. Using a large national database, the authors aimed to study the impact of age on in-hospital complications following MVD for TN. Methods Using the Nationwide Inpatient Sample (NIS) for the 10-year period from 1999 to 2008, the authors selected all patients who underwent MVD for TN. The primary outcome of interest was the in-hospital mortality rate. Secondary outcomes of interest were cardiac, pulmonary, thromboembolic, cerebrovascular, and wound complications as well as the duration of hospital stay, total hospital charges, and discharge location. An elderly cohort of patients was first defined as those 65 years of age and older and then redefined as those 75 years and older. Results A total of 3273 patients who underwent MVD for TN were identified, having a median age of 57 years. Within this sample, 31.5% were 65 years and older and 10.7% were 75 years and older. The in-hospital mortality rate was 0.68% for patients 65 years or older (p = 0.0087) and 1.16% for those 75 years or older (p = 0.0026). In patients younger than 65 years, the in-hospital mortality rate was 0.13% (3 deaths among 2241 patients). As analyzed using the chi-square test (for both 65 and 75 years as the age cutoff) and the Pearson rank correlation coefficient, the risk of cardiac, pulmonary, thromboembolic, and cerebrovascular complications was higher in older patients (that is, those 65 and older and those 75 and older), but the risks of wound complications and CNS infection were not. The risk of any in-hospital complication occurring in a patient 65 years and older was 7.36% (p < 0.0001) and 10.0% in those 75 years and older (p < 0.0001). There was no difference in the total hospital charges associated with age. The duration of the hospital stay was longer in older patients, and the likelihood of discharge home was lower in older patients. Conclusions Microvascular decompression for TN in the elderly population remains a reasonable surgical option. However, based on data from a large national database, authors of the present study suggest that complications do tend to gradually increase in tandem with an advanced age. While age does not act as a risk factor in isolation, it may serve as a convenient surrogate for complication rates. The authors hope that this information can be of use in guiding older patients through decisions for the surgical treatment of TN.

scholarly journals Atrial fibrillation and COVID-19 in older patients: a complex, dangerous, association. An analysis of the GeroCovid Registry

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
S Fumagalli ◽  
G Pelagalli ◽  
C Trevisan ◽  
S Del Signore ◽  
S Volpato ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Renal Failure ◽  
Chronic Renal Failure ◽  
Hospital Mortality ◽  
Peripheral Artery Disease ◽  
Older Patients ◽  
Cardiac Diseases ◽  
Peripheral Artery ◽  
Artery Disease

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf the GeroCovid Investigators Introduction. Atrial fibrillation (AF) is the most frequent arrhythmia diagnosed in elderly patients. It often associates with disabling complications, such as stroke and systemic embolism. COVID-19 severely affects older subjects, who show a particularly high mortality, often related to relevant alterations in coagulation and inflammation cascade.  Purpose. Aim of this study was to evaluate how the presence of a prevalent form of AF (at admission or in clinical history) influenced the clinical course of COVID-19 in an aged in-hospital population. Methods. We studied the acute patients included in GeroCovid, a multicenter retrospective-prospective registry designed by the Italian Society of Gerontology and Geriatric Medicine and the Norwegian Geriatrics Society. GeroCovid, independently of the healthcare setting and without exclusion criteria, enrolled subjects aged &gt;60 years to analyze risk factors, signs, symptoms and outcomes of COVID-19 in older people. For the purpose of this study, only the acute, in-hospital, cohort was evaluated. Results. Between March 1st and June 6th 2020, 2474 patients were enrolled in GeroCovid. Of these, 806 (32.6%) were assisted in hospital, for an acute condition (age: 79 ± 9 years; men: 51.7%). The prevalence of AF was 21.8%. Patients with the arrhythmia were older (82 ± 8 vs. 77 ± 9 years; p &lt; 0.001) and with a higher CHA2DS2-VASc score (4.1 ± 1.5 vs. 3.2 ± 1.5; p &lt; 0.001). The prevalence of almost all comorbidities was higher in AF patients (in particular, hypertension, cardiac diseases, diabetes, heart failure, peripheral artery disease, chronic renal failure, COPD, stroke, obesity). At multivariable analysis, advanced age (p = 0.010), an increased number of white blood cells (p = 0.031), the presence of cardiac diseases (p &lt; 0.001), peripheral artery disease (p = 0.030) and of signs or symptoms of heart failure (p = 0.003) characterized older patients with AF. In-hospital mortality was significantly higher in patients with the arrhythmia (36.9 vs. 27.5%; OR = 1.55, 95%CI = 1.09-2.20; p = 0.015). A multivariable logistic regression model showed that AF was an independent predictor of mortality (p = 0.021), such as male gender (p = 0.014) and the presence of peripheral artery disease (p = 0.003). COPD, stroke, chronic renal failure, diabetes and obesity were deleted from the final model. Conclusions. AF is frequently observed in older patients with COVID-19. Subjects with both conditions have a more complex clinical status and show a higher in-hospital mortality, thus requesting a particularly careful and intensive management.

scholarly journals The clinical features and prognosis of infective endocarditis in the elderly from 2007-2016 in a tertiary hospital in China

2019 ◽  
Author(s):  
Zhenzhu Wu ◽  
Yi Chen ◽  
Tingting Xiao ◽  
Tianshui Niu ◽  
Qingyi Shi ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Infective Endocarditis ◽  
Renal Insufficiency ◽  
Hospital Mortality ◽  
Older Patients ◽  
The Elderly ◽  
Tertiary Hospital ◽  
Old Patients ◽  
Younger Patients ◽  
One Year

Abstract Background Infective endocarditis (IE) is a serious disease, with a worse prognosis in the elderly. Aims To explore the clinical features and prognosis of old patients with IE in a tertiary hospital. Methods A retrospective cohort study was conducted. A total of 407 patients diagnosed as IE were divided into two groups: 348 patients under 65 years old and 59 patients over 65 years old. Results For older patients, clinical symptoms such as fever, anemia, and heart murmur were as common as in younger patients. Comorbidities like hypertension (P＜0.001) and diabetes (P=0.023) were more common in older patients. Complications like renal insufficiency (P=0.027) and arrhythmia (P＜0.001) were also more common in older patients. The old patients had a lower operation rate (40.7% vs 60.6%, P=0.004) and higher in-hospital mortality (20.3% vs 8.9%, P=0.008) compared with the younger patients. Pitt score ≥4 (P=0.043, OR=28.0, 95% CI 1.1-700.4) and renal insufficiency (P=0.011, OR=34.2, 95% CI 2.2-521.2) were independent risk factors of in-hospital mortality for older patients. Surgical treatment was a significant predictor of one-year mortality even after adjusting for the confounders (HR = 1.722, 95% CI 0.563-5.365, P = 0.005).The one-year survival rate was higher for older patients with surgical intervention than those without (95.8% vs 68.6%, P=0.007). Conclusions IE in older patients present with more comorbidities and complications as well as a higher mortality than younger patients. Surgery were underused in old patients and old patients with surgical treatment had better long-term prognosis.

scholarly journals Predictors of In-Hospital Mortality in Older Patients With COVID-19: The COVIDAge Study

2020 ◽  
Vol 21 (11) ◽  
pp. 1546-1554.e3 ◽  
Author(s):  
Aline Mendes ◽  
Christine Serratrice ◽  
François R. Herrmann ◽  
Laurence Genton ◽  
Samuel Périvier ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Older Patients
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