scholarly journals Prevalence of undiagnosed mild cognitive impairment in elderly patients undergoing thoracic surgery and its relationship with postoperative outcome: a prospective cohort study

2019 ◽  
Author(s):  
chaoyang tong ◽  
dehua wu ◽  
yaofeng shen ◽  
meiying Xu
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Thoracic Surgery ◽  
Postoperative Outcome ◽  
Hospital Length ◽  
Pulmonary Complications ◽  
Hospital Length Of Stay ◽  
Moca Score

Abstract Background The prevalence of undiagnosed mild cognitive impairment (MCI) in elderly patients scheduled for thoracic surgery and its association with adverse clinical outcomes is still unproven. Methods We enrolled 170 patients 65 year of age or older who were scheduled for thoracic surgery. 82 males and 88 females with ASA grade II-III. All the elderly patients were tested with Chinese modified version of MoCA preoperatively. According to the test results, they were divided into two groups: group N (MoCA score>25) and group AN (MoCA score≤25). Outcomes included the hospital length of stay (primary outcome), the length of stay in patients with PPCs (LOS-PPCs), the pulmonary complications (atelectasis, pulmonary infection, respiratory failure) and other complications (blood transfusion, chylothorax, new arrhythmia, myocardial infarction and acute cerebral infarction) (secondary outcomes). Data were analyzed using univariate and multivariate analyses. Results Seventy-four of 154 (49%) patients screened positive for probable mild cognitive impairment (MoCA ≤ 25) in the final analyses. The hospital length of stay and LOS-PPCs in elderly patients with mild cognitive impairment preoperatively were significantly longer than those with group N (P<0.05). Multivariate stepwise regression showed that preoperative MCI was an independent risk factor for prolonging the hospital length of stay and LOS-PPCs. Patients with a MoCA score less than or equal to 25 were more likely to have a longer hospital length of stay (OR = 2.355, 95% CI =1.137 to 4.877, P=0.021) and LOS-PPCs (OR = 6.867, 95% CI =1.116 to 42.257, P=0.038), but not related to increase the incidence of postoperative pulmonary complications (OR = 0.955, 95% CI =0.280 to 3.254, P=0.941) and other complications (OR = 1.687, 95% CI =0.502 to 5.665, P=0.398) compared to those with a MoCA score greater than 25. Conclusions The prevalence of undiagnosed probably mild cognitive impairment among elderly patients scheduled for thoracic surgery is high (49%). Such impairment is associated with a longer hospital stay and LOS-PPCs, while it is not possible to conclude that it is related to the incidence of pulmonary complications and other complications after surgery.

Outcomes of Recreational Activity-Associated Trauma in Elderly Persons on Blood-Thinning Medications

2017 ◽  
Vol 83 (4) ◽  
pp. 371-376 ◽  
Author(s):  
Zachary M. Deboard ◽  
Jonathan Grotts ◽  
Lisa Ferrigno
Keyword(s):  
Deep Vein Thrombosis ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Odds Ratio ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Elderly Persons ◽  
Recreational Activities ◽  
Vein Thrombosis ◽  
Deep Vein

With increasing life expectancy, the elderly are participating in recreational activities traditionally pursued by younger persons. Elderly patients have many reasons for worse outcomes after trauma, one of which may be the rising use of anticoagulant and/or antiplatelet medications. This study aimed to determine whether preinjury use of these agents yielded worse outcomes in geriatric patients injured during high-impact recreational activities. The National Trauma Data Bank was reviewed from 2007 to 2010 for patients ≥65 years admitted to Level I or II trauma centers with ICD-9 E-codes for specific mechanisms of injury. These included motorcycles, bicycles, snowmobiles, all-terrain vehicles, equestrian, water and alpine skiing, snowboarding, and others. Patients with preinjury bleeding disorder (BD), including warfarin and clopidogrel use, were compared with controls via a coarsened exact matching analysis. BD patients (294) were compared with 3929 controls. Although increased in BD patients, no significant mortality differences were observed in unmatched or matched analyses. BD patients yielded greater hospital length of stay (5 vs 4 days, P = 0.020) with increased odds of receiving five units or more of blood (7.0% vs 2.1%, odds ratio = 4.7, P < 0.001) and of deep vein thrombosis (7.6% vs 3.8%, odds ratio = 2.1, P = 0.018). Elderly patients with BD, including warfarin or clopidogrel use, do not seem to have significantly increased mortality after injury during specified recreational activities. BD patients had greater hospital length of stay, transfusion requirements, and deep vein thrombosis rates. These findings may inform counseling for those taking such medications as to the potential for adverse outcomes.

Use of Multicompartment Compliance Aids for Elderly Patients: Patient Viewpoints and Hospital Length of Stay

2010 ◽  
Vol 122 (4) ◽  
pp. 186-191 ◽  
Author(s):  
Siobhan H. M. Brown ◽  
Umbreen Hafeez ◽  
Ahmed H. Abdelhafiz
Keyword(s):  
Length Of Stay ◽  
Elderly Patients ◽  
Hospital Length ◽  
Hospital Length Of Stay

scholarly journals Sugammadex is associated with shorter hospital length of stay after open lobectomy for lung cancer: a retrospective observational study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Seung Won Song ◽  
Kyung Yeon Yoo ◽  
Yong Sung Ro ◽  
Taehee Pyeon ◽  
Hong-Beom Bae ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Postoperative Complications ◽  
Length Of Stay ◽  
Hospital Length ◽  
Pulmonary Complications ◽  
Hospital Length Of Stay ◽  
Research Information ◽  
Significant Difference ◽  
Open Lobectomy

Abstract Background Sugammadex is associated with few postoperative complications. Postoperative pulmonary complications (PPC) are related to prolonged hospitalizations. Present study explored whether the use of sugammadex could reduce PPCs and thereby reduce hospital length of stay (LOS) after lung surgery. Methods We reviewed the medical records of patients who underwent elective open lobectomy for lung cancer from January 2010 to December 2015. Patients were divided into the sugammadex group and pyridostigmine group. The primary outcome was hospital LOS and secondary outcomes were postoperative complications and overall survival at 1 year. The cohort was subdivided into patients with and without prolonged LOS to explore the effects of sugammadex on outcomes in each group. Risk factors for LOS were determined via multivariate analyses. After propensity score matching, 127 patients were assigned to each group. Results Median hospital LOS was shorter (10.0 vs. 12.0 days) and the incidence of postoperative atelectasis was lower (18.1 vs. 29.9%) in the sugammadex group. However, no significant difference in overall survival between the groups was seen over 1 year (hazard ratio, 0.967; 95% confidence interval, 0.363 to 2.577). Sugammadex was a predictor related to LOS (exponential coefficient 0.88; 95% CI 0.82–0.95). Conclusions Our data suggest that sugammadex is a preferable agent for neuromuscular blockade (NMB) reversal than cholinesterase inhibitors in this patient population. Trial registration This study registered in the Clinical Research Information Service of the Korea National Institute of Health (approval number: KCT0004735, Date of registration: 21 January 2020, Retrospectively registered).

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