Factores que afectan la mortalidad y la morbilidad en cirugía abdominal urgente en pacientes geriátricos |
Factors affecting mortality and morbidity in emergency abdominal surgery in geriatric patients.
Ozkan E, Fersahoğlu MM, Dulundu E, Ozel Y, Yıldız MK, Topaloğlu U.
Ulus Travma Acil Cerrahi Derg. 2010 Sep;16(5):439-44.
Abstract
BACKGROUND: The purpose of the present study was to determine the factors affecting morbidity and mortality in geriatric patients undergoing abdominal surgery. METHODS: Ninety-two patients who had undergone acute abdominal surgery at >65 years of age were evaluated in terms of surgical indications, morbidity and mortality rates and the factors affecting morbidity and mortality. Forty-eight patients (52.2%) were males and 44 (47.8%) were females. The mean age was 73.32±6.37 (65-92) years. RESULTS: The most common surgical indication was acute cholecystitis (26.09%). Morbidity was established as 21 (22.82%) and mortality as 14 (15.21%), and the most common cause of mortality was mesenteric vascular occlusion. American Society of Anesthesiology (ASA) IV was noted in 90.05% of the patients admitted to intensive care, and 92.85% of the patients had mortal progression. The mean hospitalization duration was 7.94±7.13 days (median, 7 days). While older age and high ASA scores were significantly correlated with morbidity, mortality and duration of hospitalization, gender was not (p>0.05). CONCLUSION: In order to decrease the postoperative mortality rate in geriatric patients, precaution should be taken beforehand to avoid surgical complications. By carrying out elective surgery in geriatric patients, the likelihood of common causes of acute abdomen, such as acute cholecystitis and incarcerated hernia, can be reduced.
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| El concepto reciente de la función cardiaca en pacientes ancianos |
The Recent Concept of Heart Function in Elderly Patients
Ryotaro Wake, Hidetaka Iida, Shinichi Shimodozono, Yukio Yamada, Takanori
Kusuyama, Hiroaki Takeshita and Minoru Yoshiyama1
Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Osaka, Japan.
Department of Cardiology, Tsukazaki Hospital, Hyogo, Japan.
Clinical Medicine: Geriatrics 2009:3; 9-11
Abstract:
An epidemic increase in heart failure (HF) mortality, hospitalization, and prevalence rates has been observed among older persons associated with increased an incidence and improved survival in recent years, in spite of a decrease in coronary artery and cerebrovascular disease mortality. Importantly, increases in HF mortality and morbidity rates were confined to the population over 65 years of age in the Framingham study. In contrast to middle-aged patients with HF, factors other than left ventricular (LV) systolic dysfunction contribute to HF in older patients. Epidemiological studies have established that 40 to 80 percent of older patients with heart failure, despite preserved ejection fraction without valve disease, are attributed to LV diastolic dysfunction.
Keyword: geriatrics, elderly person, diastolic heart function, heart failure
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| ¿Hay un límite de edad para la cirugía cardiaca? |
Is there an Age Limit for Cardiac Surgery?
Malakh Shrestha, Nawid Khaladj, Hassina Baraki, Axel Haverich and Christian Hagl
Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School,
Hannover, Germany.
Clinical Medicine: Geriatrics 2008:2 31-33
Abstract
Introduction: This study was undertaken to analyze the risk of peri-operative mortality and morbidity after Cardiac Surgery with Cardio-pulmonary Bypass (CPB) in Patients above 85 years of age. Patients and Methods: Between 1/2001 and 05/2005 thirty-nine patients 85 years of age at the time of surgery were examined. Median age was 87 years (85-92), 13 were males and 26 were females. 11 (28%) were urgent cases, and 4 (10%) considered as emergencies. 12 (32.5%) received CABG, 14 (35%) aortic valve replacement and in 10 (25%) a combination of the both was performed. The remaining had a combination of CABG with other operations. Results: Peri-operative mortality was 7.7% (3 pts). All were in the emergency group. One of them went into the OR under cardio-pulmonary resuscitation and died in the OR. The other two were urgent cases who died later in the ICU due to cardiac failure. Temporary neurological dysfunction (TND) was found in 10.3% (4 pts) of the survivers. Mean mechanical ventilation time was 1.5 days, mean ICU stay was 3 days and mean hospital stay 9 days. Conclusion: Cardiac surgery with CPB in Octogenarians can be performed with an acceptable mortality in elective patients, but is associated with a dismal outcome under emergency conditions.
Keywords: coronary bypass surgery, cardiac valve surgery, octogenarians
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