Objective To evaluate the effect of frailty on postoperative complications in elderly patients with esophageal cancer.Methods We enrolled the patients aged≥65 years and with esophageal cancer who underwent surgical treatment in Shanghai Chest Hospital in 2021. The modified frailty index (mFI) was calculated and the patients were divided into a non-frailty group and a frailty group. The primary outcomes were the incidence of postoperative pulmonary infection, arrhythmia, anastomotic fistula and chylothorax complications. Secondary outcomes were the time of extubation, the rate of unplanned re-intubation, the length of ICU stay, hospital stay, rate of readmission within 30 days after discharge and the mortality within 30 days after operation.Results Finally 607 patients were collected. There were 273 patients in the non-frailty group and 334 patients in the frailty group. The non-frailty group had lower rates of complications including pulmonary infection (5.5% vs. 13.5%), arrhythmia (3.7% vs. 9.3%), anastomotic fistula (2.9% vs. 7.5%), and shorter ICU stay [2.0 (0.0, 4.0) d vs. 4.0 (1.0, 6.0) d] and in-hospital stay [11.5 (9.5, 13.0) d vs. 13.0 (11.0, 18.0) d],lower rates of the readmission within 30 days (2.9% vs. 6.6%) and the mortality within 30 days (0.4% vs. 1.2%) compared with the frailty group (P<0.05).Conclusion Frail elderly patients with esophageal cancer have higher rates of postoperative complications. mFI can be used as an objective index to identify high-risk elderly patients with esophageal cancer.
ObjectiveTo investigate the clinical value of prophylactic high-flow nasal cannula oxygen therapy (HFNC) in reducing postoperative pulmonary complication (PPC) in elderly patients with non-small cell lung cancer (NSCLC). Methods The clinical data of elderly patients (over 60 years) with NSCLC who underwent video-assisted thoracoscopic lobectomy or segmental resection at the Department of Thoracic Surgery, Fujian Provincial Hospital from January 2021 to March 2022 were retrospectively analyzed. According to whether receiving HFNC after surgery, they were divided into a conventional oxygen therapy (CO) group and a HFNC group. The CO group were matched with the HFNC group by the propensity score matching method at a ratio of 1 : 1. We compared PPC incidence, white blood cell (WBC) count, procalcitonin and C-reactive protein on postoperative day (POD) 1, 3 and 5 and postoperative hospital stay between the two groups. ResultsA total of 343 patients (165 males, 178 females, average age of 67.25±4.79 years) were enrolled, with 53 (15.45%) receiving HFNC. Before matching, there were statistical differences in gender, rate of combined chronic obstructive pulmonary disease, pathology type and TNM stage between the two groups (all P<0.05). There were 42 patients successfully matched in each of the two groups, with no statistical difference in baseline characteristics (P>0.05). After propensity score matching, the results showed that the PPC incidence in the HFNC group was lower than that in the CO group (23.81% vs. 45.23%, P=0.039). WBC count on POD 3 and 5 and procalcitonin level on POD 3 were less or lower in the HFNC group than those in the CO group [ (8.92±2.91)×109/L vs. (10.62±2.67)×109/L; (7.68±1.58)×109/L vs. (8.86±1.76)×109/L; 0.26 (0.25, 0.44) μg/L vs. 0.31 (0.25, 0.86) μg/L; all P<0.05]. There was no statistical difference in the other inflammatory indexes or the postoperative hospital stay between the two groups (P>0.05). Conclusion Prophylactic HFNC can reduce the PPC incidence and postoperative inflammatory indexes in elderly patients with NSCLC, but does not shorten the postoperative hospital stay.
ObjectiveTo evaluate the feasibility and safety of da Vinci robotic surgery for elderly patients with radical surgery of lung cancer.MethodsWe retrospectively analyzed the clinical data of 59 patients aged over 70 years who underwent radical surgery of lung cancer in our hospital between 2016 and 2019. These patients were divided into two groups including a da Vinci robot group and a single-utility port video-assisted thoracoscopic surgery (VATS) group according to the patients’ selection of the treatments. There were 32 patients with 20 males and 12 females aged 73.1±2.3 years in the da Vinci robot group and 27 patients with 16 males and 11 females aged 71.2±1.3 years in the VATS group. The clinical data of the two groups were compared.ResultsThere was no statistical difference in surgery time between the two groups (t=–0.341, P=0.484). Compared with the VATS group, the da Vinci robot group had more number of lymph nodes dissected (t=1.635, P=0.015), less intraoperative blood loss (t=–2.569, P <0.001), less postoperative drainage amount within 3 days after surgery (t=–6.325, P=0.045), lower visual analogue scale (VAS) scores at postoperative 3rd day (t=–7.214, P=0.021).ConclusionThe da Vinci robot system is safe and efficient in the treatment for elderly patients with radical surgery of lung cancer with less trauma.
Objective To compare the effectiveness of internal fixation, hemiarthroplasty, and total hip arthroplasty in the treatment of displaced femoral neck fractures in elderly patients so as to provide the evidence for the selection of therapeutic methods. Methods Between May 2005 and April 2008, 108 elderly patients with displaced femoral neck fractures were treated by internal fixation with compression screw (IF group, n=31), hemiarthroplasty (HA group, n=37), and total hiparthroplasty (THA group, n=40). In IF group, there were 8 males and 23 females with an average age of 73 years (range, 65-80 years); fractures were caused by tumbl ing (25 cases) and traffic accident (6 cases), including 17 cases of Garden type III and 14 cases of Garden type IV; and the time from injury to operation ranged from 8 hours to 13 days with an average of 4.2 days. In HA group, there were 10 males and 27 females with an average age of 74 years (range, 65-80 years); fractures were caused by tumbl ing (29 cases) and traffic accident (8 cases), including 21 cases of Garden type III and 16 cases of Garden type IV; and the time from injury to operation ranged from 1 to 14 days with an average of 4.4 days. In THA group, there were 11 males and 29 females with an average age of 73 years (range, 66-80 years); fractures were caused by tumbl ing (32 cases) and traffic accident (8 cases), including 23 cases of Garden type III and 17 cases of Garden type IV; and the time from injury to operation ranged from 2 to 14 days with an average of 5.6 days. There was no significant difference in general data among 3 groups (P gt; 0.05). Results There were significant differences in operation time and blood loss among 3 groups (P lt; 0.05), and IF group was less than other 2 groups. All patients were followed up 1 year and 4 months to 2 years and 3 months with an average of 1 year and 8 months. In IF group, HA group, and THA group, the rates of early postoperative compl ications were 19.4% (6/31), 8.1% (3/37), and 7.5% (3/40), respectively; the rates of late postoperative compl ications were 29.0% (9/31), 13.5% (5/37), and 7.5% (3/40), respectively; and the reoperation rates were 29.0% (9/31), 10.8% (4/37), and 5.0% (2/40), respectively. The rates of the early postoperative compl ication, late postoperative compl ication, and reoperation rate were significantly higher in IF group than in HA group and THA group (P lt; 0.05), but there was no significant difference between HA group and THA group (P gt; 0.05). The mortal ity rates were 16.1% (5/31), 13.5% (5/37), and 15.0% (6/40) in IF group, HA group, and THA group, respectively; showing no significant difference (P gt; 0.05). According to Harris hip score, the excellent and good rates were 65.4% (17/26), 81.3% (26/32), and 85.3% (29/34) in IF group, HA group, and THA group, respectively; showing significant differences among 3 groups (P lt; 0.05). Conclusion According to patient’s age, l ife expectancy, and general conditions, THA is a reasonable choice for the patients aged 65-80 years with displaced femoral neck fracture.
ObjectiveTo evaluate the safety and efficacy of mitral valve surgery and cryoablation in elderly patients with mitral valve disease and persistent or long-term persistent atrial fibrillation.MethodsFrom May 2014 to July 2018, 144 patients with mitral valve diseases combined with persistent or long-term persistent atrial fibrillation in the Department of Cardiothoracic Surgery, General Hospital of Northern Theater Command were selected. Among them, there were 69 patients in a non-elderly group (<60 years) including 18 males and 51 females aged 52.07±5.56 years, and 75 patients in an elderly group (≥60 years) including 32 males and 43 females aged 65.23±4.29 years. A propensity-score matching (PSM) study was conducted to eliminate confounding factors. Both groups underwent mitral valve surgery and cryoablation at the same time. A 2-year follow-up was conducted after discharge from the hospital, and the perioperative and postoperative efficacy indexes were compared between the two groups.ResultsAfter PSM analysis, there were 56 patients in each group. The sinus rhythm conversion rate of the two groups at each follow-up time point was above 85%, and the cardiac function was graded asⅠorⅡ, which was significantly improved compared with that before the surgery, but there was no statistical difference between the two groups (P>0.05). Among the perioperative indicators of the two groups, the elderly group had more coronary artery bypass graft surgeries and longer postoperative ICU stay time compared with the non-elderly group (P<0.05), and the differences in other indicators were not statistically different (P>0.05).ConclusionThe mitral valve surgery and cryoablation in elderly patients with mitral valve diseases combined with persistent or long-term persistent atrial fibrillation are safe, and the short-term outcome is satisfactory.
Objective To investigate the difference in the effectiveness between proximal femoral nail anti-rotation (PFNA) and proximal femoral locking compression plate (PFLCP) for intertrochanteric fracture in elderly patients combined with hemiplegia due to cerebral infarction. Methods The clinical data of 67 cases of intertrochanteric femoral fractures combined with hemiplegia due to cerebral infarction between October 2013 and January 2017 were retrospectively analyzed. Among them, 32 cases were treated with PFNA internal fixation (PFNA group), and 35 cases were treated with PFLCP internal fixation (PFLCP group). There was no significant difference in gender, age, injury side, modified Evans classification of fracture, preoperative medical disease, and interval from injury to operation between 2 groups (P>0.05). The operation time, intraoperative blood loss, postoperative bed time, incidence of perioperative complications, time of fracture healing, and hip Harris score at 6 months and 1 year after operation were recorded and compared. Results Both groups were followed up 12-24 months with an average of 14 months. Compared with the PFLCP group, the PFNA group had shorter operation time, less intraoperative blood loss, and shorter bed time, and the differences were significant (P<0.05). X-ray films showed that the fractures healed in both groups. The fracture healing time of the PFNA group was shorter than that of the PFLCP group, but the difference was not significant (t=0.743, P=0.460). During hospitalization, there were 3 cases of pulmonary infection, 2 cases of deep venous thrombosis of lower limbs, and 1 case of urinary tract infection in the PFNA group; and the incidence of perioperative complications was 18.8% (6/32). There were 4 cases of pulmonary infection, 6 cases of deep venous thrombosis of lower limbs, 1 case of recurrent cerebral infarction, and 1 case of stress ulcer in the PFLCP group; and the incidence of perioperative complications was 34.3% (12/35). There was no significant difference in the incidence of perioperative complications between 2 groups (χ2=2.053, P=0.152). At 6 months after operation, the Harris total score and individual scores in the PFNA group were higher than those in the PFLCP group (P<0.05). At 1 year after operation, there was no significant difference in the Harris total score and pain score, life ability score, and walking ability score between the PFNA group and the PFLCP group (P>0.05); However, the joint deformity and activity score of the PFNA group was significantly better than that of the PFLCP group (t=4.112, P=0.000). Conclusion For intertrochanteric fracture in elderly patients with cerebral infarction hemiplegia, the PFNA has shorter operative time, less intraoperative blood loss, shorter bed time after operation, and better short-term hip function when compared with the PFLCP.
ObjectiveTo investigate the clinical effect of Maze Ⅳ in the treatment of elderly patients with valvular heart disease and persistent atrial fibrillation (AF).MethodsWe retrospectively analyzed the clinical data of 78 elderly patients with cardiac valve disease combined with persistent AF in our hospital from 2017 to 2018. The patients were allocated to two groups including a trial group (n=37) and a control group (n=41). There were 21 males and 16 females aged 61 to 74 (65.2±2.5) years in the trial group. There were 23 males and 18 females aged 62 to 76 (64.8±3.3) years in the control group. The clinical effects of the two groups were compared.ResultsThere was no statistical difference in baseline data between the two groups (P>0.05). The aortic occlusion time, extracorporeal circulation time, and operation time of the trial group were longer than those of the control group with statistical differences (P<0.05). There was no statistical difference in postoperative ventilator assistance time, complication rate, mortality, ICU retention time, perioperative drainage, red blood cell transfusion volume, or length of hospital stay between the two groups (P>0.05). At the time of discharge, postoperaive 1-month, 3-month, 6-month, and 12-month, the maintenance rates of sinus rhythm in the control group were statistically different from those of the trial group (P<0.05). Compared with the control group, left atrial diameter, left ventricular end diastolic diameter and the decrease of pulmonary artery systolic blood pressure were statistically different (P<0.05).ConclusionMaze Ⅳ is safe and effective in the treatment of elderly patients with valvular heart disease and persistent AF, which is conducive to the recovery and maintenance of sinus rhythm, and is beneficial to the remodeling of the left atrium and left ventricle and the reduction of pulmonary systolic blood pressure with improvement of life quality of the patients.
ObjectiveTo compare the long-term prognosis of elderly patients with stageⅠnon-small cell lung cancer (NSCLC) after lobectomy or segmentectomy. MethodsData of elderly patients with stageⅠNSCLC between 2010 and 2020 were collected from the SEER database. According to the resection method, patients were divided into a lobectomy group and a segmentectomy group. The overall survival (OS) and lung cancer-specific survival (LCSS) of the two groups were compared by propensity score matching (lobectomy : segmentectomy=2 : 1). ResultsA total of 9990 patients were included, including 5840 (58.46%) females and 4150 (41.54%) males, with an average age of (70.48±6.47) years. Among them, 9029 patients were in the lobectomy group and 961 patients were in the segmentectomy group. After propensity score matching, a total of 2883 patients were matched, including 1 922 patients in the lobectomy group and 961 patients in the segmentectomy group. There was no statistical difference in baseline data between the two groups (P>0.05). The 10-year OS rate and LCSS rate of the lobectomy group were higher than those of the segmentectomy group (OS: 51.15% vs. 38.35%, P<0.01; LCSS: 79.68% vs. 71.52%, P<0.01). Subgroup analysis showed that the survival advantage of lobectomy was found in patients aged 60-<70 years and ≥80 years; for patients 70-<80 years, there was no statistical difference in OS or LCSS between the two surgical methods (P>0.05). In addition, for patients with tumor diameter ≤2 cm (stages ⅠA1-ⅠA2), lymph node dissection number≥10, and receiving adjuvant radiotherapy/chemotherapy, segmentectomy could also achieve a similar prognosis as lobectomy. ConclusionOverall, for elderly patients with stage ⅠNSCLC, lobectomy can achieve better OS and LCSS. However, individual differences, tumor characteristics, and perioperative treatment plans should be considered comprehensively to determine the surgical method for elderly patients with stageⅠNSCLC.
Objective To evaluate the clinical efficacy of coronary artery bypass grafting in the treatment of coronary artery disease patients aged over 70 years. Methods A total of 160 patients with coronary atherosclerotic heart disease underwent off-pump coronary artery bypass grafting from January 2013 to December 2017. There were 94 males and 66 females at age of 70–85 (76.67±2.33) years. Operations were performed by using sternal median incision with the assistance of local myocardial surface fixator and shunt plug, and the saphenous vein and internal mammary arterywere used as grafted vessels. Results All the patients were received successful off-pump coronary artery bypass grafting without death, and the cardiac function improved significantly. There were 62 patients with the internal mammary artery bridge and 98 patients with the whole vein bridge. All the patients were followed-up for 1 to 4 years. All the patients had obvious relief of angina pectoris. Conclusion Off-pump coronary artery bypass grafting for the treatment of elderly patients with coronary heart disease is an effective and safe operation, especially for patients with renal insufficiency, cerebrovascular disease, respiratory disease and severe left ventricular dysfunction.
Objective To investigate the effects of different ventilation modes on postoperative pulmonary complications in elderly patients undergoing abdominal surgery. Methods The patients who underwent upper abdominal surgery under general anesthesia in Chengdu Office Hospital of the People’s Government of Tibet Autonomous Region between February 2020 and February 2021 were selected. Patients were randomly divided into volume controlled ventilation (VCV) group, pressure controlled ventilation (PCV) group, and pressure controlled ventilation-volume guarantee (PCV-VG) group according to the random number table method. All the three groups adopted the internationally recognized lung protective ventilation strategy. The transcutaneous arterial oxygen saturation and respiratory mechanics indicators of three different time periods, as well as pulmonary symptoms and signs and laboratory imaging examinations 7 days after surgery were recorded. The incidence of postoperative pulmonary complications in the three groups of patients were evaluated using the Melbourne Group Scale Version 2. Results A total of 120 patients were included, with 40 in each group. There was no statistically significant difference in the general situation of the three groups of patients (P>0.05). The platform pressure and compliance of three different time periods all changed over time (P<0.05). There were statistically significant differences in the occurrence of pulmonary complications and hospital stay among the three groups 7 days after surgery (P<0.05). Conclusion Under the internationally recognized lung protective ventilation strategy, PCV-VG mode can significantly reduce the incidence of pulmonary complications 7 days after abdominal surgery, shorten the length of hospital stay, and improve the quality of life in elderly patients.