ABSTRACT
Objective To explore the predictive value of pre-operative comprehensive geriatric assessment(CGA),especially regarding frailty,on the outcomes of fast-track surgery and the risk of post-operative complications after elective laparoscopic surgery in geriatric patients. Methods This prospective study included 75 patients aged 70 years and above undergoing elective laparoscopic surgery from June 2015 to October 2015.CGA was conducted with length of postoperative hospitalization,all-cause mortality and postoperative complications as the endpoints. Results The mean length of hospital stay after surgery was 9.7 day(9.7 ± 7.3)and was correlated with frailty scores(P=0.015)and comorbidities(P= 0.004).Multivariate Logistic regression analysis showed that frailty(OR=5.26,95% CI:1.22-22.55,P=0.025)and comorbidity(OR=5.12,95% CI:1.63-15.99,P=0.005)were predictors of prolonged hospitalization after surgery.Seventeen of 75 patients (22.7%)experienced at least one adverse postoperative outcome,and bivariate analysis showed that adverse events were correlated with poor nutrition(P= 0.012),high frailty scores(P=0.007),and multiple comorbidities(P= 0.005).Furthermore,multiple regression analysis identified malnutrition (OR= 4.30,95% CI:1.03-17.86,P= 0.045),comorbidity(OR= 5.41,95% CI:1.47-19.83,P=0.011)and frailty(OR=6.03,95% CI:1.39-26.10,P=0.016)as predictors of adverse postoperative outcomes. Conclusions Frailty is a risk factor for elderly patients undergone fast-track laparoscopic surgery,and preoperative CGA scores may be used to identify high-risk patients for adverse surgical outcomes and prolonged hospital stay.
ABSTRACT
Objective To compare the clinical effect of proximal femoral nail anti-rotation(PFNA) and dynamic hip screw(DHS) internal fixation in the treatment of femoral intertrochanteric fracture.Methods 80 patients with femoral intertrochanteric fracture were selected as research subjects.They were divided into PFNA group and DHS group by random number table,40 cases in each group.The operation time,intraoperative blood loss,postoperative wound drainage,postoperative weight-bearing time,healing time,complication rate,Harris hip function score between two groups were compared.Results The operation time of the PFNA group was lower than that of DHS group(t=22.66,P＜0.05),the amount of bleeding in operation was less than that in the DHS group(t=54.85,P＜0.05),the postoperative wound drainage volume was less than that of the DHS group(t=16.85,P＜0.05),the weight-bearing time after operation was shorter than that in the DHS group(t=20.18,P＜0.05),and the healing time was shorter than that in the DHS group(t=22.00,P＜0.05).The excellence rate of Harris hip function score in the PFNA group was 95.00％,which was significantly higher than 80.00％ in the DHS group,the difference was statistically significant(χ2=4.11,P＜0.05).The incidence rate of complication of the PFNA group was 7.50％,which was significantly lower than 25.00％ of the DHS group(χ2=4.50,P＜0.05).Conclusion Compared with DHS,PFNA internal fixation has the advantages of less operation time,less intraoperative blood loss,shorter healing time and low complication rate in the treatment of femoral intertrochanteric fracture.It is worthy to be promoted clinically.
ABSTRACT
Objective To observe the changes of carotid intima-media thickness(CIMT) and vascular endothelia function in patients with geriatric carotid plaque before and after intensive lipid lowering was performed.Methods 102 patients diagnosed with carotid plaque were ramdomly divided into common group (atorvastatin 10 mg/d,n=48) and intensive lipid lowering group (atorvastatin 20 mg/d,n=54).After one year of treatment,the fasting venous blood total cholesterol (TC),low density lipoprotein cholesterol (LDL-C),high density lipeprotein cholesterol (HDL-C) and triglyceride (TG) were assayed,and the thickest and thinnest CIMT and brachial arterial.endothelium dependent diastolic function (FMD) and carotid artery plaque index(PI) were measured by ultrasound.Results Two groups in the thickest CIMT and PI had no significant difference before and after treatment (P＞0.05).The levels of FMD,TC,LDL-C,TG and the thinnest CIMT had significant difference before and after therapy [common group:GIMT(0.85±0.20)mm,(0.83±0.22) mm,FMD(3.85±1.41)%,(7.91±1.05)%,TC(6.46±1.05) mmol/L,(4.82±1.26) mmol/L,LDL-C (4.71±1.00) mmol/L,(3.16±1.00) mmol/L,TG (1.55±0.45) mmol/L,(1.49±0.44) mmol/L;intensive lipid lowering group:CIMT(0.84±0.20) mm,(0.63±0.17) mm,FMD (3.74±1.38) %,(0.25±1.58)%,TC (6.36±1.06) mmol/L,(4.10±1.00) mmol/L,LDL-C (4.73±1.01) mmol/L、(2.28±1.26) mmol/L,TG (1.56±0.53) mmol/L,(1.50±0.49) mmol/L,P＜0.05].After one year's therapy,the difference in intensive lipid lowering group was more obvious than in common group (P＜0.05).Conclusions Intensive lipid lowering therapy is more effective to decrease TC,LDL-C and CIMT and to improve the vascular endothelia function.Atorvastatin is effective to stabilize the plaque and to retard the atheroscleresis development.