Procedural and long-term outcomes of elective endovascular abdominal aortic aneurysm repair in octogenarians / Resultados perioperatorios y a largo plazo de la reparación electiva endovascular del aneurisma de aorta abdominal en octogenarios

Abstract Objective: The aim of the study was to compare the immediate and long-term outcomes of endovascular aneurysm repair (EVAR) between patients under and over the age of 80 with abdominal aortic aneurysm (AAA). Methods: From 2011 to 2017, we conducted a retrospective cohort study with AAA patients who received elective EVAR. Primary outcomes included hospital mortality, length of stay, acute kidney injury, and the need for re-interventions. Secondary outcomes included aneurysm-related mortality, acute myocardial infarction, stroke, acute limb ischemia, and prolonged mechanical ventilation. Results: A total of 77 (62.6%) patients under the age of 80 years old and 46 (37.4%) octogenarians were included in the study. The male gender and AAA diameter did not differ among groups (92.2% vs. 82.6%, p = 0.11 and 5.4 cm [4.9-6.2 cm] vs. 5.4 cm [5-6 cm], p = 0.53, respectively). The younger patients had a higher prevalence of tobacco use (72.7% vs. 41.7%, p = 0.01). There were no deaths during the index hospitalization. The incidence of reinterventions (5.3% vs. 15.2%, p = 0.11) and acute kidney injury (14.3% vs. 23.9%, p = 0.18) did not differ between groups, but the length of stay was longer for octogenarian patients (3 days [2-4] vs. 2 days [2-3, p = 0.04]). Endoleaks were the most common cause for re-interventions (81.8%), with a prevalence of 34% across the entire cohort. There were no differences in any of the secondary outcomes between groups. Conclusion: In octogenarian patients with AAA, EVAR represents a safe procedure both during the index hospitalization and during long-term follow-up.

Resumen Objetivo: Comparar los resultados inmediatos y a largo plazo de la reparación endovascular del aneurisma de aorta abdominal (REVA) entre pacientes menores de 80 años y octogenarios. Método: Cohorte retrospectiva que incluyó pacientes con aneurisma de aorta abdominal (AAA) sometidos a REVA electiva desde 2011 hasta 2017. Se evaluaron como punto finales primarios la mortalidad hospitalaria, la duración de la estadía hospitalaria, la incidencia de insuficiencia renal aguda y el requerimiento de reintervenciones. Los puntos finales secundarios incluyeron la mortalidad asociada al aneurisma, infarto agudo de miocardio, accidente cerebrovascular, isquemia arterial aguda de las extremidades y ventilación mecánica prolongada. Resultados: Se incluyeron 77 (62.6%) pacientes menores de 80 años y 46 (37.4%) octogenarios. La prevalencia de sexo masculino y el diámetro del AAA no difirieron entre ambos grupos (92.2% vs. 82.6%, p = 0.11 y 5.4 cm [4.9-6.2 cm] vs. 5.4 cm [5-6 cm], p = 0.53, respectivamente). Los pacientes más jóvenes presentaron una mayor prevalencia de tabaquismo (72.7% vs. 41.7%, p = 0.01). No se registraron muertes durante la hospitalización índice. La incidencia de reintervenciones (5.3% vs. 15.2%, p = 0.11) e insuficiencia renal aguda (14.3% vs. 23.9%, p = 0.18) no difirieron entre ambos grupos, pero la estadía hospitalaria fue más prolongada en pacientes octogenarios (3 días [2-4 días] vs. 2 días [2-3 días], p = 0.04). La causa más frecuente de reintervenciones fue la presencia de endofugas (81.8%), con una prevalencia del 34% en toda la cohorte. No se observaron diferencias en ninguno de los puntos finales secundarios entre ambos grupos. Conclusión: En pacientes octogenarios con AAA, la REVA presentó un buen perfil de seguridad perioperatorio y a largo plazo.

Beneficios de la reparación artroscópica del manguito rotador en octogenarios. Análisis de resultados funcionales y complicaciones / Benefits of arthroscopic rotator cuff repair in octogenar ians. Analysis of functional results and complications

Resumen Introducción: Existe falta de información en la litera tura sobre los resultados de la reparación artroscópica del manguito rotador en pacientes mayores de 80 años. El objetivo de este estudio fue evaluar una serie conse cutiva de pacientes con rupturas del manguito rotador a los que se les realizó la reparación artroscópica del mismo. Métodos: Análisis retrospectivo de pacientes mayores de 80 años a quienes se les realizó reparación artroscó pica de manguito rotador entre junio de 2004 y enero de 2016. El seguimiento mínimo fue de 2 años. Para la evaluación funcional y del dolor se utilizaron las escalas Constant, Dash, UCLA y Escala Visual Análoga (EVA). Resultados: El seguimiento promedio fue de 8.4 años. Se obtuvieron mejoras significativas en la valoración del rango de movilidad y la evaluación de las escalas de Constant, Dash y UCLA, y EVA. No se registraron complicaciones mayores y solo 4 pacientes requirieron una re-operación. Conclusión: Los principales hallazgos obtenidos fue ron la mejoría funcional y del dolor en los pacientes mayores de 80 años operados por una ruptura completa del manguito rotador en forma artroscópica.

Abstract Introduction: There is a lack of information in the literature on the results of arthroscopic rotator cuff re pair in patients older than 80 years. The purpose of this study was to evaluate a consecutive series of patients with rotator cuff tears who underwent arthroscopic rotator cuff repair. Methods: Retrospective analysis of patients older than 80 years who underwent arthroscopic rotator cuff repair between June 2004 and January 2016. The mini mum follow-up was 2 years. For functional and pain assessment, the Constant, Dash, UCLA scale and Visual Analogue Scale (VAS) for pain were used. Results: The average follow-up was 8.4 years. Signifi cant improvements were obtained in the assessment of the range of motion and the evaluation of the Constant, Dash and UCLA scales, as well as in the VAS. No major complications were recorded and only 4 patients re quired a reoperation. Conclusion: The main findings obtained were func tional and pain improvement in patients over 80 years of age operated on for a complete arthroscopic rotator cuff tear.

Prevalence of non-communicable chronic diseases: arterial hypertension, diabetes mellitus, and associated risk factors in long-lived elderly people / Prevalencia de enfermedades crónicas no transmisibles: hipertensión arterial, diabetes mellitus y factores de riesgo asociados en ancianos longevos / Prevalência das doenças crônicas não transmissíveis: hipertensão arterial, diabetes mellitus e fatores de risco associados em pessoas idosas longevas

ABSTRACT Objective: To identify the prevalence of non-communicable chronic diseases: arterial hypertension, diabetes mellitus, and associated risk factors in long-lived elderly people from three Brazilian regions. Methods: This is a multicenter, cross-sectional, and comparative study conducted with elderly people aged 80 years or older. Results: Higher prevalence of arterial hypertension were observed among those who use polypharmacy (75.7%), among elderly people aged between 80 and 84 years (33.9%), as well as in elderly people who are overweight (78.2%). The prevalence of diabetes was 24% (RP: 0.76; 95% CI: 0.59-0.98) lower among women compared to men and 2.15 times higher among those who use five or more medications (RP: 2.15; 95% CI: 1.63-2.85). Conclusions: In our sample, polypharmacy, body weight, and gender determine the prevalence of non-communicable chronic diseases: arterial hypertension and diabetes mellitus in long-lived elderly people.

RESUMEN Objetivo: Identificar la prevalencia de enfermedades crónicas no transmisibles: hipertensión arterial, diabetes mellitus y los factores de riesgo asociados en ancianos longevos de tres regiones brasileñas. Métodos: Se trata de un estudio multicéntrico, transversal y comparativo, realizado con ancianos con edad igual o superior a 80 años. Resultados: Se observaron mayores prevalencias de hipertensión arterial entre aquellos que hacen uso de polifarmacia (75,7%), entre los ancianos con edad entre 80 y 84 años (33,9%), así como en ancianos que presentan sobrepeso (78,2%). La prevalencia de diabetes fue 24% (RP: 0,76; IC 95%: 0,59-0,98) menor entre las mujeres en comparación con los hombres y 2,15 veces mayor entre aquellos que utilizan cinco o más medicamentos (RP: 2,15; IC 95%: 1,63-2,85). Conclusión: En nuestra muestra, la polifarmacia, el peso corporal y el sexo determinan la prevalencia de las enfermedades crónicas no transmisibles: hipertensión arterial y diabetes mellitus en ancianos longevos.

RESUMO Objetivo: identificar a prevalência das doenças crônicas não transmissíveis: hipertensão arterial, diabetes mellitus e os fatores de risco associados em pessoas idosas longevas de três regiões brasileiras. Métodos: trata-se de um estudo multicêntrico, transversal e comparativo, realizado com pessoas idosas com idade igual ou superior a 80 anos. Resultados: foram observadas maiores prevalências de hipertensão arterial entre aqueles que fazem uso de polifarmácia (75,7%), entre as pessoas idosas com idade entre 80 e 84 anos (33,9%), bem como em pessoas idosas que apresentam sobrepeso (78,2%). A prevalência de diabetes foi 24% (RP: 0,76; IC 95%: 0,59-0,98) menor entre as mulheres quando comparadas aos homens e 2,15 vezes maior entre aqueles que utilizam cinco ou mais medicamentos (RP: 2,15; IC 95%: 1,63-2,85). Conclusões: Em nossa amostra, a polifarmácia, o peso corporal e o sexo determinam a prevalência das doenças crônicas não transmissíveis: hipertensão arterial e diabetes mellitus em pessoas idosas longevas.

Resultados a siete años de la cirugía de reemplazo valvular aórtico en mayores de 80 años / Seven-year results of aortic valve replacement surgery in patients over 80 years of age

Resumen Objetivo: Describir las características clínicas y los resultados operatorios y a siete años del reemplazo valvular aórtico en una cohorte de pacientes mayores de 80 años. Materiales y métodos: Estudio descriptivo retrospectivo de 75 pacientes consecutivos mayores de 80 años, intervenidos de reemplazo valvular aórtico exclusivo entre 2007 y 2019 en el Hospital Guillermo Grant Benavente. Se estudian sus características demográficas, clínicas, ecocardiográficas, riesgo operatorio, cirugías, complicaciones y mortalidad operatoria y supervivencia alejada hasta el 15 de marzo 2021. Resultados: La edad media de la cohorte fue 83,05 ± 2,9 años (rango 80-95) y 43 pacientes eran mujeres (57,3%). La lesión valvular predominante fue la estenosis aórtica (89,3%). 10 pacientes tenían enfermedad coronaria asociada (13,3%) y 2 endocarditis activa. El riesgo de mortalidad operatoria calculado por EuroSCORE aditivo, logístico, II y STS score fue 7,58 ± 1,8; 9,88 ± 6,5%; 3,72 ± 3,5% y 4,27 ± 3,2%, respectivamente. Se utilizó prótesis biológica en 70 (92%) pacientes. Hubo 29 complicaciones operatorias y fallecieron 11 (14,7%) pacientes. El seguimiento promedio fue 7,1 años (rango 2-14), durante el cual fallecen 28 pacientes. La supervivencia a uno, tres y cinco años fue 82, 76, 66 y 48% respectivamente. Conclusiones: La cirugía de reemplazo valvular aórtico en octogenarios en nuestro medio es un procedimiento poco frecuente. La mortalidad observada fue mayor que la estimada por las escalas de riesgo. El reemplazo valvular quirúrgico es una alternativa de tratamiento de la enfermedad de la válvula aórtica en pacientes seleccionados. Se deben evaluar estrategias para mejorar los resultados.

Abstract Objective: To describe the clinical characteristics and operative and 7-year results of aortic valve replacement in a cohort of patients older than 80 years. Materials and methods: Retrospective descriptive study of 75 consecutive patients older than 80 years of age who underwent exclusive aortic valve replacement between 2007 and 2019 at the Guillermo Grant Benavente Hospital. Demographic, clinical, echocardiographic characteristics, operative risk, surgeries, complications and operative mortality and long-term survival until March 15, 2021 are studied. Results: The mean age of the cohort was 83.05 ± 2.9 years (range 80-95) and 43 patients were women (57.3%). The predominant valve lesion was aortic stenosis (89.3%). Ten patients had an associated coronary artery disease (13.3%) and 2 had active endocarditis. The risk of operative mortality calculated by EuroSCORE additive, logistic, II and STS score was 7.58 ± 1.8; 9.88 ± 6.5%; 3.72 ± 3.5% and 4.27 ± 3.2%, respectively. A biological prosthesis was used in 70 (92%) patients. There were 31 operative complications and 11 (14.7%) patients died. The mean follow-up was 7.1 years (range 2-14), during which 28 patients died. Survival at 1, 3, and 5 years was 82, 76, 66 and 48%, respectively. Conclusions: Aortic valve replacement surgery in octogenarians in our setting is a rare procedure. The observed mortality was higher than that estimated by the risk scales. Surgical valve replacement is an alternative treatment for aortic valve disease in selected patients. Strategies to improve results should be evaluated.

Rendimiento y seguridad de las colonoscopías de screening en dos grupos etarios de pacientes de la tercera edad

Objetivo: Comparar el rendimiento y seguridad de las colonoscopías de screening en el diagnóstico del cáncer colorrectal en dos grupos de pacientes añosos. Materiales y Método: Un análisis retrospectivo de pacientes sometidos a colonoscopías de screening en Clínica INDISA, desde noviembre de 2017 hasta marzo de 2019. Se excluyeron pacientes con síntomas de alarma según criterios de Roma IV, colonoscopías de urgencia y terapéuticas. Se compararon 2 grupos de pacientes: Grupo I entre 70-79 años y Grupo II mayores de 80 años. El objetivo primario fue el rendimiento diagnóstico de la colonoscopía de screening, definida como su capacidad para identificar hallazgos significativos definidos como la presencia de adenomas, displasia de alto grado y cáncer colorrectal. Los resultados secundarios consideraron la morbilidad y mortalidad del procedimiento. Análisis estadístico descriptivo e inferencial. Resultados: Un total de 125 pacientes cumplieron con los criterios de inclusión; Grupo I: 70 pacientes y Grupo II: 55 pacientes. Los hallazgos significativos se presentaron en un 27,1% en el Grupo I y en 30,9% en el Grupo II (p = 0,675). No se observaron diferencias en la calidad de la preparación intestinal o las complicaciones relacionadas con el procedimiento. Discusión y Conclusión: Las colonoscopías de screening en el diagnóstico de cáncer colorrectal son bien toleradas en pacientes mayores de 80 años, con un rendimiento equivalente en comparación al grupo más joven. Dado el aumento de la esperanza de vida, se recomienda realizar colonoscopías en octogenarios, especialmente en aquellos con buen estado de salud.

Aim: To compare diagnostic yield of significant findings rate and safety of screening colonoscopies in two groups of elderly patients. Materials and Method: A retrospective analysis was performed on patients who underwent screening colonoscopies at INDISA Clinic, from November 2017 to March 2019. Exclusion criteria were those with "alarm" symptoms according to Rome IV criteria, emergencies and therapeutic colonoscopies were excluded. Comparison groups were patients between 70-79 years old (Grupo I), and those over 80 years old (Grupo II). The primary outcome was the diagnostic yield of screening colonoscopy, defined as its capacity to identify adenomas, high-grade dysplasia, and colorectal cancer. Secondary outcomes were morbidity and mortality of the procedure. Statistical analysis was descriptive and inferential. Results: A total of 125 patients met our inclusion criteria; Grupo I: 70 and Grupo II 55 patients. Significant findings were observed in 27.1% in Grupo I and 30.9% in Grupo II (p = 0.675). No differences in bowel prep quality or procedure-related complications were observed between both groups. Discussion and Conclusion: Screening colonoscopies for colorectal cancer are well tolerated in patients over 80 years of age, with equivalent diagnostic rates compared with the younger patient group. Given the increasing life expectancy worldwide, it is recommended to continue checking for colorectal cancer with screening colonoscopies in octogenarians, particularly healthy ones.

A efetividade da lei de prioridade especial quanto às demandas judiciais de saúde na 2ª. Instância do Tribunal de Justiça do Estado do Rio Janeiro / The effectiveness of the law of special priority in relation to judicial health demands in the 2nd. Instance of the Rio de Janeiro State Court of Justice

Resumo Objetivo Avaliar a efetividade da Lei de prioridade especial quanto às demandas judiciais de saúde na 2ª. Instância do Tribunal de Justiça do Estado do Rio Janeiro, RJ, Brasil. Método Foi realizado estudo transversal descritivo dos processos referentes aos idosos julgados no período de agosto de 2017 a julho de 2018. Os dados foram acessados no sítio eletrônico do tribunal. A efetividade da lei foi avaliada considerando: pedido de prioridade, citação da lei na decisão judicial e/ou se o tempo mediano de tramitação dos processos foi menor para os octogenários do que para os demais. Resultados Um total de 990 processos foi identificado, mas apenas 72 elegíveis (7,3%). O principal réu foi o plano de saúde (76,4%). A internação domiciliar foi a demanda predominante (31,9%). Houve pedido e decisão de prioridade para pessoa idosa (86,1%), mas nenhum para prioridade especial, também não foi observado diferença no tempo de tramitação dos processos entre os octogenários e demais pessoas idosas (p≥0,650). A maioria dos processos não foi provida (65,3%). Conclusão A lei de prioridade especial ainda não tem efetividade jurídica nas demandas ajuizadas para exercer o direito à saúde no Rio de Janeiro.

Abstract Objective To evaluate the effectiveness of the law of special priority regarding the processing of lawsuits about health demands in the 2nd Instance of the Court of Justice of the State of Rio Janeiro, RJ, Brazil. Method A descriptive cross-sectional study was carried out on the lawsuits referring to old people judged from August 2017 to July 2018. The data were accessed from the court's website. The effectiveness of the law was assessed considering: request of priority, citation of the law in the judicial decision and/or if the median time of duration of lawsuits was shorter for octogenarians than for the others. Results A total of 990 lawsuits were identified, but only 72 eligible (7.3%). The main defendant was the health plan (76.4%). The predominant demand was home care service (31.9%). There was a request and decision of priority for old people (86.1%), but none for special priority, no difference was observed too in the review time of the lawsuit between the octogenarians and of the other old people (p≥0.650). Conclusion The law of special priority still has no legal effectiveness in the lawsuits to exercise the right to health in Rio de Janeiro.

Evaluation of the impact of chronic kidney disease on the survival of octogenarian patients submitted to percutaneous coronary intervention

Objective To evaluate the impact of chronic kidney disease on the survival of patients – 80 years of age undergoing percutaneous coronary intervention (PCI) in the long term. Methods 273 subjects who underwent PCI between January 2010 and January 2016 were divided into four categories: (1) stable angina (SA) and creatinine clearance – 30 (n = 24); (2) patients with SA and CrCl <30 (n = 70); (3) patients with acute coronary syndrome (ACS) and CrCl – 30 (n = 51); (4) patients with ACS and ICC <30 (n = 128). Mortality curves were evaluated using the Kaplan-Meier method and differences between groups were compared by log-rank statistic. Multivariate analysis was performed using the Cox proportional hazards method. The 4 groups were compared and the survival between the groups was evaluated. Results Octogenarian patients with CrCl <30 with SA and ACS have lower long-term survival (p < 0.0001). Conclusion CKD has a worse long-term prognosis for patients undergoing PCI.

Percutaneous coronary intervention in octogenarian patients / Intervención coronaria percutánea en pacientes octogenarios

Abstract: Introduction: Octogenarian patients are usually excluded from studies in which the effectiveness of percutaneous coronary intervention (PCI) is compared. Objective: Our aim is to compare this procedure among octogenarians and those younger; in addition to comparing the radial access (RA) and femoral access (FA) in patients older than 80 years. Material and methods: This is a retrospective, observational, comparative, longitudinal, single-center study. Patients who have been referred for PCI, from 2010 to 2016 in Monterrey, Nuevo Leon, Mexico were included. The groups were divided into the octogenarians group (OG) and a group of younger than 80 years (YG). Results: A total of 1,282 patients were collected, of whom 92 were of the OG and 1,190 were of the YG. The FA was the most used. Similar levels of radiation time (RT), radiation dose (DR), and amount of administered contrast medium (CM), vascular complications (VC) and mortality between the two groups were found. However, the OG had more length of hospital stay (LHS). Comparing the FA against RA in the OG there were no differences in RT, RD, amount of CM, VC, death and LHS. Conclusion: The results are similar between the two groups, with a greater tendency to more LHS in the OG. There were not significant differences between the RA and FA in the OG, except that LHS in the FA.

Resumen: Introducción: Los pacientes octogenarios son usualmente excluidos de los estudios en los cuales se compara la efectividad de las intervenciones coronarias percutáneas. Objetivo: Nuestro objetivo es comparar este procedimiento entre los pacientes octogenarios y aquéllos más jóvenes; además se compara el abordaje radial y el abordaje femoral en los pacientes octogenarios. Material y métodos: Éste es un estudio retrospectivo, observacional, comparativo, longitudinal, unicéntrico. Se realizó con aquellos pacientes que se refirieron para realización de un intervencionismo coronario percutáneo, en Monterrey, Nuevo León, México del 2010 al 2016. Los grupos se dividieron en el grupo de pacientes octogenarios y el grupo de pacientes menores de 80 años. Resultados: Se recabó un total de 1,282 pacientes, de los cuales 92 eran pacientes octogenarios, mientras que 1,190 fueron más jóvenes. En ambos el abordaje femoral fue el más utilizado. Se encontraron valores similares de dosis de radiación, tiempo de radiación, cantidad de contraste administrado, complicaciones vasculares y mortalidad entre los dos grupos. Sin embargo, los pacientes octogenarios tuvieron más días de estancia hospitalaria. Al comparar el abordaje femoral y el radial en octogenarios no se encontraron diferencias en dosis de radiación, tiempo de radiación, cantidad de medio de contraste, complicaciones vasculares, muerte y días de estancia hospitalaria. Conclusiones: Los resultados fueron similares entre ambos grupos de edad, con una mayor tendencia de estancia hospitalaria en octogenarios. No se encontraron diferencias significativas entre ambos abordajes en pacientes octogenarios, a excepción de mayores días de estancia hospitalaria en el abordaje femoral.

Laparoscopic surgery for colorectal cancer in patients over 80 years of age: the morbidity outcomes

PURPOSE: The aim of this study was to compare the outcomes between patients under 60 years of age and older patients over 80 years of age who underwent laparoscopic colorectal surgery with colorectal cancer. METHODS: A retrospective analysis of 519 colorectal patients who underwent laparoscopic colorectal surgery for colorectal adenocarcinoma between January 2007 and December 2012 was collected and categorized into 2 groups of patients, those under 60 years of age (n = 404) and those over 80 years of age (n = 115). RESULTS: The group of patients over 80 years of age had a significantly higher ASA physical status classification (P < 0.001), more preoperative comorbidities (P < 0.001), had a tendency towards more tumors in a colonic location (P = 0.034), and more advanced American Joint Committee on Cancer TNM stage (P = 0.001). A higher proportion of right hemicolectomy and abdominoperineal resection was performed and more transfusions were required in the group of patients over 80 years of age (P = 0.002 and P = 0.001, respectively). There were no significant differences in operative time, conversion rate, resection margins, and numbers of harvested lymph nodes, hospital stay, and morbidity between the 2 groups. No postoperative mortality was found in the present study. The 3-year DFS for over 80 years age group and under 60 years age group were 73.5% and 73.9%, respectively (P = 0.770). CONCLUSION: Laparoscopic colorectal surgery was effective and safe for elderly patients over 80 years of age and resulted in postoperative outcomes similar to those in younger patients. The postoperative morbidity after laparoscopic colorectal cancer surgery was not increased in over 80 years of age.

Comparison of Safety after Percutaneous Coronary Intervention Between Octogenarians and Counterparts with Coronary Artery Disease

BACKGROUND: Elderly patients usually have comorbid and poor general conditions. They are more likely to have complex coronary lesions with cardiac dysfunction. Percutaneous coronary intervention (PCI) in octogenarians remains controversial. In this study, we determined the safety after PCI for octogenarians and their younger counterparts with coronary artery disease. METHODS: We reviewed 1,057 patients (110 octogenarians vs. 947 younger counterparts) who underwent PCI for coronary artery disease at Saint Carollo Hospital. We analyzed the baseline characteristics, angiographic findings, in hospital mortality, and post procedural complications between the two groups. RESULTS: The mean ages of octogenarians and younger counterparts were 83.1+/-4.5 years and 62.6+/-10.3 years, respectively. The octogenarian group had a significantly (p<0.001) higher ratio of female patients compared to their younger counterpart group (57.3% vs. 27.5%). However, the octogenarian group had a significantly (p=0.035) lower ratio of patients with history of diabetes mellitus compare to their younger counterpart group (22.7% vs. 32.6%). Incidence of acute myocardial infarction in octogenarians was significantly (p<0.001) higher than that in the younger counterparts (43.7% vs. 18.0%). There was no significant difference in admission duration, major complication, or in-hospital mortality between two groups. CONCLUSION: Our results revealed that hospital mortality and incidence of major complications in octogenarians who underwent invasive PCI were not higher than those in their younger counterparts, suggesting that PCI could be safely used in patients aged 80 years or older. However, long-term follow-up data are needed.

Caracterização e distribuição espacial de homens octogenários / Characterization and spatial distribution of male octogenarians / Caracterización y distribución espacial de hombres octogenarios

Objetivou-se descrever o perfil socioeconômico e de saúde e a qualidade de vida de homens octogenários; mapear as regiões de concentração desses idosos por número de incapacidade funcional e de morbidades. Estudo analítico, transversal e observacional em que participaram 121 homens octogenários, residentes em Uberaba-MG, em 2008. Foram aplicados os instrumentos: Questionário Brasileiro de Avaliação Funcional e Multidimensional (BOMFAQ), World Health Organization Quality of Life – BREF (WHOQOL-BREF) e World Health Organization Quality of Life Assessment for Older Adults (WHOQOL-OLD). Utilizou-se análise descritiva e odds ratio. Predominaram idosos casados, residindo com o cônjuge,analfabetos e com -4 anos de estudo, renda de um salário mínimo, -4 incapacidades e -7 comorbidades. Os idosos com maior número de incapacidade funcional e de morbidades residiam em regiões nas quais não havia cobertura pela estratégia de saúde da família. Estes resultados podem contribuir para o planejamento de ações em saúde direcionadas, considerando as especificidades dessa população.

The aim was to describe the socioeconomic and health profile, and quality of life, of octogenarian men, andto map the regions where such elderly men were concentrated, by number of functional incapacities and morbidities. The participants in this analytical, observational, cross-sectional study were 121 male octogenarians living in Uberaba, Minas Gerais, in 2008. The questionnaires used were the Brazilian Multidimensional Functional Assessment (BOMFAQ), World Health Organization Quality of Life-BREF (WHOQOL-BREF) and World Health Organization Quality of Life Assessment for Older Adults (WHOQOL-OLD). Descriptive analysis and odds ratios were used. The men were predominantly married, livingwith a spouse, illiterate, with - 4 years of schooling, income of one minimum wage, -4 incapacities and -7 comorbidities. The elderly men with most morbidities and functional incapacities lived in regions not covered by the Family Health Strategy. These results can contribute to the planning of targeted health actions considering the specific features of this population.

El objetivo fue describir el perfil socioeconómico, de salud y calidad de vida de hombres octogenários; trazarun mapa de las regiones de concentración de eses ancianos por número de discapacidad funcional y morbilidades. Estudio analítico, observacional y transversal, en una muestra de 121 hombres octogenarios que viven en Uberaba-MG-Brasil, en2008. Fueron aplicados los instrumentos: Cuestionario Brasileño de Evaluación Funcional y Multidimensional (BOMFAQ), Organización Mundial de la Salud Calidad de Vida - BREF (WHOQOL-BREF) y Organización Mundial de la Salud Calidad de Vida Evaluación del Adulto Mayor (WHOQOL-OLD). Se utilizó análisis descriptivo y odds ratio. Predominaron los ancianos casados, vivendo con su cónyuge, analfabetos y con -4 años de escolaridad, el ingreso de un salario mínimo, con -4 discapacidad y -7 comorbilidades. Los ancianos con más morbilidad y discapacidad viven en regiones donde no había cobertura de la estrategia de salud familiar. Estos resultados pueden contribuir para la planificación de acciones de salud dirigidas, teniendo en cuenta las características específicas de esta población.

Vaporización fotoselectiva prostática con láser greenlight: ¿existen más complicaciones en pacientes octogenarios? / Photoselective prostatic vaporization with greenlight laser: are there more complications in octogenarians?

Durante décadas la resección transuretral de próstata (RTU) se ha considerado el tratamiento de elección para la hiperplasia prostática benigna (HPB) sintomática. Los efectos adversos se reportan entre un 7 a 14 por ciento de los pacientes. Desde la introducción de la vaporización fotoselectiva prostática (VFSP) con láser GreenLight® su uso se ha propagado extensamente reportándose similar efectividad y mayor seguridad. Por otra parte, en los últimos años ha aumentado importantemente el número de procedimientos en octogenarios. Hoy se operan pacientes más añosos y con más comorbilidades. El objetivo de nuestro estudio fue evaluar si los pacientes octogenarios sometidos a VFSP con láser GreenLight® presentan más complicaciones que los menores de 80 años. Material y métodos: Estudio retrospectivo, de casos y controles. Se incluyeron pacientes con HPB sintomática sometidos a VFSP con láser GreenLight® entre los años 2005 y 2012. Se registró número de comorbilidades, número de fármacos, riesgo ASA y tiempo quirúrgico. Como complicaciones se consideró fiebre, requerimiento de transfusión, retención aguda de orina, estenosis de cuello, síntomas irritativos vesicales y otras. Se utilizó t-student y chi-cuadrado para comparar los grupos. Se obtuvo Odds ratio (OR) para las complicaciones. Resultados: Se incluyeron en el estudio 104 pacientes, 33 de ellos tenían 80 años o más. No existieron diferencias significativas entre los grupos. La estadía hospitalaria fue mayor en los pacientes octogenarios (60h vs 26h, p<0,001, IC 95 por ciento 14,9-54,2). No se encontraron diferencias significativas en cuanto a las complicaciones (36,4 por ciento vs 23,9 por ciento, p=0,24) con un OR de 1,82 (IC 95 por ciento 0,74 - 4.44).Conclusiones: Los octogenarios sometidos a VFSP con láser GreenLight® no presentan más complicaciones que aquellos de menor edad por lo que éste tratamiento podría considerarse como una alternativa segura y razonable para este grupo de pacientes...

For decades, transurethral resection of prostate (TURP) has been considered the treatment of choice for symptomatic benign prostatic hyperplasia (BPH). Adverse effects were reported between 7-14 percent of patients. Since the introduction Photoselective vaporization of the prostate (VFSP) with GreenLight ® laser its use has spread widely with similar effectiveness and increased safety being reported. Moreover, in recent years the number of procedures in octogenarians have significantly increased. Today more elderly patients with comorbidities are operated. The aim of our study was to evaluate whether octogenarians undergoing VFSP with GreenLight ® laser present more complications than those under 80.Methods: A retrospective, case-control study. Patients with symptomatic BPH that underwent GreenLight ® laser VFSP between 2005 and 2012 were included. Number of comorbidities, number of medications, ASA risk and operative time were recorded. As complications we considered: fever, transfusion requirements, acute urinary retention, bladder neck stenosis, bladder irritative symptoms and others. T-student and chi-square test were used to compare the groups. Odds ratio (OR) was obtained for complications. Results: The study included 104 patients, 33 of them were 80 years or older. There were no significant differences between groups. The hospital stay was higher in octogenarians (60h vs 26h, p <0.001, 95 percent CI 14.9 to 54.2). No significant differences were found in terms of complications (36.4 percent vs 23.9 percent, p = 0.24) with an OR of 1.82 (95 percent CI 0.74 - 4.44).Conclusions: Octogenarians undergoing VFSP with GreenLight ® laser did not have more complications than those younger patients, so this treatment could be considered as a safe and reasonable alternative for this group of patients...

Intermediate-term mortality and incidence of ICD therapy in octogenarians after cardiac resynchronization therapy / 老年心脏病学杂志（英文版）

Background Clinical outcomes of cardiac resynchronization therapy (CRT) in patients over the age of 80 have not been well de-scribed.MethodsWe retrospectively identified 96 consecutive patients≥ 80 years old who underwent an initial implant or an upgrade to CRT, with or without defibrillator (CRT-Dvs. CRT-P), at our institution between January 2003 and July 2008. The control cohort consisted of 177 randomly selected patients < 80 years old undergoing CRT implant during the same time period. The primary efficacy endpoint was all-cause mortality at 36 months, assessed by Kaplan-Meier time to first event curves.Results In the octogenarian cohort, mean age at CRT implant was 83.1 ± 2.9 yearsvs. 60.1 ± 8.8 years among controls (P < 0.001). Across both groups, 70% were male, mean left ventricular ejection fraction (LVEF) was 24.8% ± 14.1% and QRS duration was 154 ± 24.8 ms, without significant differences between groups. Octo-genarians were more likely to have ischemic cardiomyopathy (74%vs. 37%,P < 0.001) and more likely to undergo upgrade to CRT instead of an initial implant (42%vs. 19%,P < 0.001). The rate of appropriate defibrillator shocks was lower among octogenarians (14%vs. 27%,P = 0.02) whereas the rate of inappropriate shocks was similar (3%vs. 6%,P = 0.55). At 36 months, there was no significant difference in the rate of all-cause mortality between octogenarians (11%) and controls (8%,P = 0.381).ConclusionAppropriately selected octogenarians who are candidates for CRT have similar intermediate-term mortality compared to younger patients receiving CRT.

Endarterectomía carotídea en pacientes octogenarios / Endarterectomía carotídea em pacientes octogenários / Carotid endarterectomy in eighty year-old patients

Objetivo: No existen diferencias significativas entre pacientes octogenarios y menores de ochentaaños en eventos ACV-Muerte, intervenidos por estenosis carotídea mediante endarterectomía carotídea.Material y Métodos: Desde enero de 2006 hasta junio de 2010 se realizaron 253 endarterectomías carotídeas en 251 pacientes, 24 (9.56%) (IC95% 6.21-13.90) pacientes tenían más de 80 años. Resultados: Del total de las endarterectomías carotídeas realizadas en pacientes menores de 80 años, 4 presentaron ACV y 1 falleció en el perioperatorio (ACV-muerte (n=5/227) (2.2%) (IC 95% 0.71-5.07)). Un paciente presentó un infarto agudo de miocardio perioperatorio en este grupo(0.4%) (IC 95% 0.006-2.43). De los 24 octogenarios, 1 paciente presentó ACV perioperatorio, dando un índice de ACV-muerte de 4.16 % (n=1) (IC 95% 0.05-21.14). Al comparar la poblaciónde ambos grupos no se hallaron evidencias significativas en la aparición de eventos adversos mayores como ACV o muerte que contraindiquen la cirugía en pacientes octogenarios con significación estadística p=0.91.Conclusión: En la muestra estudiada, no existen diferencias significativas entre pacientes octogenarios y menores de ochenta años en eventos ACV-Muerte postoperatoria, intervenidos porestenosis carotidea.

Objetivo: Não existem diferenças significativas entre pacientes octogenários e pacientes menores de oitenta anos em eventos ACV-Morte, operados por estenose carotídea mediante endarterectomia carotídea.Material e Métodos: De janeiro de 2006 a junho de 2010 realizaram-se 253 endarterectomias carotídeas em 251 pacientes, 24 (9.56%) (IC 95% 6.21-13.90) pacientes tinham mais de 80 anos. Resultados: Do total das endarterectomias carotídeas realizadas em pacientes menores de 80 anos, 4 apresentaram ACV e 1 faleceu no perioperatório (ACV-morte (n: 5/227) (2.2%) (IC 95% 0.71-5.07)). Neste grupo, um paciente apresentou um infarto agudo de miocárdio perioperatório (0.4%) (IC 95% 0.006-2.43). Dos 24 octogenários, 1 paciente apresentou ACV perioperatório, dando um índice de ACV-morte de 4.16 % (n=1) (IC 95% 0.05-21.14). Ao comparar a população dos dois grupos, não se encontraram evidências significativas no aparecimento de eventos adversos maiores como ACV ou morte, que contraindiquem a cirurgia em pacientes octogenários com estatística significativa p=0.91. Conclusão: Na amostra estudada, não existem diferenças significativas entre pacientesoctogenários e pacientes menores de oitenta anos em eventos ACV-Morte pós operatória, operados por estenose carotídea.

Objective: There are no significant differences between octogenarians and younger patients than eighty years in stroke-death events, with surgery for carotid stenosis by carotid endarterectomy. Material and Methods: From January 2006 through June 2010 were 253 carotid endarterectomiesin 251 patients, 24 (9.56%) (95% CI 6.21-13.90) were older than 80 years.Results: Of all carotid endarterectomies performed in patients younger than 80 years, 4 patients had a stroke and died in the perioperative patient (stroke-death (n=5/227) (2.2%) (95% CI 0.71-5.07)). One patient had a perioperative myocardial infarction in this group (0.4%) (95% CI 0.006-2.43). Of the 24 octogenarians, 1 patient had perioperative stroke, giving a rate of stroke-death of 4.16% (n=1) (95% CI 0.05-21.14). By comparing the population of both groups were not found significant evidence in the emergence of major adverse events such as stroke or death that maycontraindicate surgery in octogenarians with statistical significance p=0.91.Conclusion: No significant differences between octogenarians and younger patients than eighty years in stroke-death events postoperative surgery for carotid stenosis in the study sample.

Aortic Valve Replacement in Octogenarians : Are Concomitant Coronary Artery Bypass Grafting Operations Predictive Factors ? / 日本心臓血管外科学会雑誌

Because of increasing life expectancy and the high incidence of aortic stenosis (AS) in high-age groups, aortic valve replacement (AVR) for severe AS has become more frequent in recent years. The purpose of this study is to analyze operative outcome in octogenarians and evaluate the effect of concomitant coronary artery bypass grafting (CABG) for coronary artery disease. Between 2003 and 2010, 77 patients (18 men) aged over 80 years (80∼88 years ; mean age, 82.7 years) underwent AVR (bioprosthesis in 75 cases). Of these patients, 43.4% were categorized in New York Heart Association (NYHA) class III∼IV and 41% had a history of congestive heart failure. In addition, 26 patients (33.8%) underwent associated CABG operations (1-4 grafts ; mean, 1.8 grafts) with AVR. Operative mortality was 5.2% (4 patients). The operation time, cardiopulmonary bypass time, and aortic clamp time were significantly longer and amount of blood transfusion needed was greater in the concomitant CABG group than in the AVR-alone group. However, there were no differences between the groups with regard to intensive care unit (ICU) stay, postoperative hospital stay, operative mortality, and long-term survival. The outcome of AVR in octogenarians was good even in concomitant CABG patients. Aggressive surgical treatment of both aortic valve disease and concomitant coronary artery disease is warranted for most patients, despite advanced age.

Aortic Valve Replacement in Octogenarians: Are Concomitant Coronary Artery Bypass Grafting Operations Predictive Factors? / 日本心臓血管外科学会雑誌

Because of increasing life expectancy and the high incidence of aortic stenosis (AS) in high-age groups, aortic valve replacement (AVR) for severe AS has become more frequent in recent years. The purpose of this study is to analyze operative outcome in octogenarians and evaluate the effect of concomitant coronary artery bypass grafting (CABG) for coronary artery disease. Between 2003 and 2010, 77 patients (18 men) aged over 80 years (80∼88 years ; mean age, 82.7 years) underwent AVR (bioprosthesis in 75 cases). Of these patients, 43.4% were categorized in New York Heart Association (NYHA) class III∼IV and 41% had a history of congestive heart failure. In addition, 26 patients (33.8%) underwent associated CABG operations (1-4 grafts ; mean, 1.8 grafts) with AVR. Operative mortality was 5.2% (4 patients). The operation time, cardiopulmonary bypass time, and aortic clamp time were significantly longer and amount of blood transfusion needed was greater in the concomitant CABG group than in the AVR-alone group. However, there were no differences between the groups with regard to intensive care unit (ICU) stay, postoperative hospital stay, operative mortality, and long-term survival. The outcome of AVR in octogenarians was good even in concomitant CABG patients. Aggressive surgical treatment of both aortic valve disease and concomitant coronary artery disease is warranted for most patients, despite advanced age.

Clinical features of acute kidney injury in the elderly / 대한내과학회지

BACKGROUND/AIMS: The number of elderly individuals continues to increase, as does the incidence of acute kidney injury (AKI). There are few data concerning the clinical features and prognosis in AKI in the elderly in Korea. METHODS: Patients over 80 years old admitted to our hospital with a diagnosis of AKI between January 2004 and December 2005 were evaluated. Etiology, clinical, and prognostic variables were analyzed. RESULTS: The mean age was 82.6+/-2.2 years. The cause of AKI was dehydration (37.1%), infection (33.9%), bleeding (8.1%), contrast material (4.8%), drugs (4.8%), obstruction (3.2%), cardiogenic shock (3.2%), renal infarction (1.6%), rhabdomyolysis (1.6%), and hepatorenal syndrome (1.6%). The mortality rate was 29.0% and the major cause of death was pneumonia (50.0%). Based on the univariate analyses, albumin, serum sodium, number of failing organs, ventilatory support, need for a vasopressor, ICU care, sepsis, and infection were all significant factors discriminating between survivors and non-survivors (p<0.05). CONCLUSIONS: AKI in the elderly is not a different entity from that encountered in other age groups and age alone should never be a drawback to appropriate therapy.

Inguinal Hernia Repair under Local Anesthesia in Octogenarians

PURPOSE: We are to describe the clinical characteristics and treatment outcomes in patients aged between 80 and 89 years who underwent inguinal hernia repair under local anesthesia. METHODS: We retrospectively reviewed the medical records of patients aged between 20 and 89 years who underwent tension free hernia repair under local anesthesia by a single surgeon between June 2001 and January 2009 and compared clinical characteristics and outcomes between octogenarians who were the eldest and sexagenarians whose incidence was the highest. RESULTS: Of the 514 patients, the number of octogenarians was 52 (8.6%) and sexagenarians were 225 (35.0%). Body mass index (BMI) was 22.5 kg/m2 in octogenarians and 23.7 kg/m2 in sexagenarians (P=0.003). Underlying diseases were present in 67.3% of octogenarians and 73.5% of sexagenarians (P=0.238). The incidence of liver disease was significantly lower in the octogenarians (1.9% vs 15.7%, P=0.004). The proportion of patients who underwent local anesthesia was significantly higher among the octogenarians (94.5% vs 82.2%, P=0.014). Operative time and postoperative hospital stay had no significant difference between both groups. Postoperative complications developed in 4 (7.7%) of the octogenarians and in 18 (9.7%) of the sexagenarians. Scrotal swelling was developed most frequently and surgery-related mortality did not developed in both groups. CONCLUSION: If local anesthesia is used appropriately, inguinal hernia repair in octogenarians is a safe procedure as like in sexagenarians and may reduce the psychiatric burden related to complications for both surgeons and elderly patients.

Heart failure in very elderly population- a profile of heart failure in patients over the age of eighty / 老年心脏病学杂志（英文版）

Objective Heart failure is an epidemic in the elderly, but there is a striking lack of data in this clinically important patient population. We investigated the demographics, cardiac performance, and medication management of a segment of the hospital population in at least their eighth decade of life. Methods We retrospectively reviewed 75 records of heart failure patients who were 80 years of age or older. Records were reviewed for demographic information, presence or absence of diastolic dysfunction, evaluation of ejection fraction, and medication usage including angiotensin-concerting enzyme (ACE) inhibitors, angiotensin receptor antagonists (ARBs),beta-adrenergic blockers, digoxin, and aldosterone antagonists. Assessment for contra-indications to ACE inhibitor or ARBs use was also performed to assess co-morbidities that limit treatment of heart failure. Results The population of very elderly with heart failure is heterogeneous. We found a higher proportion of females as well as higher rates of diastolic dysfunction in patients aged ≥ 90 years compared to patients between the ages of 80-89 years. Usage of ACE inhibitors, ARBs and beta-adrenergic blockers was strikingly low throughout the very elderly population. While co-morbid conditions limited use of agents in many cases, there was a lack of explicit contra-indication in most patients not on an ACE inhibitor or an ARB. Conclusions Heart failure is not a single disease processes, but a continuum of disease processes that vary with age. The elderly with heart failure are an undertreated population, in part due to the multitude of co-morbidities that affect them. Further prospective studies are needed to better understand the physiology and ideal treatment regiment in this growing population.

Angioplastia transluminal coronária em octogenários / Percutaneous Transluminal Coronary Angioplasty in Octogenarians

PURPOSE: To evaluate the immediate and long term results of percutaneous transluminal coronary balloon angioplasty (PTCA) in patients over 80 years old. METHODS: From 1/1/89 to 6/31/95, 97 patients with 80 years of age or older were submitted to PTCA and were divided into three groups: group A (GrA)-30 patients with stable angina, mean age of 82.5 years, 24 (80) men; group B(GrB)-40 patients with unstable angina, mean age 81.2 years, 31 (77.5) men; group C (GrC)-27 patients with myocardial infarction (MI), mean age of 82 years, 16 (59.2) men. RESULTS: Early outcome-general success rate of 84.5 and mortality rate of 5.1. The success and mortality rate were in GrA 83.3 and 3.3, in GrB 85 and 5 and in GrC 85.2 and 7.4, respectively. Late outcome-the number and percentage of patients with late follow-up and the clinic-angiographic and angiographic restenosis rates were for GrA 19(76), 52.9, 75; GrB 30(88.2), 30.8, 61.5 and GrC 12(52.2), 66.6, 85.7, respectively. CONCLUSION: PTCA can be considered an important revascularization alternative in octogenarian patients because of high early success rate, low mortality and acceptable long-term outcome.