Factors Associated with 1-Year Mortality in Elderly Patients (Age ≥ 80 Years) with Cancer Undergoing Major Abdominal Surgery: A Retrospective Cohort Study.

BACKGROUND: The number of elderly patients undergoing major abdominal surgery is increasing, but the factors affecting their postoperative outcomes remain unclear. This study aimed to identify the factors associated with 1-year mortality among elderly patients (age ≥ 80 years) with cancer undergoing major abdominal surgery. METHODS: This retrospective cohort study was conducted from March 2009 to December 2020. The study enrolled 378 patients 80 years old or older who underwent major abdominal surgery. The main outcome was 1-year mortality, and the factors associated with mortality were analyzed. RESULTS: Of the 378 patients, 92 died at 1 year (24.3%), whereas the 30-day mortality rate was 4% (n = 15). In the multivariate analysis, the factors independently associated with 1-year mortality were preoperative Eastern Cooperative Oncology Group (ECOG) performance status (PS) score higher than 1 (odds ratio [OR], 3.189; 95% confidence interval [CI], 1.595-6.377; p = 0.001), preoperative weight loss greater than 3 kg (OR, 2.145; 95% CI, 1.044-4.404; p = 0.038), use of an intraoperative vasopressor (OR, 3.090; 95% CI, 1.188-8.042; p = 0.021), and postoperative red blood cell units (OR, 1.212; 95% CI, 1.045-1.405; p = 0.011). Survival was associated with perioperative management according to an enhanced recovery after surgery (ERAS) protocol (OR, 0.370; 95% CI, 0.160-0.854; p = 0.006) and supramesocolic surgery (OR, 0.371; 95% CI, 0.158-0.871; p = 0.023). CONCLUSION: The study identified several factors associated with an encouraging 1-year mortality rate in this setting. These results highlight the need for identification of suitable targets to optimize pre-, intra-, and postoperative management in order to improve outcomes for this vulnerable population.

Echocardiography is a good way to diagnose and monitor type 1 cardiorenal syndrome in ICU.

BACKGROUND: Type-one cardiorenal syndrome (CRS) is defined by acute decompensated heart failure leading to secondary acute kidney injury. No study evaluates the reliability of transthoracic echocardiography as a help tool for diagnosis and optimization of CRS. Therefore, the aim of this study was to assess echocardiographic parameters in patients with CRS in the Intensive Care Unit. METHODS: We conducted an observational, prospective, single-center study in the ICU department of a general hospital. Patients admitted in the ICU and presenting with type 1 CRS were included. Transthoracic echocardiography was performed at baseline and at day end after treatment by the same trained operator for the same patients. We report various echocardiographic indices at these two timepoints. RESULTS: Twenty-seven patients were included. At baseline 96.3% of patients had signs of congestion (IVC dilation >2 cm), 76% had an altered S-wave (<11.5 cm/s), 72.73% had an altered TAPSE (<17 mm), 85.19% had an elevated RV/LV diameter ratio (>0.6). Between baseline and D end, IVC size and, the number of patients with an elevated RV/LV diameter ratio significantly decreased. Weight decreased, whereas natriuresis significantly increased, and the amount of vasopressors support decreased. Diuresis, and S-wave velocity showed non-significant changes. CONCLUSIONS: Main echocardiographic findings at baseline in patients with type 1 CRS consist of a right ventricular dysfunction associated an IVC dilation. We report that weight, RV/LV diameter ratio, and IVC diameter might constitute good follow-up parameters to monitor treatment response.

Surgical antimicrobial prophylaxis in intensive care unit (ICU) patients: a preliminary, observational, retrospective study.

BACKGROUND: Surgical antimicrobial prophylaxis (SAP) is supported by evidence-based guidelines. Nevertheless, SAP guidelines do not cover all clinical scenarios. To our knowledge, no information is available regarding SAP in the critically ill patients. We designed a retrospective, observational and preliminary study which the objective was to describe our professional practices in intensive care unit (ICU) patients requiring SAP. METHODS: All patients admitted for more than 48 h in the ICU and requiring surgery were retrospectively included from January 1st to December 31, 2016. We collected data related to infection, colonization and antimicrobial treatments pre- and post-operatively. We assessed the compliance of SAP to guidelines. RESULTS: Among 41 included patients, 13 (32%) were treated for an ongoing infection and 21 (51%) received at least one antibiotic during the ICU stay. Seven (17%) were colonized. Twenty-one (51%) patients received SAP according to guidelines. Thirteen postoperative infections including 1 surgical site infection were reported. For 10 (24%) patients, the ongoing antimicrobial treatment was continued in the operating room. No surgical site infection and 1 lung infection was reported. In 3 (7%) patients, no SAP was administered and 1 episode of bacteremia was noted. Three (7%) patients had their ongoing treatment changed in the operating room. Two of them developed a lung infection. The other patients were assessed individually due to complex conditions. CONCLUSIONS: These preliminary data showed a large heterogeneity in the management of SAP in the ICU, suggesting the need for specific guidelines based on clinical trials.