Subject(s)
Blood Transfusion , Colonic Diseases/surgery , Colorectal Surgery/methods , Preoperative Care , Risk Adjustment/methods , Blood Grouping and Crossmatching/methods , Blood Transfusion/methods , Elective Surgical Procedures/methods , Humans , Preoperative Care/adverse effects , Preoperative Care/methods , Risk Factors , Risk Management , Transfusion ReactionABSTRACT
Colorectal cancer has a high incidence, and approximately 60% of colorectal cancer patients are older than 70, with this incidence likely increasing in the near future. Elderly patients (> 70-75 years of age) are a very heterogeneous group, ranging from the very fit to the very frail. Traditionally, these patients have often been under-treated and recruited less frequently to clinical trials than younger patients, and thus are under-represented in publications about cancer treatment. Recent studies suggest that fit elderly patients can be treated in the same way as their younger counterparts, but the treatment of frail patients with comorbidities is still a matter of controversy. Many factors should be taken into account, including fitness for treatment, the wishes of the patient and family, and quality of life. This review will focus on the existing evidence for surgical, oncologic, and palliative treatment in patients over 70 years old with colorectal cancer. Careful patient assessment is necessary in order to individualize treatment approach, and this should rely on a multidisciplinary process. More well-designed controlled trials are needed in this patient population.
ABSTRACT
INTRODUCTION: Hospital-at-home (HaH) has been previously described as a useful model to shorten length of hospital stay. Nevertheless, few experiences have been reported on the effectiveness of this scheme in patients with postoperative complications. We described the results of home management of patients with pancreatic fistula. PATIENTS AND METHOD: A retrospective analysis was performed on the clinical data more six patients with postoperative pancreatic fistula attended in our hospital-at-home unit. RESULTS: All patients were male with ages ranging from 42 to 72 years (mean 59). The average hospital stay was 53 days (range 27 to 91). All patients, but one, presented pancreatic drainage more than 100 mL at the time of HaH admission. During HaH period hospital level treatments such as complex cures, intraabdominal lavages, specific laboratory tests, intravenous antimicrobial therapy and CT scanning were performed. The average time to closure of fistula was 93 days, of which 38 (41%) days were spent at home. At the end of HaH period all patients recovered and expressed a high degree of satisfaction. CONCLUSIONS: Our data suggest that hospital-at-home is an effective model to shorten length of hospital stay in selected patients with postoperative pancreatic fistulas.
Subject(s)
Home Care Services , Pancreatic Fistula/therapy , Postoperative Complications/therapy , Aged , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Introducción. La hospitalización a domicilio (HaD) se ha descrito como un modelo útil para acortar la estancia hospitalaria. Sin embargo, se han comunicado pocas experiencias sobre la eficacia de este recurso en pacientes con complicaciones posquirúrgicas. Nosotros describimos el resultado del manejo domiciliario de pacientes con fístulas pancreáticas. Pacientes y método. Se realizó un análisis retrospectivo de los datos clínicos de 6 pacientes con fístula pancreática posquirúrgica atendidos en nuestra unidad de hospitalización a domicilio. Resultados. Todos los pacientes eran varones con edades comprendidas entre los 42 y los 72 años (media, 59). La estancia hospitalaria media fue de 53 días (rango, 27-91 días). Todos los pacientes, excepto uno, presentaban un débito pancreático de más de 100 ml en el momento de la admisión en HaD. Durante el período de HaD se realizaron cuidados de rango hospitalario, como curas complejas, lavados intraabdominales, pruebas específicas de laboratorio, terapia antimicrobiana intravenosa y escáner. La duración media para el cierre de las fístulas fue de 93 días, de los cuales 38 (41%) transcurrieron en el domicilio. Al final del período de HaD todos los pacientes se habían curado y mostraron un alto grado de satisfacción. Conclusiones. Nuestros datos indican que la hospitalización a domicilio es un modelo eficaz para acortar la estancia hospitalaria en pacientes seleccionados con fístulas pancreáticas posquirúrgicas (AU)
Introduction. Hospital-at-home (HaH) has been previously described as a useful model to shorten length of hospital stay. Nevertheless, few experiences have been reported on the effectiveness of this scheme in patients with postoperative complications. We described the results of home management of patients with pancreatic fistula. Patients and method. A retrospective analysis was performed on the clinical data more six patients with postoperative pancreatic fistula attended in our hospital-at-home unit. Results. All patients were male with ages ranging from 42 to 72 years (mean 59). The average hospital stay was 53 days (range 27 to 91). All patients, but one, presented pancreatic drainage more than 100 mL at the time of HaH admission. During HaH period hospital level treatments such as complex cures, intraabdominal lavages, specific laboratory tests, intravenous antimicrobial therapy and CT scanning were performed. The average time to closure of fistula was 93 days, of which 38 (41%) days were spent at home. At the end of HaH period all patients recovered and expressed a high degree of satisfaction. Conclusions. Our data suggest that hospital-at-home is an effective model to shorten length of hospital stay in selected patients with postoperative pancreatic fistulas (AU)
