RESUMO
BACKGROUND: The enhanced recovery after surgery (ERAS) is nowadays a widely accepted multimodal programme of care in colorectal surgery, but still there is some reluctance in its application to very elderly patients. AIM: The aim of this study is to investigate short-term outcomes of laparoscopic resection for colorectal cancer in octogenarian patients within the ERAS programme. METHODS: Data on 162 consecutive patients aged ≥ 80 years receiving elective minimally invasive colorectal resections within ERAS programme were collected in a multicentre, retrospective database in the period 2008-2017 in Italy. Univariate and multivariate analyses were performed to assess possible risk factors for poor clinical outcomes. RESULTS: The postoperative minor morbidity rate (Clavien-Dindo 1 and 2) was 25.9%. The incidence of postoperative major morbidity rate (severe medical and surgical complications defined as Clavien-Dindo 3 and 4) accounted 6.1% and only 1.8% had an anastomotic leakage. Reoperation rate was 5.5%, perioperative 30-day mortality was 1.8%, and 30-day readmission rate was 6.8%. On average, patients were released after 6 days. A univariate analysis showed that possible risk factors for severe medical complications were: low preoperative albumin level, high Charlson Age Comorbidity Index Score and number of days in the intensive care unit (ICU); risk factors for severe surgical complications were: low preoperative albumin level; risk factors for late hospital discharge were: multivisceral resections, number of days in ICU and body mass index (BMI) > 25 kg/m2. The multivariate analysis confirmed a low level of preoperative albumin and a longer ICU stay as independent risk factors for both postoperative severe surgical complications and late hospital discharge. DISCUSSION: The minimal invasive nature of the laparoscopic approach together with a multimodal analgesia therapy, the early resumption to oral diet and mobilisation could minimize the surgical stress and play an essential role in order to reduce medical morbidity in high-risk patients. CONCLUSION: Colorectal surgery within ERAS programme in octogenarians is a safe and flexible treatment in high-volume centres.
Assuntos
Neoplasias Colorretais/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Recuperação Pós-Cirúrgica Melhorada , Estudos de Viabilidade , Feminino , Humanos , Itália , Tempo de Internação , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Reoperação , Estudos Retrospectivos , Fatores de RiscoAssuntos
Nível de Alerta/efeitos dos fármacos , Vias Auditivas/efeitos dos fármacos , Cocaína/toxicidade , Eletroencefalografia/efeitos dos fármacos , Processamento de Sinais Assistido por Computador , Estimulação Acústica , Animais , Relação Dose-Resposta a Droga , Potenciais Evocados Auditivos/efeitos dos fármacos , Feminino , Coelhos , Tempo de Reação/efeitos dos fármacos , Síndrome de Abstinência a Substâncias/fisiopatologiaAssuntos
Polpa Dentária/inervação , Eletroencefalografia/efeitos dos fármacos , Ibuprofeno/administração & dosagem , Nociceptores/efeitos dos fármacos , Administração Oral , Ensaios Clínicos como Assunto , Método Duplo-Cego , Potenciais Somatossensoriais Evocados/efeitos dos fármacos , Humanos , Medição da DorRESUMO
1. Behavioral and EEG responses were examined in nonalcoholic males with (FH+) and without (FH-) a family history of alcoholism following the consumption of a placebo and real beer. 2. FH+ subjects were less confident of being able to resist another drink following consumption of the placebo and reported higher taste ratings and feeling more intoxicated immediately following ethanol consumption than FH- subjects. 3. Both groups showed increases in EEG alpha activity (9-12Hz) following alcohol consumption. 4. Alpha activity was positively associated with desire to drink in the FH+ group before and after consumption, but was positively associated with perceived intoxication in the FH- group only after consumption.
Assuntos
Consumo de Bebidas Alcoólicas/fisiologia , Intoxicação Alcoólica , Alcoolismo/genética , Adulto , Consumo de Bebidas Alcoólicas/psicologia , Alcoolismo/fisiopatologia , Alcoolismo/psicologia , Atitude Frente a Saúde , Encéfalo/fisiologia , Eletroencefalografia , Humanos , Masculino , Placebos , Valores de Referência , Inquéritos e QuestionáriosRESUMO
Visual event-related potentials (ERPs) were obtained in two groups of young adult male subjects: One group (N = 24) considered to be at high risk for alcoholism due to paternal alcoholism and the second group (N = 26) with no family history of alcoholism. Results presented here were obtained during a baseline (no drug) condition. The ERP tasks both were target detection paradigms, but differed in several respects. One paradigm involved continuous participation in a distracting tracking task, but used an easily interpreted target stimulus. The second task involved no distractions, but entailed more complex stimuli. Both paradigms utilized level of task difficulty as an experimental variable. The results from both tasks were quite similar and demonstrated significantly lower ERP amplitudes in the high risk compared to the low risk group. Reaction times to target stimuli did not discriminate group membership, but were related to perceived task difficulty. Task difficulty was not a useful variable in discriminating group membership.
