Frailty predicts severe postoperative complications after elective colorectal surgery

Background

We aim to clarify if frailty affects severe postoperative complications in elective colorectal surgery.

Frailty predicts increased hospital and six-month healthcare cost following colorectal surgery in older adults

Background

The purpose of this study was to determine the relationship of frailty and 6-month postoperative costs.

Methods

Subjects aged ≥ 65 years undergoing elective colorectal operations were enrolled in a prospective observational study. Frailty was assessed by a validated measure of function, cognition, nutrition, comorbidity burden, and geriatric syndromes. Frailty was quantified by summing the number of positive characteristics in each subject.

Results

Sixty subjects (mean age, 75 ± 8 years) were studied. Inpatient mortality was 2% (n = 1). Overall, 40% of subjects (n = 24) were considered nonfrail, 22% (n = 13) were prefrail, and 38% (n = 22) were frail. With advancing frailty, hospital costs increased (P < .001) and costs from discharge to 6-months increased (P < .001). Higher degrees of frailty were related to increased rates of discharge institutionalization (P < .001) and 30-day readmission (P = .044).

Conclusions

A simple, brief preoperative frailty assessment accurately forecasts increased surgical hospital costs and postdischarge to 6-month healthcare costs after colorectal operations in older adults.     

Frailty and its relationship to late onset hypogonadism

The vulnerable health status usually preceding the onset of overt disability is often referred to as frailty. A stringent definition is elusive, but it may be viewed as a physiological syndrome, characterised by decreased reserve and diminished resistance to stressors, resulting from cumulative decline across multiple physiological systems and causing vulnerability to adverse outcomes. Many elements of frailty are related to the neurological system, metabolism, joints, bones and muscles. Central to frailty is the dramatic decline in muscle mass and strength with ageing. Therefore, sarcopenia seems to be the major determinant of frailty.

Several components of the frailty syndrome are related to the physiological actions of testosterone. Testosterone also has effects on psychological functioning. Testosterone (or its aromatisation product oestradiol) is required for the maintenance of bone mineral density. Testosterone also stimulates red blood cell formation.

Testosterone thus has a profound effect on body composition. A significant characteristic of ageing and a factor in frailty is the loss of muscle mass and the increase in fat mass. Androgens promote differentiation of mesenchymal multipotent cells into the myogenic lineage and inhibit their adipogenic differentiation, thus reversing the development of a downward spiral of loss of muscle mass and increase in fat mass. Skeletal muscles of older men are as responsive to the anabolic effects of testosterone as those of younger men, indicating that age as such should not be an impediment to elderly men benefiting from the anabolic effects of testosterone. So, while frailty is obviously a complex syndrome, some elements are androgen-associated and these may improve in men with subnormal testosterone levels.     

颞叶癫痫的术前评估与手术治疗

目的对行手术治疗的顽固性颞叶癫痫患者术前进行综合评估,明确致痫灶部位,实施个体化手术方案。方法对26例颞叶癫痫患者术前进行视频脑电图(V-EEG)、磁共振成像(MRI)检查,综合分析检查结果,制定相应手术方案。术中行皮层脑电描记,术后对切除组织进行病理检查,并对患者进行手术后随访。结果V-EEG、MRI两种检查定位结果完全一致的有21例。24例患者(92.3%)术后癫痫发作完全或部分缓解,2例患者(7.6%)无明显缓解。结论对顽固性颞叶癫痫患者术前进行综合评估,对制定合理的手术方案,提高治愈率有重要指导意义。