Cargando…
Mediating Medical Comorbidities in Geriatric Patients Undergoing Surgery for OVCF: From Preoperative Screening to Risk and Outcomes Optimization
OBJECTIVES: Osteoporotic vertebral compression fractures (OVCF) are a common increasing entity in elderly patients and represent a tremendous economic burden. Surgical treatment is related to high complication rates and little is known about patient-specific and internal risk factors associated with...
Autores principales: | , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10177309/ https://www.ncbi.nlm.nih.gov/pubmed/37084354 http://dx.doi.org/10.1177/21925682221130050 |
_version_ | 1785040608349388800 |
---|---|
author | Scheyerer, Max J. Lenz, Max Jacobs, Cornelius Pumberger, Matthias Spiegl, Ulrich J. A. Ullrich, Bernhard W. von der Höh, Nicolas Schnake, Klaus John |
author_facet | Scheyerer, Max J. Lenz, Max Jacobs, Cornelius Pumberger, Matthias Spiegl, Ulrich J. A. Ullrich, Bernhard W. von der Höh, Nicolas Schnake, Klaus John |
author_sort | Scheyerer, Max J. |
collection | PubMed |
description | OBJECTIVES: Osteoporotic vertebral compression fractures (OVCF) are a common increasing entity in elderly patients and represent a tremendous economic burden. Surgical treatment is related to high complication rates and little is known about patient-specific and internal risk factors associated with poor clinical results. METHODS: We carried out a comprehensive, systematic literature search according to the PRISMA checklist and algorithm. Risk factors for perioperative complications, for early inpatient readmission, for the duration of the hospital stay, the hospital mortality, the total mortality and the clinical result were analyzed. RESULTS: A total of 739 potentially usable studies were identified. After considering all inclusion and exclusion criteria, 15 studies with 15,515 patients were included. Non-adjustable risk factors were age >90 years (OR 3.27), male gender (OR 1.41), BMI less than 18.5 kg/m(2) (OR 3.97), ASA score >3 (OR 2.7), activity of daily live (ADL) (OR 1.52), dependence (OR 5.68), inpatient admission status (OR 3.22), Parkinson disease (OR 3.63) and disseminated cancer (OR 2.98). Adjustable factors were insufficient kidney function (GFR <60 mL/min, and Creatinine Clearance below 60 mg/dl) (OR 4.4), nutrition status (hypalbuminemia (<3.5 g/dl)), liver function (OR 8.9) and further cardiac and pulmonary comorbidities. DISCUSSION: We identified a couple of non-adjustable risk factors, which should be considered preoperatively in terms of risk assessment. However, even more important were adjustable factors that can be influenced preoperatively. In conclusion, we recommend a perioperative interdisciplinary cooperation, especially with geriatricians, to achieve the best possible clinical results in geriatric patients undergoing surgery for OVCF. |
format | Online Article Text |
id | pubmed-10177309 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-101773092023-05-13 Mediating Medical Comorbidities in Geriatric Patients Undergoing Surgery for OVCF: From Preoperative Screening to Risk and Outcomes Optimization Scheyerer, Max J. Lenz, Max Jacobs, Cornelius Pumberger, Matthias Spiegl, Ulrich J. A. Ullrich, Bernhard W. von der Höh, Nicolas Schnake, Klaus John Global Spine J Special Issue Articles OBJECTIVES: Osteoporotic vertebral compression fractures (OVCF) are a common increasing entity in elderly patients and represent a tremendous economic burden. Surgical treatment is related to high complication rates and little is known about patient-specific and internal risk factors associated with poor clinical results. METHODS: We carried out a comprehensive, systematic literature search according to the PRISMA checklist and algorithm. Risk factors for perioperative complications, for early inpatient readmission, for the duration of the hospital stay, the hospital mortality, the total mortality and the clinical result were analyzed. RESULTS: A total of 739 potentially usable studies were identified. After considering all inclusion and exclusion criteria, 15 studies with 15,515 patients were included. Non-adjustable risk factors were age >90 years (OR 3.27), male gender (OR 1.41), BMI less than 18.5 kg/m(2) (OR 3.97), ASA score >3 (OR 2.7), activity of daily live (ADL) (OR 1.52), dependence (OR 5.68), inpatient admission status (OR 3.22), Parkinson disease (OR 3.63) and disseminated cancer (OR 2.98). Adjustable factors were insufficient kidney function (GFR <60 mL/min, and Creatinine Clearance below 60 mg/dl) (OR 4.4), nutrition status (hypalbuminemia (<3.5 g/dl)), liver function (OR 8.9) and further cardiac and pulmonary comorbidities. DISCUSSION: We identified a couple of non-adjustable risk factors, which should be considered preoperatively in terms of risk assessment. However, even more important were adjustable factors that can be influenced preoperatively. In conclusion, we recommend a perioperative interdisciplinary cooperation, especially with geriatricians, to achieve the best possible clinical results in geriatric patients undergoing surgery for OVCF. SAGE Publications 2023-04-21 2023-04 /pmc/articles/PMC10177309/ /pubmed/37084354 http://dx.doi.org/10.1177/21925682221130050 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by-nc-nd/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Special Issue Articles Scheyerer, Max J. Lenz, Max Jacobs, Cornelius Pumberger, Matthias Spiegl, Ulrich J. A. Ullrich, Bernhard W. von der Höh, Nicolas Schnake, Klaus John Mediating Medical Comorbidities in Geriatric Patients Undergoing Surgery for OVCF: From Preoperative Screening to Risk and Outcomes Optimization |
title | Mediating Medical Comorbidities in Geriatric Patients Undergoing
Surgery for OVCF: From Preoperative Screening to Risk and Outcomes
Optimization |
title_full | Mediating Medical Comorbidities in Geriatric Patients Undergoing
Surgery for OVCF: From Preoperative Screening to Risk and Outcomes
Optimization |
title_fullStr | Mediating Medical Comorbidities in Geriatric Patients Undergoing
Surgery for OVCF: From Preoperative Screening to Risk and Outcomes
Optimization |
title_full_unstemmed | Mediating Medical Comorbidities in Geriatric Patients Undergoing
Surgery for OVCF: From Preoperative Screening to Risk and Outcomes
Optimization |
title_short | Mediating Medical Comorbidities in Geriatric Patients Undergoing
Surgery for OVCF: From Preoperative Screening to Risk and Outcomes
Optimization |
title_sort | mediating medical comorbidities in geriatric patients undergoing
surgery for ovcf: from preoperative screening to risk and outcomes
optimization |
topic | Special Issue Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10177309/ https://www.ncbi.nlm.nih.gov/pubmed/37084354 http://dx.doi.org/10.1177/21925682221130050 |
work_keys_str_mv | AT scheyerermaxj mediatingmedicalcomorbiditiesingeriatricpatientsundergoingsurgeryforovcffrompreoperativescreeningtoriskandoutcomesoptimization AT lenzmax mediatingmedicalcomorbiditiesingeriatricpatientsundergoingsurgeryforovcffrompreoperativescreeningtoriskandoutcomesoptimization AT jacobscornelius mediatingmedicalcomorbiditiesingeriatricpatientsundergoingsurgeryforovcffrompreoperativescreeningtoriskandoutcomesoptimization AT pumbergermatthias mediatingmedicalcomorbiditiesingeriatricpatientsundergoingsurgeryforovcffrompreoperativescreeningtoriskandoutcomesoptimization AT spieglulrichja mediatingmedicalcomorbiditiesingeriatricpatientsundergoingsurgeryforovcffrompreoperativescreeningtoriskandoutcomesoptimization AT ullrichbernhardw mediatingmedicalcomorbiditiesingeriatricpatientsundergoingsurgeryforovcffrompreoperativescreeningtoriskandoutcomesoptimization AT vonderhohnicolas mediatingmedicalcomorbiditiesingeriatricpatientsundergoingsurgeryforovcffrompreoperativescreeningtoriskandoutcomesoptimization AT schnakeklausjohn mediatingmedicalcomorbiditiesingeriatricpatientsundergoingsurgeryforovcffrompreoperativescreeningtoriskandoutcomesoptimization |