Proactive care of older people undergoing surgery ('POPS'): designing, embedding, evaluating and funding a comprehensive geriatric assessment service for older elective surgical patients. Comprehensive geriatric assessment can predict complications in elderly patients after elective surgery for colorectal cancer: a prospective observational cohort study. Prediction of Postoperative Complications Following Elective Surgery in Elderly Patients with Colorectal Cancer Using the Comprehensive Geriatric Assessment Preoperative modifiable risk factors in colorectal surgery: an observational cohort study identifying the possible value of prehabilitation Activities of Daily Living and Quality of Life of Elderly Patients After Elective Surgery for Gastric and Colorectal Cancers Preoperative mild cognitive dysfunction predicts pulmonary complications after coronary artery bypass graft surgery. Geriatric Assessment Improves Prediction of Surgical Outcomes in Older Adults Undergoing Pancreaticoduodenectomy: A Prospective Cohort Study The Impact of Postoperative Complications on Long-term Quality of Life After Curative Colorectal Cancer Surgery Preoperative cognitive dysfunction is related to adverse postoperative outcomes in the elderly. A Characterization of Factors Determining Postoperative Ileus After Laparoscopic Colectomy Enables the Generation of a Novel Predictive Score The Impact of the Risk Factor “Age” on the Early Postoperative Results of Surgery for Colorectal Carcinoma and Its Significance for Perioperative Management Factors Affecting Length of Stay and Complications After Elective Anterior Cervical Discectomy and Fusion: A Study of 2164 Patients From The American College of Surgeons National Surgical Quality Improvement Project Database (ACS NSQIP) Screening for predictors of adverse outcome in onco-geriatric surgical patients: A multicenter prospective cohort study. Preoperative risk assessment in elective general surgery Predicting Complications following Expander/Implant Breast Reconstruction: An Outcomes Analysis Based on Preoperative Clinical Risk Frailty predicts outcome of elective laparoscopic cholecystectomy in geriatric patients Elective Colon and Rectal Surgery Differ in Risk Factors for Wound Infection: Results of Prospective Surveillance
BACKGROUND older people undergoing elective surgery have significant post-operative problems prolonging hospitalisation . OBJECTIVE to design , embed , and evaluate an evidence -based comprehensive geriatric assessment ( CGA ) service for at-risk older patients undergoing elective surgery . SETTING urban teaching hospital . SUBJECTS elective surgical patients aged 65 + . INTERVENTION multidisciplinary preoperative CGA service with post-operative follow-through ( proactive care of older people undergoing surgery [ ' POPS ' ] ) . METHODS observational cohort study and multilevel surveys ( development and modelling phase ) . Prospect i ve ' before and after ' comparison ( exploratory evaluation ) . RESULTS findings from the development phase showed high levels of preoperative co-morbidity , no multidisciplinary preoperative input , and multiple potentially preventable post-operative problems delaying discharge in older elective surgery patients . Comparison of 2 cohorts of elective orthopaedic patients ( pre-POPS vs POPS , N = 54 ) showed the POPS group had fewer post-operative medical complications including pneumonia ( 20 % vs 4 % [ p = 0.008 ] ) and delirium ( 19 % vs 6 % [ p = 0.036 ] ) , and significant improvements in areas reflecting multidisciplinary practice including pressure sores ( 19 % vs 4 % [ p = 0.028 ] ) , poor pain control ( 30 % vs 2 % [ p<0.001 ] ) , delayed mobilisation ( 28 % vs 9 % [ p = 0.012 ] ) and inappropriate catheter use ( 20 % vs 7 % [ p = 0.046 ] ) . Length of stay was reduced by 4.5 days . There were fewer delayed discharges relating to medical complications ( 37 % vs 13 % ) or waits for OT assessment or equipment ( 20 % vs 4 % ) . CONCLUSION a proactive evidence -based CGA service for at-risk older elective surgical patients was developed according to MRC framework for complex interventions . Pre/post comparison in elective orthopaedic patients showed improved ( within method ological limitations ) post-operative outcomes indicative of better clinical effectiveness and efficiency , and contributed to the service obtaining mainstream funding . Informed by the present study , a r and omised controlled trial is ongoing OBJECTIVE To examine the association between the outcomes of a pre-operative comprehensive geriatric assessment ( CGA ) and the risk of severe post-operative complications in elderly patients electively operated for colorectal cancer . METHODS One hundred seventy-eight consecutive patients ≥ 70 years electively operated for all stages of colorectal cancer were prospect ively examined . A pre-operative CGA was performed , and patients were categorized as fit , intermediate , or frail . The main outcome measure was severe complications within 30 days of surgery . RESULTS Twenty-one patients ( 12 % ) were categorized as fit , 81 ( 46 % ) as intermediate , and 76 ( 43 % ) as frail . Eighty-three patients experienced severe complications , including three deaths ; 7/21 ( 33 % ) of fit patients , 29/81 ( 36 % ) of intermediate patients and 47/76 ( 62 % ) of frail patients ( p=0.002 ) . Increasing age and ASA classification were not associated with complications in this series . CONCLUSION CGA can identify frail patients who have a significantly increased risk of severe complications after elective surgery for colorectal cancer Aims : The study aims to determine whether the Comprehensive Geriatric Assessment ( CGA ) could predict complications of colorectal cancer ( CRC ) surgery and identify the problems . So we compared the prognostic value of the CGA with patient characteristics and determined predictive scores . Methods : A total of 156 patients aged 75 years and older , who underwent surgery for CRC at Osaka University Hospital , were enrolled . Each patient was examined by the CGA prospect ively , and all postoperative complications were obtained from the medical records . The CGA included the  Barthel Index ( BI ) , Vitality Index , instrumental activities of daily living ( iADL ) , Mini-Mental State Examination ( MMSE ) and Geriatric Depression Score ( GDS ) .  All elements were retrospectively compared in patients with or without postoperative complications , including delirium , surgical site infection and ileus . Results : Overall , postoperative complications developed in 76 patients ( 48.7 % ) . The BI and MMSE were associated with the incidence of complications , and BI , iADL , MMSE and GDS were significantly related with delirium . Multivariate logistic analysis identified the MMSE as a significant determinant of postoperative complications after adjusting for other determined predictive scores including the prognostic nutritional index and performance status . Conclusion : The CGA was a useful predictor of postoperative complications in elderly patients when administered before surgery for CRC Abstract Background : Colorectal cancer ( CRC ) is the second most prevalent type of cancer in the world . Surgery is the most common therapeutic intervention , and associated with 20–40 % reduction in physiological and functional capacity . Postoperative complications occur in up to 50 % of patients result ing in higher mortality rates and greater hospital costs . The number and severity of complications is closely related to patients ’ preoperative performance status . The aim of this study was to identify the most important preoperative modifiable risk factors that could be part of a multimodal prehabilitation program . Methods : Prospect ively collected data of a consecutive series of Dutch CRC patients undergoing colorectal surgery were analyzed . Modifiable risk factors were correlated to the Comprehensive Complication Index ( CCI ) and compared within two groups : none or mild complications ( CCI < 20 ) , and severe complications ( CCI ≥20 ) . Multivariate logistic regression analysis was done to explore the combined effect of individual risk factors . Results : In this 139 patient cohort  , smoking , malnutrition , alcohol consumption , neoadjuvant therapy , higher age , and male sex , were seen more frequently in the severe complications group ( CCI ≥20 ) . Patients with severe complications had significantly longer hospital stay ( 16 vs. 6 days , p < 0.001 ) . The risk for severe complications was increased in patients with ASA score III [ adjusted odds ratio ( OR ) 4.4 , 95 % CI 1.04–18.6 ] , and hemoglobin level < 7 mmol/l ( adjusted OR 3.3 , 95 % CI 1.3–8.2 ) . Compared to having no risk factors , more than one risk factor increased OR of severe complications ( crude OR 5.2 , 95 % CI 1.8–15 ) . Conclusion : This study revealed that the risk of getting severe complications increases with the number of risk factors present preoperatively . Several preoperative patient-related risk factors are modifiable . Multimodal prehabilitation may improve patients ’ preoperative status and should be tested in a multicenter r and omized controlled trial . With an international consortium ( Copenhagen , Montreal , Paris , Eindhoven ) we initiated a r and omized controlled trial ( NTR5947 ) Objective : To establish reliable st and ards for surgical application to elderly patients 75 years old or older with gastric or colorectal cancer with special reference to the postoperative recovery of activities of daily living ( ADL ) and quality of life ( QOL ) . Summary Background Data : ADL and QOL are important outcomes of surgery for the elderly . However , there has been only limited evidence on the natural course of recovery of functional independence . Methods : Two hundred twenty-three patients 75 years old or older with gastric or colorectal cancer were prospect ively examined .  Physical conditions , ADL , and QOL  were evaluated preoperatively and at the first , third , and sixth postoperative month . Results : The mortality and morbidity rates were 0.4 % and 28 % , respectively . Twenty-four percent of patients showed a decrease in ADL at 1 month postoperatively , but most patients recovered from this transient reduction , with only 3 % showing a decline at the sixth postoperative month ( 6POM ) . ADL of these patients was likely to decrease after discharge from the hospital . QOL of the patients showed a recovery to an extent equal to or better than their average preoperative scores . Conclusions : Of the patients 75 years old or older who underwent elective surgery for gastric or colorectal cancer , only a few showed a protracted decline in ADL and most exhibited better QOL after surgery . This indicates that surgical treatment should be considered , whenever needed , for elderly patients 75 years old or older with gastric or colorectal cancer . Estimation of Physical Ability and Surgical Stress is useful for predicting postoperative declines in ADL and protracted disability ; this could aid in establishing a directed rehabilitation program for preventing protracted disability in elderly patients OBJECTIVES In elderly patients with mild cognitive impairment , noncompliance with respiratory exercises , ineffective expectoration , reluctance in mobilization , and difficulty in learning the use of drugs such as inhalers were observed in the early postoperative period after coronary artery bypass graft surgery . It was hypothesized that respiratory complications may be more frequent in these patients , and so the postoperative respiratory complications in patients with preoperative mild cognitive impairment were compared with the postoperative respiratory complications of a control group . DESIGN A prospect i ve cohort control . SETTING A university hospital . PARTICIPANTS Patients undergoing elective coronary artery bypass graft surgery . INTERVENTIONS Investigators separated 48 patients > 70 years old who were scheduled for elective coronary artery bypass graft surgery into two groups : patients with preoperative mild cognitive impairment  ( group A , n = 25 ) and patients with no cognitive impairment  ( control group ; group B , n = 23 ) . The patients ' cognitive status was evaluated preoperatively by the Montreal Cognitive Assessment test . MEASUREMENTS AND MAIN RESULTS Pulmonary functions and respiratory complications were evaluated via chest x-rays and spirometry tests preoperatively and postoperatively . A significant difference was observed between the groups , particularly with regard to atelectasis and prolonged ventilation ( p<0.001 and p<0.05 ) . No significant impairment was observed in the spirometry tests of the control group . However , a significant deterioration was observed in the postoperative spirometry tests of patients with preoperative mild cognitive impairment . CONCLUSIONS This study suggested that mild cognitive impairment was associated with pulmonary complications after coronary artery bypass graft surgery Objective : To prospect ively evaluate the additional value of geriatric assessment ( GA ) for predicting surgical outcomes in a cohort of older patients undergoing a pancreaticoduodenectomy ( PD ) for pancreatic tumors . Background : Older patients are less often referred for possible PD . St and ard preoperative assessment s may underestimate the likelihood of significant adverse outcomes . The prospect i ve utility of vali date d GA has not been studied in this group . Methods : PD-eligible patients were enrolled in a prospect i ve outcome study . St and ard preoperative assessment s were recorded . Elements of vali date d GA were also measured , including components of Fried 's model of frailty , the Vulnerable Elders Survey ( VES-13 ) , and the Short Physical Performance Battery ( SPPB ) . All postoperative adverse events were recorded , systematic ally review ed , and grade d using the Clavien-Dindo system by a surgeon blinded to the GA results . Multivariate regression analyses were conducted . Results : Seventy-six older patients underwent a PD . Significant unrecognized vulnerability was identified at the baseline : Fried 's “ exhaustion ” ( 37.3 % ) , SPPB < 10 ( 28.5 % ) , and VES-13 > 3 ( 15.4 % ) . Within 30 days of PD , 46 % experienced a severe complication ( Clavien-Dindo grade ≥III ) . In regression analyses controlling for age , the body mass index , the American Society of Anesthesiologists score , and comorbidity burden , Fried 's “ exhaustion ” predicted major complications [ odds ratio ( OR ) = 4.06 ; P = 0.01 ] , longer hospital stays ( & bgr ; = 0.27 ; P = 0.02 ) , and surgical intensive care unit admissions ( OR = 4.30 ; P = 0.01 ) . Both SPPB ( OR = 0.61 ; P = 0.04 ) and older age predicted discharge to a rehabilitation facility ( OR = 1.1 ; P < 0.05 ) and age correlated with a lower likelihood of hospital readmission ( OR = 0.94 ; P = 0.02 ) . Conclusions : Controlling for st and ard preoperative assessment s , worse scores on GA prospect ively and independently predicted important adverse outcomes  . Geriatric assessment may help identify older patients at high risk for complications from PD Objective : To investigate the effect that complications have on patients ' long-term quality of life ( QoL ) after curative colorectal cancer surgery .  Background : Colorectal cancer surgery is a high risk , with approximately 1 in 3 patients suffering a complication . The long-term consequences of postoperative complications are important but have poorly been documented . Methods : The MRC-CLASICC trial ( laparoscopic-assisted vs open surgery for colorectal cancer ) included prospect i ve evaluation of QoL using vali date d scoring question naires : EORTC QLQ-C30/CR38 and EQ5D . These were used to compare QoL at 3 , 6 , 18 , and 36 months to baseline values for patients categorized into 2 groups : ( i ) those suffering any complication and ( ii ) those suffering any of 5 common complications ( wound , chest , anastomotic leak , hemorrhage , and cardiac event ) . Results : A total of 614 of 794 CLASICC patients were suitable for inclusion . Complications occurred in 215 ( 35.0 % ) patients , including : wound complications ( 61 , 9.9 % ) , chest infection ( 50 , 8.1 % ) , anastomotic leak ( 27 , 4.4 % ) , hemorrhage ( 14 , 2.3 % ) , and cardiac event ( 26 , 4.2 % ) . Significant long-term differences in QoL between patients with and without complications were found for Physical and Social Function , Role Functioning , and Body Image on EORTC QLQ-C30/QLQ-CR38 analysis and Mobility , Self-care , and Pain/Discomfort on EQ5D analysis . No significant differences were seen for emotional/cognitive functioning , global QoL , financial difficulties , or future perspectives . Risk factors of age , gender , ASA ( American Society of Anesthesiologists ) grade , and stoma moderated the impact of complications in the short- to medium-term QoL , but had less influence on long-term QoL. Conclusions : Postoperative complications have adverse effects on long-term QoL , particularly for Physical , Role and Social Functioning , and Body Image , as well as for Mobility , Self-care , and Pain/Discomfort . These findings should inform future preoperative counseling and health care planning BACKGROUND Preoperative risk stratification is commonly performed by assessing end-organ function ( such as cardiac and pulmonary ) to define postoperative risk . Little is known about impaired preoperative cognition and outcomes . The purpose of this study was to evaluate the impact of baseline impaired cognition on postoperative outcomes in geriatric surgery patients . STUDY DESIGN Subjects 65 years and older undergoing a planned elective operation requiring postoperative ICU admission were recruited prospect ively .  Preoperative baseline cognition was assessed using the vali date d Mini-Cog test . Impaired cognition was defined as a Mini-Cog score of ≤ 3 . Delirium was assessed using the Confusion Assessment Method -ICU by a trained research team . Adverse outcomes were defined using the Veterans Affairs Surgical Quality Improvement Program definitions . RESULTS One hundred and eighty-six subjects were included , with a mean age of 73 ± 6 years . Eighty-two subjects ( 44 % ) had baseline impaired cognition . The impaired cognition group had the following unadjusted outcomes : increased incidence of 1 or more postoperative complications ( 41 % vs 24 % ; p = 0.011 ) , higher incidence of delirium ( 78 % vs 37 % ; p < 0.001 ) , longer hospital stays ( 15 ± 14 vs 9 ± 9 days ; p = 0.001 ) , higher rate of discharge institutionalization ( 42 % vs 18 % ; p = 0.001 ) , and higher 6-month mortality ( 13 % vs 5 % ; p = 0.040 ) . Adjusting for potential confounders determined by univariate analysis , logistic regression found impaired cognition was still associated with the occurrence of 1 or more postoperative complications ( odds ratio = 2.401 ; 95 % CI , 1.185 - 4.865 ; p = 0.015 ) . Kaplan-Meier survival analysis revealed higher mortality in the impaired cognition group ( log-rank p = 0.008 ) . CONCLUSIONS Baseline cognitive impairment in older adults undergoing major elective operations is related to adverse postoperative outcomes including increased complications , length of stay , and long-term mortality . Improved underst and ing of baseline cognition and surgical outcomes can aid surgical decision making in older adults Background / Objective : Postoperative ileus ( POI ) after colorectal surgery is associated with prolonged hospital stay and increased costs . The aim of this study is to investigate pre- , intra- , and postoperative risk factors associated with the development of POI in patients undergoing laparoscopic partial colectomy .  Methods : Patients operated between 2004 and 2008 were retrospectively identified from a prospect ively maintained data base , and clinical , metabolic , and pharmacologic data were obtained . Postoperative ileus was defined as the absence of bowel function for 5 or more days or the need for reinsertion of a nasogastric tube after starting oral diet in the absence of mechanical obstruction . Associations between likelihood of POI and study variables were assessed univariably by using & khgr;2 tests , Fisher exact tests , and logistic regression models . A scoring system for prediction of POI was constructed by using a multivariable logistic regression model based on forward stepwise selection of preoperative factors . Results : A total of 413 patients ( mean age , 58 years ; 53.5 % women ) were included , and 42 ( 10.2 % ) of them developed POI . Preoperative albumin , postoperative deep-vein thrombosis , and electrolyte levels were associated with POI . Age , previous abdominal surgery , and chronic preoperative use of narcotics were independently correlated with POI on multivariate analysis , which allowed the creation of a predictive score . Patients with a score of 2 or higher had an 18.3 % risk of POI ( P < 0.001 ) . Conclusion : Postoperative ileus after laparoscopic partial colectomy is associated with specific preoperative and postoperative factors . The likelihood of POI can be predicted by using a preoperative scoring system . Addressing the postoperative factors may be expected to reduce the incidence of this common complication in high-risk patients The risks and benefits of surgery for colorectal cancer in old patients have not been unequivocally defined . The present investigation was carried out in 309 hospitals as a prospect i ve multicenter study . In the period between 1 January 2000 and 31 December 2001 , a total of 19,080 patients were recruited for the study ; 16,142 ( 84.6 % ) patients were younger than 80 years ( < 80 ) and 2932 ( 15.4 % ) were 80 years and older ( ≥ 80 ) . Significant differences between the age groups were observed for general postoperative complications ( 22.3 % for < 80 years ; 33.9 % for ≥ 80 ) . Specific postoperative complications were identical in both groups . Overall , significantly elevated morbidity and mortality rates were found with increasing age ( morbidity : 33.9 % vs. 43.5 % ; mortality : 2.6 % vs. 8.0 % ) . The distribution of tumor stages revealed a significantly higher percentage of locally advanced tumors in the older age group ( stage II : 28.0 % vs. 34.4 % ) . In contrast , no increase in metastasizing tumors was found in the older age group ( stage IV : 17.4 % vs. 14.1 % ) . Logistic regression showed that , in concert with a number of other parameters , age is a significant influencing factor on postoperative morbidity and mortality . The increase in postoperative morbidity and mortality rates associated with aging is a result of the increase in general postoperative complications , in particular , pneumonia and cardiovascular complications . Age as such does not represent a contraindication for surgical treatment . The short-term outcome and quality of life are of overriding importance for the geriatric patient Study Design : Retrospective review of the prospect i ve American College of Surgeons National Surgical Quality Improvement Project ( ACS NSQIP ) data base with 30-day follow-up of 2164 patients undergoing elective anterior cervical discectomy and fusion ( ACDF ) .  Objective : To determine factors independently associated with increased length of stay ( LOS ) and complications after ACDF to facilitate preoperative planning and setting of realistic expectations for patients and providers . Summary of Background Data : The effect of individual preoperative factors on LOS and complications has been evaluated in small-scale studies . Large data base analysis with multivariate analysis of these variables has not been reported . Methods : The  ACS NSQIP data base from 2005 to 2010 was  queried  for patients undergoing ACDF procedures .  Preoperative and perioperative variables were collected . Multivariate regression determined significant predictors ( P<0.05 ) of extended LOS and complications . Results : Average LOS was 2.0±4.0 days ( mean±SD ) with a range of 0–103 days . By multivariate analysis , age 65 years and above , functional status , transfer from facility , preoperative anemia , and diabetes were the preoperative factors predictive of extended LOS . Major complications , minor complications , and extended surgery time were the perioperative factors associated with increased LOS . The elongating effect of these variables was determined , and ranged from 0.5 to 5.0 days . Seventy-one patients ( 3.3 % ) had a total of 92 major complications , including return to operating room ( 40 ) , venous thrombotic events ( 13 ) , respiratory ( 21 ) , cardiac ( 6 ) , mortality ( 5 ) , sepsis ( 4 ) , and organ space infection ( 3 ) . Multivariate analysis determined ASA score ≥3 , preoperative anemia , age 65 years and above , extended surgery time , and male sex to be predictive of major complications ( odds ratios ranging between 1.756 and 2.609 ) . No association was found between levels fused and LOS or complications . Conclusion : Extended LOS after ACDF is associated with factors including age , anemia , and diabetes , as well as the development of postoperative complications . One in 33 patients develops a major complication postoperatively , which are associated with an increased LOS of 5 days AIMS The aim of this study was to investigate the predictive ability of screening tools regarding the occurrence of major postoperative complications in onco-geriatric surgical patients and to propose a scoring system . METHODS 328 patients ≥ 70 years undergoing surgery for solid tumors were prospect ively recruited . Preoperatively , twelve screening tools were administered . Primary endpoint was the incidence of major complications within 30 days . Odds ratios ( OR ) and 95 % confidence intervals ( 95 % CI ) were estimated using logistic regression . A scoring system was derived from multivariate logistic regression analysis . The area under the receiver operating characteristic curve ( AUC ) was applied to evaluate model performance . RESULTS At a median age of 76 years , 61 patients ( 18.6 % ) experienced major complications . In multivariate analysis , Timed Up and Go ( TUG ) , ASA-classification and Nutritional Risk Screening ( NRS ) were predictors of major complications ( TUG>20 OR 3.1 , 95 % CI 1.1 - 8.6 ; ASA ≥ 3 OR 2.8 , 95 % CI 1.2 - 6.3 ; NRS impaired OR 3.3 , 95 % CI 1.6 - 6.8 ) . The scoring system , including TUG , ASA , NRS , gender and type of surgery , showed good accuracy ( AUC : 0.81 , 95 % CI 0.75 - 0.86 ) . The negative predictive value with a cut-off point > 8 was 93.8 % and the positive predictive value was 40.3 % . CONCLUSIONS A substantial number of patients experience major postoperative complications . TUG , ASA and NRS are screening tools predictive of the occurrence of major postoperative complications and , together with gender and type of surgery , compose a good scoring system Despite improved surgical techniques there is still a risk of mortality in elective general surgery .  In a prospect i ve study preoperative data from 3250 patients were collected and compared with postoperative systemic complications , using univariate χ2 analysis . Highly significant ( P < 0.00001 ) variables were subjected to stepwise logistic regression analysis . The severity of operative procedure , higher American Society of Anesthesiologists ( ASA ) grade , symptoms of respiratory disease and malignancy were found to be significant risk factors predicting postoperative morbidity ( P<0.05 ) . Using these four variables , a simple preoperative risk scoring system has been defined . Class A ( up to 5 points ) was defined as a low‐risk group ( systemic complication rate 5.0 per cent ) , class B ( 5–7 points ) was intermediate risk ( systemic complication rate 17.9 per cent ) and class C ( 8–10 points ) was high risk ( systemic complication rate 33.3 per cent ) . Patients at high risk for perioperative and postoperative complications are more likely to be identified by this analysis than by using the ASA classification alone Background : Complications following postmastectomy reconstruction  can cause significant morbidity . The compound effect of individual risk factors on the development of complications following exp and er/implant reconstruction has not , however , been well delineated . This study evaluated the impact of clinical risk factors to predict complications following postmastectomy exp and er/implant reconstruction . Methods : From 2003 through 2004 , 1170 exp and er/implant reconstructions were performed at a single center . A prospect ively maintained data base was review ed . Variables including age , smoking status , body mass index , history of diabetes , hypertension , chemotherapy and /or radiation , as well as timing and laterality of reconstruction were evaluated . The primary endpoint was the development of a complication ; the secondary endpoint was failure of reconstruction . Results : Over the 2 year study period , 1170 exp and er/implant reconstructions were performed in 884 patients . The odds of developing complications was 2.2 times greater in smokers ( p < 0.001 ) and 2.5 times greater in women over 65 ( p = 0.008 ) . Patients who were obese were at nearly two times the odds of having complications ( p = 0.02 ) , as were patients with hypertension ( p = 0.02 ) . Similarly , the odds of reconstructive failure were five times greater in smokers ( p < 0.001 ) . Age was not a significant predictor of reconstructive failure ( p = 0.09 ) ; yet , failure was nearly seven times greater in obese patients ( p < 0.001 ) , and four more times likely in those who were hypertensive ( p = 0.005 ) . Conclusions : Smoking , obesity , hypertension , and age over 65 were independent risk factors for perioperative complications following exp and er/implant breast reconstruction . Smoking , obesity , and hypertension were similarly associated with reconstructive failure . This information can be used to evaluate overall procedural risks and individualize reconstructive options Background Frailty is a phenotype characterized by complex and challenging medical problems and higher susceptibility to adverse health outcomes . It can be derived at by a multidimensional process known as comprehensive geriatric assessment ( CGA ) , which assesses the functional reserves of the elderly . In this study we report for the first time on a prospect i ve evaluation of the association between CGA and postoperative complications after elective laparoscopic cholecystectomy for biliary disease . Methods Fifty-seven patients older than 65 years who were to undergo elective laparoscopic cholecystectomy for uncomplicated biliary disease were prospect ively examined .  Preoperative CGA was performed and the patients were categorized as fit or frail . The main outcome of the study was the rate of any postoperative complication within 30 days of surgery . Results There were 29 women ( 50.9 % ) and the median ( interquartile range ) age of the cohort was 73 ( 8.8 ) years . Thirty-two patients ( 56.1 % ) were categorized as frail and 25 ( 43.9 % ) as fit . The overall incidence of postoperative complications was 23.7 % , most of which were grade I and II ( 18.8 % ) . Frail patients , according to the CGA assessment , experienced a significantly higher incidence of postoperative complications compared to their fit counterparts ( 84.6 vs. 15.4 % , p = 0.023 ) . Frail patients experienced a significantly higher frequency of prolonged ( more than 2 days ) postoperative hospital stay compared with their fit counterparts ( p = 0.023 ) . Conclusions Preoperative CGA may predict postoperative complications and prolonged postoperative hospital stay of elderly patients who undergo elective laparoscopic cholecystectomy . Larger-scale studies independently assessing this association are warranted Objective : The objective of this study was to clarify the incidence and risk factors for developing incisional surgical site infection ( SSI ) in both elective colon and rectal surgery . Summary Background Data : SSI is a frequent complication after elective colorectal resection . The National Nosocomial Infection Surveillance system surveys all colorectal surgeries together , without differentiating the type of colorectal surgery performed . However , rectal surgery may have a higher risk for SSI , and identifying risk factors that are more specific to each procedure would be more predictive . Methods : We conducted prospect i ve SSI surveillance of all elective colorectal resections performed by a single surgeon in a single institution from November 2000 to July 2004 . The data for colon and rectal surgeries were collected separately . The outcome of interest was incisional SSI . Univariate and multivariate analyses were performed to determine the predictive significance of variables in each type of surgery . Results : A total of 556 colorectal resections , consisting of 339 colon and 217 rectal surgeries , were admitted to the program . The incisional SSI rates in colon and rectal surgeries were 9.4 % and 18.0 % , respectively ( P = 0.0033 ) . Risk factors for developing incisional SSI in colon surgery were ostomy closure ( OR = 7.3 ) and lack of oral antibiotics ( OR = 3.3 ) , while in rectal surgery , risk factors were preoperative steroids ( OR = 3.7 ) , preoperative radiation ( OR = 2.8 ) , and ostomy creation ( OR = 4.9 ) . Conclusions : Colon and rectal surgeries differ with regard to incidence and risk factors for developing incisional SSI . SSI surveillance for such surgeries should be performed separately , as this should lead to more efficient identification of risk factors and a reduction in SSI
Conclusion Geriatric syndromes are important prognostic factors for postoperative complications .
Background Elective surgeries can be associated with significant harm to older adults .
The present study aim ed to identify the prognostic factors associated with the development of postoperative complications among older adults undergoing elective surgery .