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Results of General Surgical Treatment of Patients Over 80 Years of Age in Single-Site Experience

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Fiszer P., Pogorzelski R., Toutounchi S., Szostek M., Krajewska E., Jakuczun W., Tworus R., Skórski M.
Polish Journal of Surgery
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2012
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vol. 84
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issue 4
173-176
EN
The aim of the study was to evaluate the results of general surgical treatment of patients over 80 years of age.Material and methods. Three hundred and four patients aged 80 to 105 years with general surgical disorders, treated in 2005-2009, were retrospectively included in the study. The collected information included demographic data, coexisting diseases, the mode of admission, the diagnosis, the method and result of treatment, and also potential complications and 30-day mortality. The data were subjected to statistical analysis.Results. The study group included 186 women and 118 men. Two hundred patients (65.8%) were admitted in an emergency setting. The most common causes of immediate hospitalisation were: mechanical ileus (26.5%), gastrointestinal bleeding (22%), trauma (16%), and gall-bladder disorders (8.5%). The remaining 104 (34.2%) patients were operated upon on an elective basis. An emergency operation was required by 121 (60%) of the patients admitted in an emergency setting; the remaining ones were treated conservatively. Hernia plasties (27.5%), cholecystectomies (15.3%), colorectal resections (13.2%), strumectomies (11.2%) and endoscopies (6.1%) predominated among elective surgeries.The total number of complications and mortality were 19.4% and 14.5%, respectively. The number of complications and mortality were significantly higher in the group of patients admitted in an emergency setting (25.5% and 20.5%, respectively) than in patients admitted on an elective basis (8.7% and 2.9%, respectively), p<0.01.The mean duration of hospitalisation was 9.7 days (1 to 60 days), with a small difference between the groups of patients treated on an elective and emergency basis (8.5 and 10.4 days), p=0.181.Conclusions. The results of surgical treatment of elderly patients do not significantly differ from the results of treatment of the general population. Much worse results, coupled with a significant increase in mortality, are observed in patients admitted and treated on an emergency basis.
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Safe and uncomplicated inguinal hernia surgery in the elderly – message from anesthesiologists to general surgeons

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Chlebny T., Zelga P., Pryt M., Zelga M., Dziki A.
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EN
Introduction Elderly patients are often discouraged from surgery due to the risk of complications that increases with age. Aim We wanted to assess mortality, morbidity, and complications in patients older than 75 years who underwent elective or emergency inguinal hernia repair in a single center. Methods All patients older than 75 years who were operated on because of inguinal hernia in the Department of General and Colorectal Surgery, Medical University of Lodz between 2003 and 2015 were analyzed. Detailed information was collected with regard to patient demographics, mode of admission, comorbidities, type of intervention, applied anesthesia, and 30-day outcomes. Postoperative outcomes included medical and surgical complications, readmissions, and survival status. Results One hundred thirty-two patients older than 75 years were operated on for inguinal hernia, 16 (12.1%) in an emergency setting and 116 (87.9%) in an elective setting. Eighteen patients (13.6%) developed complications, 8 (50%) in the emergency group, and 10 (8.6%) in the elective group. In the emergency group, severe medical complications (Clavien-Dindo 4) were frequent, whereas in the elective group, severity of surgical and medical complications was not significantly different (Clavien-Dindo median score 2, p=0.6084), and these complications were classified as mild (Clavien-Dindo 1-2). One death occurred in the emergency group. Conclusion Inguinal hernia surgery in the elderly may be safe and effective in an elective setting and if regional anesthesia is used. Careful examination of patients before surgery and identification of potential risk factors associated with co-existing diseases are vital for reducing the risk of complications. Key point: Hernia surgery in patients older than 65 years is a low-risk intervention, if carried out in an elective setting.
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Vitrectomy in stage 5 retinopathy of prematurity - surgical and functional results of 1000 vitrectomies

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Prost M. E.
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issue 2
108-113
EN
Despite improvements in neonatal care, retinopathy of prematurity is still leading cause of blindness in the world. The most treatment problems pose stage 4 and 5 of this disease. Performing vitrectomy in stage 5 is a subject of controversy among ophthalmologists due to unsatisfactory functional results after the surgery. Therefore, our aim was to present the results of 1000 vitrectomies performed by the author in years 1994–2019 in 1018 eyes of 692 children with stage 5 retinopathy of prematurity. In these children lens sparing vitrectomies and lensectomy-vitrectomy with limbal approach were performed. The results were compared with visual function of 127 untreated children with stage 5 retinopathy of prematurity. Visual acuity of treated patients ranged from 0.05 to no light perception in stage 5 and from no light perception to finger counting in the untreated group. Comparing the functional results of treated and untreated patients, it can be concluded that vitrectomy gives a better chance of gaining useful vision.
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