Publications by authors named "Ellene Yan"
Background And Aims: Postoperative sleep disturbances are associated with delayed recovery and increased incidences of complications. This systematic review aims to determine the impact of perioperative pharmacological therapies on postoperative sleep quality in the hospital.
Material And Methods: We searched MEDLINE, MEDLINE ePubs and In-Process Citations (Daily), Embase Classic + Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and PubMed for randomized controlled trials (RCTs) from inception to May 2022, with continued literature surveillance until August 2023.
Background And Aims: Delayed neurocognitive recovery (DNR) and postoperative neurocognitive disorder (P-NCD) are common postoperative complications affecting older patients. This review evaluates perioperative approaches for preventing DNR and P-NCD in older noncardiac surgical patients.
Material And Methods: We searched databases for relevant articles from inception through June 2022 and updated in May 2023 (PROSPERO ID CRD42022359289).
Aims: Early detection and management of sleep disturbances can improve postoperative outcomes given the high prevalence of sleep disturbances and unrecognized cognitive impairment in older surgical patients. There is an association between sleep disturbances and cognitive impairment in the general population. However, the relationship in older surgical patients has not been systematically investigated.
View Article and Find Full Text PDFObjective: Patients with obstructive sleep apnea (OSA) may be at increased risk for adverse events during procedural sedation, however, there remains a gap in the literature quantifying these risks. This systematic review and meta-analysis aimed to evaluate the risk of peri-procedural adverse events in OSA patients undergoing procedural sedation in ambulatory settings, compared to those without OSA.
Methods: Four databases were systematically searched for studies published from January 1, 2011 to January 4, 2024.
Article Synopsis
- The study aimed to investigate the prevalence and changes in functional disability among older surgical patients before and after surgery, as well as identify risk factors and compare clinical outcomes between patients with and without functional disability.
- A total of 307 patients aged 65 and older undergoing non-cardiac surgery were assessed using a disability measurement tool, revealing that a significant number had preoperative functional disability, but many showed improvement post-surgery.
- Patients with preoperative functional disability had a higher likelihood of persistent disability after 180 days, and factors like preoperative functional status and depression significantly increased the odds of long-term disability.
Background: There is a significant gap in research exploring changes in postoperative health-related quality of life (HRQoL) among patients aged 65 years and older undergoing hip or knee arthroplasty.
Objectives: To investigate the variations in HRQoL improvement, as evaluated by patient-reported outcome measures following total hip arthroplasty, total knee arthroplasty, and partial knee arthroplasty between the young-old and old-old adults.
Methods/design: We searched six online databases (including MEDLINE, Embase) from their inception dates to May 15, 2023.
Study Rationale: Although the STOP-Bang questionnaire has been validated for its efficacy and diagnostic performance in various settings, there is no review that summarizes the pertinent evidence of the STOP-Bang questionnaire in the different populations. We aimed to review the evidence of the diagnostic performance of the STOP-Bang questionnaire, correlation between STOP-Bang scores and the probability of obstructive sleep apnea (OSA), and its clinical application in various populations.
Study Impact: This review guides healthcare providers in the sleep medicine and perioperative medicine disciplines to be better informed when using the STOP-Bang questionnaire in the different populations.
Study Objectives: To determine the prevalence of suspected cognitive impairment using the Centers for Disease Control and Prevention (CDC) cognitive question, Ascertain Dementia Eight-item Questionnaire (AD8), Modified Telephone Interview for Cognitive Status (TICS-M), and Telephone Montreal Cognitive Assessment (T-MoCA), the agreement between each tool beyond chance, and the risk factors associated with a positive screen.
Design: Multicenter prospective study.
Setting: Remote preoperative assessments.
Study Objective: To determine the diagnostic accuracy of the Montreal Cognitive Assessment (MoCA) in detecting cognitive impairment (CI) and assess the association of MoCA scores with adverse postoperative outcomes in surgical populations.
Design: Systematic review and meta-analysis.
Setting: Perioperative setting.
Article Synopsis
- This study examines the prevalence of preoperative depression in older patients (aged 65 and above) undergoing elective non-cardiac surgery, and its impact on health outcomes during and after surgery.
- A systematic review of 13 studies revealed that 23% of these patients experienced preoperative depression, primarily assessed using the Geriatric Depression Scale (GDS-15).
- The research highlights the importance of addressing mental health issues in the surgical planning process to optimize recovery and reduce complications post-surgery.
Background: The suitability of ambulatory surgery for patients with obstructive sleep apnea (OSA) remains controversial. This systematic review and meta-analysis aimed to evaluate the odds of perioperative adverse events in patients with OSA undergoing ambulatory surgery, compared to patients without OSA.
Methods: Four electronic databases were searched for studies published between January 1, 2011 and July 11, 2023.
Background: The Mini-Cog is a rapid screening tool that can be administered to older adults to detect cognitive impairment (CI); however, the accuracy of the Mini-Cog to detect CI for older patients in various healthcare settings is unclear.
Objectives: To evaluate the diagnostic accuracy of the Mini-Cog to screen for cognitive impairment in older patients across different healthcare settings.
Methods/design: We searched nine electronic databases (including MEDLINE, Embase) from inception to January 2023.
Background: The Ascertain Dementia 8-item Questionnaire (AD8) is a screening tool for cognitive impairment that can be administered to older persons and/or their informants.
Objectives: To evaluate the diagnostic accuracy and compare the predictive parameters of the informant and participant-completed Ascertain Dementia 8-item Questionnaire (iAD8 and pAD8, respectively) in older adults with cognitive impairment.
Methods/design: We searched ten electronic databases (including MEDLINE (Ovid), Embase) from tool inception to March 2022.
Article Synopsis
- The study aimed to evaluate how common postoperative delirium is in older patients undergoing non-cardiac surgeries and its related outcomes.
- A systematic review and meta-analysis of 54 studies, involving nearly 21,000 patients, revealed that 19% of elective surgery patients and 32% of emergency surgery patients experienced delirium postoperatively.
- The presence of delirium significantly increased the risk of mortality and complications, such as longer hospital stays and unplanned ICU admissions, highlighting its serious impact on older surgical patients.
Study Objective: Instrumental activities of daily living (IADLs) are essential to patient function and quality of life after surgery. In older surgical patients, the incidence of preoperative IADL dependence has not been well characterized in the literature. This systematic review and meta-analysis aimed to determine the pooled incidence of preoperative IADL dependence and the associated adverse outcomes in the older surgical population.
View Article and Find Full Text PDFDetermining the prevalence and risk factors related to sleep disturbance in surgical patients would be beneficial for risk stratification and perioperative care planning. The objectives of this systematic review and meta-analysis are to determine the prevalence and risk factors of sleep disturbances and their associated postoperative complications in surgical patients. The inclusion criteria were: (1) patients ≥18 years old undergoing a surgical procedure, (2) in-patient population, and (3) report of sleep disturbances using a validated sleep assessment tool.
View Article and Find Full Text PDFBackground: Older patients with preoperative cognitive impairment are at risk for increased postoperative complications after noncardiac surgery. This systematic review and meta-analysis aimed to determine the association between preoperative cognitive impairment and dementia and postoperative outcomes in older surgical patients after cardiac surgery.
Methods: Eight electronic databases were searched from inception to January 4, 2022.
Article Synopsis
- The study aimed to assess how cognitive impairment (CI) and dementia affect health outcomes in older patients (60+) undergoing non-cardiac surgeries.
- Through a systematic review and meta-analysis of 53 studies involving nearly 200,000 patients, significant risks associated with CI and dementia were identified, including higher rates of delirium, mortality, and complications post-surgery.
- Key findings revealed that cognitive impairment notably increases the likelihood of adverse outcomes, such as needing assisted care after discharge and higher chances of 30-day readmissions.