Introduction: national reports have highlighted deficiencies in care provided to older surgical patients and suggested a role for innovative, collaborative, inter-specialty models of care. The extent of geriatrician-led perioperative services in the UK (excluding orthogeriatric services) has not previously been described. This survey describes current services and explores barriers to further development.
Methods: an electronic survey was sent to clinical leads for geriatric medicine at all 161 acute NHS health care trusts in the UK. Reminders were sent on three occasions over an 8-week period. The survey examined preoperative and postoperative care and organisational issues. Responses were analysed descriptively.
Results: there were 130 respondents (80.7%). One-third (38) of respondents described providing some geriatric medicine input in older surgical patients. Preoperative services existed in 15 (12%), where 14 provided risk assessment and 13 preoperative optimisation. Twenty-six respondents (20%) delivered care postoperatively, of them 10 took a reactive approach, 11 a proactive approach and 5 provided a combination of reactive and proactive care. Barriers to establishing perioperative geriatric medicine services included funding, workforce issues and a lack of inter-specialty collaboration.
Conclusion: a national appetite exists to provide geriatrician-led services to older surgical patients yet the majority of existing services remain reactive and do not use comprehensive geriatric assessment as an organising principle. This survey suggests that funding for geriatricians in perioperative care has not yet been universally established. Future efforts should focus on dissemination of experiential knowledge and published resources, collaboration with commissioners and empirical research to overcome the barriers described.
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http://dx.doi.org/10.1093/ageing/afu084 | DOI Listing |
Ann Surg Oncol
January 2025
Breast Surgery Section, Division of GI and Oncologic Surgery, Massachusetts General Hospital, Boston, MA, USA.
Background: Nipple-sparing mastectomy (NSM) is infrequently performed in older women, at least in part owing to concerns regarding age-related complications. We describe postoperative outcomes of NSM in older women and risk factors for complications, with the goal of informing patient selection and decision-making.
Patients And Methods: Cases of NSM with immediate implant-based reconstruction were identified from an institutional database (2009-2019).
Surg Radiol Anat
January 2025
Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias str, Goudi, Athens, 11527, Greece.
Background: The skull base ligaments have been extensively studied in the literature due to their clinical and surgical significance. The posterior petroclinoid fold (PPCNF) and petroclival ligament (PCVL) are two adjacent structures that have barely been studied and are frequently confused. The present study uses an innovative classification system to investigate the PPCNF and PCVL ossification patterns.
View Article and Find Full Text PDFEur Spine J
January 2025
Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.
Objective: This study systematically assesses the learning curve of Unilateral Biportal Endoscopic (UBE) techniques across various spinal surgeries, focusing on its influence on operative efficiency and complication rates to guide optimized training and practice.
Methods: Systematic searches in PubMed, Web of Science, Embase, Scopus, and Cochrane Library identified studies on UBE learning curves for patients aged 18 or older, comparing early and mastery phases. Two reviewers independently extracted data on surgery type, operative time, and complications.
World J Urol
January 2025
Department of Urology, Charité - Universitaetsmedizin Berlin, Corporate Member of Freie Universitaet Berlin, Humboldt-Universitaet zu Berlin, Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
Purpose: The objective of this study was to evaluate the perioperative outcomes and complications associated with the use of acetylsalicylic acid (ASA) in deceased donor kidney transplantation (KTX), with a particular focus on bleeding events.
Methods: We retrospectively analyzed 157 kidney transplant recipients (KTRs) who underwent KTX at Charité Berlin, Department for Urology, between February 2014 and December 2017. Patients were divided into two groups: patients with ASA in their preoperative medication (Group A, n = 59) and patients without ASA use (Group B, n = 98).
Arch Orthop Trauma Surg
January 2025
Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Tübingen, Germany.
Introduction: Perilunate dislocations (PLD) and perilunate fracture-dislocations (PLFD) are high-energy wrist injuries often linked to significant post-traumatic osteoarthritis. This study aims to determine whether PLD and PLFD yield different radiological outcomes following surgical treatment while identifying prognostic factors for worse outcomes.
Materials And Methods: We retrospectively analyzed 51 patients treated for perilunate injuries between 2000 and 2022.
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