Introduction: Geriatric hip fractures are associated with high morbidity and mortality. Identifying reliable preoperative biomarkers may help predict postoperative mortality and improve perioperative management. Materials and Method:This retrospective study included 913 patients aged 65 years and older who underwent surgeryfor hip fractures between January 2017 and January 2024. Demographic characteristics, comorbidities, fracture type, surgical and anesthesia methods, ASA score, and preoperative hemoglobin, albumin, and lymphocyte levels were recorded. Mortality status was evaluated, and the diagnostic performance of albumin and lymphocyte levels in predicting mortality was assessed using receiver operating characteristic (ROC) curve analysis. Results: The mean age of the patients was 79.6 +/- 9.7 years, and the postoperative mortality rate was 51.6%. Mortality was significantly associated with lower preoperative albumin and lymphocyte levels (p<0.001). A preoperative albumin level <3.5 g/dL demonstrated excellent predictive performance for mortality, with a sensitivity of 99.8% and specificity of 99.5% (AUC: 0.997). The predictive accuracy of lymphocyte count was lower (AUC: 0.622). Mortality rates were also significantly higher in patients with an ASA score >= 4 and in those who received blood transfusions. Conclusions: Preoperative serum albumin is a highly accurate biomarker for predicting mortality in geriatric patients undergoing hip fracture surgery. Low albumin levels may reflect malnutrition and reduced physiological reserve, contributing to poorer postoperative outcomes. Routine assessment of albumin may facilitate early identification of high-risk patients and support individualized perioperative management strategies.
Introduction: Expanding the living kidney donor pool has increased interest in evaluating geriatric individuals (>= 60 years) as potential donors. Concerns regarding age-related comorbidities and perioperative risks have historically limited the use of older donors. This study aimed to compare perioperative outcomes between geriatric and young living kidney donors. Materials and Method: Data from donors who underwent laparoscopic living donor nephrectomy at a single tertiary center between June 2018 and December 2024 were retrospectively reviewed. Donors were divided into two groups according to age: a Geriatric Group (>= 60 years, n=29) and a Young Group (<= 40 years, n=100). Donors aged 41-59 years were excluded by design to maximize between-group contrast. Demographic characteristics, comorbidities, perioperative morbidity parameters, length of hospital stay, and recipient outcomes were compared. Missing BMI data (32.5%) were handled by multiple imputation using Rubin's rules. Results: The mean age was 65.4 +/- 5.5 years in the geriatric group and 29.9 +/- 5.5 years in the young group (p<0.001). Hypertension was more prevalent among geriatric donors (31.0% vs. 1.0%; p<0.001), and surgical drains were used more frequently (58.6% vs. 23.0%; p=0.001). After multiple imputation, BMI was significantly higher in geriatric donors (28.4 +/- 5.1 vs. 25.4 +/- 5.6; p=0.029). Length of hospital stay was longer in the geriatric group (4.62 +/- 1.08 vs. 4.11 +/- 0.85 days; p=0.013). No significant differences were found in postoperative infection, bleeding, or creatinine levels. No graft loss or mortality occurred. Conclusion: With careful selection, geriatric living kidney donors demonstrate acceptable perioperative outcomes comparable to younger donors. Chronological age alone should not be an exclusion criterion for living kidney donation.
Introduction: With nonagenarians (>= 90 years) increasingly presenting with non-traumatic acute abdomen, evidence on CT-based etiologies and shortterm outcomes remains scarce, underscoring the need for focused data. To evaluate the etiological distribution and short-term mortality in nonagenarians undergoing abdominopelvic CT for non-traumatic acute abdomen. Materials and Method: This retrospective study included patients aged 90-99 who underwent CT between January 2013 and September 2023. Radiological findings were classified into 12 etiological subgroups. Malignancy status and surgical or image-guided interventions were documented. Mortality was assessed at 24 hours, 7 days, and 30 days. Categorical comparisons used chisquare or Fisher's exact tests (p<0.05). Results: A total of 529 patients (mean age: 92.9 years) were analyzed; 55.4% (n=293) had positive CT findings, most frequently hepatopancreatobiliary (10.8%), vascular (10.4%), and intestinal obstruction/torsion (8.5%). Malignancy-related etiologies comprised 31.7% of positive cases. Surgical or interventional treatment was performed in 10.4% (n=55). Overall mortality was 1.5% at 24 hours, 6.2% at 7 days, and 18.3% at 30 days. One-month mortality was higher in patients with positive CT findings (27.3%) compared to negative (7.2%, p<0.001). Among positive cases, malignancy-related etiologies showed significantly increased 30-day mortality (49.5% vs. 17.0%, p<0.001). Patients undergoing intervention also had elevated mortality (43.6% vs. 23.5%, p=0.003). Mortality varied by etiology, with gastrointestinal bleeding, perforation, and vascular causes carrying the greatest risk (p<0.001). Conclusion: This cohort provides a comprehensive overview of CT-based etiologies and outcomes in nonagenarians with acute abdomen. Malignancy, certain etiologies, and the need for intervention were strongly linked with adverse prognosis.
Introduction: Although postoperative delirium in patients with hip fractures has been extensively studied, preoperative delirium has rarely been examined. We investigated the riskfactors for developing preoperative delirium in patients with hip fracture and their relation to mortality. Materials and Method: We retrospectively reviewed the records of 316 patients who underwent hip fracture surgery. Preoperative delirium was defined according to the Diagnostic and Statistical Manual-5 criteria, and the time of onset of delirium (0-24 hours) was recorded. We evaluated patient demographics, medical conditions, laboratory results, movement patterns, and death rates. Results: Preoperative delirium occurred in 16.5% of the patients. Most patients who experienced delirium developed symptoms during the first six hours of hospitalization. The preoperative delirium group showed lower serum albumin levels (3.2 +/- 0.5 vs 3.6 +/- 0.6 g/dL, p<0.001), lower prognostic nutritional index values (31.2 +/- 6.8 vs 36.1 +/- 7.5, p<0.001) and elevated creatine kinase levels (168 vs 92 U/L, p<0.001). Alzheimer's/dementia (odds ratio: 5.43), creatine kinase levels above 100 U/L (odds ratio: 3.65), albumin levels below 3.5 g/dL (odds ratio: 3.12), prognostic nutritional index values under 35 (odds ratio: 2.78) and dependent mobilization (odds ratio: 2.18) were independent risk factors. The multivariate logistic regression model showed suitable discrimination power through its area under curve value of 0.687 which fell within a 95% confidence interval of 0.599 to 0.774 while achieving sensitivity at 65.8% and specificity at 61.2% and accuracy at 61.7%. The preoperative delirium group experienced a 36.5% one-year mortality rate, which was significantly higher than the 18.2% mortality rate in the non-delirium group (p=0.001). Conclusion: The risk factors for preoperative delirium include low albumin levels, low prognostic nutritional index values, elevated creatine kinase, dependent mobilization, and neurocognitive impairment. The presence of preoperative delirium leads to an extended postoperative delirium duration and elevated patient mortality rates. The research results require analysis based on the study design which used a single center to collect retrospective data and the difficulties of detecting delirium through medical records analysis.
Introduction: Alzheimer's disease is a common condition that can be challenging to diagnose, primarily due to the high costs and limited availability of specific tests. This study aimed to explore the relationship between peripheral inflammation markers, such as pan-immune-inflammation-value and the C-reactive protein-albumin-lymphocyte and their ability to predict the severity of the disease. Materials and Method: Atotal of 232 patients diagnosed with Alzheimer'stype dementia and 52 healthy individuals with no history of the disease were retrospectively included in the study conducted between January 2024 and November 2025. The patients were classified into five groups based on the Clinical Dementia Rating Scale. After a 10-12 hour fast, venous blood samples were collected from all participants, and demographic and clinical data were obtained from the hospital information system. The analysis included complete blood count parameters (leukocytes, neutrophils, lymphocytes, monocytes, and platelets), C-reactive protein levels, serum albumin levels, and routine biochemical parameters from the blood samples. Results: Although there was no significant difference in pan-immune-inflammation values between the study groups (p = 0.721), the C-reactive protein-albumin-lymphocyte index showed a significant decrease as the severity of dementia increased. Similarly, Albumin-Lymphocyte Ratio, Systemic Inflammatory Index, Neutrophil-Lymphocyte Ratio, and Platelet-Lymphocyte Ratio also showed significant differences between the groups (p < 0.05). Conclusion: The findings of this study highlight the attractiveness of the C-reactive protein-albumin-lymphocyte index and the albumin/lymphocyte ratio as potential screening tools for dementia risk assessment in clinical settings.
Introduction: This study aimed to examine the relationship between hopelessness and death anxiety among geriatric individuals. Materials and Method: A cross-sectional study was conducted with individuals aged 65 years and older (N = 220) registered at a community health center in Turkey. Participants completed the Descriptive Characteristics Form and as well as the Death Anxiety Scale and the Beck Hopelessness Scale. Results: The mean scores for death anxiety and hopelessness were 53.32 +/- 13.29 and 9.42 +/- 3.86, respectively. The study revealed that the subdimensions of the Death Anxiety Scale were predominantly positively and weakly correlated with hopelessness and hope components, while motivation loss showed varying levels of negative correlation (p < 0.05). Conclusion: The findings indicate that geriatric individuals experience above-moderate levels of death anxiety and report moderate levels of hopelessness. Furthermore, it was observed that as feelings of hopelessness increased, death anxiety intensified accordingly.
Introduction: Pseudoexfoliation syndrome is an age-related condition characterized by abnormal fibrillar material accumulation in the ocular and systemic tissues. Several studies have suggested that pseudoexfoliation syndrome is associated with neurodegenerative processes via different mechanisms. In our study, cognitive function was evaluated using the Mini-Mental State Examination in patients with pseudoexfoliation syndrome, pseudoexfoliation glaucoma, and primary open-angle glaucoma and compared with healthy controls. Materials and Method: In this prospective study, 43 patients aged >= 60 years were diagnosed with pseudoexfoliation syndrome (Group I), 40 with pseudoexfoliation glaucoma (Group II), 43 with primary open-angle glaucoma (Group III), and 72 healthy individuals who served as controls (Group IV). The Mini-Mental State Examination was administered in a quiet room by the same neurologist who was blinded to the participants' diagnoses. Results: Astatistically significant difference was observed among the groups in Mini-Mental State Examination scores (p=0.001). Pairwise comparisons adjusted using the Bonferroni correction revealed significant differences between Groups I and IV, Groups II and III, and Groups II and IV (p=0.036; p=0.036; p=0.0012, respectively). In patients with pseudoexfoliation syndrome, Mini-Mental State Examination scores inversely correlated with age (p=0.003, r=-0.323); however, this association was not observed in the other groups (p=0.09). Conclusion: Mini-Mental State Examination scores were significantly lower in patients with pseudoexfoliation syndrome and pseudoexfoliation glaucoma than in the control group and patients with primary open-angle glaucoma. Additionally, Mini-Mental State Examination performance inversely correlated with age in the pseudoexfoliation group. These findings suggest that pseudoexfoliation may not be confined to ocular pathology alone but may also be associated with systemic cognitive impairment.
Introduction: The increasing elderly population has led to a rising number of emergency hip fractures requiring surgical treatment. Evidence regarding early mortality and intensive care outcomes across different elderly age groups remains limited. This study aimed to assess the effect of age on early clinical outcomes in elderly patients undergoing emergency hip arthroplasty. Materials and Method: This retrospective observational cohort study included 599 patients aged 65-95 years who underwent emergency hip arthroplasty between January 1, 2021, and May 15, 2025. Patients were categorized into three age groups: 65-74 years, 75-84 years, and 85-95 years. Demographic data, comorbidities, perioperative variables, laboratory and arterial blood gas parameters, mortality outcomes, and lengths of hospital and intensive care unit stay were analyzed and compared between groups. Results: In-hospital and intensive care unit mortality increased significantly from the 65-74 to the 75-84 age group, with no further increase observed in patients aged 85-95 years. Postoperative intensive care unit admission rates increased with age. Hospital and intensive care unit lengths of stay were similar across age groups. Admission laboratory and arterial blood gas parameters were comparable, except for serum albumin levels, which declined significantly with age. Conclusion: Although age was associated with increased early mortality and higher intensive care unit admission rates, very advanced age was not linked to additional increases in early mortality.
Introduction: We evaluated the clinical attitudes of thoracic surgery specialists and residents in Turkey toward thoracic surgery in elderly patients, their perceptions of geriatric support in surgical decision-making, and their educational needs. Materials and Method: This descriptive, cross-sectional survey study included thoracic surgery specialists, academic surgeons, and residents currently practicing in Turkey. Data were collected anonymously via Google Forms between July and September 2025. The questionnaire comprised items related to demographic characteristics, surgical decision-making, geriatric support, multidisciplinary approach, and educational needs. Statistical analysis included descriptive statistics, comparative tests, effect size calculations, and multivariable logistic regression analysis. Results: The study recruited 103 participants. A large majority of participants (90.3%) reported that minimally invasive approaches were advantageous for patients aged >= 65 years, and strong agreement was observed with the statement that chronological age alone should not be considered a contraindication to surgery. Overall performance status was identified as the primary determinant in surgical decision-making. Overall, 62.1% of participants reported limited access to geriatric specialists at their institution, and 60.2% stated that they had not received structured education on the management of elderly patients. In addition, residents demonstrated a more indecisive attitude toward non-operative approaches compared with specialists and academic surgeons, with 60.0% of residents reporting uncertainty. Conclusion: Thoracic surgeons support an individualized, multidisciplinary approach to surgical care in elderly patients, but limited access to geriatric support and gaps in education restrict the full implementation of this approach in clinical practice. Stronger geriatric-based multidisciplinary models and educational programs could improve the quality of care for elderly patients when they undergo thoracic surgery.
Introduction: Adhesive capsulitis causes severe pain and limited movement, particularly in older adults. Treating this condition in elderly patients is difficult because standard therapies can carry risks due to age-related health issues and multiple medications. Suprascapular nerve pulsed radiofrequency provides a potentially safer, minimally invasive option. This study assessed the effectiveness and safety of this method in patients aged 65 and older. Materials and Method: Thirty-two patients with adhesive capsulitis received ultrasound-guided suprascapular nerve pulsed radiofrequency. The primary outcome was the Shoulder Pain and Disability Index; secondary outcomes included Numeric Rating Scale scores for activity and rest pain. Assessments occurred at baseline, 4, and 12 weeks. Results: Post-procedure assessments at 4 and 12 weeks demonstrated statistically significant reductions in Shoulder Pain and Disability Index scores and Numeric Rating Scale scores compared to baseline. While Shoulder Pain and Disability Index pain scores stayed consistent between weeks 4 and 12, a small but statistically significant rise in resting pain was observed at week 12 compared to week 4; however, pain levels remained significantly lower than pretreatment levels. No serious procedure-related adverse events were reported. Conclusion: Ultrasound-guided Suprascapular nerve pulsed radiofrequency seems to be an effective and safe treatment for chronic shoulder pain in elderly patients with adhesive capsulitis. Besides pain relief, long-lasting functional improvements may help reduce the social and psychological challenges linked to the condition. Due to its good safety profile, this method offers a valuable option for vulnerable patients with few other treatment choices.
Introduction: Community-acquired pneumonia remains a leading cause of morbidity and mortality among older adults. Although conventional scoring systems, such as CURB-65 and pneumonia severity indexes, provide prognostic guidance, novel inflammation-and nutrition-based biomarkers may offer enhanced predictive accuracy. This study evaluated and compared the prognostic performance of six novel biomarkers; neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, prognostic nutritional index, lymphocyteto-monocyte ratio, C-reactive protein-to-albumin ratio, and modified Glasgow prognostic score in comparison with conventional scoring systems in elderly patients hospitalized with community-acquired pneumonia. Materials and Method: A total of 105 patients aged >= 65 years who were hospitalized with community-acquired pneumonia between 2020 and 2025 were included in this retrospective cohort study, and their clinical, laboratory, and demographic data were collected. Prognostic performance for 30-day mortality was assessed using receiver-operating characteristic curves, Area Under the Receiver Operating Characteristic Curve and Kaplan-Meier survival analyses. Results: C-reactive protein-to-albumin ratio demonstrated the highest discriminatory ability, followed by prognostic nutritional index and neutrophilto-lymhocyte ratio. Although elevated platelet lymphocyte ratio was associated with reduced survival rates (p=0.038), none of the novel biomarkers remained independent predictors in multivariate Cox regression analyses. Conclusion: C-reactive protein-to-albumin ratio is a simple, cost-effective, and highly predictive biomarker for in-hospital mortality in elderly patients with community-acquired pneumonia, outperforming other indices and complementing conventional scores. Estimation of C-reactive protein-to-albumin ratio may facilitate early risk stratification and guide interventions in this population.
Introduction: The primary aim of our study was to determine the frequency of chronic diseases and quality of life in elderly patients admitted to a sleep unit. Materials and Method: The study was conducted with participants over 65 years of age who applied to the sleep unit with complaints such as sleep disorders, snoring, suffocation during sleep, somnolence, daytime sleepiness. Data were obtained by using Personal Information Form, Quality of Life Scale and polysomnography reports. Cronbach Alpha reliability analysis, Chi-Square, Independent groups t-test, One-way ANOVA Analysis of Variance, Pearson Correlation Analysis and Linear Regression Analysis were used to evaluate the data. Results: It was determined that 66.3% of the participants had a diagnosis of chronic disease, most frequently diabetes mellitus, hypertension, asthma, chronic obstructive pulmonary disease and heart diseases. 89% of the participants had obstructive sleep apnea syndrome. Quality of life levels were determined to be at a good level. It was determined that there was a negative correlation between the apnea hypopnea index value of the participants and the sort form-12 total score, and a one-unit increase in apnea hypopnea index values significantly decreased the quality of life of the patients by 0.174 times. Conclusion: It was determined that most of the participants were diagnosed with chronic diseases and obstructive sleep apnea syndrome and that the quality of life levelswere at a good level, however, the increase in apnea hypopnea index value significantly decreased the quality of life.
Introduction: Postoperative pulmonary complications are among the most frequent and serious causes of morbidity and mortality in older surgical patients. Age-related physiological changes, reduced respiratory reserve, and comorbidities increase their vulnerability to adverse respiratory outcomes. The incidence and risk factors of postoperative pulmonary complications were evaluated in older adults undergoing major abdominal surgery. Materials and Method: This retrospective study included 239 patients aged ?65 years who underwent elective major abdominal surgery. Clinical and perioperative data were analyzed, and postoperative pulmonary complications?such as bronchospasm, infiltration, infection, atelectasis, pneumothorax, or acute respiratory distress syndrome?were assessed. Logistic regression identified independent predictors. Results: The incidence of postoperative pulmonary complications was 22.2% (n=53). Patients with complications were older (p < 0.001) and slightly higher intraoperative positive end-expiratory pressure levels (p = 0.007), although other ventilatory parameters were not fully available. Multivariate analysis identified age (OR = 1.097; p = 0.005), positive end-expiratory pressure (OR = 1.452; p = 0.014), ASA ? 3 (OR = 30.532; p < 0.001), and upper abdominal surgery (OR = 2.322; p = 0.022) with the caveat that positive end-expiratory pressure evaluation was limited by the retrospective study design as independent risk factors. Conclusion: Advanced age, high American Society of Anesthesiologists scores, upper abdominal surgery, and higher intraoperative PEEP were associated with increased postoperative pulmonary complication risk in elderly abdominal surgery patients. Due to limitations in available ventilatory data, the association of PEEP with complications should be interpreted cautiously. Optimizing preoperative status may help reduce complications and improve postoperative outcomes in this population.
Introduction: This study aims to assess the predictive efficacy of the modified Frailty Index for 30-day postoperative outcomes in elderly patients undergoing vascular surgery and to evaluate its additional value compared with conventional tools. Materials and Method: This retrospective cohort study examined 155 consecutive patients aged >= 65 years who underwent elective vascular surgery. The preoperative 11-item modified Frailty Index was calculated using National Surgical Quality Improvement Program variables. The primary endpoint was 30-day mortality, and secondary endpoints included surgical site infection, myocardial infarction, septic shock, reintubation, stroke, and acute kidney injury. Results: The mean age was 71.98 +/- 5.59 years. The 30-day mortality rate was 16.8%. The modified Frailty Index was higher in non-survivors than in survivors (3.96 +/- 1.48 vs 1.96 +/- 1.11, p<0.001) and showed excellent mortality prediction (Area Under the Curve=0.851, 95% CI: 0.778-0.924), with a threshold of 2.5 (sensitivity 84.6%, specificity 73.6%). In the multivariate analysis, adjusting for age, sex, American Society of Anesthesiologists score, and Geriatric Nutritional Risk Index, the modified Frailty Index remained associated with mortality (adjusted OR=2.79, 95% CI, 1.52-5.13; p=0.001). Each point increase correlated with higher risk of surgical site infection (OR=1.55, 95% CI: 1.19-2.03, p=0.001), myocardial infarction (OR=2.46, 95% CI: 1.27-4.78, p=0.008), septic shock (OR =2.46, 95% CI: 1.27-4.78, p=0.008), reintubation (OR=2.70, 95% CI: 1.82-4.02, p<0.001), and renal failure (OR=2.05, 95% CI: 1.43-2.94, p< 0.001). Conclusions: The 11-item modified Frailty Index predicted adverse outcomes in geriatric vascular surgery patients. Its use in risk stratification may improve perioperative management.
Inroduction: As life expectancy increases globally and populations swiftly, the significance of geriatric rehabilitation has grown progressively each year. The objective of this study was to conduct a systematic bibliometric analysis of the scientific literature on geriatric rehabilitation published in the last decade. Materials and Method: The Web of Science Core Collection database used to examine scientific papers on geriatric rehabilitation from 2015 to 2025. We used VOSviewer and Bibliometrix to do bibliometric analyses. The research analyzed yearly publication trends, contributions by country, productivity authors and institutions, prominent journals, collaboration networks, citation distributions, co-citation analyses, keywords, and commonly cited references. Results: We found a total of 666 publications, of which 588 were original articles and 78 reviews. The average yearly increase in publications was 4.97%. The Netherlands ranked first in both publication numbers and international collaborations, followed by Germany and Australia. Vrije University Amsterdam and Leiden University were among the most productive universities. Commonly used keywords were "rehabilitation," "geriatric rehabilitation," "older adults," "aging," and "frailty." In the last few years, the keywords "virtual reality," "index," "consensus," "hospitalization," and "quality of life" have become more popular. Conclusion: Our analysis shows that research on geriatric rehabilitation been steadily increasing over the past ten years. Research in this domain predominantly concentrated on functional enhancement; however, recent years have witnessed an expansion in technological applications and multidisciplinary methodologies. These kinds of studies are expected to help future research health policy.
Introduction: Although physical activity is a key component of healthy aging, engagement levels among older adults are influenced by sociocultural, economic, and environmental factors that vary across countries. This study aimed to compare these barriers and facilitators of physical activity participation among American and Turkish older adults. Materials and Method: Data were collected from 128 older adults (64 per country), aged >= 65 years and older, through structured interviews and surveys conducted in parks and senior activity centers in Turkiye, and Florida, United States. The San Diego Health and Exercise Questionnaire and the Structured Interview Questions on Physical Activity Participation Factors were utilized to assess participation patterns and influencing factors. A mixed-methods research design was employed; qualitative data from interviews were analyzed using content analysis, and cross-country differences in questionnaire responses were assessed using the chi-squared test. Results: Turkish participants reported significantly higher psychological (chi(2) =15.7-42.5, p<0.001), individual (chi(2)=3.9-8.4, p<0.05), social (chi(2)=20.2-52.5, p<0.001) and environmental (chi(2)=27.2-34.2, p<0.001) barriers compared to their American older adults. Structured interviews result further showed that social pressure (chi(2)= 8.5-39.2, p<0.001), gender influence (chi(2)=7.3-66.0, p<0.05) had more pronounced effects on Turkish older adults. Additionally, Turkish participants reported limited access to exercise facilities and insufficient support(p<0.05). Conclusion: Older adults in Turkiye face more pronounced sociocultural and infrastructural barriers to physical activity compared with their counterparts in the United States. Addressing these challenges requires comprehensive reforms in education, economic investment, and cultural awareness. Without targeted and sustainable interventions, opportunities for active aging will remain limited. Culturally informed strategies are essential to promote equitable access to physical activity and to enhance the overall health and well-being of older adults in Turkiye.
Introduction: The objective of this study was to assess the association between elevated frailty levels and the risk of postoperative myocardial injury in elderly patients undergoing orthopedic procedures. Materials and Method: All patients aged 65 years and older who underwent surgery atthe Orthopedics Department of our hospital between May 1, 2023, and May 1, 2024, were included. Demographic data such as age, sex, comorbidities, and surgical indications were documented preoperatively. Frailty status was assessed using the FRAIL Index and categorized into three groups. Pre-anesthetic baseline measurements of heart rate and mean arterial pressure were obtained before the initiation of anesthesia and subsequently monitored every 10 minutes intraoperatively. Data regarding perioperative blood transfusion, intravenous fluid administration, vasopressor requirement, and anesthesia technique were collected. Troponin T levels were measured at 0, 6, 12, 24, 48, and 72 hours postoperatively. Outcomes assessed included intensive care unit and hospital length of stay, incidence of postoperative complications, and all-cause mortality within 30 days following surgery. Results: A total of 206 patients were included in the final analysis. Among them, 56.7% were classified as frail, 33.5% as pre-frail, and 9.7% as non-frail. The overall incidence of myocardial injury after non-cardiac surgery was 44.4%, occurring in 63.2% of frail patients, 23.2% of pre-frail patients, and 5.3% of non-frail patients. Thirty-day adverse outcomes and mortality were significantly higher in frail patients, who also demonstrated longer intensive care and hospital stays. Conclusion: In elderly individuals undergoing orthopedic procedures, greater degrees of frailty are strongly associated with an increased risk of postoperative myocardial injury following non-cardiac surgery.
Introduction: The aim of this study was to determine the rates of mechanical failure in patients who underwent proximal femoral nail fixation for intertrochanteric femur fractures, to identify the radiological risk factors for these failures, and to examine in particularthe influence of the tip-apex distance and the femoral neck-shaft angle on treatment outcomes. Materials and Method: A total of 90 patients who underwent proximal femoral nail fixation for intertrochanteric femoral neck fractures between 2019 and 2024 were retrospectively evaluated. Demographic, clinical, and radiological data were analyzed. The relationship between treatment success and the femoral neck-shaft angle and tip-apex distance was investigated. Statistical analyses included the Mann-Whitney U test, chi-square test, receiver operating characteristic curve analysis, and logistic regression. Results: Mechanical failure occurred in 66.7% of the patients. In this group, the femoral neck-shaft angle was significantly higher (129.66 +/- 7.20 degrees, p=0.037), and the tip-apex distance value was greater (25.25 +/- 8.37 mm, p=0.045). Receiver operating characteristic curve analysis revealed cutoff values of 119 degrees for the femoral neck-shaft angle and 27 mm for the tip-apex distance. Conclusion: The most important factors associated with treatment failure are improper implant positioning with an unfavorable femoral neck-shaft angle and an increased tip-apex distance. Maintaining the femoral neck-shaft angle within the range of 125 degrees-130 degrees and a tip-apex distance of less than 25 mm during surgical planning appears to improve success rates. However, these parameters alone are insufficient, and comprehensive evaluation of all contributing factors remains essential for clinical success.
Introduction: This study evaluates the prognostic value of optic nerve sheath diameter measurement as a noninvasive indicator of elevated intracranial pressure and its potential role in guiding decompressive surgical decision-making in elderly patients with ischemic stroke. Materials and Method: This multicenter retrospective observational study included patients over 65 years of age who were hospitalized with middle cerebral artery infarction between 2023 and 2025. Patients with intracranial mass lesions, hydrocephalus, orbital pathology, or a history of head trauma were excluded. Preoperative and postoperative optic nerve sheath diameter measurements were obtained using computed tomography at a distance of 3 mm posterior to the optic disc. Clinical and radiological parameters, including Glasgow Coma Scale, Glasgow Outcome Scale, infarct volume, and degree of midline shift, were systematically analyzed. Results: A total of 97 patients were included (57.7% female; mean age 75.3 +/- 8.5 years). The mean preoperative optic nerve sheath diameter was 4.21 +/- 0.81 mm. Increased preoperative optic nerve sheath diameter, larger infarct volume, and greater midline shift were significantly associated with lower Glasgow Outcome Scale scores (p = 0.035). An optic nerve sheath diameter threshold above 4.4 mm predicted poorer outcomes, while postoperative optic nerve sheath diameter variation showed no significant correlation with prognosis Conclusion: Preoperative optic nerve sheath diameter measurement may serve as a rapid, noninvasive, and reliable parameter for prognostication and for supporting early surgical decision-making in elderly patients with ischemic stroke. However, individualized multidisciplinary evaluation remains crucial given the complex clinical profile of this population.
Introduction: As the global population ages, the prevalence of age related decline and geriatric syndromes has increased. Postoperative cognitive dysfunction is a frequent but under-recognized complication in older patients. Frailty, characterized by reduced physiological reserve, may heighten vulnerability to cognitive decline after hospitalization and surgery. Although both conditions have been studied separately, their direct association remains unclear. This study investigated the relationship between frailty, geriatric syndromes, and postoperative cognitive dysfunction to improve understanding of perioperative cognitive vulnerability. Materials and Method: A total of 305 patients aged >= 65 years were classified into four groups: outpatients, patients without recent surgery, and surgical patients under spinal or general anesthesia. Frailty was assessed with the Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight scale and the 11-item Modified Frailty Index. Cognitive function was evaluated with the Montreal Cognitive Assessment at baseline and on day three. A decline of more than one standard deviation was defined as postoperative cognitive dysfunction. Results: Postoperative cognitive dysfunction occurred in 46% of patients. Univariate analysis showed associations with age, chronic disease, geriatric syndromes, American Society of Anesthesiologists physical status score, and frailty. Multivariate analysis identified age, American Society of Anesthesiologists score, and frailty as independent predictors. Patients aged >= 85 years and those in American Society of Anesthesiologists class III had 11.6-and 3.2-fold higher risk, respectively. Frail and pre-frail individuals had 11.3-and 4.2-fold higher risk, respectively Conclusion:Advanced age, higher American Society of Anesthesiologists score, and frailty markedly increased the risk of postoperative cognitive dysfunction. Routine frailty screening may help identify vulnerable patients and guide preventive strategies.
