Background: Preoperative fasting is a standard procedure before surgery to allow adequate gastric emptying and reduce the risk of pulmonary aspiration during induction of anaesthesia. However, prolonged preoperative fasting has been shown to cause physiological stress and discomfort. We evaluated the association between preoperative fasting duration and postoperative complications in older patients undergoing hip fracture surgery in a teaching hospital. Methods: Data were collected retrospectively from electronic medical records for all patients aged >= 65 years who underwent hip fracture surgery in 2023. Baseline characteristics, type of surgical procedure, postoperative complications, inpatient mortality, and readmissions within 30 days of discharge were recorded. Patients were categorised by fasting duration (<8 hours vs. >= 8 hours), and comparisons were made to evaluate the impact of fasting duration on clinical outcomes. Results: A total of 224 patients with a mean age of 79.68 (SD 6.62) years were included. The mean duration of preoperative fasting was 588.63 (SD 156.19) minutes. Ninety five (42.4%) older patients developed postoperative complications, with delirium (n = 64, 28.57%), pneumonia (n = 12, 5.36%), and venous thromboembolism (n = 5, 2.23%) being the most common. No significant differences in baseline characteristics were observed between patients fasted for <8 hours (n = 77, 34.4%) and those fasted for >= 8 hours (n = 147, 65.6%). There was also no significant association between fasting duration and postoperative complications. Conclusions: In this study, prolonged fasting beyond 8 hours was not associated with postoperative complications in older patients undergoing hip fracture surgery. These findings suggest that fasting duration alone may not be the primary contributor to postoperative morbidity, highlighting the need for a comprehensive perioperative approach.
Background: Isolated rapid eye movement (REM) sleep behavior disorder (iRBD), characterized by dream enactment behavior, is diagnosed based on the demonstration of REM sleep without atonia (RSWA) on video polysomnography (vPSG). Screening using validated questionnaires is crucial owing to the high burden and cost of vPSG. Therefore, this study investigated the reliability and validity of the Turkish version of the Mayo Sleep Questionnaire (MSQ-T). Methods: This national multicenter study was prospectively conducted in 13 accredited sleep clinics in Turkey. A total of 238 participants (51 with iRBD, 54 with obstructive sleep apnea, and 133 healthy controls) underwent a detailed clinical evaluation and full-night vPSG, and all completed the MSQ-T. The MSQ was translated into Turkish and back-translated into English, with high performance metrics. Results: Question 1 indicated that patients with a sleep disorder consistent with iRBD had sensitivities of 96.1% and 96.3% and specificities of 95.7% and 82.4%, respectively, when filled in by patients and bed partners. Questions 5and 6, which investigated OSA displayed sensitivities of 82.5% and 79.4% and specificities of 48.1% and 42.8%, respectively, when filled-in by patients and bed partners. Conclusions: Our study demonstrated that MSQ-T has a high sensitivity and specificity for the diagnosis of iRBD. Considering the importance of the early and accurate diagnosis of iRBD in implementing the risk of neurodegeneration, our results are encouraging for the use of the MSQ-T as a valid and reliable screening tool for iRBD and its discrimination from other sleep disorders. Copyright (c) 2026, Taiwan Society of Geriatric Emergency & Critical Care Medicine.
An 89-year-old man with type 2 diabetes and normal renal function developed severe lactic acidosis during right hepatectomy after taking a single 500 mg dose of metformin on the day of surgery. The onset of metformin-associated lactic acidosis (MALA) was likely precipitated by blood loss, hemodynamic instability, and hepatic vascular clamping, which impaired lactate clearance. This rare case - only the second reported in a patient without renal dysfunction - underscores the importance of withholding metformin preoperatively and carefully selecting vascular control techniques that balance bleeding risk with hepatic perfusion to reduce metabolic complications during liver surgery.
Background: Sorafenib and lenvatinib are tyrosine kinase inhibitors (TKIs) approved as the first-line treatments for advanced hepatocellular carcinoma (HCC). However, only a few studies have investigated the efficacy of sorafenib and lenvatinib in elderly patients with HCC in Taiwan. Methods: This retrospective study analyzed patients with advanced HCC receiving first-line sorafenib or lenvatinib between July 2020 and December 2022 at MacKay Memorial Hospital and compared their clinical outcomes. The elderly group included patients aged >= 65 years as they began using TKIs. Results: Eighty patients were enrolled, including 53 who received sorafenib and 27 who received lenvatinib. The baseline characteristics of the groups were comparable. Median overall survival (OS) was 26.53 months for sorafenib and 20.37 months for lenvatinib (p = 0.991). The progression-free survival (PFS) was similar between the groups (5.43 vs. 6.50 months, p = 0.995). The objective response rates (ORR) was 9.4% for sorafenib and 22.2% for lenvatinib, whereas the disease control rates (DCR) was 50.9% and 70.4%, respectively. Treatment-related adverse events were mostly mild (grades 1-2); sorafenib was associated with higher rates of hand-foot skin reactions and diarrhea, whereas lenvatinib had higher rates of proteinuria and fatigue. Conclusion: In elderly Taiwanese patients with advanced HCC, sorafenib and lenvatinib demonstrated comparable survival outcomes, although lenvatinib exhibited a better response. Both drugs were well tolerated with distinct adverse effect profiles. Further studies are needed to refine treatment selection for elderly populations. Further research is warranted to optimize individualized treatment strategies in elderly patients with advanced HCC. Copyright (c) 2026, Taiwan Society of Geriatric Emergency & Critical Care Medicine.
Background: To investigate the prevalence of social isolation among elderly patients with hematologic disorders and analyze its relationship with family functioning and activities of daily living (ADL) and related influencing factors. Methods: The clinical data of 173 elderly patients with neutropenia were retrospectively analyzed. Social support and functional status were assessed using the Social Isolation Scale, University of California, Los Angeles Loneliness Scale, Family Adaptation, Partnership, Growth, Affection, and Resolve (APGAR) Index, ADL scale, and Social Support Scale. Binary logistic regression analysis was to identify the factors influencing social isolation. Results: Logistic regression analysis indicated that family functioning, as measured by the total Family APGAR Scale score (odds ratio [OR] = 0.623), was a protective factor against social isolation (p < 0.05), suggesting that good family functioning may reduce the risk of social isolation in elderly patients. High levels of social support (OR = 0.039) were identified as protective factors against social isolation (p < 0.05), whereas blurred vision or blindness (OR = 2.419) constituted a risk factor for social isolation (p < 0.05). Conclusion: Elderly patients with neutropenia exhibit a high incidence of social isolation, influenced by factors such as family functioning, ADL, social support levels, and visual conditions. Enhancing social support, improving ADL function, and addressing the social needs of patients with visual impairments may mitigate the risk of social isolation.
