Introduction Older and younger adults are offered similar analgesic options after hemorrhoid surgery (HS), but the differences in pain between the two populations are unknown. This study aims to compare postoperative pain outcomes after HS in older and younger individuals. Methods This is a retrospective analysis of electronic medical records of patients who underwent HS between 2018 and 2023. Patients were excluded if additional anorectal procedures were performed at the time of HS. Data related to pain-related outcomes were compiled: (1) need for narcotic prescription refills; (2) documentation of a pain-related phone call within 30 d; (3) urgent postoperative office visit before regular scheduled follow-up; and (4) pain-related postoperative emergency department visits. Associations between age and pain-related outcomes were tested using Fisher's exact test, chi-square test, and covariate adjusted logistic regression modeling. Results There were a total of 249 patients, 60 older adults, and 189 younger adults. Compared to younger patients, older adults demonstrated a reduced frequency of pain-related phone calls (10.3 versus 32.1%, P < 0.01) and opioid refills (0 versus 14.4%, P < 0.01). After adjusting for confounders, older age remained inversely associated with pain-related postoperative phone calls (odds ratio = 0.25, 95% confidence interval = [0.1-0.6], P = 0.003). Conclusions Older adults had better pain outcomes after HS in comparison to younger patients. These findings suggest that the postoperative analgesic needs of older patients after HS are lower than those of younger patients. Decisions regarding opioid prescription in older adults recovering from HS should be tailored to avoid narcotic-related complications.

Mini abstract The financial benefits of instituting the American College of Surgeons Geriatric Surgery Verification Program far exceed the costs, with the added benefits of enhanced patient satisfaction and improved staff morale.

Background: The simplified frailty index (sFI) is a commonly used instrument to estimate postoperative risk, but its correlation with phenotypic frailty has been questioned. This study evaluates the relationship between sFI and phenotypic frailty, as measured by the Sinai Abbreviated Geriatric Evaluation (SAGE).Methods: Charts were retrospectively reviewed from patients >= 75 years old who underwent surgery between 2012-2022. The sFI score was calculated by adding 1 point for hypertension, COPD, congestive heart failure, functional dependence, and diabetes (score 0-5). SAGE was calculated by adding 1 point for normal gait speed, normal Mini-Cog (c), and independent activities of daily living (ADL) (0-3). Spearman rank correlation was used to test the relationship between sFI and SAGE. SAGE components were used as binary-dependent outcomes in covariate-adjusted logistic regression modeling to evaluate associations with sFI scores while adjusting for potential confounders.Results: 334 patients were assessed, with a mean age of 84.0. SAGE and sFI scores were significantly associated, with a modest inverse relationship (r=-0.24, p<0.0001). Each 1-point increase in sFI score was associated with increased odds of ADL deficit (OR 2.3, 95%CI [1.5-3.8], p<0.0001) and abnormal gait speed (OR 1.9, 95%CI 1.2-3.0, p<0.01). The sFI score was not associated with deficits in the Mini-Cog (OR 1.5, 95%CI [0.96-2.3], p=0.07).Conclusion: Higher sFI was significantly associated with increased phenotypic frailty, particularly with the loss of physical condition and function but not associated with cognitive deficit. Therefore, sFI may not be an appropriate tool to estimate postoperative complications related to cognition, such as delirium risk.

People with alcohol dependence admitted to the hospital for any diagnosis can suffer alcohol withdrawal syndrome. 1 Duby J.J. Berry A.J. Ghayyem P. et al. Alcohol withdrawal syndrome in critically ill patients: protocolized versus nonprotocolized management. J Trauma Acute Care Surg. 2014; 77: 938-943 Google Scholar Twenty-five percent of medical inpatients have alcoholism, and 18% to 25% develop withdrawal. 1 Duby J.J. Berry A.J. Ghayyem P. et al. Alcohol withdrawal syndrome in critically ill patients: protocolized versus nonprotocolized management. J Trauma Acute Care Surg. 2014; 77: 938-943 Google Scholar Alcoholism is associated with increased risk for infection, sepsis, mortality, and length of stay. Additionally—and especially relevant given currently scarce health care resources—alcohol withdrawal causing critical illness strains ICU resources. Some of these patients are admitted for alcohol withdrawal specifically; others are admitted for any number of diagnoses, including trauma: in one study, 30% of the patients studied for alcohol withdrawal were treated by trauma surgery. 1 Duby J.J. Berry A.J. Ghayyem P. et al. Alcohol withdrawal syndrome in critically ill patients: protocolized versus nonprotocolized management. J Trauma Acute Care Surg. 2014; 77: 938-943 Google Scholar Alcohol use disorder is reported in 59% to 67% of trauma patients, and up to 44% of geriatric or very old inpatients. 2 Maldonado J.R. Sher Y. Ashouri J.F. et al. The “Prediction of Alcohol Withdrawal Severity Scale” (PAWSS): systematic literature review and pilot study of a new scale for the prediction of complicated alcohol withdrawal syndrome. Alcohol. 2014; 48: 375-390 Google Scholar Trauma and geriatric patients are unique populations with comorbidities and concurrent diagnoses such as dementia, delirium, and traumatic brain injury that can complicate alcohol withdrawal assessment and treatment, whether due to comorbidities or resulting from medications. 3 Wojnar M. Wasilewski D. Zmigrodzka I. Grobel I. Age-related differences in the course of alcohol withdrawal in hospitalized patients. Alcohol. 2001; 36: 577-583 Google Scholar At our urban, academic-affiliated, community-based Level II trauma hospital, we need a unique hospital-based protocol for management of alcohol withdrawal syndrome in geriatric trauma patients.

Powell, Jocelyn DO; D'Adamo, Christopher PhD; Mavanur, Arun MD, MBBS, FACS; Svoboda, Shane MD, FACS; Demos, Jasmine S DNP, MSN, ANP-BC, RN-BC, NPFA, GCN; Katlic, Mark R. MD, MMM, FACS; Wolf, Joshua MD Author Information

Introduction: Telehealth has become mainstream during the COVID-19 pandemic, but its role in managing older patients is not well defined. This systematic review aims to assess the postoperative benefits of perioperative telehealth interventions in older adults. Methods: PubMed, Cochrane, and Embase databases were searched through October 2020. Two separate reviewers screened abstracts from the search. Studies were included in the final list if they measured outcomes of telehealth interventions in the perioperative period for patients > 65 years old. Disagreements were settled by a third reviewer, and results were compiled from the final list of articles. Due to heterogeneity, a meta-analysis was not pursued. Results: The search yielded a total of 770 abstracts. Five were included in the review, three randomized and two prospective pilot projects with a collective total of 395 patients. Four studies found that there was a postoperative benefit following perioperative telehealth interventions. Specifically, the interventions improved subjective perceptions of recovery and symptom severity. Though not statistically significant, patients in all included studies had improvements in physical functioning. There was a consistent pattern of steady improvement from baseline in all health areas in older patients. A notable limitation in one study was that participants experienced technical difficulties and required ongoing technical support. Conclusion: Perioperative telehealth interventions in older adults can lead to improved clinical outcomes, but existing data are limited. More studies are needed to evaluate the application of telehealth to older adults with frailty, whose ability to participate in the technology may be limited.

Background: Patients with Crohn's disease are particularly susceptible to preoperative frailty owing to the chronic nature of the illness and immunosuppressive therapy. The hypothesis in this study was that frailty would have a greater impact on postoperative outcome than age in older individuals with Crohn's disease. Methods: Data were obtained from the National Surgical Quality Improvement Program (NSQIP) from the years 2012 to 2018. Patients with Crohn's disease who underwent a bowel resection were identified from diagnostic and procedure codes. Frailty was assessed using the 5-point Simplified Frailty Index (0-not frail, 5-most frail). Age was defined as an ordinal variable with 3 age ranges (18-64, 65-79, >80 years). Aggregate morbidity was classified according to the standard NSQIP definitions. Simplified Frailty Index was evaluated as a potential predictor of morbidity and mortality using covariate-adjusted logistic regression modeling. Results: A total of 9,023 patients underwent bowel resection for Crohn's disease during the study period. Patient Simplified Frailty Index ranged from 0 to 3 (Simplified Frailty Index = 0, 82%; 1, 15%; 2, 2.5%; 3, 0.1%), and higher Simplified Frailty Index was associated with increased age (P < .01). In multivariate regression, a Simplified Frailty Index was significantly associated with postoperative morbidity (Simplified Frailty Index > 2: odds ratio = 2.59, 95% confidence interval [1.84-3.63], P < .0001). In contrast, age was not found to be a significant predictor of morbidity when adjusted for Simplified Frailty Index and other covariates (P > .05). Conclusion: Frailty is a stronger predictor than age for morbidity in Crohn's-related bowel resection. Functional assessments and vulnerability screening should be used to determine surgical candidacy rather than age alone. (c) 2021 Elsevier Inc. All rights reserved.