COLECTOMY OUTCOMES IN PATIENTS OVER 65 WITH ULCERATION COLITIS

Introduction: There are limited data regarding surgical outcomes for elderly patients with Ulcerative Colitis, and we sought to examine the post operative outcomes in this population. Methods: The ACS NSQIP was queried for all patients with a diagnosis of ulcerative colitis and compared elderly patients (those aged 65 and older) to younger patients under age 65. Univariate and multivariate logistic regression was done to evaluate differences in morbidity and mortality rates. Results: 2,699 patients were analyzed, of which 493 (18.3%) were defined as elderly. Elderly patients had more comorbidities compared to younger patients but were less likely to be on preoperative steroids (47.1% vs 74.2%, p\u3c0.0001). Elderly patients had a higher proportion of emergent cases (27.6% vs 8.2%, p\u3c0.0001) and an average 3 day longer hospital stay, (p\u3c0.0001). There were no significant differences in the rates of anastomotic leak, surgical site infections or 30-day readmission. Elderly patients had a higher rate of morbidity (47.3% vs 26.8%, p\u3c0.0001) and mortality (8.9% vs 1.2%, p\u3c0.0001). Multivariate analysis showed elderly patients had significantly increased odds for morbidity (OR 2.45, 95% CI: 2.00-2.99, p\u3c0.0001) and 30-day mortality (OR 7.91, 95% CI: 4.85-12.91, p\u3c0.001). Preoperative sepsis significantly increased the risk of morbidity (OR 3.457, 95% CI: 2.27-5.26, p \u3c0.0001) and mortality (OR 3.11, 95% CI: 1.48-6.57, p\u3c0.003). Conclusions: Elderly patients with Ulcerative Colitis that undergo a colectomy are at increased risk for both morbidity and mortality. Optimizing these patients may reduce the risk, but further prospective trials are warranted to further elucidate the ideal optimization strategies.https://scholarlycommons.henryford.com/sarcd2021/1009/thumbnail.jp

Percutaneous coronary revascularization is associated with higher exercise capacity after myocardial infarction

Background Cardiopulmonary exercise testing (CPET) is a valuable tool to assess exercise tolerance and prognosis in heart failure. Limited studies have evaluated its clinical utility in patients with myocardial infarction (MI). The purpose of this study was to evaluate exercise capacity in post-MI patients based on whether they received percutaneous coronary intervention (PCI) or were treated with medical therapy. Methods We retrospectively identified patients who completed a CPET within 1 year after an acute MI. A general linear mixed model was developed to compare peak oxygen uptake (VO2) between patients who did and did not receive PCI with adjustments for age, sex, ST-elevation MI (STEMI), and presence of chronic total occlusion (CTO). A sub-analysis was performed in patients with CTO. Results Between April 2002 and March 2019, 436 patients (age= 57±11 years; 65% male; 63% white; 40% STEMI; 30% CTO; 70% PCI) completed a CPET within 1 year post-MI. Among 175 patients who suffered a STEMI, 84% underwent PCI. Among 261 patients who suffered a non-STEMI, 61% underwent PCI. There was significant variability of PCI performed between sex, race, MI type, and age (P\u3c0.05). As shown in the Table, PCI was associated with significantly higher adjusted peak VO2 among the entire cohort and the subgroup of patients with CTO (n=130). Conclusion Among patients who suffer an acute MI, PCI is associated with higher exercise capacity as determined by peak VO2. This effect was larger in patients who present with CTO