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1. Risk factors for postoperative morbidity following appendectomy in the elderly: a nationwide prospective cohort study

Author

Poillucci, Gaetano, Podda, Mauro, Pisanu, Adolfo, Mortola, Lorenzo, Dalla Caneva, Patrizia, Massa, Giulia, Costa, Gianluca, Savastano, Riccardo, Cillara, Nicola, Collaborative Study Group endorsed by SICUT ACOI SICG SICE and Italian Chapter of WSES, Agresta, F, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Balducci, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, Pp, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buonanno, Gm, Canini, T, Cardella, S, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Costa, G, Crucitti, A, Dalla Caneva, P, De Luca, M, De Manzoni Garberini, A, De Nisco, C, De Prizio, M, De Sol, A, Dibella, A, Falcioni, T, Falco, N, Farina, C, Finotti, E, Fontana, T, Francioni, G, Fransvea, P, Frezza, B, Garulli, G, Genna, M, Giannessi, S, Gioffrè, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laterza, E, Leonardi, A, Lepre, L, Lorenzon, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Massa, G, Mecarelli, V, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, Gm, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Pisanu, A, Podda, M, Poillucci, G, Porfidia, R, Rossi, G, Ruscelli, P, Spagnoli, A, Sulis, R, Tartaglia, D, Tranà, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Vasquez, G, Zago, M, Zanoni, E., Poillucci G., Podda M., Pisanu A., Mortola L., Dalla Caneva P., Massa G., Costa G., Savastano R., Cillara N., Agresta F., Alemanno G., Anania G., Antropoli M., Argenio G., Atzeni J., Avenia N., Azzinnaro A., Baldazzi G., Balducci G., Barbera G., Bellanova G., Bergamini C., Bersigotti L., Bianchi P.P., Bombardini C., Borzellino G., Bozzo S., Brachini G., Buonanno G.M., Canini T., Cardella S., Carrara G., Cassini D., Castriconi M., Ceccarelli G., Celi D., Ceresoli M., Chiarugi M., Cimino F., Cobuccio L., Cocorullo G., Colangelo E., Crucitti A., De Luca M., De Manzoni Garberini A., De Nisco C., De Prizio M., De Sol A., Dibella A., Falcioni T., Falco N., Farina C., Finotti E., Fontana T., Francioni G., Fransvea P., Frezza B., Garulli G., Genna M., Giannessi S., Gioffre A., Giordano A., Gozzo D., Grimaldi S., Gulotta G., Iacopini V., Iarussi T., Laterza E., Leonardi A., Lepre L., Lorenzon L., Luridiana G., Malagnino A., Mar G., Marini P., Marzaioli R., Mecarelli V., Mingoli A., Nigri G., Occhionorelli S., Paderno N., Palini G.M., Paradies D., Paroli M., Perrone F., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Piccoli M., Porfidia R., Rossi G., Ruscelli P., Spagnoli A., Sulis R., Tartaglia D., Trana C., Travaglino A., Tomaiuolo P., Valeri A., Vasquez G., Zago M., Zanoni E., Poillucci, G, Podda, M, Pisanu, A, Mortola, L, Dalla Caneva, P, Massa, G, Costa, G, Savastano, R, Cillara, N, Agresta, F, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Balducci, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buonanno, G, Canini, T, Cardella, S, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Crucitti, A, De Luca, M, De Manzoni Garberini, A, De Nisco, C, De Prizio, M, De Sol, A, Dibella, A, Falcioni, T, Falco, N, Farina, C, Finotti, E, Fontana, T, Francioni, G, Fransvea, P, Frezza, B, Garulli, G, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laterza, E, Leonardi, A, Lepre, L, Lorenzon, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Mecarelli, V, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Porfidia, R, Rossi, G, Ruscelli, P, Spagnoli, A, Sulis, R, Tartaglia, D, Trana, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Vasquez, G, Zago, M, and Zanoni, E

Subjects
medicine.medical_specialty, Multivariate analysis, Sports medicine, Settore MED/18 - CHIRURGIA GENERALE, Critical Care and Intensive Care Medicine, Acute appendicitis, Appendectomy, Elderly, Frail patients, Postoperative complications, NO, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Risk Factors, Acute appendicitis, Appendectomy, Elderly, Frail patients, Postoperative complications, Internal medicine, medicine, Humans, Frail patient, Orthopedics and Sports Medicine, In patient, Prospective Studies, Prospective cohort study, Aged, Retrospective Studies, 030222 orthopedics, Creatinine, business.industry, Postoperative complication, 030208 emergency & critical care medicine, Perioperative, Length of Stay, Appendicitis, chemistry, Emergency Medicine, Laparoscopy, Surgery, Acute appendiciti, Morbidity, Risk assessment, business
Abstract

Background: A limited number of studies investigating perioperative risk factors associated with emergency appendectomy in elderly patients have been published to date. Whether older age may be associated with poorer outcomes following appendectomy is still a matter of debate. The primary aim of this study was to determine the predictors of postoperative morbidity following appendectomy in patients aged ≥ 65years. Methods: Data regarding all elderly patients who underwent emergency appendectomy from January 2017 to June 2018 admitted 36 Italian surgical departments were prospectively collected and analyzed. Baseline demographics and perioperative variables were evaluated. Uni- and multivariate analyses adjusted for differences between groups were carried out to determine possible predictors of adverse outcomes after appendectomy. Results: Between January 2017 and June 2018, 135 patients aged ≥ 65years with a diagnosis of AA met the study inclusion criteria. Twenty-six patients (19.3%) were diagnosed with some type of postoperative complication. Decreasing the preoperative hemoglobin level showed a statistically significant association with postoperative complications (OR 0.77, CI 0.61–0.97, P = 0.03). Preoperative creatinine level (P = 0.02, OR 2.04, CI 1.12–3.72), and open appendectomy (P = 0.03, OR 2.67, CI 1.11–6.38) were significantly associated with postoperative morbidity. After adjustment, the only independent predictor of postoperative morbidity was preoperative creatinine level (P = 0.04, OR 2.01, CI 1.05–3.89). Conclusions: In elderly patients with AA, perioperative risk assessment in the emergency setting must be as accurate as possible to identify modifiable risk factors that can be addressed before surgery, such as preoperative hemoglobin and creatinine levels.

Published
2019

2. The use of emergency laparoscopy for acute abdomen in the elderly: the FRAILESEL Italian Multicenter Prospective Cohort Study

Author

Costa, Gianluca, Fransvea, Pietro, Podda, Mauro, Pisanu, Adolfo, Carrano, Francesco Maria, Iossa, Angelo, Balducci, Genoveffa, Agresta, Ferdinando Collaborative Study Group: Agresta, F, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Balducci, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, Pp, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buonanno, Gm, Canini, T, Cardella, S, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Costa, G, Crucitti, A, Dalla Caneva, P, De Luca, M, De Manzoni Garberini, A, De Nisco, C, De Prizio, M, De Sol, A, Dibella, A, Falcioni, T, Falco, N, Farina, C, Finotti, E, Fontana, T, Francioni, G, Fransvea, P, Frezza, B, Garulli, G, Genna, M, Giannessi, S, Gioffrè, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laterza, E, Leonardi, A, Lepre, L, Lorenzon, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Massa, G, Mecarelli, V, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, Gm, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Pisanu, A, Podda, M, Poillucci, G, Porfidia, R, Rossi, G, Ruscelli, P, Spagnoli, A, Sulis, R, Tartaglia, D, Tranà, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Vasquez, G, Zago, M, Zanoni, E., Costa G., Fransvea P., Podda M., Pisanu A., Carrano F.M., Iossa A., Balducci G., Agresta F., Alemanno G., Anania G., Antropoli M., Argenio G., Atzeni J., Avenia N., Azzinnaro A., Baldazzi G., Barbera G., Bellanova G., Bergamini C., Bersigotti L., Bianchi P.P., Bombardini C., Borzellino G., Bozzo S., Brachini G., Buonanno G.M., Canini T., Cardella S., Carrara G., Cassini D., Castriconi M., Ceccarelli G., Celi D., Ceresoli M., Chiarugi M., Cillara N., Cimino F., Cobuccio L., Cocorullo G., Colangelo E., Crucitti A., Dalla Caneva P., De Luca M., de Manzoni Garberini A., De Nisco C., De Prizio M., De Sol A., Dibella A., Falcioni T., Falco N., Farina C., Finotti E., Fontana T., Francioni G., Frezza B., Garulli G., Genna M., Giannessi S., Gioffre A., Giordano A., Gozzo D., Grimaldi S., Gulotta G., Iacopini V., Iarussi T., Laterza E., Leonardi A., Lepre L., Luridiana G., Malagnino A., Mar G., Marini P., Marzaioli R., Massa G., Mecarelli V., Mingoli A., Nigri G., Occhionorelli S., Paderno N., Palini G.M., Paradies D., Paroli M., Perrone F., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Piccoli M., Poillucci G., Porfidia R., Rossi G., Ruscelli P., Spagnoli A., Sulis R., Tartaglia D., Trana C., Travaglino A., Tomaiuolo P., Valeri A., Vasquez G., Zago M., Zanoni E., Costa, G, Fransvea, P, Podda, M, Pisanu, A, Carrano, F, Iossa, A, Balducci, G, Agresta, F, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buonanno, G, Canini, T, Cardella, S, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Crucitti, A, Dalla Caneva, P, De Luca, M, de Manzoni Garberini, A, De Nisco, C, De Prizio, M, De Sol, A, Dibella, A, Falcioni, T, Falco, N, Farina, C, Finotti, E, Fontana, T, Francioni, G, Frezza, B, Garulli, G, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laterza, E, Leonardi, A, Lepre, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Massa, G, Mecarelli, V, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Poillucci, G, Porfidia, R, Rossi, G, Ruscelli, P, Spagnoli, A, Sulis, R, Tartaglia, D, Trana, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Vasquez, G, Zago, M, and Zanoni, E

Subjects
Male, Settore MED/18 - CHIRURGIA GENERALE, Endoscopy, Gastrointestinal, Cohort Studies, 0302 clinical medicine, Postoperative Complications, Elderly, Abdomen, 80 and over, Medicine, Prospective Studies, Prospective cohort study, Laparoscopy, Abdomen, Acute, Aged, 80 and over, medicine.diagnostic_test, Mortality rate, Age Factors, Prognosis, Multicenter study, Italy, Acute abdomen, 030220 oncology & carcinogenesis, Emergency surgery, 030211 gastroenterology & hepatology, Female, medicine.symptom, Cohort study, Risk, Gastrointestinal, medicine.medical_specialty, Acute, Malignancy, NO, 03 medical and health sciences, Humans, Aged, business.industry, acute abdomen, elderly, emergency surgery, laparoscopy, multicenter study, Endoscopy, medicine.disease, Surgery, Emergencies, Morbidity, business, Procedures and Techniques Utilization, Abdominal surgery
Abstract

As the world population is aging rapidly, emergency abdominal surgery for acute abdomen in the elderly represents a global issue, both in developed and developing countries. Data regarding all the elderly patients who underwent emergency abdominal surgery from January 2017 to December 2017 at 36 Italian surgical departments were analyzed with the aim to appraise the contemporary reality regarding the use of emergency laparoscopy for acute abdomen in the elderly. 1993 patients were enrolled. 1369 (68.7%) patients were operated with an open technique; whereas, 624 (31.3%) underwent a laparoscopic operation. The postoperative morbidity rate was 32.6%, with a statically significant difference between the open and the laparoscopic groups (36.2% versus 22.1%, p < 0.001). The reported mortality rate was 8.8%, with a statistically significant difference between the open and the laparoscopic groups (11.2% versus 2.2%, p < 0.001). Our results demonstrated that patients in the ASA II (58.1%), ASA III (68.7%) and ASA IV (88.5%) groups were operated with the traditional open technique in most of the cases. Only a small percentage of patients underwent laparoscopy for perforated gastro-duodenal ulcer repair (18.9%), adhesiolyses with/without small bowel resection (12.2%), and large bowel resection (10.7%). Conversion to open technique was associated with a higher mortality rate (11.1% versus 2.2%, p < 0.001) and overall morbidity (38.9% versus 22.1%, p = 0.001) compared with patients who did not undergo conversion. High creatinine (p < 0.001) and glycaemia (p = 0.006) levels, low hemoglobin levels (p < 0.001), oral anticoagulation therapy (p = 0.001), acute respiratory failure (p < 0.001), presence of malignancy (p = 0.001), SIRS (p < 0.001) and open surgical approach (p < 0.001) were associated with an increased risk of postoperative morbidity. Regardless of technical progress, elderly patients undergoing emergency surgery are at very high risk for in-hospital complications. A detailed analysis of complications and mortality in the present study showed that almost 9% of elderly patients died after surgery for acute abdomen, and over 32% developed complications.

Published
2020

3. The Emergency Surgery Frailty Index (EmSFI): development and internal validation of a novel simple bedside risk score for elderly patients undergoing emergency surgery

Author

Costa, Gianluca, Bersigotti, Laura, Massa, Giulia, Lepre, Luca, Fransvea, Pietro, Lucarini, Alessio, Mercantini, Paolo, Balducci, Genoveffa, Sganga, Gabriele, Crucitti, ERASO (Elderly Risk Assessment, Surgical Outcome) Collaborative Study Group:, F Agresta, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Balducci, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, P Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, M Buonanno, G, Canini, T, Cardella, S, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Costa, G, Crucitti, A, P Dalla Caneva, M De Luca, A de Manzoni Garberini, C De Nisco, M De Prizio, A De Sol, Dibella, A, Falcioni, T, Falco, N, Farina, C, Finotti, E, Fontana, T, Francioni, G, Fransvea, P, Frezza, B, Garbarino, G, Garulli, G, Genna, M, Giannessi, S, Gioffrè, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laracca, G, Laterza, E, Leonardi, A, Lepre, L, Lorenzon, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Massa, G, Mecarelli, V, Mercantini, P, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, M Palini, G, Paradies, D, Paroli, M, Perrone, F, Petrucciani, N, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Pisanu, A, Podda, M, Poillucci, G, Porfidia, R, Rossi, G, Ruscelli, P, Spagnoli, A, Sulis, R, Tartaglia, D, Tranà, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Vasquez, G, Zago, M, Zanoni, E, Costa, G, Bersigotti, L, Massa, G, Lepre, L, Fransvea, P, Lucarini, A, Mercantini, P, Balducci, G, Sganga, G, Crucitti, A, Agresta, F, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Barbera, G, Bellanova, G, Bergamini, C, Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buonanno, G, Canini, T, Cardella, S, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Dallacaneva, P, Deluca, M, deManzoni Garberini, A, Denisco, C, Deprizio, M, Desol, A, Dibella, A, Falcioni, T, Falco, N, Farina, C, Finotti, E, Fontana, T, Francioni, G, Frezza, B, Garbarino, G, Garulli, G, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laracca, G, Laterza, E, Leonardi, A, Lorenzon, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Mecarelli, V, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petrucciani, N, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Pisanu, A, Podda, M, Poillucci, G, Porfidia, R, Rossi, G, Ruscelli, P, Spagnoli, A, Sulis, R, Tartaglia, D, Trana, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Vasquez, G, Zago, M, and Zanoni, E

Subjects
Aging, medicine.medical_specialty, Frail Elderly, Frailty Index, Emergency surgery, Frailty, Predictive tool, Procedure-specific morbidity, Procedure-specifc morbidity, Logistic regression, Risk Assessment, NO, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Risk Factors, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Internal validation, Aged, Frailty, Emergency surgery, Predictive tool, Procedure-specifc morbidity, Univariate analysis, Framingham Risk Score, Receiver operating characteristic, business.industry, Test (assessment), Italy, 030220 oncology & carcinogenesis, Emergency medicine, Original Article, Geriatrics and Gerontology, business
Abstract

Background Frailty assessment has acquired an increasing importance in recent years and it has been demonstrated that this vulnerable profile predisposes elderly patients to a worse outcome after surgery. Therefore, it becomes paramount to perform an accurate stratification of surgical risk in elderly undergoing emergency surgery. Study design 1024 patients older than 65 years who required urgent surgical procedures were prospectively recruited from 38 Italian centers participating to the multicentric FRAILESEL (Frailty and Emergency Surgery in the Elderly) study, between December 2016 and May 2017. A univariate analysis was carried out, with the purpose of developing a frailty index in emergency surgery called “EmSFI”. Receiver operating characteristic curve analysis was then performed to test the accuracy of our predictive score. Results 784 elderly patients were consecutively enrolled, constituting the development set and results were validated considering further 240 consecutive patients undergoing colorectal surgical procedures. A logistic regression analysis was performed identifying different EmSFI risk classes. The model exhibited good accuracy as regard to mortality for both the development set (AUC = 0.731 [95% CI 0.654–0.772]; HL test χ2 = 6.780; p = 0.238) and the validation set (AUC = 0.762 [95% CI 0.682–0.842]; HL test χ2 = 7.238; p = 0.299). As concern morbidity, our model showed a moderate accuracy in the development group, whereas a poor discrimination ability was observed in the validation cohort. Conclusions The validated EmSFI represents a reliable and time-sparing tool, despite its discriminative value decreased regarding complications. Thus, further studies are needed to investigate specifically surgical settings, validating the EmSFI prognostic role in assessing the procedure-related morbidity risk.

Published
2020

4. Frailty and emergency surgery in the elderly: protocol of a prospective, multicenter study in Italy for evaluating perioperative outcome (The FRAILESEL Study)

Author

Mingoli, A, Costa, Gianluca, Massa, Giulia, Agresta, F., Anania, G., Ansaloni, L., Antropoli, M., Argenio, G., Atzeni, J., Avenia, N., Azzinnaro, A., Balani, A., Baldazzi, G., Balducci, G., Barbera, G., Bellanova, G., Bergamini, C., Bersigotti, L., Bianchi, P. P., Bombardini, C., Borzellino, G., Bozzo, S., Brachini, G., Buccoliero, F., Buonanno, G. M., Buononato, M., Campanile, F. C., Canini, T., Cardella, S., Carrara, G., Cascini, F., Cassini, D., Castriconi, M., Catalini, G., Catena, F., Ceccarelli, G., Celi, D., Ceresoli, M., Chiarugi, M., Cillara, N., Cimino, F., Cobuccio, L., Coccolini, F., Cocorullo, G., Colangelo, E., Costa, G., Crafa, F., Crucitti, A., Dalla Caneva, P., De&nbsp, Luca, M., de&nbsp, Manzoni Garberini, A., De Nisco, C., Sol, A., Falcioni, T., Falco, N., Farina, C., Filippone, G., Finotti, E., Fiume, S., Fontana, T., Francioni, G., Fransvea, P., Frezza, B., Gemini, Simone, Genna, M., Giannessi, S., Gioffrè, A., Giordano, A., Gozzo, D., Grimaldi, S., Gulotta, G., Iarussi, T., Laterza, E., Lepre, L., Lorenzon, L., Lotti, R., Luridiana, G., Marini, P., Marzaioli, R., Massa, G., Mulas, S., Nagliati, C., Nigri, G., Niolu, P., Noviello, A., Occhionorelli, S., Paderno, N., Palini, G. M., Paradies, D., Paroli, M., Perrone, F., Petruzzelli, L., Pezzolla, A., Piazza, D., Piazza, V., Piccoli, M., Pisanu, A., Podda, M., Poillucci, Gaetano, Porfidia, R., Rossi, G., Ruscelli, P., Santella, S., Sartelli, M., Spagnoli, A., Sulis, R., Tarasconi, A., Tranà, C., Travaglino, A., Valeri, A., Vasquez, G., Zago, Michela, Zanoni, E., Costa, G, Massa, G, Anania, G, Atzeni, J, Cardella, S, Cimino, F, Cocorullo, G, Falco, N, Farina, M, Fontana, T, Gulotta, G, Piazza, D, Agresta, F, Ansaloni, L, Antropoli, M, Argenio, G, Avenia, N, Azzinnaro, A, Balani, A, Baldazzi, G, Balducci, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buccoliero, F, Buonanno, G, Buononato, M, Campanile, F, Canini, T, Carrara, G, Cascini, F, Cassini, D, Castriconi, M, Catalini, G, Catena, F, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cillara, N, Cobuccio, L, Coccolini, F, Colangelo, E, Crafa, F, Crucitti, A, Dalla Caneva, P, Deluca, M, deManzoni Garberini, A, De Nisco, C, Desol, A, Falcioni, T, Farina, C, Filippone, G, Finotti, E, Fiume, S, Francioni, G, Fransvea, P, Frezza, B, Gemini, S, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Iarussi, T, Laterza, E, Lepre, L, Lorenzon, L, Lotti, R, Luridiana, G, Marini, P, Marzaioli, R, Mingoli, A, Mulas, S, Nagliati, C, Nigri, G, Niolu, P, Noviello, A, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, V, Piccoli, M, Pisanu, A, Podda, M, Poillucci, G, Porfidia, R, Rossi, G, Ruscelli, P, Santella, S, Sartelli, M, Spagnoli, A, Sulis, R, Tarasconi, A, Trana, C, Travaglino, A, Valeri, A, Vasquez, G, Zago, M, and Zanoni, E

Subjects
Elderly patient, Emergency surgery, Frailty, Geriatric, Risk assessment, Scores, Aged, Aged, 80 and over, Clinical Protocols, Emergencies, Female, Humans, Italy, Logistic Models, Male, Multivariate Analysis, Outcome Assessment, Health Care, Postoperative Complications, Prognosis, Prospective Studies, ROC Curve, Risk Assessment, Frail Elderly, Outcome Assessment, 030230 surgery, law.invention, 0302 clinical medicine, Quality of life, law, 80 and over, Prospective cohort study, Multivariate Analysi, Emergencie, Mortality rate, Score, Intensive care unit, Outcome Assessment (Health Care), 030220 oncology & carcinogenesis, elderly patient, emergency surgery, frailty, geriatric, risk assessment, scores, Human, medicine.medical_specialty, Logistic Model, Prognosi, NO, 03 medical and health sciences, medicine, Clinical Protocol, business.industry, Perioperative, Surgery, Health Care, Prospective Studie, Settore MED/18 - Chirurgia Generale, Emergency medicine, Life expectancy, Observational study, Postoperative Complication, business
Abstract

Improvements in living conditions and progress in medical management have resulted in better quality of life and longer life expectancy. Therefore, the number of older people undergoing surgery is increasing. Frailty is often described as a syndrome in aged patients where there is augmented vulnerability due to progressive loss of functional reserves. Studies suggest that frailty predisposes elderly to worsening outcome after surgery. Since emergency surgery is associated with higher mortality rates, it is paramount to have an accurate stratification of surgical risk in such patients. The aim of our study is to characterize the clinicopathological findings, management, and short-term outcome of elderly patients undergoing emergency surgery. The secondary objectives are to evaluate the presence and influence of frailty and analyze the prognostic role of existing risk-scores. The final FRAILESEL protocol was approved by the Ethical Committee of “Sapienza” University of Rome, Italy. The FRAILESEL study is a nationwide, Italian, multicenter, observational study conducted through a resident-led model. Patients over 65years of age who require emergency surgical procedures will be included in this study. The primary outcome measures are 30-day postoperative mortality and morbidity rates. The Clavien-Dindo classification system is used to categorize complications. The secondary outcome measures include length of hospital stay, length of stay in intensive care unit, and predictive value for morbidity and mortality of several frailty and surgical risk-scores. The results of the FRAILESEL study will be disseminated through national and international conference presentations and peer-reviewed journals. The study is also registered at ClinicalTrials.gov (ClinicalTrials.gov identifier: NCT02825082).

Published
2018

5. Oncological outcomes in oncoplastic breast surgery: A single institution analysis

Author

Lombardi, A., Maggi, S., Stanzani, G., Vitale, V., Bersigotti, L., Romano, C., Jacopo Vittori, Pastore, E., and Amanti, C.

Subjects
oncoplastic surgery, invasive breast cancer, conservative surgery, Treatment Outcome, conservative surgery, invasive breast cancer, oncoplastic surgery, Humans, Breast Neoplasms, Female, Neoplasm Invasiveness, Mastectomy, Segmental, Mastectomy
Abstract

Oncoplastic surgery is a well-acknowledged technique that combines conserving treatment in breast cancer with plastic surgery reconstruction. The aim of our analysis is to evaluate the safety of this surgical procedure in the setting of invasive primary breast cancer, and then compare breast oncoplastic surgery with the Veronesi quadrantectomy.We have analyzed 1541 patients who underwent breast surgery for primary breast tumor between October 2004 and May 2018 at Sant'Andrea University Hospital in Rome: 880 women experienced the breast oncoplastic approach, while 660 patients received conservative surgery alone. The median follow-up time was 14 years with a completeness of 70% (1067 pts vs 1554). The statistic comparison across these subpopulations suggested that there are no statistically significant results in term of Overall Survival, Disease Related Survival, Local recurrence or positive margins. Therefore oncoplastic surgery for primary invasive breast cancer represents a feasible procedure and an oncological safe surgical option.

6. Secretory breast cancer. Case report

Author

Augusto Lombardi, Maggi S, Bersigotti L, Lazzarin G, Nuccetelli E, and Amanti C

Subjects
Clinical Practice, Treatment Outcome, triple-negative carcinoma, Carcinoma, juvenile/secretory breast cancer, Humans, chemoresistance, Breast Neoplasms, Female, Middle Aged, Mastectomy, Segmental, Prognosis
Abstract

Secretory carcinoma of the breast is a rare tumor initially described in children but occurring equally in adult population. This unusual breast cancer subtype has a generally favorable prognosis, although several cases have been described in adults with increased aggressiveness and a risk of metastases. However, surgery is still considered the most appropriate treatment for this pathology. We describe the case of a 50 – year-old woman who has undergone a breast conservative surgery for a little tumor, preoperatively diagnosticated by a fine needle aspiration biopsy (FNAB) as a well differentiated infiltrating carcinoma.

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