Comprehensive geriatric assessment to predict adverse events in elderly patients undergoing posterior lumbar fusion surgery.

PURPOSE: Although comprehensive geriatric assessment (CGA) has been used widely, its impact on adverse events in elderly patients has not been fully examined. The present study aimed to investigate the relationships between subcomponents of CGA and adverse events (AEs) in elderly patients undergoing posterior lumbar fusion surgery. METHODS: A total of 242 eligible elderly patients enrolled. Our CGA included activities of daily living, instrumental activities of daily living, nutritional status, cardiac function, pulmonary function, renal function, frailty, cognition, anxiety, depression, delirium, chronic pain score, comorbidity and polypharmacy. Comprehensive complication index was used to summarize postoperative complications and its severity. Logistic regression was performed to determine the relationships between subcomponents of a CGA and postoperative AEs. RESULTS: Present study found that female were more vulnerable to have AEs. Postoperative major AEs were associated with delirium (odds ratio (OR): 4.302, 95% confidence interval (CI) 1.720-10.761, p = 0.002), nutritional status (OR: 3.030, 95%CI 1.218-7.541, p = 0.017), cognitive impairment (OR: 4.122, 95%CI 1.179-14.407, p = 0.027), Charlson comorbidity index (CCI) (OR: 4.800, 95%CI 1.852-12.440, p = 0.001) and severe dependent (OR: 3.772, 95%CI 1.116-9.841, p = 0.007). Further analysis showed that delirium (OR: 2.824, 95%CI 1.068-7.467, p = 0.036) and CCI (OR: 3.221, 95%CI 1.184-8.766, p = 0.022) were independently related to major AEs. CONCLUSIONS: These results indicate that preoperative screening preoperative delirium, cognitive, nutrition and CCI are essential to prevent postoperative major AEs of the surgical elderly.

Epidemiological and clinical features, treatment status, and economic burden of traumatic spinal cord injury in China: a hospital-based retrospective study.

Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death. China has the largest population of patients with traumatic spinal cord injury. Previous studies of traumatic spinal cord injury in China have mostly been regional in scope; national-level studies have been rare. To the best of our knowledge, no national-level study of treatment status and economic burden has been performed. This retrospective study aimed to examine the epidemiological and clinical features, treatment status, and economic burden of traumatic spinal cord injury in China at the national level. We included 13,465 traumatic spinal cord injury patients who were injured between January 2013 and December 2018 and treated in 30 hospitals in 11 provinces/municipalities representing all geographical divisions of China. Patient epidemiological and clinical features, treatment status, and total and daily costs were recorded. Trends in the percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department and cost of care were assessed by annual percentage change using the Joinpoint Regression Program. The percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department did not significantly change overall (annual percentage change, -0.5% and 2.1%, respectively). A total of 10,053 (74.7%) patients underwent surgery. Only 2.8% of patients who underwent surgery did so within 24 hours of injury. A total of 2005 (14.9%) patients were treated with high-dose (≥ 500 mg) methylprednisolone sodium succinate/methylprednisolone (MPSS/MP); 615 (4.6%) received it within 8 hours. The total cost for acute traumatic spinal cord injury decreased over the study period (-4.7%), while daily cost did not significantly change (1.0% increase). Our findings indicate that public health initiatives should aim at improving hospitals' ability to complete early surgery within 24 hours, which is associated with improved sensorimotor recovery, increasing the awareness rate of clinical guidelines related to high-dose MPSS/MP to reduce the use of the treatment with insufficient evidence.

Comprehensive geriatric assessment for older orthopedic patients and analysis of risk factors for postoperative complications.

BACKGROUND: The comprehensive geriatric assessment (CGA) has been proposed as a supplementary tool to reduce perioperative complications of geriatric patients, however there is no universally accepted standardization of CGA for orthopedic surgery. In this study, a novel CGA strategy was applied to evaluate the conditions of older patients undergoing orthopedic surgery from a broad view and to identify potential risk factors for postoperative complications. METHODS: A prospective cohort study was conducted from March 2019 to December 2020.The study enrolled patients (age > 75 years) for elective or confined orthopedic surgery. All patients were treated by a multidisciplinary team. A structured CGA was conducted to identify high-risk older patients and to facilitate coordinated multidisciplinary team care by a geriatric team. The basic patient characteristics, CGA results, postoperative complication and mortality rates were collected. Multivariate logistic regression analysis was used to identify risk factors for postoperative complications. RESULTS: A total of 214 patients with an age of 81.07 ± 4.78 (range, 75-100) years were prospectively enrolled in this study. In total, 66 (30.8%) complications were registered, including one death from myocardial infarction (mortality rate, 0.5%). Poor Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) were accompanied by frailty, worse perioperative risk, pain, and nutritional status. Poor ADL was also associated with higher risks of falling, polypharmacy, and cardiac and respiration complications. Poor IADL was associated with a higher risk of cardiac and respiration complications. Higher stroke risk was accompanied by higher risks of cardiac complications, delirium, and hemorrhage. Worse American Society of Anesthesiologists (ASA) score was associated with worse ADL, IADL, frailty, and higher delirium risk. Multivariate logistic regression analysis showed that spinal fusion (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.65 to 0.83; p = 0.0214), blood loss(OR, 1.68; 95% CI, 1.31 to 2.01; p = 0.0168), ADL (severe dysfunction or worse) (OR, 1.45; 95% CI, 1.16 to 1.81; p = 0.0413), IADL (serious dependence) (OR, 1.08; 95% CI, 1.33 to 1.63; p = 0.0436), renal function (chronic kidney disease (CKD) ≥ stage 3a) (OR, 2.01; 95% CI, 1.54 to 2.55; p = 0.0133), and malnutrition(OR, 2.11; 95% CI, 1.74 to 2.56; p = 0.0101) were independent risk factors for postoperative complications. CONCLUSION: The CGA process reduces patient mortality and increases safety in older orthopedic surgery patients. Spinal fusion, blood loss, ADL (severe dysfunction or worse), IADL (serious dependence), renal function (CKD ≥ stage 3a) and nutrition mini nutritional assessment (MNA) (malnourished) were independent risk factors of postoperative complications following orthopaedic surgery in older patients.

Analysis of standard accounting method of economic compensation for ecological pollution in watershed.

With rapid development of social industry and agriculture, there is an increasing demand for water resources in a watershed, which leads to a series of serious problems in the watershed such as water resource shortage, water environment deterioration, water resource pollution, etc. This paper builds an econometric model of economic loss due to water pollution in a watershed based on the basic process of standard water pollution compensation calculation of economic loss. The econometric model is used to calculate the amount of compensation for economic loss due to water pollution; a mathematic model method of water environment is applied to calculate the degree of effect on the lower reaches; thus the proportion of the impact on the areas in the lower reaches to overall impact is obtained. The amount of compensation that should be borne by all areas is obtained in combination of amount of compensation for water pollution. Empirical analysis is carried out by taking the Taihu Basin for example, and the standard compensation and the amount of compensation for the economic loss caused by water pollution between different areas along the Jiangnan Canal in the Taihu Basin are defined, which provides scientific and theoretical bases for standard calculation of the water pollution compensation. This provides a theoretical basis for solving the problem of water pollution in the watershed and the contradiction in the development of the watershed, and realizing social equity and harmonious development.

Evaluation on Early Drought Warning System in the Jinghui Channel Irrigation Area.

With the economic growth, continuous global environment deterioration, and increasingly serious water resources shortage, droughts have become more and more serious and produced great impacts on both the regional ecology and sustainable economic development. This paper has established the "green, blue, yellow, orange, and red lights" as the early warning grades for agricultural droughts. By using the two influencing factors, namely precipitation and soil moisture, this paper has established the drought assessment index evaluation model using weighted coupling method. It has carried out the analogue simulation of the early drought warning based on the Jinghui Channel's 2013 water source situations. The soil moisture in January and February is relatively ideal, and the actual early drought warning is expressed by the "green light". The soil moisture deficit is comparatively serious in March, but the situation concerning water inflow is ideal with the "green light". Actually, the early warning signal is basically consistent with the soil moisture drought degree between April and August. The actual early warning is expressed by the "green light" as well, but the soil moisture is not so ideal, however, this is the seeding time of the winter wheat so the lack of soil moisture has no impact on the crops output. In November and December, the winter wheat is at the growth and development stage and does not need much moisture. At this stage, the soil moisture is relatively poor. By integrating the time effects into the early drought warning system, this paper provides administrators of irrigation areas with a scientific decision-making based on the drought control measures.

The multi-user evolutionary game simulation in water quality-based water source system.

Water is a crucial factor for human living and maintaining ecological system health. Water resource conflict has become an important factor which restricts regional economic development and affects the harmony and stability of society. This paper, on the one hand, builds a trilateral evolution game model of water intaking in the upper, middle, and lower reaches in terms of water-quality conflict, and makes an analysis of the evolutionary stable strategy of the model on the foundation of a cross-border water resource conflict warning system and based on the view of evolution game. The paper verifies related conclusions by using numerical simulation calculation examples and makes sensitivity analysis of the change of the parameters of the model. The result of the research indicates that (1) there are three groups of system local gradual stable points [Formula: see text] and [Formula: see text] in the trilateral game of water quality-based cross-border conflicts. This means that there are three groups of evolutionary stable strategies: (non-cooperation, non-cooperation, cooperation), (cooperation, non-cooperation, cooperation), and (non-cooperation, cooperation, cooperation). The conclusion obtained via verification by using numerical simulation is that upper and middle reaches are the sections which most likely lead to conflicts, so the strategy selected therefor is (non-cooperation, non-cooperation, cooperation); (2) in water quality-based cross-border conflict, the factor [Formula: see text] of compensation cost increased because excessive transfer of pollutants has a significant effect on water-intaking group strategy evolution path. It is of great theoretical and practical significance to the scientific operation of cross-border water quality and water amount conflicts and the realization of the goal of water resources management.

Health assessment of spatial and temporal distribution of arsenic in soils irrigated with reclaimed water.

Reclaimed water is an important water resource for agricultural irrigation. Based on the systematic analysis of experimental data, this paper studies the spatiotemporal transformation and distribution of As in soil-crop system. Through the comparison with groundwater irrigation, reclaimed water irrigation was tested and studied in connection with the greenhouse vegetables in the growing season. The accumulation, distribution and transportation of As in different depths of soil within 7 days after reclaimed water irrigation were analyzed and discussed. The results showed that the concentration of As was the highest on the first day after irrigation; it was the highest at the depth of 100 cm on the third day after irrigation, but its concentration in the topsoil slightly decreased; from the fifth to the seventh day, the concentrations of As in the different layers of soil were almost the same, but it was the highest at the depth of 80-120 cm; and it decreased slightly with the increase in depth when the depth was less than 120 cm. As in soil during the growing season varied as the frequency of irrigation increased. The specific situation was as follows: as the accumulated As in the topsoil increased, the increased As at the depth of 80-120 cm would become less and the concentration of As at 200 cm would fall. Therefore, when the appropriate concentration of reclaimed water is used for irrigation, the concentration of As in the deep layer soil will comply with the standard limits of GB15618-1995 and the irrigation with reclaimed water of appropriate concentration will not cause As pollution.