Preoperative Evaluation of the Elderly Surgical Patient

2001 ◽  
pp. 126-143 ◽  
Author(s):  
Darlene Gabeau ◽  
Ronnie A. Rosenthal
Keyword(s):  
Preoperative Evaluation ◽  
The Elderly ◽  
Surgical Patient

Preoperative Evaluation of the Elderly Surgical Patient

2017 ◽  
Author(s):  
Tracy S. Wang ◽  
Jennifer Roberts
Keyword(s):  
Functional Status ◽  
Surgical Outcomes ◽  
Patient Population ◽  
Preoperative Evaluation ◽  
The Elderly ◽  
Diagnostic Approach ◽  
Surgical Patient ◽  
Specific Patient ◽  
Specific Patient Population ◽  
Specific Disease

The following is a detailed approach to the preoperative evaluation of the elderly surgical patient. A focus is placed on physiologic changes in the elderly that predispose them to complications and a systems-based approach to appropriate perioperative evaluation. Specifically, recommendations on the workup of cardiovascular, pulmonary, and renal systems are discussed. We also introduce the concept of frailty as a measure of an elderly patient's overall physiologic reserve. Finally, a diagnostic approach to common elderly-specific disease processes such as decreased functional status, malnutrition, and delirium is outlined. Throughout, an emphasis is placed on how to carefully assess this specific patient population and optimize preoperative functional status to improve surgical outcomes in the elderly. This review has 1 figure, 4 tables, and 62 references.

Preoperative Evaluation of the Elderly Surgical Patient

2017 ◽  
Author(s):  
Tracy S. Wang ◽  
Jennifer Roberts ◽  
Nicholas G Berger
Keyword(s):  
Risk Assessment ◽  
Elderly Population ◽  
Preoperative Evaluation ◽  
Hospital Costs ◽  
The Elderly ◽  
The United States ◽  
Surgical Patient ◽  
Key Words Aging ◽  
Major Morbidity ◽  
Short Term Mortality

The elderly population uses a significant portion of health care resources in the United States and poses an increasing challenge to perioperative care. Many reports point to both increasing age and frailty as important risk factors for short-term mortality; cardiovascular, pulmonary, and renal complications; and increased length of stay and hospital costs following operation. To provide the best care for the aging US population, it is important for the clinician to be familiar with the appropriate presurgical workup specific to the comorbidities prevalent to the elderly population. This review discusses the postoperative complications facing elderly surgical patients and the physiologic complications of aging, with a particular emphasis on the concept of frailty as a predictor of major morbidity and mortality. With age and comorbidities in mind, this review discusses the relevant preoperative cardiovascular, respiratory, and renal workup and includes important guidelines for appropriate risk assessment and reduction in the elderly surgical patient. This review contains 1 figure, 5 tables, and 86 references. Key words: aging, anesthesia, elderly, frailty, outcomes, preoperative workup, risk assessment

Preoperative Evaluation of the Elderly Surgical Patient

2017 ◽  
Author(s):  
Tracy S. Wang ◽  
Jennifer Roberts ◽  
Nicholas G Berger
Keyword(s):  
Risk Assessment ◽  
Elderly Population ◽  
Preoperative Evaluation ◽  
Hospital Costs ◽  
The Elderly ◽  
The United States ◽  
Surgical Patient ◽  
Key Words Aging ◽  
Major Morbidity ◽  
Short Term Mortality

The elderly population uses a significant portion of health care resources in the United States and poses an increasing challenge to perioperative care. Many reports point to both increasing age and frailty as important risk factors for short-term mortality; cardiovascular, pulmonary, and renal complications; and increased length of stay and hospital costs following operation. To provide the best care for the aging US population, it is important for the clinician to be familiar with the appropriate presurgical workup specific to the comorbidities prevalent to the elderly population. This review discusses the postoperative complications facing elderly surgical patients and the physiologic complications of aging, with a particular emphasis on the concept of frailty as a predictor of major morbidity and mortality. With age and comorbidities in mind, this review discusses the relevant preoperative cardiovascular, respiratory, and renal workup and includes important guidelines for appropriate risk assessment and reduction in the elderly surgical patient. This review contains 1 figure, 5 tables, and 86 references. Key words: aging, anesthesia, elderly, frailty, outcomes, preoperative workup, risk assessment

scholarly journals Perioperative Multimodal Anesthesia Using Regional Techniques in the Aging Surgical Patient

2014 ◽  
Vol 2014 ◽  
pp. 1-13 ◽  
Author(s):  
Diana Nordquist ◽  
Thomas M. Halaszynski
Keyword(s):  
Drug Therapy ◽  
Adverse Effects ◽  
Elderly Patients ◽  
Regional Anesthesia ◽  
Pain Control ◽  
The Elderly ◽  
Surgical Patient ◽  
Cochrane Central Register ◽  
Promising Alternative ◽  
Age Related

Background. Elderly patients have unique age-related comorbidities that may lead to an increase in postoperative complications involving neurological, pulmonary, cardiac, and endocrine systems. There has been an increase in the number of elderly patients undergoing surgery as this portion of the population is increasing in numbers. Despite advances in perioperative anesthesia and analgesia along with improved delivery systems, monotherapy with opioids continues to be the mainstay for treatment of postop pain. Reliance on only opioids can oftentimes lead to inadequate pain control or increase in the incidence of adverse events. Multimodal analgesia incorporating regional anesthesia is a promising alternative that may reduce needs for high doses and dependence on opioids along with any potential associated adverse effects. Methods. The following databases were searched for relevant published trials: Cochrane Central Register of Controlled Trials and PubMed. Textbooks and meeting supplements were also utilized. The authors assessed trial quality and extracted data. Conclusions. Multimodal drug therapy and perioperative regional techniques can be very effective to perioperative pain management in the elderly. Regional anesthesia as part of multimodal perioperative treatment can often reduce postoperative neurological, pulmonary, cardiac, and endocrine complications. Regional anesthesia/analgesia has not been proven to improve long-term morbidity but does benefit immediate postoperative pain control. In addition, multimodal drug therapy utilizes a variety of nonopioid analgesic medications in order to minimize dosages and adverse effects from opioids while maximizing analgesic effect and benefit.

Prevention and Control of Trichotomy Infection in the Elderly Surgical Patient: An Umbrella Review

2021 ◽  
Vol 1 (2) ◽  
Author(s):  
Teresa Ferreira ◽  
Filipe Orfao ◽  
Cesar Fonseca ◽  
Lara Guedes de Pinho
Keyword(s):  
Health Care ◽  
Narrative Analysis ◽  
Data Extraction ◽  
Elderly Person ◽  
The Elderly ◽  
World Health ◽  
Surgical Patient ◽  
Risk Of Infection ◽  
Umbrella Review ◽  
And Control

Introduction: The World Health Organization creates norms and guidelines for the adoption of good practices in health care that are provided to the surgical patient. In order to prevent and control infections associated with health care, the nurse must follow the guidelines for preparing the surgical patient for success. These infections can be particularly harmful to the elderly person given their vulnerability. The preoperative preparation, includes the trichotomy as one of the interventions to be performed, however, is one of the most controversial interventions that has caused in clinical practice, by the potential risk of infection in the surgical patient. Aim: To investigate the need for trichotomy, or removal of hair, in the preparation of the skin of the surgical patient, clarifying which is the most appropriate technique in the prevention of infection. Methodology: we conducted an umbrella review. The documentary research followed the consultation of bibliographic sources in the Cumulative Index to Nursing & Allied Health (CINAHL) and Public/Publisher Medline (PubMed) databases. The researched articles were grouped in a time horizon between 2011 and 2020. Afer data extraction, a narrative analysis was performed. Results: We found 40 articles from which 8 were selected. Conclusion: Trichotomy should be avoided by increasing the risk of infection of the surgical site. Innovative haircut and vacuum technologies can help in hair removal, mitigating the risk of contaminating the surgical incision. The timing of the trichotomy is not consensual among researchers.

Pulmonary Diseases: Preoperative Assessment

2018 ◽  
Author(s):  
Suzanne Bennett ◽  
Quinn M Nguyen
Keyword(s):  
Risk Factors ◽  
Pulmonary Disease ◽  
Pulmonary Function Tests ◽  
Preoperative Evaluation ◽  
Pulmonary Complications ◽  
Perioperative Outcomes ◽  
Surgical Patient ◽  
Postoperative Pulmonary Complications ◽  
Related Risk ◽  
Obstructive Sleep

Postoperative pulmonary complications contribute to significant morbidity, mortality, and healthcare costs. The surgical patient with underlying pulmonary disease experiences a higher risk for postoperative pulmonary complications. Evaluation of the patient with pulmonary disease prior to surgery allows for the early identification of risk factors and opportunity for optimization resulting in improved perioperative outcomes for all surgical procedures. Complete understanding of the anesthetic options and their effect on pulmonary physiology and postoperative pulmonary complications assists in the evaluation and management of the patient with pulmonary disease. The patient-related risk factors, procedure-related risk factors, and risk factor stratification must be evaluated and performed while taking into consideration the risk and type of surgery. A thorough preoperative evaluation of the patient with pulmonary disease allows for the rational development of a multidisciplinary perioperative plan with the goal of reducing postoperative pulmonary complications. This review contains 5 figures, 7 tables, and 48 references. Keywords: assessment of perioperative risk, asthma, bronchitis, cessation of smoking, COPD, emphysema, obstructive sleep apnea, perioperative smoking, Pulmonary Function Tests (PFTs), nitrogen washout

Preoperative Evaluation of the Cardiac Surgical Patient

2019 ◽  
pp. 3-10
Author(s):  
Rebecca M. Gerlach
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Carotid Artery Disease ◽  
Perioperative Complications ◽  
Preoperative Evaluation ◽  
Surgical Patient ◽  
Efficient Manner ◽  
Obstructive Sleep ◽  
Reduce Risk ◽  
Artery Disease

Patients undergoing cardiac surgery are at elevated risk for perioperative complications; however, certain risk factors may be modifiable. Preoperative evaluation performed in advance of surgery provides an opportunity for the perioperative anesthesiologist to intervene to reduce risk. Performing a focused history and physical examination informs the selection of appropriate preoperative tests. Risk assessment via tools specific to cardiac surgery provide a detailed risk profile. Certain diseases common to cardiac surgical patients deserve particular focus during assessment. Poorly controlled diabetes mellitus and resultant hyperglycemia are modifiable risk factors. Undiagnosed obstructive sleep apnea is common and associated with postoperative complications. Concurrent carotid artery disease presents a management conundrum requiring multidisciplinary planning. Preoperative anemia is common; when due to iron deficiency, it is easily treated to improve outcomes. In addition to gathering information about the patient, the goal of preoperative evaluation is to identify ways to reduce risk and improve outcome from surgery in a resource-efficient manner.

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