Emergency surgery in the elderly patient: a quality improvement approach

Peden, Carol J.

doi:10.1111/j.1365-2044.2011.06769.x

Cited by 41 publications

(42 citation statements)

References 35 publications

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“…'Care Bundles' standardise the provision of care, and have been shown to increase the reliability of key steps of care, for example, by reducing the prevalence of ventilator-associated pneumonia [11,59]. Recent guidelines recommend that the need for postoperative critical care is based on an assessment of risk of mortality and morbidity, with admission to critical care for all patients with a predicted mortality greater than 10% [12,60].…”

Section: Postoperative Managementmentioning

confidence: 99%

“…Given that the number of elderly patients presenting for emergency surgery is likely to rise as the population ages, this review summarises the evidence on which such guidance is based, and provides information about how anaesthetists might participate in audit and research aimed at improving local and national outcomes for these most vulnerable of patients. More recently, national audits have reported several-fold variations in the care of elderly emergency surgical patients in the UK [4][5][6], and importantly, these data are beginning to be used to drive quality improvement [11] through professional guidance [12][13][14] that advocates early, focused, multidisciplinary 70 …”

mentioning

confidence: 99%

“…More recently, national audits have reported several-fold variations in the care of elderly emergency surgical patients in the UK [4][5][6], and importantly, these data are beginning to be used to drive quality improvement [11] through professional guidance [12][13][14] that advocates early, focused, multidisciplinary care, and targeted research. This review summarises the evidence on which such guidance is based.…”

mentioning

confidence: 99%

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Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

2013

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SummaryNational reports recommended that peri-operative care should be improved for elderly patients undergoing emergency surgery. Postoperative mortality and morbidity rates remain high, and indicate that emergency ruptured aneurysm repair, laparotomy and hip fracture fixation are high-risk procedures undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely to rise as the population ages, this review summarises the evidence on which such guidance is based, and provides information about how anaesthetists might participate in audit and research aimed at improving local and national outcomes for these most vulnerable of patients. More recently, national audits have reported several-fold variations in the care of elderly emergency surgical patients in the UK [4][5][6], and importantly, these data are beginning to be used to drive quality improvement [11] through professional guidance [12][13][14] that advocates early, focused, multidisciplinary 70

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Section: Postoperative Managementmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

2013

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“…Failure to involve physicians, delays to surgery and inadequate postoperative care were amongst the concerns. A number of suggestions have been made to try and improve this situation [2], but elderly patients will inevitably experience greater morbidity and mortality than will younger patients. The fitter the patient, the less likely he/she is to experience complications, and this is true for both cardiac and non-cardiac surgery [3,4].…”

Section: Outcomes In the Elderlymentioning

confidence: 99%

“…It infers that increasing life expectancy will only lead to additional years of chronic illness and misery, particularly if patients require hospitalisation or surgery [2].…”

Section: Money Money Moneymentioning

confidence: 99%

The ageing patient – sans everything?

Keays

2013

Anaesthesia

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Predictors and preventers of postoperative bedridden status in the elderly ages over 75 after emergency general surgery: a retrospective cohort study

Nagakawa,

Taniguchi,

Yukutake

et al. 2023

Acute Medicine & Surgery

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AimWe investigated the proportion of bedridden patients after emergency surgery among the elderly ages over 75; defined as the latter‐stage elderly in Japan, the associated factors, and interventions used to prevent it.MethodsEighty‐two latter‐stage elderly patients who underwent emergency surgery for non‐traumatic illness between January 2020 and June 2021 in our hospital were included in the study. Backgrounds and various perioperative factors were compared retrospectively between the groups including patients who became bedridden from Performance Status Scale 0 to 3 before admission (Bedridden group) and those who did not (Keep group).ResultsThree cases of death and seven patients who were bedridden before admission were excluded. The 72 remaining patients were divided into the Bedridden group (n = 10, 13.9%) and the Keep group (n = 62, 86.1%). There were significant differences in the prevalence of dementia, pre‐ and postoperative circulatory dynamics, renal dysfunction, coagulation abnormality, length of stay in the high care unit/intensive care unit, and number of hospital days, with a relative risk of 13 (1.74–96.71), a sensitivity of 1.00, and a specificity of 0.67 for a preoperative shock index of 0.7 or higher being associated with the Bedridden group. Among patients with a preoperative shock index of 0.7 or higher, there was a significant difference in SI at 24 h postoperatively between the two groups.ConclusionPreoperative shock index may be the most sensitive predictor. Early circulatory stabilization seems to be protective against patients becoming bedridden.

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Emergency surgery in the elderly patient: a quality improvement approach

Cited by 41 publications

References 35 publications

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

The ageing patient – sans everything?

Predictors and preventers of postoperative bedridden status in the elderly ages over 75 after emergency general surgery: a retrospective cohort study

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