Perioperative management of the hospitalized patient

Michota, Franklin A.; Frost, Shaun D.

doi:10.1016/s0025-7125(02)00020-2

Cited by 21 publications

(2 citation statements)

References 70 publications

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“…Lipowski first proposed the distinction of delirium in clinical subtypes, based on the level and persistence of locomotor activity (55). The incidence of delirium is between 10 and 55% in post-operative patients, depending on the type of operation in which the patient was submitted, with a higher rate in orthopaedic operations compared to general surgery (56). Furthermore, the incidence of delirium is considerably higher in elderly patients.…”

Section: Discussionmentioning

confidence: 99%

Pathogenesis and treatment of post-operative cognitive dysfunction

Pappa¹,

Theodosiadis²,

Tsounis³

et al. 2017

Electron physician

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Cognitive disorders common in the post-operative period, are the post-operative delirium (POD) and the post-operative cognitive dysfunction (POCD). The Diagnostic and Statistical Manual of Mental Disorders (DSM) does not mention POCD as a separate disease entity, and thus little is known about the pathogenesis of this disorder. The aim of this study was to review, detect and highlight the most important data cited, regarding pathogenesis mechanisms and treatment of the post-operative cognitive dysfunction (POCD). The study was carried out from March 2015 to June 2015. Literature review was achieved by searching a number of bibliographic databases including PubMed, Google Scholar and SCOPUS, surveying published articles from 1955 to 2014. As far as the selection criteria, the material consists of scientific articles published mainly over the last fifteen years, while material published before 2000 was selected because it was considered to be important. This review showed that deficits are observed in one or more discrete areas of the patient’s mental state, such as attention, concentration, memory, psychomotor speed and more. This condition is usually developed over a period of more than a week or month after surgery and is more common in elderly patients. Mechanisms that have been proposed to explain this phenomenon are hyperventilation, hypotension, cerebral microemboli and inflammatory mechanisms. Its differential diagnosis will be made mainly from delirium. POCD treatment will first include the exclusion of any other serious diseases that can cause organic psychosyndrome and then focus on the actual symptoms.

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Section: Discussionmentioning

confidence: 99%

Pathogenesis and treatment of post-operative cognitive dysfunction

Pappa¹,

Theodosiadis²,

Tsounis³

et al. 2017

Electron physician

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“…With increasing patient age and complexity of medical conditions, there is a need for comprehensive preoperative evaluation and medical optimisation to enable the anaesthetist and surgeon to deliver the best surgical outcome. 2 3 The concept of preoperative medical assessment by internal medicine physicians is moving beyond the early adopter stage, with preoperative physician-led clinics being set up across the USA and internationally. In the USA, several dedicated preoperative assessment clinics have been established to address this need and provide high-quality care.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of preoperative medical consultations by internal medicine physicians: a systematic review

et al. 2017

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ObjectiveClinics have been established to provide preoperative medical consultations, and enable the anaesthetist and surgeon to deliver the best surgical outcome for patients. However, there is uncertainty regarding the effect of such clinics on surgical, in-hospital and long-term outcomes. A systematic review of the literature was conducted to determine the effectiveness of preoperative medical consultations by internal medicine physicians for patients listed for elective surgery.DesignSystematic searches of MEDLINE, EMBASE, CINAHL, PubMed, Current Contents and the NHS Centre for Reviews and Dissemination were conducted up to 30 April 2017.SettingElective surgery.Study selectionRandomised controlled trials and non-randomised comparative studies conducted in adults.Outcome measuresLength of hospital stay, perioperative morbidity and mortality, costs and quality of life.ResultsThe one randomised trial reported that preadmission preoperative assessment was more effective than the option of an inpatient medical assessment in reducing the frequency of unnecessary admissions with significantly fewer surgical cancellations following admission for surgery. A small reduction in length of stay in patients was also observed. The three non-randomised studies reported increased lengths of stay, costs and postoperative complications in patients who received preoperative assessment. The timing and delivery of the preoperative medical consultation in the intervention group differed across the included studies.ConclusionFurther research is required to inform the design and implementation of coordinated involvement of physicians and surgeons in the provision of care for high-risk surgical patients. A standardised approach to perioperative decision-making processes should be developed with a clear protocol or guideline for the assessment and management of surgical patients.

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Hospitalists and geriatrics

Whitcomb

2006

Journal of Hospital Medicine

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Perioperative management of the hospitalized patient

Cited by 21 publications

References 70 publications

Pathogenesis and treatment of post-operative cognitive dysfunction

Pathogenesis and treatment of post-operative cognitive dysfunction

Effectiveness of preoperative medical consultations by internal medicine physicians: a systematic review

Hospitalists and geriatrics

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