Perioperative Morbidität und Mortalität geriatrischer Patienten

Lauven, P. M.; Stoeckel, H.; Ebeling, B. J.

doi:10.1055/s-2007-1001098

Cited by 19 publications

(11 citation statements)

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“…In ASA grade 4 patients the threshold was found between the CRI score II and III (4.4% mortality vs. 7.3%). Although the most frequent cause of peri-operative mortality is reported to be cardiac complications [1,2,4,14,15,19], the CRI group alone did not predict perioperative mortality as well as the ASA grade. The CRI has been evaluated prospectively in patients undergoing abdominal aortic surgery [10,11] and noncardiac surgery [13].…”

Section: Discussionmentioning

confidence: 79%

“…Anaesthetists have taken a leading role in identifying predictors of peri-operative mortality. In 1941 the American Society of Anesthesiologists published a physical status classification for surgical procedures (ASA grade) which has been used world-wide since that time [1][2][3][4][5][6][7]. According to its definition ASA grade is not primarily a risk predictor although it has often been advocated as such.…”

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confidence: 99%

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Can ASA grade or Goldman's cardiac risk index predict peri‐operative mortality? A study of 16 227 patients

Prause

Ratzenhofer-Comenda

Pierer³

et al. 1997

Anaesthesia

139

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SummaryThis trial was designed to study the correlation between peri-operative mortality in patients undergoing elective surgery and the physical status classification of the American Society of Anesthesiologists, the Goldman multifactorial cardiac risk index or the two indices combined. All patients scheduled for elective surgery over a 5-year period were evaluated pre-operatively and were scored according to both indices. Of 16 227 patients studied, 215 died within 4 weeks of operation. Both indices correlated significantly with peri-operative mortality, the ASA grade showing a closer correlation. A regression tree analysis divided the combination groups into five subgroups where the mortality was lowest (0.4%) in ASA grade Յ2 and cardiac risk index group I (score 0-5 points) and increased up to 7.3% in ASA grade = 4 and cardiac risk index group Ն3 (score >13 points). We conclude that for this large number of patients peri-operative mortality can be predicted with the ASA grade and, to a lesser degree, with the cardiac risk index. Applied in the correct way, the combination of the two scores can increase the accuracy of prediction of perioperative mortality.

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Section: Discussionmentioning

confidence: 79%

mentioning

confidence: 99%

Can ASA grade or Goldman's cardiac risk index predict peri‐operative mortality? A study of 16 227 patients

Prause

Ratzenhofer-Comenda

Pierer³

et al. 1997

Anaesthesia

139

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“…Ähnliche Untersuchungen wurden auch [28], in Dä-nemark von Pedersen et al [22,23,24] in Südafrika von Harrison [10], in Finnland von Hovi-Viander [13,27], in Australien von Holland [12] und in Kanada von Cohen und Duncan [1][2][3][4][5] durchgeführt und publiziert. In Deutschland und Österreich wurden solche Untersuchungen bisher nur retrospektiv angestellt [14,15] …”

Section: Intraoperative Zwischenfälleunclassified

Erhebungen zur kausalen perioperativen MortalitätVersuch einer deutschen „CEPOD-Studie”*,**

Fichtner

Dick

1997

Anaesthesist

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In order to further reduce perioperative mortality in critically ill patients, every hospital should aim to optimize the structure of the surgical and anaesthesiological departments. A delay due to logistical or personnel problems may be a co-factor in perioperative mortality. Recovery rooms with experienced personnel should be the standard in postoperative anaesthesiological care. (ABSTRACT TRUNCATED)

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“…In the university hospitals of Bonn, Germany in 1988, 3% of all patients were> 80 years of age, 11 % > 70 years of age. Additionally, today 0.6% of our patients are > 85 years (Lauven et al 1990). In the total German population this group amounts to 1.1 % and it is expected that in 2030 about 4 to 5% of the German population will be > 85 years, i.e.…”

Section: Contentsmentioning

confidence: 85%

The Safe Use of Anaesthetics and Muscle Relaxants in Older Surgical Patients

1993

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Age greater than or equal to 75 years is not a special risk for adverse outcomes after general anaesthesia on its own but an indicator of risk. Biological or physiological age expressed by preoperative health status is much more important than chronological age. The type of anaesthesia seems to play no, or only a minor role. It is, however, most important to reduce the dosage considerably. As a rule of thumb, the dosage should be reduced by 10 to 15% for every decade over the age of 40. In addition, patients must be monitored extensively intra- and postoperatively, ideally in an intensive care setting. The controversy concerning regional versus general anaesthesia should be studied further. Regional anaesthesia techniques like high spinal or epidural anaesthesia that are haemodynamically effective do not reduce morbidity and mortality postoperatively but have the risk of profound hypertension. Peripheral blockades and spinal or epidural anaesthesia without additional sedation may, however, be associated with a reduced incidence of complications. The reduced reserves of geriatric patients demand for experienced anaesthetists and surgeons as well as intense intra- and postoperative monitoring. To secure a short recovery period, we recommend administration of short-acting drugs like propofol, midazolam, alfentanil, vecuronium, atracurium or isoflurane in appropriately reduced dosages.

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Perioperative Morbidität und Mortalität geriatrischer Patienten

Cited by 19 publications

References 0 publications

Can ASA grade or Goldman's cardiac risk index predict peri‐operative mortality? A study of 16 227 patients

Can ASA grade or Goldman's cardiac risk index predict peri‐operative mortality? A study of 16 227 patients

Erhebungen zur kausalen perioperativen MortalitätVersuch einer deutschen „CEPOD-Studie”*,**

The Safe Use of Anaesthetics and Muscle Relaxants in Older Surgical Patients

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