Preoperative Assessment of Older Adults

Abstract

Caring for older patients who need surgery presents challenging medical situations. The clinical paradigm involves identifying coexisting disease, defining the urgency of the intervention, and predicting postoperative complications based on the type of surgery planned. The prime function of the medical consultant is searching for correctable medical conditions. The consultant must carefully identify coexisting and comorbid conditions. Emergency surgery should be avoided, if possible, by elective planning. The risk of surgery varies with the procedure. Non-body cavity surgery, with the exception of hip fracture repair, is usually tolerated well. Age is a risk factor for surgery, but coexisting disease is more important than age alone. The net effect of improvements in surgical outcome advances the age at which surgical risk becomes prohibitive.

A Simple Novel Model to Predict Hospital Mortality, Surgical Site Infection, and Pneumonia in Elderly Patients Undergoing Operation

“…This result was similar to those of previous studies [3,4,5,6,7,8,9,10,11]. As to morbidity, it seems that albumin also had an important impact on infectious complications in the elderly.…”

“…Due to the great advances in surgical and anesthetic techniques, operative mortality in older patients has declined over the past decades [3]. An increasing body of evidence now shows that age alone is not an adverse factor in surgery [4,5].…”

Risk factors for postoperative systemic complications in elderly patients with brain tumors

“…[8][9][10] Nevertheless, in general surgery, the rates of postoperative mortality and complications have been reported to be higher in elderly patients, and postoperative complications are also more likely to be more severe in this age group than in younger patients. 34 The prognosis has been reported to be particularly poor for elderly patients undergoing emergency surgery. 18 This also applies to elderly patients with brain tumors, and there have been sporadic reports involving patients with gliomas and meningiomas.…”

Risco nutricional em cirurgia avaliado pelo índice de massa corporal ajustado ou não para pacientes idosos

“…Realmente observou-se risco duas vezes maior de complicações pós-operatórias e 2,6 vezes maior de óbitos em pacientes com idade avançada, quando comparados aos mais jovens. Tais achados estão de acordo com outros trabalhos da literatura, mostrando que, muito embora a morbidade e a mortalidade operatória em pacientes idosos venham diminuindo com o tempo (20) , a idade avançada tem correlação positiva com complicações (18) . Deve-se considerar nesses resultados o aumento de co-morbidades e doenças consumptivas, em especial neoplasias que acompanham os pacientes idosos, observando-se correlatamente percentual signifi cativamente maior de neoplasias malignas.…”