Preoperative Assessment of the Older Patient

Oresanya, Lawrence B.; Lyons, William; Finlayson, Emily

doi:10.1001/jama.2014.4573

Cited by 289 publications

(196 citation statements)

References 91 publications

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“…In one of the randomised controlled trials included in the review, CGA reduced the rate of complications by 11.8% and the time to 'fit for discharge' by 0.5 days in patients undergoing elective orthopaedic surgery (Huddleston et al, 2004). In addition, the use of preoperative geriatric assessment markers to assess patient frailty has demonstrated good predictive ability for postoperative complications, discharge to a nursing facility, and 6-month mortality in patients undergoing major surgery (Robinson et al, 2009;Makary et al, 2010;Oresanya et al, 2014). Determining which patients are at risk for adverse postoperative events using CGA can also help guide preoperative and postoperative management of surgical patients in several other ways.…”

Section: Discussionmentioning

confidence: 99%

The impact of age on complications, survival, and cause of death following colon cancer surgery.

Aquina

Mohile

Tejani

et al. 2016

JCO

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Section: Discussionmentioning

confidence: 99%

The impact of age on complications, survival, and cause of death following colon cancer surgery.

Aquina

Mohile

Tejani

et al. 2016

JCO

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“…Validated risk-stratification tools provide objective data to surgeons to one aspect of a patient's operative risk (cardiovascular, pulmonary, psychological, etc. ), 8,10,16,23,26,29,30 but their utility to spinal surgery is limited. Given that the vast majority of spinal procedures are elective, surgical candidates are generally without any active exacerbations of their medical problems.…”

mentioning

confidence: 99%

Morphometrics as a predictor of perioperative morbidity after lumbar spine surgery

Zakaria¹,

Schultz

Mossa-Basha

et al. 2015

FOC

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OBJECT Improved objective assessments of perioperative risk after spine surgery are necessary to decrease postoperative morbidity and mortality rates. Morphometric analysis has proven utility in predicting postoperative morbidity and mortality in surgical disciplines. The aim of the present study was to evaluate whether morphometrics can be applied to the cases of patients undergoing lumbar spine surgery. METHODS The authors performed a retrospective review of the perioperative course of 395 patients who underwent lumbar surgery at their institution from 2013 to 2014. Preoperative risk factors such as age, diabetes, smoking, coronary artery disease, and body mass index (BMI) were recorded. Preoperative MRI was used to measure the psoas muscle area at the L-4 vertebra and paraspinal muscle area at the T-12 vertebra. Primary outcomes included unplanned return to the operating room, 30- and 90-day readmissions, surgical site infection, wound dehiscence, new neurological deficit, deep vein thrombosis, pulmonary embolism, myocardial infarction, urinary tract infection, urinary retention, hospital-acquired pneumonia, stroke, and prolonged stay in the intensive care unit. RESULTS The overall rate of adverse events was 30%, the most common event being urinary retention (12%). Greater age (p = 0.015) and tobacco usage (p = 0.026) were both significantly associated with complications for all patients, while diabetes, coronary artery disease, and high BMI were not. No surgery-related characteristics were associated with postoperative morbidity, including whether surgery required instrumentation, whether it was a revision, or the number of vertebral levels treated. Using multivariate regression analysis, male and female patients with the lowest psoas tertile had an OR of 1.70 (95% CI 1.04–2.79, p = 0.035) for having postoperative complications. Male patients in the lowest psoas tertile had an OR of 2.42 (95% CI 1.17–5.01, p = 0.016) for having a postoperative complication. The paraspinal muscle groups did not provide any significant data for postoperative morbidity, even after multivariate analysis. CONCLUSIONS The morphometric measurement of psoas muscle size may be a sensitive predictive tool compared with other risk factors for perioperative morbidity in male patients undergoing lumbar surgery.

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“…Specifically, 3% to 5% of elderly people who have had hip and knee surgeries would experience acute confusion or delirium for a specific period. Therefore, insufficient pre-surgery assessments and post-surgery complications are factors related to elderly delirium [6,19]. The functional, cognitive, psychosocial, and other factors are decreases in energy, activities of daily living and instrumental activities of daily living, and cognition, as well as increases in sleep disturbances, depression, social isolation, long-term bed rests, environmental overstimulus, catheter use, and need for restraint [2,5,[7][8][9][10]14,16,17].…”

Section: Related Factors Of Elderly Deliriummentioning

confidence: 99%

“…Moreover, delaying the time of delirium might increase the incidence of illness, patients' dependence, the needs of nursing homes, and death rates because of the heavy burden on the health care system and society [1,4,5,7,9,10,14,16,18,19]. In addition, a study reported that urinary tract infection (UTI) rates in elderly patients with delirium ranged from 25.9% to 32% compared with 13% in those without delirium; in patients with UTI, delirium rates ranged from 30% to 35%, compared with 7.7% to 8% in those without UTI [11].…”

Section: Consequences Of Elderly Deliriummentioning

confidence: 99%

Integrate Literature Review of Delirium on the Elders

Chen¹,

Ku²

2017

J Gerontol Geriatr Res

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Delirium is a common problem for elderly hospitalized patients and those transferred from one place to another. The risk of delirium increases considerably with age. This article provides an integrated review of the literature on delirium in elderly patients; on the basis of this review, the characteristics of elderly delirium can be defined as follows: acute confusion with fluctuating changes in consciousness, orientation, attention, perceptions, emotion, thinking, sleeping patterns, and behaviors, which could develop and disappear in a short period. The related factors of elderly delirium include demographic and physical factors, as well as cognitive, functional, psychosocial, and other factors. Furthermore, scales for assessing elderly delirium include the short portable mental status questionnaire, mini-mental status examination, Confusion Assessment Method-ICU (CAM-ICU), delirium observation screening scale, NEECHAM Confusion Scale, Groningen Frailty Indicator, and Hasegawa's Dementia Scale-Revised. Although the CAM-ICU has the least items and affords the fastest assessment, it lacks the items to measure orientation, perceptions, emotions, sleeping patterns, and behaviors, which are the characteristics of elderly delirium identified in the integrated literature review. Based on the literature review findings, the authors recommend that future studies should develop a comprehensive delirium assessment scale for elderly patients, including the related factors and defining characteristics, thus enabling health care professionals to care for and manage delirium problems effectively and efficiently. Moreover, the authors suggest developing an assessment scale to distinguish between the three problems (delirium, dementia, and depression) and reduce misdiagnosis rates, which would result in reduced hospitalization times, death rates, cost to the health care system, and patients being transferred to nursing homes.©

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Preoperative Assessment of the Older Patient

Abstract: Geriatric conditions may be associated with adverse surgical outcomes. A comprehensive evaluation of treatment goals and communication of realistic risk estimates are essential to guide individualized decision making.

Cited by 289 publications

References 91 publications

The impact of age on complications, survival, and cause of death following colon cancer surgery.

The impact of age on complications, survival, and cause of death following colon cancer surgery.

Morphometrics as a predictor of perioperative morbidity after lumbar spine surgery

Integrate Literature Review of Delirium on the Elders

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