Preoperative Evaluation for Major Noncardiac Surgery

Hernandez, Adrian F.; Newby, L. Kristin; O’Connor, Christopher M.

doi:10.1001/archinte.164.16.1729

Cited by 31 publications

(17 citation statements)

References 74 publications

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“…Various studies have investigated these general risk factors; whole blood Hb, serum TP, and serum albumin levels and natural killer cell activity are thought to reflect the patients' nutritional status. 4,15,16,29,31 However, potentially unique risk factors in elderly patients undergoing brain tumor surgery have not been examined; thus, the present study provides clinically very meaningful information. A low preoperative KPS score indicates undernutrition and reduced physiological immunity, which makes patients more vulnerable to infections.…”

Section: Discussionmentioning

confidence: 99%

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

Asano¹,

Nakano²,

Takeda³

et al. 2009

JNS

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Object. In elderly patients with brain tumors, the prevention of postoperative systemic complications is extremely important, and identification of the risk factors would be useful for planning therapy. The authors investigated ways to avoid postoperative complications by identifying risk factors.Methods. The study population included 84 patients, 70 years of age or older, who underwent surgical brain tumor removal. The following independent factors were assessed by univariate and multivariate analyses: sex, age, preoperative underlying diseases and complications, histopathological findings, preoperative Karnofsky Performance Scale (KPS) score, preoperative whole blood hemoglobin (Hb) level, preoperative serum total protein (TP) level, operation time, intraoperative blood loss, change in Hb level (difference between pre-and postoperative values), and change in TP level (difference between pre-and postoperative values). The cutoff values for significant independent factors were also determined.Results. Overall, 35 (41.7%) of the 84 patients had a total of 56 postoperative systemic complications. Univariate analysis identified the preoperative KPS score, intraoperative blood loss, change in Hb level, and change in TP level as risk factors for postoperative complications, and multivariate analysis extracted the following risk factors: the preoperative KPS score (p = 0.0450, OR 4.020), intraoperative blood loss (p = 0.0104, OR 6.571), and change in Hb levels (p = 0.0023, OR 9.301). The cutoff values were: KPS score < 80%, intraoperative blood loss ≥ 350 ml, and change in Hb level ≥ 2.0 g/dl.Conclusions. In elderly patients with brain tumors, low preoperative KPS score, high intraoperative blood loss, and a large difference between pre-and postoperative Hb levels are significant risk factors for postoperative systemic complications. (DOI: 10.3171/2008.10.17669) Key WorDs • brain tumor • elderly patient • postoperative systemic complication • risk factorAbbreviations used in this paper: Hb = hemoglobin; KPS = Karnofsky Performance Scale; NYHA = New York Heart Association; PAF = paroxysmal atrial fibrillation; ROC = receiver operating characteristic; TP = total protein. J Neurosurg / Volume 111 / August 2009Risk factors for postoperative systemic complications 259 present study evaluated a wide spectrum of postoperative systemic complications other than neurological deficits, the results should be useful in other fields of surgery. MethodsThe study included 84 patients (41 men and 43 women) 70 years of age or older (mean age 73.7 years), who had undergone surgery under general anesthesia for brain tumor removal between 1994 and 2006. Thirteen patients had malignant astrocytic tumors, 12 had metastatic brain tumors, 30 had meningiomas, 15 had pituitary adenomas, 8 had schwannomas, and 6 had other types of tumors (Table 1). A transsphenoidal sublabial approach was used in the patients with pituitary adenomas, and conventional craniotomy was used in all the other patients. Postoperatively, all patients were treated wi...

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Section: Discussionmentioning

confidence: 99%

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

Asano¹,

Nakano²,

Takeda³

et al. 2009

JNS

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“…Previously published risk scores to estimate cardiac morbidity and mortality for noncardiac surgery have included heart failure as an important risk factor (135). Heart failure patients with planned urgent noncardiac surgery have a lower than 10% risk, but this is still approximately double the risk of other patients with similar comorbid burden.…”

Section: Practical Tipsmentioning

confidence: 99%

“…The fluid and electrolyte balance should be carefully followed during the recovery phase and until the patient is clinically stable from both a surgical and heart failure perspective. If possible, all usual heart failure medications should be administered before and after noncardiac surgery, with the possible exception of diuretics in the stable patient without volume overload (135)(136)(137). While preoperative stress testing is usually recommended for patients with ischemic heart disease, no clear benefit has been shown with the routine use of intraoperative, invasive, central hemodynamic monitoring (pulmonary artery catheter) or transesophageal echocardiography (Figure 1) (138,139).…”

Section: Practical Tipsmentioning

confidence: 99%

Canadian Cardiovascular Society Consensus Conference recommendations on heart failure update 2007: Prevention, management during intercurrent illness or acute decompensation, and use of biomarkers

Arnold¹,

Howlett²,

Dorian³

et al. 2007

Canadian Journal of Cardiology

124

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“…Despite its popularity, this method may not be suitable for all patients. Older adults now comprise the largest population of surgical patients (6) and may be at particular risk for deleterious outcomes associated with PCA use. Contributing factors can include undiagnosed renal dysfunction, potentially deleterious drug-drug interactions, and undetected cognitive impairment.…”

Section: Introductionmentioning

confidence: 99%

Can the cognitively impaired safely use patient-controlled analgesia?

Licht¹,

El²,

Reid³

2018

J of Opioid Management

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While patient-controlled analgesia (PCA) is considered the standard in postoperative pain control, research examining PCA use among cognitively impaired older adults is lacking. We reviewed a case series of ten adults aged 65 years and older admitted to the geriatrics or orthopedic services of an urban tertiary care center in New York City with acute pain and cognitive impairment or dementia and were administered PCA. Four patients from this cohort are presented in detail, demonstrating the challenges of PCA use in this population. A series of clinical pearls follows each case, outlining strategies for improving pain management. Our findings suggest that cognitive evaluations limited to alertness and orientation and failure to perform functional assessments may hinder the identification of patients who are poor candidates for PCA. Once PCA has been initiated, clinicians must regularly review device use and document cognitive function and pain score patterns to identify PCA underuse or misuse. Finally, rapid fluctuations in cognitive or functional status may require adoption of a more flexible pain management strategy. Despite these challenges, a subset of cognitively impaired older adults can successfully understand and operate PCA devices. Additional research is needed to 1) develop screening tools for identifying and monitoring older adults who may benefit from PCA and 2) create innovative approaches to improving pain management in the cognitively impaired.

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Preoperative Evaluation for Major Noncardiac Surgery

Cited by 31 publications

References 74 publications

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

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

Canadian Cardiovascular Society Consensus Conference recommendations on heart failure update 2007: Prevention, management during intercurrent illness or acute decompensation, and use of biomarkers

Can the cognitively impaired safely use patient-controlled analgesia?

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