Preoperative assessment of the older surgical patient: honing in on geriatric syndromes

Sunghye Kim,1 Amber K Brooks,2 Leanne Groban21Department of Hospital Medicine, 2Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USAAbstract: Nearly 50% of Americans will have an operation after the age of 65 years. Traditional preoperative anesthesia consult...

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Autores principales:	Kim S, Brooks AK, Groban L
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	Frailty Mobility-disability Postoperative delirium Preoperative evaluation Stress Response Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/99b8386785e54882ad36e3d7b14754d5
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spelling	oai:doaj.org-article:99b8386785e54882ad36e3d7b14754d52021-12-02T00:18:47ZPreoperative assessment of the older surgical patient: honing in on geriatric syndromes1178-1998https://doaj.org/article/99b8386785e54882ad36e3d7b14754d52014-12-01T00:00:00Zhttps://www.dovepress.com/preoperative-assessment-of-the-older-surgical-patient-honing-in-on-ger-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Sunghye Kim,1 Amber K Brooks,2 Leanne Groban21Department of Hospital Medicine, 2Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USAAbstract: Nearly 50% of Americans will have an operation after the age of 65 years. Traditional preoperative anesthesia consultations capture only some of the information needed to identify older patients (defined as ≥65 years of age) undergoing elective surgery who are at increased risk for postoperative complications, prolonged hospital stays, and delayed or hampered functional recovery. As a catalyst to this review, we compared traditional risk scores (eg, cardiac-focused) to geriatric-specific risk measures from two older female patients seen in our preoperative clinic who were scheduled for elective, robotic-assisted hysterectomies. Despite having a lower cardiac risk index and Charlson comorbidity score, the younger of the two patients presented with more subtle negative geriatric-specific risk predictors – including intermediate or pre-frail status, borderline malnutrition, and reduced functional/mobility – which may have contributed to her 1-day-longer length of stay and need for readmission. Adequate screening of physiologic and cognitive reserves in older patients scheduled for surgery could identify at-risk, vulnerable elders and enable proactive perioperative management strategies (eg, strength, balance, and mobility prehabilitation) to reduce adverse postoperative outcomes and readmissions. Here, we describe our initial two cases and review the stress response to surgery and the impact of advanced age on this response as well as preoperative geriatric assessments, including frailty, nutrition, physical function, cognition, and mood state tests that may better predict postoperative outcomes in older adults. A brief overview of the literature on anesthetic techniques that may influence geriatric-related syndromes is also presented. Keywords: frailty, mobility-disability, postoperative delirium, preoperative evaluation, stress responseKim SBrooks AKGroban LDove Medical PressarticleFrailtyMobility-disabilityPostoperative deliriumPreoperative evaluationStress ResponseGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 10, Pp 13-27 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Frailty Mobility-disability Postoperative delirium Preoperative evaluation Stress Response Geriatrics RC952-954.6
spellingShingle	Frailty Mobility-disability Postoperative delirium Preoperative evaluation Stress Response Geriatrics RC952-954.6 Kim S Brooks AK Groban L Preoperative assessment of the older surgical patient: honing in on geriatric syndromes
description	Sunghye Kim,1 Amber K Brooks,2 Leanne Groban21Department of Hospital Medicine, 2Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USAAbstract: Nearly 50% of Americans will have an operation after the age of 65 years. Traditional preoperative anesthesia consultations capture only some of the information needed to identify older patients (defined as ≥65 years of age) undergoing elective surgery who are at increased risk for postoperative complications, prolonged hospital stays, and delayed or hampered functional recovery. As a catalyst to this review, we compared traditional risk scores (eg, cardiac-focused) to geriatric-specific risk measures from two older female patients seen in our preoperative clinic who were scheduled for elective, robotic-assisted hysterectomies. Despite having a lower cardiac risk index and Charlson comorbidity score, the younger of the two patients presented with more subtle negative geriatric-specific risk predictors – including intermediate or pre-frail status, borderline malnutrition, and reduced functional/mobility – which may have contributed to her 1-day-longer length of stay and need for readmission. Adequate screening of physiologic and cognitive reserves in older patients scheduled for surgery could identify at-risk, vulnerable elders and enable proactive perioperative management strategies (eg, strength, balance, and mobility prehabilitation) to reduce adverse postoperative outcomes and readmissions. Here, we describe our initial two cases and review the stress response to surgery and the impact of advanced age on this response as well as preoperative geriatric assessments, including frailty, nutrition, physical function, cognition, and mood state tests that may better predict postoperative outcomes in older adults. A brief overview of the literature on anesthetic techniques that may influence geriatric-related syndromes is also presented. Keywords: frailty, mobility-disability, postoperative delirium, preoperative evaluation, stress response
format	article
author	Kim S Brooks AK Groban L
author_facet	Kim S Brooks AK Groban L
author_sort	Kim S
title	Preoperative assessment of the older surgical patient: honing in on geriatric syndromes
title_short	Preoperative assessment of the older surgical patient: honing in on geriatric syndromes
title_full	Preoperative assessment of the older surgical patient: honing in on geriatric syndromes
title_fullStr	Preoperative assessment of the older surgical patient: honing in on geriatric syndromes
title_full_unstemmed	Preoperative assessment of the older surgical patient: honing in on geriatric syndromes
title_sort	preoperative assessment of the older surgical patient: honing in on geriatric syndromes
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/99b8386785e54882ad36e3d7b14754d5
work_keys_str_mv	AT kims preoperativeassessmentoftheoldersurgicalpatienthoninginongeriatricsyndromes AT brooksak preoperativeassessmentoftheoldersurgicalpatienthoninginongeriatricsyndromes AT grobanl preoperativeassessmentoftheoldersurgicalpatienthoninginongeriatricsyndromes
_version_	1718403817932849152

Preoperative assessment of the older surgical patient: honing in on geriatric syndromes

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