Perioperative considerations in nonagenarians.

Autor:	Tecos ME; University of Nebraska Medical Center, Department of Surgery, Omaha, NE., Kern BS; Spectrum Health Michigan State University, Department of Surgery, Grand Rapids, MI.; Baystate Medical Center Department of Surgery, Hanover, MD., Foje NA; University of Nebraska Medical Center, Department of Surgery, Omaha, NE.; University of Nebraska Medical Center, College of Medicine, Omaha, NE., Leif ML; University of Nebraska Medical Center, College of Medicine, Omaha, NE., Schmidt M; Washington University in St. Louis, Department of Surgery, St. Louis, MO.; St. Louis University, School of Medicine, St. Louis, MO., Steinberger A; Baystate Medical Center Department of Surgery, Hanover, MD., Bajinting A; St. Louis University, School of Medicine, St. Louis, MO., Buesing KL; University of Nebraska Medical Center, Department of Surgery, Omaha, NE.; University of Nebraska Medical Center, College of Medicine, Omaha, NE.
Jazyk:	angličtina
Zdroj:	Surgery open science [Surg Open Sci] 2020 Apr 26; Vol. 2 (4), pp. 45-49. Date of Electronic Publication: 2020 Apr 26 (Print Publication: 2020).
DOI:	10.1016/j.sopen.2020.03.004
Abstrakt:	Objective: The nation's aging population presents novel perioperative challenges. Potential benefits of operative interventions must be scrutinized in relation to recoverable quality of life. The purpose of this study is to evaluate common risk calculators used for medical decision making in a nonagenarian patient population. Methods: Retrospective medical record review was performed on patients 90 years or older who underwent operative interventions requiring anesthesia at a large academic medical center between January 1, 2013, and December 31, 2017. GraphPad 8.2.1 was used for statistical analysis. Results: Significant differences were found when data were stratified by age for elective versus emergent cases (P value < .0001), ability to return to baseline function (P value  = .0062), and mortality (P value < .0001). Significant differences were found in emergent and elective cases, ability to return to baseline function, readmissions, and mortality (all P values < .0001) when stratified by American Society of Anesthesiologists score. Ability of patients to return to baseline functionality after intervention was influenced by their preintervention level of functionality (P value = .0008). American College of Surgeons and Portsmouth Physiologic and Operative Severity Score for Enumeration of Mortality and Morbidity risk calculators underestimated the need for rehabilitation and overestimated mortality for this population (all P values < .0001). Conclusion: Perioperative cares of the extreme geriatric population are complex and should be approached collaboratively. Rehabilitation and postoperative assistance resources should be assessed and used fully. Input from palliative care teams should be sought appropriately. End-of-life and escalation-of-care discussions should ideally be organized prior to emergent interventions. Frailty and risk calculators should be used and considered for formal implementation into the preoperative workflow. (© 2020 The Author(s).)
Databáze:	MEDLINE
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