Preoperative frailty assessment combined with prehabilitation and nutrition strategies: Emerging concepts and clinical outcomes
| Autor: | Chikezie N. Okeagu, Farees Hyatali, Elyse M. Cornett, Alan D. Kaye, Richard D. Urman, Erik M. Helander, Karina Gritsenko, Fallon A. Anzalone, Michael P Webb, Jordan S. Renschler |
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| Rok vydání: | 2020 |
| Předmět: |
Parenteral Nutrition
medicine.medical_specialty Adverse outcomes Prehabilitation Vulnerability Nutritional Status Risk Assessment 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology Preoperative Care medicine Humans Intensive care medicine Postoperative Care Polypharmacy Frailty business.industry Stressor Preoperative Exercise Cognition Combined Modality Therapy Frailty assessment Treatment Outcome Anesthesiology and Pain Medicine Parenteral nutrition business 030217 neurology & neurosurgery |
| Zdroj: | Best Practice & Research Clinical Anaesthesiology. 34:199-212 |
| ISSN: | 1521-6896 |
| DOI: | 10.1016/j.bpa.2020.04.008 |
| Popis: | Important elements of the preoperative assessment that should be addressed for the older adult population include frailty, comorbidities, nutritional status, cognition, and medications. Frailty has emerged as a plausible predictor of adverse outcomes after surgery. It is present in older patients and is characterized by multisystem physiologic decline, increased vulnerability to stressors, and adverse clinical outcomes. Preoperative preparation may include a prehabilitation program, which aims to address nutritional insufficiencies, modify chronic polypharmacy, and enhance physical and respiratory conditions prior to hospital admission. Special considerations are taken for particularly high-risk patients, where the approach to prehabilitation can address specific, individual risk factors. Identifying patients who are nutritionally deficient allows practitioners to intervene preoperatively to optimize their nutritional status, and different strategies are available, such as immunonutrition. Previous studies have shown an association between increased frailty and the risk of postoperative complications, morbidity, hospital length of stay, and 30-day and long-term mortality following general surgical procedures. Evidence from numerous studies suggests a potential benefit of including a standard assessment of frailty as part of the preoperative workup of older adult patients. Studies addressing validated frailty assessments and the quantification of their predictive capabilities in various surgeries are warranted. |
| Databáze: | OpenAIRE |
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