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Perioperative care of the elderly patient

Abstract

Surgical risk increases with age, primarily from loss of cardiac and pulmonary reserve. Complications are tolerated poorly by the elderly, emphasizing the importance of their prediction and prevention. Surgical risk in this population is significant, but with careful preoperative assessment and perioperative management acceptable morbidity and mortality are possible. This review proposes a general approach to the elderly surgical patient and applies it to the most significant sources of morbidity and mortality: pulmonary and cardiac complications. Risk assessment based on validated tools is utilized, and perioperative management recommendations based on the state of the art are examined. In addition, pulmonary embolism and postoperative confusion are examined separately with the same overall strategy.

Résumé

Le risque opératoire augmente avec l'âge, principalement par diminution des capacités cardiaque et respiratoire. Chez les sujets âgés les complications sont mal tolérées, soulignant l'importance de l'appréciation de leur risque et de leur prévention. Le risque opératoire dans cette population est non négligeable mais grâce à une évaluation pré-opératoire et une prise en charge péri-opératoire soigneuses, il est possible de réduire la morbidité et la mortalité à des taux acceptables. Cette étude propose une prise en charge globale du sujet âgé chirurgical et l'applique aux causes les plus courantes de morbidité et de mortalité c'est à dire les complications pulmonaires et cardiaques. L'évaluation du risque est faite au moyen de scores validés et il est tenu compte dans la prise en charge périopératoire de ces patients de l'état actuel des conaissances. De plus, l'embolie pulmonaire et les syndromes confusionnels post-opératoires sont étudiés séparément avec la même stratégie globale.

Resumen

El riesgo quirúrgico se aumenta con la edad fundamentalmente por pérdida de reserva cardiaca y pulmonar. Las complicaciones son mal toleradas por el anciano, lo cual destaca la importancia de su predicción y prevención. El riesgo quirúrgico en la población de edad avanzada es significativo, pero mediante una cuidadosa valoración preoperatoria y el debido manejo perioperatorio, se logran aceptables tasas de morbilidad y mortalidad. La presente revisión propone un aproche general al paciente quirúrgico de edad avanzada y su aplicación a las fuentes más significativas de morbilidad y mortalidad: las complicacione pulmonares y cardiacas. La valoración del riesgo basada en métodos de validez reconocida son utilizados y se analizan las recomendaciones de manejo perioperatorio con fundamento en el estado del arte. Además, se analizan el embolismo pulmonar y el estado de confusión mental postoperatorio, por separado pero utilizando la misma estrategia.

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Correspondence to Jonathan L. Meakins M.D., D.Sc., F.R.C.S.(C.), F.A.C.S..

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Ergina, P.L., Gold, S.L. & Meakins, J.L. Perioperative care of the elderly patient. World J. Surg. 17, 192–198 (1993). https://doi.org/10.1007/BF01658926

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Keywords

  • Pulmonary Embolism
  • Preoperative Assessment
  • Surgical Risk
  • Cual
  • Risk Increase