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Perioperative Patientenführung in der Altersendoprothetik

Perioperative patient management in orthogeriatrics

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Zusammenfassung

Die perioperative Patientenführung in der Altersendoprothetik stellt hohe Anforderungen an Ärzte und pflegerische Mitarbeiter. Anästhesie- und operationsbedingte Risiken sowie patienteneigene Risikofaktoren/Komorbiditäten müssen adäquat adressiert und interdisziplinär abgewogen werden. Insbesondere das kardiale Risiko, Anämie, Blutungsrisiken und deren Management bei Antikoagulation sowie zerebrale Beeinträchtigungen können den intra- und postoperativen Verlauf erheblich beeinflussen. Umgekehrt vermag eine prä-, intra- und postoperative Therapieoptimierung nicht nur den unmittelbaren perioperativen Verlauf, sondern auch die Krankenhausletalität, -morbidität und das Langzeitergebnis maßgeblich zu beeinflussen. Erfreulicherweise gewinnen Publikationen bezüglich der perioperativen Betreuung bei geriatrischen Patienten zunehmend an Qualität und Quantität, nicht zuletzt vor dem Hintergrund der demographischen Entwicklung der Bevölkerung. Entsprechend können immer mehr spezifische, in der perioperativen Betreuung relevante Einflussgrößen identifiziert werden. Grundlegende Überlegungen werden in dieser Kurzübersicht zusammengefasst, um den klinisch Tätigen Entscheidungsgrundlagen und -hilfen an die Hand zu geben.

Abstract

The management of major orthopedic surgery in the elderly prototypically reflects the perioperative risks of geriatric, often very frail patients reflecting an aging population. To improve outcome, the risks of anesthesia and surgery as well as of patient comorbidities must be thoroughly assessed and balanced using a multidisciplinary approach. Particular risks include cardiopulmonary morbidity, anemia, risk of hemorrhage and the management by anticoagulation, cerebral impairments as well as frailty and limited physiological reserves in general. Accordingly, an optimized therapy prior to, during, and after surgery will likely influence not only the immediate postoperative course but also hospital mortality and long-term outcome. Publications on the topic of perioperative management of geriatric patients are fortunately gaining in quality and quantity, not least against the background of the demographic developments. Accordingly, specific influencing factors relevant for perioperative management can be increasingly more identified. This short review summarizes the current state of knowledge to provide an overview and rationale for clinical decision making.

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  1. Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen, Deutschland

    P. Moldzio &  J. Peters

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Moldzio, P., Peters, J. Perioperative Patientenführung in der Altersendoprothetik. Orthopäde 46, 54–62 (2017). https://doi.org/10.1007/s00132-016-3370-6

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