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Postoperative Management of the Geriatric Patient

  • Daniel Ramirez
  • Vivyenne Roche
  • Philippe ZimmernEmail author
Chapter

Abstract

Taking care of the geriatric patient is extremely rewarding, but this population also poses specific challenges, especially in the surgical practice of Urology. Many times the benefits of surgery outweigh the risks. The patient’s history needs to be carefully reviewed prior to making any decision for surgical intervention. Some of the most significant concerns include the patient’s medical comorbidities, cognitive function, functional status, social support, and living arrangements. Physiological changes of aging, also called “homeostenosis,” further diminish their ability to cope with postoperative physiologic stresses. This chapter focuses on clinical care of the geriatric urologic patient in the postoperative period.

Keywords

Estimate Blood Loss Partial Nephrectomy Geriatric Patient Confusion Assessment Method Central Pontine Myelinolysis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Polanczyk CA, Marcantonio E, Goldman L, Rohde LE, Orav J, Mangione CM, et al. Impact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery. Ann Intern Med. 2001;134(8):637–43.PubMedCrossRefGoogle Scholar
  2. 2.
    Hamel MB, Henderson WG, Khuri SF, Daley J. Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc. 2005;53(3):424–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Makary MA, Segev DL, Pronovost PJ, Syin D, Bandeen-Roche K, Patel P, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010;210(6):901–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142–8.PubMedGoogle Scholar
  5. 5.
    The American Geriatrics Society 2012 Beers Criteria Update Expert Panel: American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012; 60(2):616–31.Google Scholar
  6. 6.
    Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. TheMini-Cog: a cognitive ‘vital signs’ measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry. 2000;15(11):1021–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990;113(12):941–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Marcantonio ER, Goldman L, Mangione CM, Ludwig LE, Muraca B, Haslauer CM, et al. A clinical prediction rule for delirium after elective noncardiac surgery. JAMA. 1994;271(2):134–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Baskett PJ. ABC of major trauma. Management of hypovolaemic shock. BMJ. 1990;300(6737):1453–7.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Carson JL, Duff A, Poses RM, Berlin JA, Spence RK, Trout R, et al. Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet. 1996;348(9034):1055–60.PubMedCrossRefGoogle Scholar
  11. 11.
    Tircoveanu R, Van der Linden P. Hemodilution and anemia in patients with cardiac disease: what is the safe limit? Curr Opin Anaesthesiol. 2008;21(1):66–70.PubMedCrossRefGoogle Scholar
  12. 12.
    Kaufman JD, Lepor H. Reoperation versus observation in men with major bleeding after radical retropubic prostatectomy. Urology. 2005;66(3):561–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Hedican SP, Walsh PC. Postoperative bleeding following radical retropubic prostatectomy. J Urol. 1994;152(4):1181–3.PubMedGoogle Scholar
  14. 14.
    Lakatta EG, Levy D. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: Part I: aging arteries: a “set up” for vascular disease. Circulation. 2003;107(1):139–46.PubMedCrossRefGoogle Scholar
  15. 15.
    Shulman A, Wolf R. Alcohol ingestion, hormonal changes, and the skin. Clin Dermatol. 1999;17(4):405–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Goldman L, Caldera DL, Nussbaum SR, Southwick FS, Krogstad D, Murray B, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med. 1977;297(16):845–50.PubMedCrossRefGoogle Scholar
  17. 17.
    Ommen SR, Odell JA, Stanton MS. Atrial arrhythmias after cardiothoracic surgery. N Engl J Med. 1997;336(20):1429–34.PubMedCrossRefGoogle Scholar
  18. 18.
    Ergina PL, Gold SL, Meakins JL. Perioperative care of the elderly patient. World J Surg. 1993;17(2):192–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Jin F, Chung F. Minimizing perioperative adverse events in the elderly. Br J Anaesth. 2001;87(4):608–24.PubMedGoogle Scholar
  20. 20.
    Wallace A, Layug B, Tateo I, Li J, Hollenberg M, Browner W, et al. Prophylactic atenolol reduces postoperative myocardial ischemia. McSPI Research Group. Anesthesiology. 1998;88(1):7–17.PubMedCrossRefGoogle Scholar
  21. 21.
    Alves RJ, Campos RN, Nakiri K. Chronic and regular use of statin prevents atrial fibrillation in period after cardiac surgery. Arq Bras Cardiol. 2010;95(5):614–20.PubMedCrossRefGoogle Scholar
  22. 22.
    Kurz K, Katus HA, Der GE. akute Thoraxschmerz. [Acute chest pain]. Internist (Berl). 2005;46(9):957–64.CrossRefGoogle Scholar
  23. 23.
    Lee TH, Rouan GW, Weisberg MC, Brand DA, Cook EF, Acampora D, et al. Sensitivity of routine clinical criteria for diagnosing myocardial infarction within 24 hours of hospitalization. Ann Intern Med. 1987;106(2):181–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Giannitsis E, Katus HA. Der akute posteriore Myokardinfarkt. Eine typische Fehldiagnose. [Acute posterior myocardial infarct. A typical diagnostic error]. Internist (Berl). 2002;43(5):618–23.CrossRefGoogle Scholar
  25. 25.
    Watters JM, Clancey SM, Moulton SB, Briere KM, Zhu JM. Impaired recovery of strength in older patients after major abdominal surgery. Ann Surg. 1993;218(3):380–90. discussion 90-3.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Romano S, Bartone G, Romano L. Ischemia and infarction of the intestine related to obstruction. Radiol Clin North Am. 2008;46(5):925–42.PubMedCrossRefGoogle Scholar
  27. 27.
    Telfer S, Fenyo G, Holt PR, de Dombal FT. Acute abdominal pain in patients over 50 years of age. Scand J Gastroenterol Suppl. 1988;144:47–50.PubMedGoogle Scholar
  28. 28.
    Hendrickson M, Naparst TR. Abdominal surgical emergencies in the elderly. Emerg Med Clin North Am. 2003;21(4):937–69.PubMedCrossRefGoogle Scholar
  29. 29.
    Maglinte DD, Balthazar EJ, Kelvin FM, Megibow AJ. The role of radiology in the diagnosis of small-bowel obstruction. AJR Am J Roentgenol. 1997;168(5):1171–80.PubMedCrossRefGoogle Scholar
  30. 30.
    Qalbani A, Paushter D, Dachman AH. Multidetector row CT of small bowel obstruction. Radiol Clin North Am. 2007;45(3):499–512.PubMedCrossRefGoogle Scholar
  31. 31.
    Kemppainen H, Raiha I, Sourander L. Clinical presentation of peptic ulcer in the elderly. Gerontology. 1997;43(5):283–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Griffin MR. Epidemiology of nonsteroidal anti-inflammatory drug-associated gastrointestinal injury. Am J Med. 1998;104(3A):23S–9. discussion 41S-42S.PubMedCrossRefGoogle Scholar
  33. 33.
    Fenyo G. Acute abdominal disease in the elderly: experience from two series in Stockholm. Am J Surg. 1982;143(6):751–4.PubMedCrossRefGoogle Scholar
  34. 34.
    Gardner TB, Vege SS, Chari ST, Pearson RK, Clain JE, Topazian MD, et al. The effect of age on hospital outcomes in severe acute pancreatitis. Pancreatology. 2008;8(3):265–70.PubMedCrossRefGoogle Scholar
  35. 35.
    Swan MC, Banwell PE. The open abdomen: aetiology, classification and current management strategies. J Wound Care. 2005;14(1):7–11.PubMedGoogle Scholar
  36. 36.
    Barker DE, Kaufman HJ, Smith LA, Ciraulo DL, Richart CL, Burns RP. Vacuum pack technique of temporary abdominal closure: a 7-year experience with 112 patients. J Trauma. 2000;48(2):201–6. discussion 206–207.PubMedCrossRefGoogle Scholar
  37. 37.
    Rucinski J, Margolis M, Panagopoulos G, Wise L. Closure of the abdominal midline fascia: meta-analysis delineates the optimal technique. Am Surg. 2001;67(5):421–6.PubMedGoogle Scholar
  38. 38.
    Bell Jr RH, Drach GW, Rosenthal RA. Proposed competencies in geriatric patient care for use in assessment for initial and continued board certification of surgical specialists. J Am Coll Surg. 2011;213(5):683–90.PubMedCrossRefGoogle Scholar
  39. 39.
    Gupta N, Sivaramakrishna, Kumar R, Dogra PN, Seth A. Comparison of standard transurethral resection, transurethral vapour resection and holmium laser enucleation of the prostate for managing benign prostatic hyperplasia of >40 g. BJU Int. 2006;97(1):85–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Nieder AM, Meinbach DS, Kim SS, Soloway MS. Transurethral bladder tumor resection: intraoperative and postoperative complications in a residency setting. J Urol. 2005;174(6):2307–9.PubMedGoogle Scholar
  41. 41.
    Rassweiler J, Stolzenburg J, Sulser T, Deger S, Zumbe J, Hofmockel G, et al. Laparoscopic radical prostatectomy–the experience of the German Laparoscopic Working Group. Eur Urol. 2006;49(1):113–9.PubMedGoogle Scholar
  42. 42.
    Bhandari A, McIntire L, Kaul SA, Hemal AK, Peabody JO, Menon M. Perioperative complications of robotic radical prostatectomy after the learning curve. J Urol. 2005;174(3):915–8.PubMedGoogle Scholar
  43. 43.
    Desai MM, Aron M, Gill IS. Laparoscopic partial nephrectomy versus laparoscopic cryoablation for the small renal tumor. Urology. 2005;66(5 Suppl):23–8.PubMedCrossRefGoogle Scholar
  44. 44.
    Steffens J, Humke U, Ziegler M, Siemer S. Partial nephrectomy with perfusion cooling for imperative indications: a 24-year experience. BJU Int. 2005;96(4):608–11.PubMedCrossRefGoogle Scholar
  45. 45.
    Wille AH, Roigas J, Deger S, Tullmann M, Turk I, Loening SA. Laparoscopic radical nephrectomy: techniques, results and oncological outcome in 125 consecutive cases. Eur Urol. 2004;45(4):483–8. discussion 8-9.PubMedGoogle Scholar
  46. 46.
    Shuford MD, McDougall EM, Chang SS, LaFleur BJ, Smith Jr JA, Cookson MS. Complications of contemporary radical nephrectomy: comparison of open vs. laparoscopic approach. Urol Oncol. 2004;22(2):121–6.PubMedCrossRefGoogle Scholar
  47. 47.
    Carson M, Liu E. Perioperative Infections and Fevers. Johns Hopkins Consultative Medicine Essentials. 2012 http://www.jhcape.com/site/article.cfm?ID=17.

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Daniel Ramirez
    • 1
  • Vivyenne Roche
    • 2
  • Philippe Zimmern
    • 1
    Email author
  1. 1.Department of UrologyUT Southwestern Health Science CenterDallasUSA
  2. 2.Department of Internal MedicineUT Southwestern Health Science CenterDallasUSA

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