Advertisement

Perioperative Management of the Geriatric Patient

  • Bellal Joseph
  • Peter Rhee
Chapter

Abstract

It is obvious and well known that the geriatric population is growing in number and complexity in modern surgical practice. Advances in surgical and anesthetic techniques, combined with sophisticated perioperative monitoring are some of the reasons for the complexity. Therefore, a more comprehensive and multidisciplinary approach is necessary to adequately address the significant differences in physiology and outcomes presented by this challenging group. The optimal goal of surgical critical care for geriatric patients is not only to reduce mortality rates, but for them to maintain and preserve a good quality of life and increase their ability to return to their pre-injury level of function and independence. Ideally, following discharge, patients should be able to live independently, healthfully, and be reintegrated into their previous social life. The mortality of intensive care patients increases gradually with age and reaches around 20% in patients between 60 and 75 years of age. Obviously the mortality rate of older patients is much greater than for the younger cohorts [1].

Notes

Acknowledgement

There are no identifiable conflicts of interests to report.

The authors have no financial or proprietary interest in the subject matter or materials discussed in the manuscript.

References

  1. 1.
    Horn J. Intensive care and the elderly. Arch Gerontol Geriatr. 1997;25(1):101–10.CrossRefPubMedGoogle Scholar
  2. 2.
    Angus DC, Barnato AE, Linde-Zwirble WT, Weissfeld LA, Watson RS, Rickert T, Rubenfeld GD. Use of intensive care at the end of life in the United States: an epidemiologic study. Crit Care Med. 2004;32(3):638–43.CrossRefPubMedGoogle Scholar
  3. 3.
    Bagshaw SM, Webb SA, Delaney A, George C, Pilcher D, Hart GK, Bellomo R. Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis. Crit Care. 2009;13(2):R45.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Kim PK, Kauder DR, Schwab CW. Acute care surgery and the elderly, Acute Care Surgery. New York: Springer; 2007. p. 187–93.CrossRefGoogle Scholar
  5. 5.
    Levkoff SE, Cleary PD, Wetle T, Besdine RW. Illness behavior in the aged. J Am Geriatr Soc. 1988;36(7):622–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Watters JM, Blakslee JM, March RJ, Redmond ML. The influence of age on the severity of peritonitis. Can J Surg. 1996;39(2):142.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Joseph B, Hassan A. Geriatric trauma patients: what is the difference? Current Surgery Reports. 2016;4(1):1–6.CrossRefGoogle Scholar
  8. 8.
    Beliveau MM, Multach M. Perioperative care for the elderly patient. Med Clin N Am. 2003;87(1):273–89.CrossRefPubMedGoogle Scholar
  9. 9.
    Neumayer L, Hosokawa P, Itani K, El-Tamer M, Henderson WG, Khuri SF. Multivariable predictors of postoperative surgical site infection after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg. 2007;204(6):1178–87.CrossRefPubMedGoogle Scholar
  10. 10.
    Kirby JP, Mazuski JE. Prevention of surgical site infection. Surg Clin N Am. 2009;89(2):365–89.CrossRefPubMedGoogle Scholar
  11. 11.
    Kaye KS, Anderson DJ, Sloane R, Chen LF, Choi Y, Link K, Sexton DJ, Schmader KE. The effect of surgical site infection on older operative patients. J Am Geriatr Soc. 2009;57(1):46–54.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Barie PS. Surgical site infections: epidemiology and prevention. Surg Infect. 2002;3(S1):s9–s21.CrossRefGoogle Scholar
  13. 13.
    Dellinger EP, Hausmann SM, Bratzler DW, Johnson RM, Daniel DM, Bunt KM, Baumgardner GA, Sugarman JR. Hospitals collaborate to decrease surgical site infections. Am J Surg. 2005;190(1):9–15.CrossRefPubMedGoogle Scholar
  14. 14.
    Cunha BA. Urinary tract infections in males. In: Bope E, Rakel R, editors. Conn’s current therapy, 2003. Philadelphia: Elsevier Science; 2003. p. 733–5. ISBN 0–7216-8745–8.Google Scholar
  15. 15.
    Feldman C. Pneumonia in the elderly. Med Clin N Am. 2001;85(6):1441–59.CrossRefPubMedGoogle Scholar
  16. 16.
    Radtke F, Franck M, Hagemann L, Seeling M, Wernecke K, Spies C. Risk factors for inadequate emergence after anesthesia: emergence delirium and hypoactive emergence. Minerva Anestesiol. 2010;76(6):394–403.PubMedGoogle Scholar
  17. 17.
    Young J, Inouye SK. Delirium in older people. BMJ: British Medical Journal. 2007;334(7598):842.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Ansaloni L, Catena F, Chattat R, Fortuna D, Franceschi C, Mascitti P, Melotti R. Risk factors and incidence of postoperative delirium in elderly patients after elective and emergency surgery. Br J Surg. 2010;97(2):273–80.CrossRefPubMedGoogle Scholar
  19. 19.
    Lagoo-Deenadayalan SA, Newell MA, Pofahl WE. Common perioperative complications in older patients. In: Principles and practice of geriatric surgery. New York: Springer; 2011. p. 361–76.CrossRefGoogle Scholar
  20. 20.
    Strøm C, Rasmussen L. Challenges in anaesthesia for elderly. Singap Dent J. 2014;35:23–9.CrossRefGoogle Scholar
  21. 21.
    McGory ML, Maggard MA, Ko CY. A meta-analysis of perioperative beta blockade: what is the actual risk reduction? Surgery. 2005;138(2):171–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Auerbach AD, Goldman L. β-blockers and reduction of cardiac events in noncardiac surgery: scientific review. JAMA. 2002;287(11):1435–44.PubMedGoogle Scholar
  23. 23.
    Mehta RH, Rathore SS, Radford MJ, Wang Y, Wang Y, Krumholz HM. Acute myocardial infarction in the elderly: differences by age. J Am Coll Cardiol. 2001;38(3):736–41.CrossRefPubMedGoogle Scholar
  24. 24.
    Ryder DL. The use of β-blockers to decrease adverse perioperative cardiac events. Dimens Crit Care Nurs. 2008;27(2):47–53.CrossRefPubMedGoogle Scholar
  25. 25.
    Badner NH, Knill RL, Brown JE, Novick TV, Gelb A. Myocardial infarction after noncardiac surgery. Anesthesiology. 1998;88(3):572–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Loran DB, Hyde BR, Zwischenberger JB. Perioperative management of special populations: the geriatric patient. Surg Clin N Am. 2005;85(6):1259–66.CrossRefPubMedGoogle Scholar
  27. 27.
    Amar D, Zhang H, Leung DH, Roistacher N, Kadish AH. Older age is the strongest predictor of postoperative atrial fibrillation. The Journal of the American Society of Anesthesiologists. 2002;96(2):352–6.Google Scholar
  28. 28.
    Ramsay JG. Cardiac management in the ICU. Chest J. 1999;115(suppl_2):138S–44S.CrossRefGoogle Scholar
  29. 29.
    Amar D. Prevention and management of perioperative arrhythmias in the thoracic surgical population. Anesthesiol Clin. 2008;26(2):325–35.CrossRefPubMedGoogle Scholar
  30. 30.
    Ergina PL, Gold SL, Meakins JL. Perioperative care of the elderly patient. World J Surg. 1993;17(2):192–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Polanczyk CA, Marcantonio E, Goldman L, Rohde LE, Orav J, Mangione CM, Lee TH. Impact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery. Ann Intern Med. 2001;134(8):637–43.CrossRefPubMedGoogle Scholar
  32. 32.
    McAlister FA, Bertsch K, Man J, Bradley J, Jacka M. Incidence of and risk factors for pulmonary complications after nonthoracic surgery. Am J Respir Crit Care Med. 2005;171(5):514–7.CrossRefPubMedGoogle Scholar
  33. 33.
    Feinberg MJ, Knebl J, Tully J, Segall L. Aspiration and the elderly. Dysphagia. 1990;5(2):61–71.CrossRefPubMedGoogle Scholar
  34. 34.
    Wood DL. Failure of pain relief after surgery: attitudes of ward staff and patients toward postoperative analgesia. Plast Reconstr Surg. 1996;97(7):1523.Google Scholar
  35. 35.
    Katz PR. Geriatrics syllabus for specialists: the American Geriatrics Society; 2002.Google Scholar
  36. 36.
    Brunt L, Quasebarth M, Dunnegan D, Soper N. Outcomes analysis of laparoscopic cholecystectomy in the extremely elderly. Surg Endosc. 2001;15(7):700–5.CrossRefPubMedGoogle Scholar
  37. 37.
    Cagetti B, Cossu M, Pau A, Rivano C, Viale G. The outcome from acute subdural and epidural intracranial haematomas in very elderly patients. Br J Neurosurg. 1992;6(3):227–31.CrossRefPubMedGoogle Scholar
  38. 38.
    Joseph B, Pandit V, Aziz H, Kulvatunyou N, Hashmi A, Tang A, O'Keeffe T, Wynne J, Vercruysse G, Friese RS, et al. Clinical outcomes in traumatic brain injury patients on preinjury clopidogrel: a prospective analysis. The journal of trauma and acute care surgery. 2014;76(3):817–20.CrossRefPubMedGoogle Scholar
  39. 39.
    Pennings JL, Bachulis BL, Simons CT, Slazinski T. SUrvival after severe brain injury in the aged. Arch Surg. 1993;128(7):787–94.CrossRefPubMedGoogle Scholar
  40. 40.
    Chang W-H, Tsai S-H, Su Y-J, Huang C-H, Chang K-S, Tsai C-H. Trauma mortality factors in the elderly population. International Journal of Gerontology. 2008;2(1):11–7.CrossRefGoogle Scholar
  41. 41.
    Watts HF, Kerem Y, Kulstad EB. Evaluation of the revised trauma and injury severity scores in elderly trauma patients. Journal of emergencies, trauma, and shock. 2012;5(2):131.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Carillo E, Richardson J, Malias M, Cryer H, Miller F. Long term outcome of blunt trauma in the elderly. Surg Gynecol Obstet. 1993;176:559–64.Google Scholar
  43. 43.
    Jokar TO, Rhee PM, Zangbar B, Kulvatunyou N, Khalil M, O'Keeffe T, Tang AL, Friese RS, Gries LM, Joseph B. Redefining the association between old age and poor outcomes after trauma: the impact of the frailty syndrome. J Am Coll Surg. 2015;221(4):S83–S4.CrossRefGoogle Scholar
  44. 44.
    Joseph B, Pandit V, Zangbar B, Kulvatunyou N, Hashmi A, Green DJ, O’Keeffe T, Tang A, Vercruysse G, Fain MJ. Superiority of frailty over age in predicting outcomes among geriatric trauma patients: a prospective analysis. JAMA Surg. 2014;149(8):766–72.CrossRefPubMedGoogle Scholar
  45. 45.
    de Vries NM, Staal JB, van Ravensberg CD, Hobbelen JS, Olde Rikkert MG. Nijhuis-van der Sanden MW. Outcome instruments to measure frailty: a systematic review. Ageing Res Rev. 2011;10(1):104–14.CrossRefPubMedGoogle Scholar
  46. 46.
    Joseph B, Pandit V, Zangbar B, Kulvatunyou N, Tang AL, O'Keeffe T, Green DJ, Fain MJ, Friese RS, Rhee PM. Emergency general surgery in the elderly: too old or too frail? J Am Coll Surg. 2014;219(3):S53–S4.CrossRefGoogle Scholar
  47. 47.
    Joseph B, Phelan H, Hassan A, Jokar TO, O'Keeffe T, Azim A, Gries L, Kulvatunyou N, Latifi R, Rhee P. The impact of frailty on failure-to-rescue in geriatric trauma patients: a prospective study. J Trauma Acute Care Surg. 2016;81(6):1150–5.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Trauma, Department of SurgeryUniversity of ArizonaTucsonUSA

Personalised recommendations