surgery in the elderly; geriatric surgery
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Epidemiology
Laboratory
Complications
- 14% of older adults die within a year of undergoing major surgery
- risk factors for death within 1 year of major surgery include:
- probable dementia* (33%)
- frailty* (28%)
- emergency surgery (22%)
- elderly >= 90 years* are 6x as likely to die than those age 65-70 years
- other risk factors
- heart disease
- kidney disease
- self-care issues
- mobility issues
- 30% of elderly do not return to baseline function 6 months after major surgery
- those most likely to recover have elective surgery with preparation in advance
- other postoperative complications
* 9% of elderly >= 90 years undergo major surgery
* 12% of frail elderly undergo major surgery
* 12% of elderly with probable dementia undergo major surgery[3]
Management
- see general surgery for general guidelines & postoperative complications for specific guidelines
- prevention of postoperative delirium & postoperative cognitive impairment
- preoperative screening for frailty & dementia
- American College of Surgeons Geriatric Surgery Verification Program Standards has formalized guidelines for care of geriatric surgery patient[5][6]
- in addition to the above
- geriatric surgery nurse, education of nurses & providers
- geriatric-friendly rooms
- shared decision-making
- discussion of life-sustaining treatments every 3 days for ICU patients
- access to & return of hearing aids, eye glasses & dentures
- provide water-tight container for these items
- nutrition & medication plan
- rescreening for vulnerabilties prior to transition of care
- plan for follow-up
- communication with primary care provider
- implementation of the Geriatric Surgery Verification Program
- in addition to the above
More general terms
Additional terms
References
- ↑ 1.0 1.1 Graham J Should Older Seniors Risk Major Surgery? New Research Offers Guidance. Medscape. Nov 28, 2022 https://www.medscape.com/viewarticle/984658
Gill TM, Vander Wyk B, Leo-Summers L et al Population-Based Estimates of 1-Year Mortality After Major Surgery Among Community-Living Older US Adults. JAMA Surg. Published online October 19, 2022 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36260323 https://jamanetwork.com/journals/jamasurgery/fullarticle/2797666 - ↑ Berian JR, Rosenthal RA, Baker TL et al Hospital Standards to Promote Optimal Surgical Care of the Older Adult: A Report From the Coalition for Quality in Geriatric Surgery. Ann Surg. 2018 Feb;267(2):280-290 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28277408
- ↑ 3.0 3.1 Becher RD, Vander Wyk B, Leo-Summers L et al The Incidence and Cumulative Risk of Major Surgery in Older Persons in the United States. Ann Surg. 2021 Jul 14;10.1097/SLA.0000000000005077 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34261884 PMCID: PMC8758792 (available on 2023-01-14)
- ↑ Graham J Should Older Adults Risk Major Surgery? New Research Offers Guidance. Annals of Long-Term Care. Nov 29, 2022 https://www.hmpgloballearningnetwork.com/site/altc/news/should-older-seniors-risk-major-surgery-new-research-offers-guidance
- ↑ 5.0 5.1 Berian JR, Rosenthal RA, Baker TL et al Hospital Standards to Promote Optimal Surgical Care of the Older Adult: A Report From the Coalition for Quality in Geriatric Surgery. Ann Surg. 2018 Feb;267(2):280-290. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28277408
- ↑ 6.0 6.1 Katlic MR Let It Rain: The American College of Surgeons Geriatric Surgery Verification Program. J Am Geriatr Soc 2020. Nov 12. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33184851 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.16928
- ↑ 7.0 7.1 Jones TS, Jones EL, Richardson V et al Preliminary data demonstrate the Geriatric Surgery Verification program reduces postoperative length of stay. J Am Geriatr Soc. 2021 Jul;69(7):1993-1999. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33826150
- ↑ 8.0 8.1 8.2 8.3 Ehrlich AL, Owodunni OP, Mostales JC et al Early Outcomes following Implementation of a Multispecialty Geriatric Surgery Pathway. Ann Surg. 2022 Jul 15. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35837966
- ↑ American College of Surgeons Accreditation & Verification Geriatric Surgery Verification Advancing Care of older adult patients https://www.facs.org/quality-programs/accreditation-and-verification/geriatric-surgery-verification/
- ↑ List of hospitals participating in Geriatric Surgery Verification Programs https://www.facs.org/quality-programs/accreditation-and-verification/geriatric-surgery-verification/participating-gsv-hospitals/