surgery

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[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]

Epidemiology

  • 1/3 of all surgeries performed in patients > 65 years of age

Indications

Contraindications

  • pregnancy not a contraindication
    • *general surgery as safe for pregnant women as it is for nonpregnant women[14]

Laboratory

Complications

Management

Notes

  • older surgeons may have a small advantage in operative mortality rates over younger colleagues[22]
  • female surgeons 50-59 years of age with lowest operative mortality rates[22]
    • no other differences in gender with operative mortality
  • internist involvement helps only as part of a multidisciplinary team[26]

More general terms

More specific terms

Additional terms

References

  1. ↑ Stedman's Medical Dictionary 27th ed, Williams & Wilkins, Baltimore, 1999.
  2. ↑ 2.0 2.1 Journal Watch 24(1):11, 2004 Birkmeyer JD et al, N Engl J Med 349:2117, 2003 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14645640
  3. ↑ Surgical site infection National Institute for Cost Effectiveness (NICE) http://www.nice.org.uk/Guidance/CG74
  4. ↑ 4.0 4.1 Ghaferi AA et al Variation in hospital mortality associated with inpatient surgery. N Engl J Med 2009 Oct 1; 361:1368 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19797283 <Internet> http://content.nejm.org/cgi/content/full/361/14/1368?ijkey=294abe840512f21af94da7bf1cf5a5bccb489006&keytype2=tf_ipsecsha
    Jacobs DO. Variation in hospital mortality associated with inpatient surgery - An S.O.S. N Engl J Med 2009 Oct 1; 361:1398. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19797288 <Internet> http://content.nejm.org/cgi/content/full/361/14/1398?ijkey=4912dc43fd0dfc3fec779ce907adeb6d01438c1c&keytype2=tf_ipsecsha
  5. ↑ 5.0 5.1 5.2 Moore LJ et al Sepsis in General Surgery The 2005-2007 National Surgical Quality Improvement Program Perspective Arch Surg. 2010;145(7):695-700. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20644134 <Internet> http://archsurg.ama-assn.org/cgi/content/abstract/145/7/695
  6. ↑ 6.0 6.1 Bradley KA et al. Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery. J Gen Intern Med 2011 Feb; 26:162. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20878363
    Harris AHS et al. Preoperative alcohol screening scores: Association with complications in men undergoing total joint arthroplasty. J Bone Joint Surg Am 2011 Feb; 93:321 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21325583
  7. ↑ 7.0 7.1 Mills E et al. Smoking cessation reduces postoperative complications: A systematic review and meta-analysis. Am J Med 2011 Feb; 124:144. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21295194
  8. ↑ O'Leary JG, Yachimski PS, Friedman LS. Surgery in the patient with liver disease. Clin Liver Dis. 2009 May;13(2):211-31. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19442915
  9. ↑ 9.0 9.1 Paul Olson TJ et al. Surgeon-reported conflict with intensivists about postoperative goals of care. JAMA Surg 2013 Jan; 148:29 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23324837
    Schwarze ML et al. Surgeons expect patients to buy-in to postoperative life support preoperatively: Results of a national survey. Crit Care Med 2013 Jan; 41:1. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23222269
  10. ↑ 10.0 10.1 Devereaux PJ et al for the POISE-2 Investigators. Aspirin in patients undergoing noncardiac surgery. N Engl J Med 2014 Mar 31 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24679062 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1401105
    Devereaux PJ et al for the POISE-2 Investigators. Clonidine in patients undergoing noncardiac surgery. N Engl J Med 2014 Mar 31 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24679061 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1401106
  11. ↑ 11.0 11.1 Urbach DR et al. Introduction of surgical safety checklists in Ontario, Canada. N Engl J Med 2014 Mar 13; 370:1029. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24620866 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMsa1308261
    Leape LL. The checklist conundrum. N Engl J Med 2014 Mar 13; 370:1063. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24748068 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1315851
  12. ↑ 12.0 12.1 Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  13. ↑ 13.0 13.1 Livhits M, Ko CY, Leonardi MJ et al Risk of surgery following recent myocardial infarction. Ann Surg. 2011 May;253(5):857-64. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21372685
  14. ↑ 14.0 14.1 Moore HB et al Effect of Pregnancy on Adverse Outcomes After General Surgery. JAMA Surg. Published online May 13, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25969946 <Internet> http://archsurg.jamanetwork.com/article.aspx?articleid=2289162
  15. ↑ 15.0 15.1 ProPublica. July 13, 2015 Making the Cut. Why choosing the right surgeon matters even more than you know. https://www.propublica.org/article/surgery-risks-patient-safety-surgeon-matters
    ProPublica. Surgeon Scorecard https://projects.propublica.org/surgeons/
  16. ↑ 16.0 16.1 Ladha K et al. Intraoperative protective mechanical ventilation and risk of postoperative respiratory complications: Hospital based registry study. BMJ 2015; 351:h3646 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26174419
  17. ↑ 17.0 17.1 17.2 Monk TG et al. Association between intraoperative hypotension and hypertension and 30-day postoperative mortality in noncardiac surgery. Anesthesiology 2015 Aug; 123:307. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26083768
    Mascha EJ et al. Intraoperative mean arterial pressure variability and 30-day mortality in patients having noncardiac surgery. Anesthesiology 2015 Apr 30; 123:79. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25929547
  18. ↑ Merrill AL et al Clinical Effect of Surgical Volume. N Engl J Med 2016; 374:1380-1382. April 7, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27050211 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMclde1513948
  19. ↑ 19.0 19.1 McIsaac DI, Bryson GL, van Walraven C. Association of Frailty and 1-Year Postoperative Mortality Following Major Elective Noncardiac Surgery: A Population- Based Cohort Study. JAMA Surg. 2016 Jun 1;151(6):538-45. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26791334
    Mosquera C, Spaniolas K, Fitzgerald TL. Impact of frailty on surgical outcomes: The right patient for the right procedure. Surgery. 2016 Aug;160(2):272-80. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27267548
  20. ↑ 20.0 20.1 20.2 20.3 World Health Organization (WHO) WHO recommends 29 ways to stop surgical infections and avoid superbugs. WHO News Release, Nov 3, 2016 http://www.who.int/mediacentre/news/releases/2016/recommendations-surgical-infections/en/
    Allegranzi B, Zayed B, Bischoff P et al New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence- based global perspective. Lancet Infectious Diseases. Nov 2, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27816414 <Internet> http://thelancet.com/journals/laninf/article/PIIS1473-3099(16)30402-9/fulltext
    Allegranzi B, Bischoff P, de Jonge S et al New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infectious Diseases. Nov 2, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27816413 <Internet> http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(16)30398-X/fulltext
  21. ↑ 21.0 21.1 21.2 21.3 Writing Committee for the VISION Study Investigators Association of Postoperative High-Sensitivity Troponin Levels With Myocardial Injury and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery. JAMA. 2017;317(16):1642-1651 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28444280 <Internet> http://jamanetwork.com/journals/jama/article-abstract/2620089
  22. ↑ 22.0 22.1 22.2 Tsugawa Y, Jena AB, Newhouse RL et al Age and sex of surgeons and mortality of older surgical patients: observational study. BMJ 2018;361:k1343 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29695473 Free PMC Article https://www.bmj.com/content/361/bmj.k1343
    Coburn N, Wallis CJD, Baxter N. Links between age and sex of surgeons and patients' outcomes. BMJ 2018;361:k1691 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29695477 https://www.bmj.com/content/361/bmj.k1691
  23. ↑ 23.0 23.1 American Academy of Nursing Twenty-Five Things Nurses and Patients Should Question Choosing Wisely. An initiative of the ABIM Foundation Released April 19, 2018 (21-25) http://www.choosingwisely.org/societies/american-academy-of-nursing/
  24. ↑ 24.0 24.1 The NeuroVISION Investigators Perioperative covert stroke in patients undergoing non-cardiac surgery (NeuroVISION): a prospective cohort study Lancet. Aug 15, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31422895 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31795-7/fulltext
    Vlisides PE, Avidan MS, Mashour GA Uncovering covert stroke in surgical patients Lancet. Aug 15, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31422896 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31770-2/fulltext
    Szczeklik W, Dmytriw AA, Agid R et al Rationale and design for the detection and neurological impact of cerebrovascular events in non-cardiac surgery patients cohort evaluation (NeuroVISION) study: a prospective international cohort study. BMJ Open. 2018 Jul 6;8(7):e021521. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29982215 Free PMC Article
    Mrkobrada M, Hill MD, Chan MT, Sigamani A et al Covert stroke after non-cardiac surgery: a prospective cohort study. Br J Anaesth. 2016 Aug;117(2):191-7. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27440630 Free Article
  25. ↑ NEJM Knowledge+ Question of the Week, June 30, 2020 https://knowledgeplus.nejm.org/question-of-week/635/
    Bratzler DW et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013 Feb 1; 70:195 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23327981
  26. ↑ 26.0 26.1 Shaw M et al. Evaluation of internal medicine physician or multidisciplinary team comanagement of surgical patients and clinical outcomes: A systematic review and meta-analysis. JAMA Netw Open 2020 May 1; 3:e204088 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32369179 Free PMC article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2765514
  27. ↑ 27.0 27.1 Althoff FC, Wachtendorf LJ, Rostin P et al Effects of night surgery on postoperative mortality and morbidity: a multicentre cohort study BMJ Qual Saf. 2020;Epub Oct 9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33028658 https://psnet.ahrq.gov/issue/effects-night-surgery-postoperative-mortality-and-morbidity-multicentre-cohort-study
  28. ↑ 28.0 28.1 Sun EC et al. Assessment of perioperative outcomes among surgeons who operated the night before. JAMA Intern Med 2022 May 23; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/35604661 PMCID: PMC9127708 Free PMC article https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2792088
  29. ↑ 29.0 29.1 29.2 Shah SK et al. Patients living with dementia have worse outcomes when undergoing high-risk procedures. J Am Geriatr Soc 2022 Oct; 70:2838. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35637607 PMCID: PMC9588582 (available on 2023-10-01) https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.17893
    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
  30. ↑ 30.0 30.1 Reich KM, Gill SS, Eckenhoff R et al Association between surgery and rate of incident dementia in older adults: A population-based retrospective cohort study. J Am Geriatr Soc 2025. 72(5):1348-1359 PMID: https://www.ncbi.nlm.nih.gov/pubmed/38165146 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18736
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