Geriatric Preoperative Optimization: A Review

Zietlow, Kahli; Wong, Serena P.; Heflin, Mitchell T.; McDonald, Shelley; Sickeler, Robert; Devinney, Michael J.; Blitz, Jeanna; Lagoo‐Deenadayalan, Sandhya; Berger, Miles

doi:10.1016/j.amjmed.2021.07.028

Cited by 41 publications

(28 citation statements)

References 65 publications

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“…Frailty is a clinical syndrome, the importance of which has been rapidly recognized in perioperative elderly populations [40]. Frailty syndrome is measured as the sum of various indicators, including unintentional weight loss, fatigue, muscle weakness, low physical activity, low gait speed, poor balance, visual impairment, and cognitive impairment [41,42]. The prevalence of preoperative frailty varies significantly (up to 50-60%) depending on age and the type of surgery, with a steep increase observed in older patients [43][44][45][46].…”

Section: Preoperative Cognitive Assessmentmentioning

confidence: 99%

Does Preoperative Cognitive Optimization Improve Postoperative Outcomes in the Elderly?

Ishizawa

2022

JCM

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Perioperative neurocognitive disorder (PND) is a growing concern, affecting several million elderly patients each year in the United States, but strategies for its effective prevention have not yet been established. Humeidan et al. recently demonstrated that preoperative brain exercise resulted in a decrease in postoperative delirium incidence in elderly surgical patients, suggesting the potential of presurgical cognitive optimization to improve postoperative cognitive outcomes. This brief review summarizes the current knowledge regarding preoperative cognitive optimization and highlights landmark studies, as well as current ongoing studies, as the field is rapidly growing. This review further discusses the benefit of cognitive training in non-surgical elderly populations and the role of cognitive training in patients with preexisting cognitive impairment or dementia. The review also examines preclinical evidence in support of cognitive training, which can facilitate understanding of brain plasticity and the pathophysiology of PND. The literature suggests positive impacts of presurgical cognitive optimization, but further studies are encouraged to establish effective cognitive training programs for elderly presurgical patients.

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Section: Preoperative Cognitive Assessmentmentioning

confidence: 99%

Does Preoperative Cognitive Optimization Improve Postoperative Outcomes in the Elderly?

Ishizawa

2022

JCM

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“…Los cambios en la fisiología debido al envejecimiento y una mayor prevalencia de condiciones comórbidas colocan en una posición de mayor riesgo de complicaciones perioperatorias al adulto mayor (6,8,9), tales como delirio postoperatorio, infección pulmonar, eventos cardiovasculares y una tasa general más alta de morbilidad postoperatoria, hospitalizaciones prolongadas y mortalidad, además de deterioro general y cognitivo a largo plazo (8,10,11). Si bien los pacientes ancianos que se someten a cirugía tienen mayores riesgos de morbimortalidad, la edad cronológica por sí sola puede ser un mal predictor.…”

Section: Generalidadesunclassified

“…La fragilidad, definida como una disminución de la reserva fisiológica, se asocia con deficiencias multisistémicas y parece superior a la edad cronológica en la predicción de resultados en dichos pacientes (2). Los pacientes adultos mayores que requieren algún tipo de intervención quirúrgica, a menudo requieren un nivel de atención diferente al de los pacientes más jóvenes durante el período perioperatorio (11). Un buen resultado postoperatorio se define no solo por el éxito quirúrgico, sino mucho más por la preservación del rendimiento, la funcionalidad, la autonomía y la calidad de vida (12).…”

Section: Generalidadesunclassified

“…Corresponde a un síndrome geriátrico secundario a la pérdida de reserva tanto cognitiva, como física. Existen diferentes herramientas clínica que se utilizan para medir el grado de fragilidad (11). La fragilidad se cuantifica mediante la evaluación de un espectro de características exclusivas de los adultos mayores.…”

Section: Fragilidadunclassified

“…Si alguno de estos factores es positivo, se debe interconsultar para una evaluación nutricional, con la unidad de soporte nutricional (4). Por otro lado, la obesidad también se considera un factor de mal pronóstico de complicaciones posoperatorias; en este caso, se sigue considerando el índice de masa corporal para su diagnóstico (11).Si se determina que un paciente es de alto riesgo para presentar fragilidad (utilizando como guía las características clínicas antes mencionadas), se debe considerar la pre habilitación con entrenamiento físico y suplementos nutricionales orales. Referir a un especialista en geriatría permite una evaluación más extensa, y llevar a cabo medidas de pre habilitación en una unidad de tratamiento geriátrico (12).…”

Section: Fragilidadunclassified

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Cuidados perioperatorios en el paciente adulto mayor

Castillo

Quesada

Cordero³

2022

Rev.méd.sinerg.

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La población adulta mayor es el segmento de la población mundial de más rápido crecimiento, y con ello el número de intervenciones quirúrgicas, tanto electivas como de emergencia, aumenta cada día. Los pacientes mayores representan una complejidad mayor, en comparación con los paciente jóvenes, en cuanto a factores fisiológicos, sociológicos y psicológicos que desafían los modelos de atención actuales. El objetivo de realizar una intervención quirúrgica debe ser ofrecer la mejor calidad de vida posible, a pesar de que representan un desafío médico a causa de la comorbilidad asociada y la reserva cardiopulmonar disminuida.

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Population-Based Estimates of 1-Year Mortality After Major Surgery Among Community-Living Older US Adults

et al. 2022

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ImportanceDespite their importance to guiding public health decision-making and policies and to establishing programs aimed at improving surgical care, contemporary nationally representative mortality data for geriatric surgery are lacking.ObjectiveTo calculate population-based estimates of mortality after major surgery in community-living older US adults and to determine how these estimates differ according to key demographic, surgical, and geriatric characteristics.Design, Setting, and ParticipantsProspective longitudinal cohort study with 1 year of follow-up in the continental US from 2011 to 2018. Participants included 5590 community-living fee-for-service Medicare beneficiaries, aged 65 years or older, from the National Health and Aging Trends Study (NHATS). Data analysis was conducted from February 22, 2021, to March 16, 2022.Main Outcomes and MeasuresMajor surgeries and mortality over 1 year were identified through linkages with data from the Centers for Medicare &amp; Medicaid Services. Data on frailty and dementia were obtained from the annual NHATS assessments.ResultsFrom 2011 to 2017, of the 1193 major surgeries (from 992 community-living participants), the mean (SD) age was 79.2 (7.1) years; 665 were women (55.7%), and 30 were Hispanic (2.5%), 198 non-Hispanic Black (16.6%), and 915 non-Hispanic White (76.7%). Over the 1-year follow-up period, there were 206 deaths representing 872 096 survey-weighted deaths and 13.4% (95% CI, 10.9%-15.9%) mortality. Mortality rates were 7.4% (95% CI, 4.9%-9.9%) for elective surgeries and 22.3% (95% CI, 17.4%-27.1%) for nonelective surgeries. For geriatric subgroups, 1-year mortality was 6.0% (95% CI, 2.6%-9.4%) for persons who were nonfrail, 27.8% (95% CI, 21.2%-34.3%) for those who were frail, 11.6% (95% CI, 8.8%-14.4%) for persons without dementia, and 32.7% (95% CI, 24.3%-41.0%) for those with probable dementia. The age- and sex-adjusted hazard ratios for 1-year mortality were 4.41 (95% CI, 2.53-7.69) for frailty with a reduction in restricted mean survival time of 48.8 days and 2.18 (95% CI, 1.40-3.40) for probable dementia with a reduction in restricted mean survival time of 44.9 days.Conclusions and RelevanceIn this study, the population-based estimate of 1-year mortality after major surgery among community-living older adults in the US was 13.4% but was 3-fold higher for nonelective than elective procedures. Mortality was considerably elevated among older persons who were frail or who had probable dementia, highlighting the potential prognostic value of geriatric conditions after major surgery.

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Geriatric Preoperative Optimization: A Review

Cited by 41 publications

References 65 publications

Does Preoperative Cognitive Optimization Improve Postoperative Outcomes in the Elderly?

Does Preoperative Cognitive Optimization Improve Postoperative Outcomes in the Elderly?

Cuidados perioperatorios en el paciente adulto mayor

Population-Based Estimates of 1-Year Mortality After Major Surgery Among Community-Living Older US Adults

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