Wie können postoperative Komplikationen bei Patienten mit Frailty vermieden werden?

Mörgeli, Rudolf; Wollersheim, Tobias; Spies, Claudia; Balzer, Felix; Koch, Susanne; Treskatsch, Sascha

doi:10.1055/s-0043-104685

Cited by 7 publications

(2 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Regardless of interdisciplinary conferences or prehabilitation programs, simply being aware of a patient’s frailty status allows us to implement perioperative preventive measures and heighten our vigilance for complications in this vulnerable collective. These measures may be employed before, during, or after the operation, and include steps such as preoperative warming, careful choice of anaesthetics, advanced hemodynamic and neuromonitoring, appropriate delirium and pain management, early mobilization, and others [30].…”

Section: Discussionmentioning

confidence: 99%

Routine frailty assessment predicts postoperative complications in elderly patients across surgical disciplines – a retrospective observational study

et al. 2019

Self Cite

View full text Add to dashboard Cite

BackgroundFrailty is a frequent and underdiagnosed functional syndrome involving reduced physiological reserves and an increased vulnerability against stressors, with severe individual and socioeconomic consequences. A routine frailty assessment was implemented at our preoperative anaesthesia clinic to identify patients at risk.ObjectiveThis study examines the relationship between frailty status and the incidence of in-hospital postoperative complications in elderly surgical patients across several surgical disciplines.DesignRetrospective observational analysis.SettingSingle center, major tertiary care university hospital. Data collection took place between June 2016 and March 2017.PatientsPatients 65 years old or older were evaluated for frailty using Fried’s 5-point frailty assessment prior to elective non-cardiac surgery. Patients were classified into non-frail (0 criteria, reference group), pre-frail (1–2 positive criteria) and frail (3–5 positive criteria) groups.Main outcome measuresThe incidence of postoperative complications was assessed until discharge from the hospital, using the roster from the National VA Surgical Quality Improvement Program. Propensity score matching and logistic regression analysis were performed.ResultsFrom 1186 elderly patients, 46.9% were classified as pre-frail (n = 556), and 11.4% as frail (n = 135). The rate of complications were significantly higher in the pre-frail (34.7%) and frail groups (47.4%), as compared to the non-frail group (27.5%). Similarly, length of stay (non-frail: 5.0 [3.0;7.0], pre-frail: 7.0 [3.0;9.0], frail 8.0 [4.5;12.0]; p < 0.001) and discharges to care facilities (non-frail:1.6%, pre-frail: 7.4%, frail: 17.8%); p < 0.001) were significantly associated with frailty status. After propensity score matching and logistic regression analysis, the risk for developing postoperative complications was approximately two-fold for pre-frail (OR 1.78; 95% CI 1.04–3.05) and frail (OR 2.08; 95% CI 1.21–3.60) patients.ConclusionsThe preoperative frailty assessment of elderly patients identified pre-frail and frail subgroups to have the highest rate of postoperative complications, regardless of age, surgical discipline, and surgical risk. Significantly increased length of hospitalisation and discharges to care facilities were also observed. Implementation of routine frailty assessments appear to be an effective tool in identifying patients with increased risk. Now future studies are needed to investigate whether patients benefit from optimization of patient counselling, process planning, and risk reduction protocols based on the application of risk stratification.

show abstract

Section: Discussionmentioning

confidence: 99%

Routine frailty assessment predicts postoperative complications in elderly patients across surgical disciplines – a retrospective observational study

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, a perioperative nutritional intervention in patients (≥75 years) undergoing elective general, gynecologic oncology, and orthopedic surgery showed less postoperative delirium in the group receiving the perioperative nutritional intervention, but it was not statistically significant [31] . According to the current literature, elderly patients have an impaired response to stressors and the risk of postoperative delirium can be reduced if early mobilization and nutritional support are provided during the perioperative period [32] .…”

Section: Relationship Between Preoperative Oral Carbohydrate Consumpt...mentioning

confidence: 99%

Progress in the study of the effect of preoperative oral carbohydrates on postoperative delirium in elderly patients

2023

IJFM

View full text Add to dashboard Cite

As the population ages, the number of elderly patients who choose to undergo surgical procedures is gradually increasing, but the incidence of postoperative delirium in elderly patients is gradually increasing due to their physiological changes, preoperative malnutrition, and prolonged preoperative fasting. The role of preoperative carbohydrates as a contemporary element of the rapid recovery surgery (ERAS) paradigm in preventing the onset of postoperative delirium has become a clinical research hotspot. A full understanding of the safety and feasibility of preoperative oral carbohydrates for elderly patients will help to reduce the incidence of postoperative delirium and promote early recovery of elderly patients. This paper presents a review of the effects of preoperative oral carbohydrates on POD in elderly patients.

show abstract

Frailty assessment tools predict perioperative outcome in elderly patients with endometrial cancer better than age or BMI alone: a retrospective observational cohort study

Anić

Flohr

Schmidt

et al. 2022

J Cancer Res Clin Oncol

View full text Add to dashboard Cite

Objective Five commonly used global health assessment tools have been evaluated to identify and assess the preoperative frailty status and its relationship with perioperative in-hospital complications and transfusion rates in older women with endometrial cancer (EC). Methods Preoperative frailty status was examined by the G8 questionnaire, the Eastern Cooperative Oncology Group performance status, the Charlson Comorbidity Index and the American Society of Anesthesiologists Physical Status System, as well as the Lee-Schonberg prognostic index. The main outcome measures were perioperative laboratory values, intraoperative surgical parameters and immediately postoperative complications. Results 153 consecutive women ≥ 60 years with all stages of EC, who received primary elective surgery at the University Medical Center Mainz between 2008 and 2019 were classified with selected global health assessment tools according to their preoperative performance status. In contrast to conventional prognostic parameters like older age and higher BMI, increasing frailty was significantly associated with preoperative anemia and perioperative transfusions (p < 0.05). Moreover, in patients preoperatively classified as frail significantly more postoperative complications (G8 Score: frail: 20.7% vs. non-frail: 6.7%, p = 0.028; ECOG: frail: 40.9% vs. non-frail: 2.8%, p = 0.002; and CCI: frail: 25.0% vs. non-frail: 7.4%, p = 0.003) and an increased length of hospitalization were recorded. According to propensity score matching, the risk for developing postoperative complications for frail patients was approximately two-fold higher, depending on which global health assessment tool was used. Conclusions Preoperatively assessed frailty significantly predicts post-surgical morbidity rates in contrast to conventionally used single prognostic parameters such as age or BMI. A standardized preoperative assessment of frailty in the routine work-up might be beneficial in older cancer patients before major surgery to include these patients in a prehabilitation program with nutrition counseling and physiotherapy to adequately assess the perioperative risk.

show abstract

Wie können postoperative Komplikationen bei Patienten mit Frailty vermieden werden?

Cited by 7 publications

References 42 publications

Routine frailty assessment predicts postoperative complications in elderly patients across surgical disciplines – a retrospective observational study

Routine frailty assessment predicts postoperative complications in elderly patients across surgical disciplines – a retrospective observational study

Progress in the study of the effect of preoperative oral carbohydrates on postoperative delirium in elderly patients

Frailty assessment tools predict perioperative outcome in elderly patients with endometrial cancer better than age or BMI alone: a retrospective observational cohort study

Contact Info

Product

Resources

About