Cirurgia geriátrica: perspectivas atuais - uma revisão não sistemática da literatura / Geriatric surgery: current perspectives - A non-systematic literature review

Introdução: Observa-se aumento da expectativa de vida na maioria das populações do mundo. Tal mudança impacta diretamente o meio cirúrgico, pelo qual a população geriátrica precisa ser atendida conforme suas especificidades e nuances, a fim de garantir um atendimento de qualidade. Objetivo: Identificar os principais achados científicos mais recentes sobre a temática da cirurgia geriátrica, evidenciando, assim, a relevância do tema, além de impulsionar novos estudos na área. Método: As edições de 2017 a 2020 das seguintes revistas de alto impacto foram consultadas: Annals of Surgery, Journal of the American College of Surgeons, Surgery Journal e Annals of Surgical Oncology. Foi incluído nesta revisão o artigo original mais recente de cada uma delas sobre a temática "cirurgia geriátrica". Resultados: Um dos estudos, que determinou a incidência da necessidade de cirurgia e o tempo de recuperação em pacientes geriátricos, encontrou associação com melhores desfechos: caráter eletivo do procedimento e paciente sem fragilidade. Outro avaliou fatores de risco geriátrico-específicos e suas implicações, como declínio funcional e úlceras de pressão. O terceiro analisou a associação de características hospitalares com resultados clínicos após cirurgia geriátrica de alto risco. O quarto consistiu em uma coorte que avaliou a factibilidade do uso de tecnologias de monitoramento remoto pós-alta hospitalar em pacientes de 65 anos ou mais submetidos à cirurgia oncológica. Conclusão: Estes dados corroboram a necessidade de investimento em pesquisas para subsidiar planejamento e implementação de melhorias focadas nas necessidades da população geriátrica na cirurgia, diminuindo morbimortalidade e melhorando a qualidade de vida do paciente.

Introduction: There is an increase in life expectancy in most populations in the world. Such a change directly impacts the surgical environment, through which the geriatric population needs to be attended to according to their specificities and nuances, in order to guarantee quality care. Objective: To identify the most recent scientific findings on the subject of geriatric surgery, thus supporting the relevance of the theme, in addition to promoting new studies in the area. Method: The 2017 to 2020 editions of the following high-impact journals were consulted: Annals of Surgery, Journal of the American College of Surgeons, Surgery Journal and Annals of Surgical Oncology. The most recent original article by each of these on the topic "geriatric surgery" were included in this review. Results: One of the studies, which determined the incidence of the need for surgery and the recovery time in geriatric patients, found an association with better outcomes: elective nature of the procedure and patient without frailty. Another assessed geriatric-specific risk factors and their implications, such as functional decline and pressure ulcers. The third analyzed the association of hospital characteristics with clinical outcomes after high-risk geriatric surgery. The fourth consisted in a cohort that evaluated the feasibility of using post-discharge remote monitoring technologies in patients aged 65 years and over undergoing cancer surgery. Conclusion: These data corroborate the need for further investment in research to support planning and implementation of improvements focused on the needs of the geriatric population in surgery, reducing morbidity and mortality and improving the patient's quality of life.

Surgical diseases and surgical outcomes in geriatric patients

Background: To study the demography, disease distribution and co morbid conditions, complications and mortality among elderly patients undergoing operation in general surgical wards.Methods: A prospective observational study was conducted among elderly patients of age ≥60 years admitted in General Surgery wards at our institute for a period of a year. Results: A total of 137 patients were recruited in this study. Out of them 62.04% were men and 37.96% were women. Most common system involved was hepatobiliary with a total of 38 cases (27.7%), most common surgical disease in our study was hernias (27%) and gallstone disease (25%). About 55.5% of our study population had co morbid medical conditions. Hypertension was the most common co morbidity (38%) in our study. Out of 137 cases, 115 cases were elective cases and 22 were emergency cases, operated in emergency settings. About 16.7% of the study population had surgical complications. Post-operative seroma formation at the surgical site was the most common complication. About 7 cases were succumbed to death and mortality rate was about 5.1% in our study population.Conclusion: Prevalence of medical co morbidities is higher in elderly population. Out of them, hypertension and diabetes mellitus are the most common co morbid conditions. Most common indications for elective surgery in our study are hernias and gallstone disease. Early elective surgical intervention is preferred in elderly population when presented, as age, co morbidities and emergency settings increase risk of perioperative mortality.

Impact of chronologic age in the elderly with gastric cancer / 대한외과학회지

PURPOSE: Although the incidence of gastric cancer has declined in the general population, it is the second most frequent cause of death due to malignancy in the world with its incidence in the elderly increasing as a result of increased life expectancy. This present study tried to find the optimal treatment for patients aged 75 years or older with gastric cancer through comparison of the clinicopathological characteristics, surgical outcomes, and identifying prognostic factors of survival. METHODS: Elderly patients who underwent gastric resection for gastric cancer from January, 1999 to February, 2009 (n = 470) were divided into two groups: very elderly patients, 75 years or older (n = 95), and younger elderly patients, between 65 and 74 years old (n = 365). RESULTS: Distinct characteristics of very elderly patients included more frequent underlying disease, deeper invasion, and more frequent lymph node metastasis. There were significant differences in overall survival between the two groups at stages III-B and IV. However, postoperative hospital stays, postoperative morbidity, mortality and early stage did not differ between curatively resected patients in the two groups. CONCLUSION: Due to improved postoperative care, gastrectomy of gastric cancer is the treatment of choice in very elderly patients. Therefore, early diagnosis through regular medical screening and curative gastrectomy with lymph node dissection should be performed in very elderly gastric cancer patients.

El paciente geriátrico y el acto anestésico: nova et vetera / The geriatric patient and the anesthetic act: nova et vetera

A medida que la población envejece, más pacientes geriátricos deben someterse a cirugías, bien sea electivas o urgentes. Dado que el envejecimiento es una experiencia única y personal, cada paciente que va ser sometido a cirugía debe abordarse de manera individual. La valoración de la reserva funcional ha llegado a ser la piedra angular en el plan anestésico y es marcador pronóstico integral. Se dan pautas para su valoración, así como de la capacidad funcional, con el fin de minimizar los riesgos de la anestesia y la cirugía. En la presente revisión se discuten los cambios de los órganos con la edad, el papel de las enfermedades intercurrentes como factores determinantes del riesgo, otros factores que incrementan el riesgo de complicaciones y los problemas perioperatorios que se pueden presentar, entre otros, los relacionados con el estado cognitivo.

As the population ages, more geriatric patients should undergo Esther elective or urgent surgery. Given that ageing is a unique and individual experience, each patient that goes to surgery, must be addressed on an individual basis. The assessment of the functional reserve has become the cornerstone in the anesthetic plan and is the fore-casting integral marker. Guidelines for its assessment are given, as well as its functional capacity, in order to minimize the risks of anesthesia and surgery. In this review, changes in organs with age, the role of intercurrent diseases, and other factors that increase the risk of complications, perioperative problems that may arise, including those related to cognitive stes are discussed.

Factors Which Influence Mortality Following Operation on Patients over 65 Years of Age

BACKGROUND: There is a continuing increase in geriatric population. Many workers have reported an increased mortality rate after operation on patients over 65 years of age. The aim of this study is to analyze and to measure the risk factors associated with geriatric surgery. METHODS: We reviewed the medical records of 467 patients over 65 years of age who had been admitted and operated on in the department of General Surgery, Konkuk University Hospital, between January, 1993 and December, 1999. An analysis was done on age and sex distribution, duration of admission, type of anesthesia, duration of general anesthesia, number of benign and malignant disease, number of coexistent disease, number of emergency and elective operation, and then, we analyzed the above factors to know whether they influence mortality rate or not. RESULTS: 1) Overall operative mortality rate was 4.3%, and the factors influencing mortality rate were, malignant disease, coexisting disease, emergency operation and long duration of general anesthesia. 2) Old age in itself did not affect the mortality. CONCLUSION: In order to reduce the operative mortality in geriatric surgery, careful preoperative evaluation and elective surgery rather than emergency operation must be done, and the operation chosen should be the one of less magnitude, not very radical operations to achieve permanent cures.

Clinical Analysis of Surgical Geriatric Patients over 65 Years of Age

BACKGROUND: Advanced age alone should not be a serious deterrent to surgery. Preoperative evaluation of concomitant illness, operation time, accurate and minimal, but adequate surgery will serve to minimize morbidity and mortality in elderly patients. METHODS: The total number of surgical patients admitted to Kwang Hye Hospital, Pusan, from March 1994 to August 1996 was 3211, and the number of surgical geriatric patients admitted during the same period was 214. Operations were performed on 139 patients. We recorded information about age, sex, anesthesia type, operation time, non malignancy vs malignancy, emergency vs elective "Surgery", coexisting disease, and APACHE II score, and we examined the patients for results affecting postoperative morbidity and mortality. RESULTS: Postoperative complications occured in 55 cases (39.6%), and the operative mortality was 2.2%. The significant factors affecting postoperative morbidity were emergency operation, malignancy and APACHE II score. The operation time and coexisting diseases were not significant. Age had little effect on the postoperative prognosis CONCLUSIONS: Performance of elective surgery and preoperative evaluation of the APACHE II score are important factors.

Clinical Characteristics of the Geriatric Surgical Patients

BACKGROUND: Due to rapid economic growth and the development of medical science, the human life span is increasing nowadays. Due to this, old-aged people are increasing in number. However, the physiologic reserve power of old-aged people is lower than that of younger people. Therefore, it is necessary to be very careful about peri-operative care when doing surgery on old-aged people under general or spinal anesthesia. METHODS: We analyzed the medical records of 460 patients over 65 years of age who had undergone operations from August 1990 to July 1996 at the Department of General Surgery, Inchon Medical Center. RESULTS: (1) The ratio of geriatric surgical patients to all surgical patients during the same period was 14.7% (460/3122). Especially, the proportion of geriatric surgical patients increased to 17.0% during the last 2 years of this study compared to 16.2% for the previous 2 years, and 10.6% for the first 2 years. (2) The age distribution was 148 patients from 65 to 69 years (32.2%), 158 patients from 70 to 74 years (34.3%), 90 patients from 75 to 79 years (19.6%), and 64 patients over 80 years (13.9%). There was no significant difference between the number of men and women, there being 232 men and 228 women. (3) Among the 464 cases, 99 cases (21.3%) were malignant diseases compared to 365 cases (78.7%) of benign disease. Stomach cancer was the most common, 36 cases, colon cancer accounted for 31 cases and hepatobiliary cancer for 12 cases. Of the benign diseases, 103 cases (28.2%) were acute appendicitis, 85 (23.4%) were hepatobiliary diseases, 73 (20.1%) were hernias, and 35 (9.6%) were anal diseases. (4) Two hundred twenty-two (222) preoperative-associated diseases were found in 460 patients (48.3%). Cardiovascular disease was the most common (17.4%), and pulmonary disease was the 2nd most common (15.9%). (5) Of the total 133 cases of postoperative complication occurrence, wound infection was the most common, 43 cases, followed by pneumonia, 30 cases, respiratory failure, 11 cases, and renal failure, 7 cases. (6) The postoperative mortality rate was 5.0% and the most common cause was respiratory failure, 8 cases, followed by sepsis, 8 cases. CONCLUSION: The field of geriatric surgery must be pioneered and developed more by surgeons because the number of geriatric surgical patients is increasing more rapidly at present than in the past.

Clinical Analysis of Surgical Geriatric Patients over 65 Years of Age

As the span of life is prolonged by socioeconomic and medical development, the percentage of the geriatric population is increasing annually. Now, surgical therapy for the geriatric patients is an important area of medicine. To understand the clinical significance of surgical geriatric patients, an analysis was made of the records at the Surgical Department of City hospital, East Seoul, for 182 patients over 65 years of age, who were treated from January 1990 through December 1995. The results are as follows: 1) The number of surgical patients admitted during the 6 years was 2,734, and the number of surgical geriatric patients admitted during the same period was 257 patients (9.4% of all surgical patients). The percentage of geriatric patients show an increasing tendency from 8.1% in 1994 to 11.3% in 1995. 2) The sex distribution was 140 male patients (54.5%) and 117 female patients (45.3%), a ratio of 1 : 0.83. 3) The average duration of admission was 18.2 days and durations of admission of less than 1 week were most common (21.8% of all geriatric admissions). 4) Of the 182 cases treated surgically, 139 cases (76.4%) involved general anesthesia, 32 cases (17.6%) anesthesia administered spinally, and 11 cases (60%) local anesthesia; One hour or less of general anesthetic time was most common (41.7%). 5) Malignant disease was found in 46 patients (25.3%); stomach cancer was the most frequently found malignant disease. Non-malignant disese was found in 136 patients (74.7%); appendicitis was the most frequently found non-malignant disease. 6) Coexistent disease was noticed in 108 patients (59.3%); cardiovascular disease was the most frequently found (27.1%), and chronic pulmonary disease (21.3%) and hypoproteinemia (14.2%) were next. 7) Operations were performed on 182 patients of the total 257 patients, operation rate of 70.8%. The old age group had a low operation rate. 8) Postoperative complications were occurred in 43 cases (23.6%), and operative mortality was 2.7%. The significant factors affecting postoperative morbidity and mortality were malignancy, long duration for the general anesthetic time, coexistent disease, and emergency operation. The results suggest that the number and the rate of surgical geriatric patients have increased and that age has little effect on the postoperative prognosis. Thus, we believe that more active preoperative treatment, complete therapy for coexistent disease, execution of elective surgery and a short anesthetic time for intentional surgery are important factors for decreasing postoperative morbidity and mortality for surgical geriatric patients.