Preoperative assessment of geriatric patients
Journal of the Korean Medical Association
;
: 364-370, 2017.
Artigo
em Coreano
| WPRIM
| ID: wpr-156634
ABSTRACT
Geriatric patients are vulnerable to stress associated with surgery. The preoperative assessment of elderly patients plays an important role in their perioperative care, in terms of risk identification, preoperative optimization, and the avoidance of postoperative complications. The preoperative assessment of geriatric patients may require multidisciplinary consultation and include a consideration of neurocognitive function, functional status, frailty, nutrition, substance abuse, polypharmacy, and decision-making capacity, as well as a meticulous evaluation of comorbidities. Preoperative laboratory tests should be ordered after a review of the medical charts, history, and physical examination. Any abnormal findings should be well documented. Cardiac and pulmonary complications are common in elderly patients. Risk identification according to surgical invasiveness, the continuation or cessation of medication, and preoperative risk-reduction strategies should be considered. Renal function should be evaluated and the dosage of medications should be adjusted based on the glomerular filtration rate, not serum levels of creatinine alone. Postoperative cognitive dysfunction, delirium, frailty, functional dependence, malnutrition, and polypharmacy are associated with poor postoperative outcomes; risk factors should be screened for and corrected preoperatively, if possible. Delays in the operation and prolonged operative times increase morbidity. Despite its importance, there are still no standardized preoperative assessment guidelines for Korean geriatric patients. Further studies should evaluate the clinical impact and cost-effectiveness of a preoperative geriatric assessment targeting the actual medical environment of Korea. Medical conditions should be optimized and proactive risk-reduction strategies should be used as part of a comprehensive preoperative assessment to improve surgical outcomes while avoiding a functional decline after surgery.
Texto completo:
DisponíveL
Índice:
WPRIM (Pacífico Ocidental)
Assunto principal:
Exame Físico
/
Complicações Pós-Operatórias
/
Comorbidade
/
Avaliação Geriátrica
/
Fatores de Risco
/
Polimedicação
/
Transtornos Relacionados ao Uso de Substâncias
/
Assistência Perioperatória
/
Creatinina
/
Delírio
Tipo de estudo:
Estudo de etiologia
/
Guia de Prática Clínica
/
Estudo prognóstico
/
Fatores de risco
Limite:
Idoso
/
Humanos
País/Região como assunto:
Ásia
Idioma:
Coreano
Revista:
Journal of the Korean Medical Association
Ano de publicação:
2017
Tipo de documento:
Artigo
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