ABSTRACT
Risk prediction is a subject of increasing clinical interest, and publications in this area are likely to have an important influence on patient care in the near future. A multiplicity of risk prediction systems, many of them computer-based, will raise a number of ethical and practical questions. These questions need to be addressed by the originators of systems, the editors of journals, practising clinicians, and the lay public.
Subject(s)
Ethics, Medical , Patient Selection , Risk Assessment , Surgical Procedures, Operative , Biomedical Research , Contraindications , Humans , Interdisciplinary Communication , Risk Factors , Withholding TreatmentABSTRACT
A study was carried out assessing the practical use of a simple system of scoring information which can help in making a diagnosis or establishing a prognosis in an individual patient. The system was introduced in 1984 for use in gastroenterology, but it can be employed in a wide range of medical and surgical settings. This series was concerned with predicting postoperative respiratory complications in a group of elderly surgical patients. The system combines elements from Baye's theorem and logistic regression, though no mathematical knowledge is required to apply it in clinical practice. The method by which results are presented is easy to understand, yet at the same time more complex ideas such as conflict of evidence and doubt may be embraced if the clinician so desires.
Subject(s)
Postoperative Complications/diagnosis , Respiration Disorders/diagnosis , Aged , Aged, 80 and over , Bayes Theorem , Humans , Logistic Models , Methods , Prognosis , RiskABSTRACT
A prospective study has been carried out on 288 general surgical patients aged 65 years and over. The present report looks at pre-operative patient characteristics. A high rate of pre-operative morbidity was found, with only one patient in five having no pre-operative medical problem. Evidence of respiratory disease was found in 29%, 14% gave a history of previous congestive heart failure, 9% had symptoms of angina, 5% had had strokes in the past, and 9% had an impaired mental score. In 30% of patients, three or more pre-operative medical problems were detected. When compared with those aged 65-74 years, patients aged 75 years and over were more likely to be admitted non-electively, had significantly more cardiovascular signs and poorer mental scores. When compared with elective admissions, patients admitted non-electively were older, had more clinical and radiological signs of respiratory disease and lower mental scores. The findings of the present study have been compared with previous reports of elderly surgical patients.
Subject(s)
Preoperative Care , Surgical Procedures, Operative , Age Factors , Aged , Aged, 80 and over , Cardiovascular Diseases , Central Nervous System Diseases , Female , Humans , Male , Mental Health , Prospective Studies , Respiration DisordersABSTRACT
A prospective study was carried out on 288 general surgical patients aged 65 years and over. Over 40% of patients suffered no post-operative complication. The commonest post-operative problem was respiratory, with 17% of patients having simple atelectasis, 12% acute bronchitis and 10% pneumonia. Six per cent of patients developed post-operative heart failure and/or myocardial infarction. Delirium was noted post-operatively in 7% of patients, and new focal neurological signs in 1%. The post-operative hospital fatality rate was 5% (4% when deaths due to carcinomatosis were excluded). Nine patients out of ten spent less than a month in hospital. The relation of post-operative morbidity and mortality to seven factors was examined: type of surgery, urgency of surgery, urgency of admission, age, number of pre-operative medical diagnoses, American Society of Anesthetists' grade, and pre-operative mobility level. It appears that pre-operative medical fitness rather than chronological age is the main determinant of post-operative outcome in the elderly surgical patient.
Subject(s)
Postoperative Complications , Age Factors , Aged , Aged, 80 and over , Female , Humans , Male , Physical Fitness , Postoperative Complications/mortality , Prognosis , Prospective Studies , Respiration Disorders/etiology , Risk FactorsABSTRACT
Currently, approximately one in four patients admitted to surgical beds is over 65 years of age and about 10% are over 75. Much of the excess morbidity and mortality in the older patient appears to have its roots in coincidental medical problems which are present before operation. This is the rationale behind a careful preoperative medical assessment in the older patient.
