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PREOPERATIVE ASSESSMENT OF THE GERIATRIC PATIENT

PREOPERATIVE ASSESSMENT OF THE GERIATRIC PATIENT. Cheryl Hinners M.D. CASE. MR. PREOP IS A 75YO WM WITH THE PMH OF COPD(NO MEDS, CONTINUES TO SMOKE), DM-2, OA, HTN, AND CAD WITH AN MI 5 YRS AGO. HE HAS BEEN DIAGNOSED WITH PROSTATE CA AND AN OPEN PROSTATECTOMY IS PLANNED.

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PREOPERATIVE ASSESSMENT OF THE GERIATRIC PATIENT

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  1. PREOPERATIVE ASSESSMENT OF THE GERIATRIC PATIENT Cheryl Hinners M.D.

  2. CASE • MR. PREOP IS A 75YO WM WITH THE PMH OF COPD(NO MEDS, CONTINUES TO SMOKE), DM-2, OA, HTN, AND CAD WITH AN MI 5 YRS AGO. HE HAS BEEN DIAGNOSED WITH PROSTATE CA AND AN OPEN PROSTATECTOMY IS PLANNED. • LIVES INDEPENDENTLY, SWING DANCES 2X /WEEK. MEDS; ASA, IBPROFEN, NPH BID, FELODIPINE

  3. MORE THAN 50% OF OLDER AMERICANS WILL HAVE A SURGICAL PROCEDURE AFTER AGE 65 • ASA CLASSIFICATIONS • DECREASED SURGICAL MORTALITY

  4. PREOP ASSESSMENT • IDENTIFY INCREASE RISK FOR COMPLICATIONS • MAKE RECOMMENDATIONS • COMORBID CONDITIONS • PHARMACOLOGIC TX • FUNCTIONAL/PSYCHOLOGIC STATES

  5. ASSESSING RISK OF CARDIAC COMPLICATIONS • MOST COMMON AND SERIOUS • STRONGEST PREDICTORS OF ADVERSE CARDIAC OUTCOMES • RECENT MI • UNCOMPENSATED CHF • USA • ARRYTHMIAS

  6. PRACTICE GUIDELINES MAJOR CLINICAL PREDICTORS • USA, CHF, ARRYTHMIAS, SEVERE VALVULAR DZ INTERMEDIATE • MILD ANGINA, PRIOR MI, COMPENSATED CHF, DM

  7. MINOR CLINICAL PREDICTORS • ADVANCED AGE • ABNORMAL EKG • ABNORMAL RHYTHM • LOW FUNCTIONAL CAPACITY(METS) • H/O STROKE • UNCONTROLLED HTN

  8. PROCEDURE RISK • HIGH • EMERGENT • MAJOR VESSEL PROCEDURE • PVD PROCEDURE • PROLONGED PROCEDURE

  9. INTERMEDIATE RISK • CAROTID ENDARTECTOMY • HEAD AND NECK PROCEDURES • INTRAPERITONEAL/INTRATHORACIC • ORTHOPEDIC • PROSTATE

  10. LOW RISK PROCEDURES • BREAST • CATARACT • ENDOSCOPIC

  11. MANAGEMENT OF SELECTED PROBLEMS • HTN • DIASTOLIC BP >110 OR MAJOR FLUCTUATIONS IN BP • ELEVATED BP • REVIEW MEDS, CONSIDER AGE-RELATED CHANGES, VOLUME STATUS, PAIN, FULL BLADDER.

  12. CHF • SIGNIFICANT RF FOR CARDIAC COMPLICATIONS • TX OF SYSTOLIC DYSFUNCTION • MANAGEMENT INTRAOP

  13. PULMONARY DISEASE • POSTOP MORBIDITY IN 40% ELDERLY FROM RESPIRATORY PROBLEMS • AGE-RELATED CHANGES • ANESTHESIA • SURGICAL PROCEDURE • POSTOP PAIN MEDS

  14. ****PREOP FUNCTIONAL LEVEL IS A RELIABLE PREDICTOR OF PULMONARY COMPLICATIONS******

  15. INTERVENTIONS • SMOKING CESSATION • COPD CONSIDERATIONS

  16. DIABETES • MEDICATION CONSIDERATIONS

  17. THROMBOEMBOLIC DZ • OCCUR IN 20-30% OF PATIENTS UNDERGOING GENERAL SURGERY • HIGHER INCIDENCE , >40% • HIP/KNEE • GYN CA/ OPEN PROSTATECTOMY • NEUROSURG

  18. NEUROPSYCHIATRIC DISORDERS • DEMENTIA • DELIRIUM • DEPRESSION EXACERBATION • ALCOHOLISM

  19. POSTOP PAIN • PAIN SCALE • MEDICATIONS • LAXATIVES

  20. PREDICTORS OF POOR OUTCOME • ADVANCED AGE • POOR FUNCTIONAL STATUS • IMPAIRED COGNITION • LIMITED SOCIAL SUPPORT

  21. IATROGENIC ILLNESS • DVT • DOSING DRUGS • DRUG-DRUG INTERATIONS • PRESSURE ULCERS • DEHYDRATION

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