Anestéziológia a intenzívna medicína 1/2018
Geriatrický pacient a perioperačný manažment
Geriatric patient and perioperative management
Introduction. Aging is a serious demographic problem for Slovakia. This fact is more and more immediately touching anaesthesiologists, because more and more patients are and will be in a higher age operated for chronic and acute illnesses. Objective of the work. To determine preoperative complicating illnesses, perioperative complications, predictors of mortality and mortality of patients operated in the hospital of the authors under general or regional anaesthesia at the age ≥ 80 years during urgent and planned surgery of all surgical disciplines (except of cardio and thoracic surgery), and during endoscopic procedures. Methodology. Retrospective, observational, non interventional study, without personal data, so the consent of Ethics Committee was not requested. The authors have focused on the set of patients whose anaesthesia has been made at the age ≥ 80 years. Retrospectively evaluated 291 cards from the anaesthetic database EVAN and from the hospital information system. Mortality was checked in the database of the Office for the supervision of health care. Of post-operative complications only complications in the immediate postoperative period recorded in anaesthetic records were analysed. The cause of death has not been determined. Results. From the preoperative complicating diseases the most common were ischemic heart disease (81.7%), arterial hypertension (89.7%), arrhythmia (42.6%), neurological diseases (41.2%), diabetes mellitus (28.9%), kidney (26.1%), lungs (15.5%) and liver (13.0%) diseases, in 6.9% of patients devices or stents were implanted, 21.3% of patients received anticoagulant and antiplatelet therapy. From the perioperative problems were hypotension in 45.2% patients (patients who were administered ephedrine or other vasopressors), in 43.3% hypertension, arrhythmia in 15.1%, bronchospasm in 2.7% patients. In hospital mortality after planned and urgent operations was 32.6%, mortality within 1 year was 43.3%. Predictors of mortality were ASA (p < 0.001), urgency of procedure (p < 0.002) and Hb <120 g/l prior to surgery (p < 0.009). Anaemia before surgery increased the risk of death 1.68 times. Mortality was higher in patients with preoperative renal disease. Conclusion. In order to maintain quality of life in the post-operative period, careful and sensitive management within teamwork is crucial to reduce the complications and mortality of geriatric patients.
Keywords: geriatric patient, perioperative management, co-existing diseases, predictors of mortality, mortality
