Mark Katlic, MD, MMM, FACS
SAFETY
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O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | F E B R U A R Y 2 0 1 4
Gear Up for Geriatrics
They can handle surgery, but not the complications of surgery.
T
he results of surgery in the elderly are typically worse than sur-
gery in younger age groups. Some hospitals and surgery centers
achieve excellent results with geriatric patients, but data from
across the country show that being elderly is a risk factor for surgery.
They experience more complications, longer lengths of stay, longer
times in the OR and recovery, and more deaths. Here are practical steps
we can take to protect our older patients.
In pre-op
You typically do routine blood tests and listen to the heart and lungs,
perhaps ask for EKGs and chest
X-rays, and consult with a cardiologist or internist to
ensure patients are stable for surgery. A more
comprehensive pre-op clinical evaluation of
elderly patients presenting for elective sur-
gery could also include a test for frailty,
which involves assessing handgrip strength
and gait speed, and historical questions
about weight loss and energy level. A
timed-up-and-go test is a simple alternative.
Also test for cognition, using a mini-cog
test, which involves having patients recall 3
words and draw an accurate clock face, includ-
ing numbers and hands, for a specified time.
Conduct a hearing screening and an assess-
ment of instrumental activities of daily
living to determine patients' exec-
utive functioning.
BETTER WITH AGE Your perioperative team must
step up its efforts when caring for older patients.
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