[Preoperative risk identification using the Identification of Seniors at Risk? : Suitability as sole screening tool...

As more aged patients are surgically treated in hospitals without specialized geriatric care, patients at risk for perioperative complications must be identified and treatment must be adapted. The aim was the use of the Identification of Seniors at Risk (ISAR) as a screening tool for the identification of high-risk patients, who need specialized perioperative care. The study presented investigated the use of ISAR screening not only as recommended in the emergency room but also in validation tests as a new option in elective surgery.

Routine data recorded during inpatient admission of 389 patients were evaluated retrospectively. The ISAR as well as a cognitive screening with the mini mental state examination (MMSE) were conducted in patients as long as a previously diagnosed dementia was not present. Delirium was recorded using the Confusion Assessment Method (CAM). A total of 88 patients from trauma surgery served as an example for emergency surgery and 93 patients from orthopedics for elective surgery. All patients received treatment by the department of Anesthetic and Perioperative Geriatric Care.

According to an ISAR score of ≥2 points, 85.2% of traumatology and 48.4% of elective orthopedic patients were considered to be geriatric high-risk patients. Among ISAR negative patients many suffered from preoperative cognitive decline (MMST or diagnosed dementia), especially in the elective orthopedics group. Delirium occurred in 5.7% of trauma surgery patients and in 4.3% of elective orthopedic patients.

With 2 as a cut-off, the use of ISAR as a screening tool was only conditionally suitable. In particular, the expected filter function was not fulfilled in both groups.