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Related Experiment Video

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Perioperative considerations in nonagenarians.

Maria E Tecos¹, Brittany S Kern^2,3, Nathan A Foje^1,4

¹University of Nebraska Medical Center, Department of Surgery, Omaha, NE.

Surgery Open Science

|October 19, 2020

Summary

Risk calculators underestimate rehabilitation needs and overestimate mortality in nonagenarians. Perioperative care for this population requires collaborative approaches, focusing on pre-intervention function and appropriate resource allocation.

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Area of Science:

Geriatric Medicine
Perioperative Care
Surgical Risk Assessment

Background:

The aging population presents unique challenges in perioperative care.
Assessing surgical risks and benefits is crucial for maintaining quality of life in older adults.

Purpose of the Study:

To evaluate the accuracy of common risk calculators in nonagenarian patients (90 years and older).
To analyze factors influencing outcomes in this specific demographic.

Main Methods:

Retrospective review of medical records for patients aged 90+ undergoing surgery.
Analysis of data from January 2013 to December 2017 at a major academic medical center.
Statistical analysis using GraphPad 8.2.1.

Main Results:

Significant differences in outcomes (elective vs. emergent, return to function, mortality) were observed when stratified by age and American Society of Anesthesiologists (ASA) score.
Pre-intervention functional status significantly impacted post-intervention recovery.
Risk calculators (ACS, P-POSSUM) underestimated rehabilitation needs and overestimated mortality in this cohort.

Conclusions:

Perioperative care for nonagenarians is complex and necessitates a multidisciplinary approach.
Early assessment of rehabilitation needs and proactive end-of-life discussions are vital.
Integrating frailty assessment and refining risk calculators for the extreme elderly is recommended for preoperative workflow.