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高齢患者の術前評価:ナラティブ・レビュー
Lawrence B Oresanya1, William L Lyons2, Emily Finlayson1
1Department of Surgery, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco.
JAMA
|May 29, 2014
まとめ
高齢者は,認知障害や脆弱性などの症状から,重大な外科的リスクに直面しています. 総合的な手術前評価とリスクの明確なコミュニケーションは,この集団における知的な手術決定に不可欠です.
科学分野:
- ゲリアトリック・メディシン (老年医学)
- 外科手術の結果の研究
- 患者の安全性についてです.
背景:
- 高齢者の手術は,死亡率,合併症,機能低下のリスクの増加と関連しています.
- 術前評価,リスク評価,および最適化は,この患者グループにとって非常に重要です.
研究 の 目的:
- 治療目標の定義と有害な結果のリスク要因の検討により,高齢の外科患者の意思決定の見直しを行う.
- 高齢の外科患者の評価と最適化戦略を提案する.
主な方法:
- メドライン,EMBASE,Web of Scienceで2000年から2013年にかけての研究の体系的レビュー.
- 60歳以上の患者を含め,老年状態 (機能的/認知障害,栄養失調,弱さ) と死亡率と合併症との関係に焦点を当てた.
主要な成果:
- 150万人以上の患者を対象とした54件の研究を分析した.
- 研究設計と研究結果における有意な異質性.
- 認知障害,栄養失調,施設収容などの術前状態は,妄想や施設への退院を含む死亡率や合併症の増加と関連していた.
結論:
- 高齢者疾患は,高齢者の不良な外科的結果と関連しています.
- 治療目標の包括的な評価と現実的なリスクコミュニケーションは,個別化された外科的意思決定に不可欠です.
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