Oncogeriatrics (part 6.). The usefulness of routine preoperative investigations in the qualification of an older patient for elective surgery
Streszczenie
Medical history, physical examination and a Comprehensive Geriatric Assessment remain the most important elements in preparing an older patient for surgery, to determine the number of preoperative additional tests, and remain the strongest predictors of postoperative outcome. The additional 40-60 minutes devoted to its implementation at the time of qualification for surgery, is well worth the chance to significantly reduce the risk of complications in the postoperative period. The patient’s chronological age alone is not a criterion for the type and number of additional tests. Routine biochemical blood serum tests (with the exceptions of haemoglobin, creatinine, albumin and HbA1c in diabetic patients) and other preoperative static investigations have not been shown to affect the risk of postoperative complications, no more so in the older population. It is also misleading to believe that a large number of preoperative tests will protect the attending physician from legal liability.
Słowa kluczowe: older patientpreoperative investigationselective surgeryelderly
Referencje
- Eurostat. Mortality and life expectancy statistics. http://epp.eurostat.ec.europa.eu/statistics_explained/index.php/Mortality_and_life_expeancy_statistics.
- National Institute for Health and Care Excellence. Preoperative tests (update) Routine preoperative tests for elective surgery. April 2016 . https://www.nice.org.uk/guidance/NG45.
- Hert SDe, Staender S, Fritsch G, et al. Pre-operative evaluation of adults undergoing elective noncardiac surgery. Eur J Anaesthesiol. 2018; 35(6): 407–465.
- Präoperative Evaluation erwachsener Patienten vor elektiven, nichtkardiochirurgischen Eingriffen. Der Anaesthesist. 2010; 59(11): 1041–1050.
- Grodzicki T, Kenig J. Problemy okołooperacyjne u osób w wieku podeszłym. PZWL Wydawnictwo Lekarskie 2018.
- Chung F, Yuan H, Yin L, et al. Elimination of preoperative testing in ambulatory surgery. Anesth Analg. 2009; 108(2): 467–475.
- Wijeysundera DN, Austin PC, Beattie WS, et al. Outcomes and processes of care related to preoperative medical consultation. Arch Intern Med. 2010; 170(15): 1365–1374.
- Ramesh B, Pillai VS, Koshy RC, et al. Role of preoperative investigations in elderly patients undergoing oncosurgical procedures - A retrospective review audit. J Anaesthesiol Clin Pharmacol. 2018; 34(4): 535–539.
- Dehne MG, Junger A, Hartmann B, et al. Serum creatinine and perioperative outcome--a matched-pairs approach using computerised anaesthesia records. Eur J Anaesthesiol. 2005; 22(2): 89–95.
- Bierle DM, Raslau D, Regan DW, et al. Preoperative Evaluation Before Noncardiac Surgery. Mayo Clin Proc. 2020; 95(4): 807–822.
- National Institute for Health and Care Excellence. Preoperative tests (update) Routine preoperative tests for elective surgery. April 2016.
- Dzankic S, Pastor D, Gonzalez C, et al. The prevalence and predictive value of abnormal preoperative laboratory tests in elderly surgical patients. Anesth Analg. 2001; 93(2): 301–8, 2nd contents page.
- Seicean A, Schiltz NK, Seicean S, et al. Use and utility of preoperative hemostatic screening and patient history in adult neurosurgical patients. J Neurosurg. 2012; 116(5): 1097–1105.
- van Klei WA, Bryson GL, Yang H, et al. The value of routine preoperative electrocardiography in predicting myocardial infarction after noncardiac surgery. Ann Surg. 2007; 246(2): 165–170.
- Liu LL, Dzankic S, Leung JM. Preoperative electrocardiogram abnormalities do not predict postoperative cardiac complications in geriatric surgical patients. J Am Geriatr Soc. 2002; 50(7): 1186–1191.
- Joo HS, Wong J, Naik VN, et al. The value of screening preoperative chest x-rays: a systematic review. Can J Anaesth. 2005; 52(6): 568–574.
- Preoperative pulmonary risk startification for noncardiothoracic surgery: systemic review for the american college of physicians. Ann Internal Med. 2006; 144: 581–595.
![](https://journals.viamedica.pl/plugins/generic/popups/images/icons/close.png)