|
 The study team examined data from 44 studies of postoperative
complications among almost 13,000 patients and found that, overall,
about one in four elderly people experienced complications after
surgery.
Even though surgeons often consider age when assessing elderly
patients’ odds of postoperative complications, age did not appear to
influence the risk, the study found. But factors like frailty,
dementia, depression and smoking were all tied to a higher risk of
complications for older surgical patients.
“Frailty and cognitive impairment are geriatric syndromes, whereas
age is merely a reflection of how long someone has been alive,” said
lead study author Dr. Jennifer Watt, a geriatrician at the
University of Toronto and the Li Ka Shing Knowledge Institute of St.
Michael’s Hospital.
“Many people have had the experience of knowing two older adults of
similar age, but recognizing that one of those older adults is very
robust, spending their typical day exercising at the gym, visiting
with friends, and completing a challenging Sudoku puzzle on their
iPad; while the other is more frail, spending their typical day at
home, needing help to cook meals because they get short of breath
from heart failure, and struggling to remember medical
appointments,” Watt said by email.
Geriatric syndromes like frailty and cognitive impairment were
associated with higher odds of complications like pneumonia,
infections and blood clots, the researchers report in BMC Medicine.
Frailty in particular was also associated with longer hospital
stays, especially among frail patients who also experienced
postoperative complications.
In addition, frailty was linked to a greater chance that patients
would be moved to another hospital or to a nursing home or another
type of institutional setting and not discharged to their own home.
[to top of second column] |
One limitation of the analysis is that many of the smaller studies
used varied methods to look at the relationship between age and
complications after surgery, making it difficult for researchers to
calculate meaningful differences in outcomes based on specific risk
factors.
Even so, the findings highlight a need for surgeons to assess
elderly patients’ risk of complications using a more nuanced
approach that considers how well they function in daily life, said
Dr. Carolyn Dacey Seib of the UCSF Medical Center in San Francisco.
“The most likely reason that age was not an independent predictor of
complications is that other geriatric syndromes, such as frailty,
cognitive impairment and functional decline, are more representative
of a patient’s surgical risk than chronological age,” Seib, who
wasn’t involved in the study, said by email.
“This doesn’t mean that frail or cognitively impaired patients
should not ever undergo surgery,” Seib added. “It means they or
their decision-makers should be informed of their risk and should be
able to make an individualized decision about whether the potential
benefit is worth the risk given what is most important to them.”
SOURCE: http://bit.ly/2ASruOD BMC Medicine, online January 12, 2018.
[© 2018 Thomson Reuters. All rights
reserved.] Copyright 2018 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
Thompson Reuters is solely responsible for this content.
 |
