PERIOPERATIVE ISSUES

Perioperative Issues

Perioperative Issues

Some 50 years ago, surgery was considered to be too risky for elderly patients. Today, centenarians undergo a wide variety of surgical procedures. The development of information regarding the perioperative care of elderly surgical patients is in its infancy; however, there is some information that suggests pathways caring for these patients. Ther word perioperative refers to the complete experience surrounding an operative procedure—deciding to have an operation, preparing for surgery, undergoing anesthesia, recovering from the surgery, and getting back to the expected level of function (Deiner , 2004, 165-170).

The principal risk to patients undergoing surgery is not chronological age but rather a combination of physiological age and disease load. A robust 90-year-old may have a relatively low risk from undergoing many surgical procedures, whereas a 65-year-old with disease in one or more systems may be at high risk.

When making a decision to undergo surgery, patients should understand that techniques have evolved rapidly. An impressive example is the treatment of abdominal aortic aneurysms. In the past, this disease, in which the largest artery of the body becomes enlarged and distorted and can burst, thereby causing rapid death, was treated with a very involved open abdomen surgical operation that required days in an intensive care unit (ICU). Currently, the same disease frequently can be treated by passing a replacement tube into the ballooned vessel by passing a very sophisticated device by way of an artery in the groin. The development of such endovascular (operating from inside the blood vessels) techniques require very short recovery times with very little pain, and the patient frequently goes home the following morning. Many procedures in the abdomen are accomplished using laparoscopes; that is, instruments that allow surgeons to operate through three or four small (quarter-inch) holes rather than a long incision in the middle of the belly. These “minimally invasive” techniques appear to have significant benefit for elderly surgical candidates when they can be used safely. (Deiner , 2004, 165-170)

Because getting old and developing illness tend to occur simultaneously, coordinated perioperative care includes paying attention to general medical conditions with the perspective of both assessing function and, where possible, improving or maximizing the function of a particular body system. A general preoperative history and physical examination should indicate whether any additional testing is required. For example, if the patient has congestive heart failure, a circumstance in which the pumping function of the heart is limited, special tests are frequently requested to assess that function. Occasionally, doctors find other medical problems that should be fixed before surgery. (Lawrence , 2003, 1717-1722)

Following a surgical procedure, the patient goes to a postanesthesia care unit (PACU, still sometimes called the recovery room) or to an ICU. Some procedures are done on an ambulatory basis, meaning that the patient will go home the same day. Advanced age by itself is not a reason to keep a patient in the hospital. Ambulatory PACUs tend to have the patient sit in a chair and frequently invite family members to stay ...