Stefan Mihaela, Iglesia Lino Laura, Fernandez Gladys
Department of Internal Medicine, Baystate Medical Center, Springfield, MA 01199, USA.
Hosp Pract (1995). 2011 Feb;39(1):41-51. doi: 10.3810/hp.2011.02.373.
Preoperative evaluation of elderly patients is an important component of surgical practice in the 21st century. It can offer a comprehensive geriatric evaluation and be a key element in decreasing postoperative morbidity and mortality in this unique population group. Advanced surgical and anesthetic techniques have contributed to an increasing number of elderly and sicker geriatric patients undergoing surgery. Elderly patients have limited physiologic reserve and pose many challenges in the perioperative setting, and a careful preoperative risk assessment aimed toward minimizing operative risks is essential. Advanced age increases the risk of developing complications post-surgery, but comorbidities are more important than age alone. General recommendations include avoiding drugs that increase the risk of delirium, ensuring appropriate hydration and calorie intake, minimizing bed rest, promoting ambulation, and early planning for discharge. Collaboration between surgeons and medical consultants aids in the identification of functional, cognitive, and nutritional deficits, provides structure for development and implementation of management plans, and promotes optimal patient outcome after surgical intervention in the elderly.
老年患者的术前评估是21世纪外科手术实践的重要组成部分。它可以提供全面的老年评估，并且是降低这一特殊人群术后发病率和死亡率的关键因素。先进的外科手术和麻醉技术使得越来越多病情较重的老年患者能够接受手术。老年患者生理储备有限，在围手术期会带来诸多挑战，因此进行仔细的术前风险评估以尽量降低手术风险至关重要。高龄会增加术后发生并发症的风险，但合并症比年龄本身更为重要。一般建议包括避免使用增加谵妄风险的药物、确保适当的水合作用和热量摄入、尽量减少卧床休息、促进活动以及尽早规划出院。外科医生与医学顾问之间的合作有助于识别功能、认知和营养缺陷，为管理计划的制定和实施提供框架，并促进老年患者手术干预后的最佳治疗效果。
