Department of Geriatric Medicine, Huadong Hospital affiliated to Fudan University, 221 West Yan'An Road, Shanghai 200040, China.
Eur J Intern Med. 2012 Sep;23(6):487-94. doi: 10.1016/j.ejim.2012.06.009. Epub 2012 Jul 4.
With the changing global demographic pattern, our health care systems increasingly have to deal with a greater number of elderly patients, which consequently also takes its toll on our surgical services. The elderly are not simply older adults. They represent a heterogeneous branch of the population with specific physiological, psychological, functional and social issues that require individualised attention prior to surgery. Increased acknowledgement that chronological age alone is not an exclusion criterion, along with advances in surgical and anaesthetic techniques have today lead to decreased reluctance to deny the elderly surgical treatment. In order to ensure a safe perioperative period, we believe that a comprehensive, multidisciplinary and proactive preoperative assessment will be helpful to detect the multiple risk factors and comorbidities common in older patients, to assess functional status and simultaneously allow room for early preoperative interventions and planning of the intra- and postoperative period. In this review we outline the currently available preoperative geriatric risk assessment tools and provide an insight on how a comprehensive, multidisciplinary and proactive approach can help improve perioperative outcome.
随着全球人口结构的变化，我们的医疗保健系统越来越需要应对更多的老年患者，这也对我们的外科服务造成了影响。老年人不仅仅是年龄较大的成年人。他们代表了人口中一个具有特定生理、心理、功能和社会问题的异质分支，这些问题在手术前需要个性化关注。越来越认识到，仅根据年龄来判断并不足以作为排除标准，加上外科和麻醉技术的进步，今天已经减少了拒绝老年患者接受手术治疗的情况。为了确保围手术期的安全，我们认为全面、多学科和积极主动的术前评估将有助于发现老年患者常见的多种风险因素和合并症，评估功能状态，并同时为术前干预和围手术期规划留出空间。在这篇综述中，我们概述了目前可用的老年术前风险评估工具，并介绍了全面、多学科和积极主动的方法如何有助于改善围手术期结果。
