Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Università Cattolica del Sacro Cuore, Rome, Italy.
Aging Clin Exp Res. 2020 Sep;32(9):1647-1673. doi: 10.1007/s40520-020-01624-x. Epub 2020 Jul 10.
Surgical outcomes in geriatric patients may be complicated by factors such as multiple comorbidities, low functional performance, frailty, reduced homeostatic capacity, and cognitive impairment. An integrated multidisciplinary approach to management is, therefore, essential in this population, but at present, the use of such an approach is uncommon. The Perioperative Management of Elderly patients (PriME) project has been established to address this issue.
To develop evidence-based recommendations for the integrated care of geriatric surgical patients.
A 14-member Expert Task Force of surgeons, anesthetists, and geriatricians was established to develop evidence-based recommendations for the pre-, intra-, and postoperative care of hospitalized older patients (≥ 65 years) undergoing elective surgery. A modified Delphi approach was used to achieve consensus, and the strength of recommendations and quality of evidence was rated using the U.S. Preventative Services Task Force criteria.
A total of 81 recommendations were proposed, covering preoperative evaluation and care (30 items), intraoperative management (19 items), and postoperative care and discharge (32 items).
These recommendations should facilitate the multidisciplinary management of older surgical patients, integrating the expertise of the surgeon, the anesthetist, the geriatrician, and other specialists and health care professionals (where available) as needed. These roles may vary according to the phase and setting of care and the patient's conditions.
老年患者的手术结果可能会受到多种合并症、功能表现低下、虚弱、内稳态能力下降和认知障碍等因素的影响。因此，在这一人群中，综合多学科管理方法至关重要，但目前，这种方法的应用并不常见。围手术期老年患者管理（PriME）项目的建立就是为了解决这个问题。
制定针对老年外科患者综合护理的循证建议。
成立了一个由外科医生、麻醉师和老年病学家组成的 14 人专家任务小组，为接受择期手术的住院老年患者（≥65 岁）制定术前、术中和术后护理的循证建议。采用改良 Delphi 方法达成共识，并使用美国预防服务工作组标准来评估建议的强度和证据质量。
共提出了 81 项建议，涵盖了术前评估和护理（30 项）、术中管理（19 项）和术后护理及出院（32 项）。
这些建议应有助于老年外科患者的多学科管理，整合外科医生、麻醉师、老年病学家和其他专家以及其他卫生保健专业人员（如有）的专业知识，根据护理阶段和环境以及患者的病情需要进行整合。这些角色可能会有所不同。
