Georgetown University School of Medicine, Washington, DC.
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Curr Opin Anaesthesiol. 2020 Dec;33(6):732-739. doi: 10.1097/ACO.0000000000000901.
The number and the complexity of procedures taking place at ambulatory surgery centers is steadily increasing. The rate at which medically complex patients, including those with baseline neurocognitive disorders, are undergoing ambulatory procedures is seeing a concurrent rise. Given the significant physical and psychological stress associated with surgery even in the ambulatory setting, it is essential to evaluate the ability of a patient to acclimate to stressful triggers in order to assess risk of subpar medical outcomes and increased mortality. In this review, we discuss recent advances in the assessment of both cognition and frailty and describe the implementation of these tools in the ambulatory surgery setting.
Recent Society for Perioperative Assessment and Quality Improvement (SPAQI) recommendations for evaluating at-risk patients focus on a two-pronged approach that encompasses screening for both impaired cognition and frailty. Screening should ideally occur as early as possible, but tools such as the Mini-Cog examination and FRAIL Questionnaire are efficient and effective even when used the day of surgery in high-risk patients.
The recognition of at-risk patients using standardized screening and the use of this assessment to guide perioperative monitoring and interventions is essential for optimizing outcomes for the complex ambulatory surgery patient.
随着门诊手术中心进行的手术数量和复杂性不断增加，包括有基线神经认知障碍在内的病情复杂的患者接受门诊手术的比例也在同步上升。鉴于即使在门诊环境下手术也会给患者带来显著的身心压力，因此评估患者适应压力诱因的能力以评估手术效果欠佳和死亡率增加的风险至关重要。在这篇综述中，我们讨论了认知和衰弱评估的最新进展，并描述了这些工具在门诊手术环境中的应用。
最近，围手术期评估和质量改进协会（SPAQI）对高危患者的评估建议侧重于包括认知障碍和衰弱筛查的两方面方法。筛查最好尽早进行，但即使在高风险患者中，使用 Mini-Cog 检查和 FRAIL 问卷等工具在手术当天也同样高效且有效。
使用标准化筛查识别高危患者，并使用该评估来指导围手术期监测和干预，这对优化复杂门诊手术患者的预后至关重要。
