Department of Medicine for Elderly People, Whipps Cross Hospital, Barts Health NHS Trust, London, UK
Department of Medicine for Elderly People, Whipps Cross Hospital, Barts Health NHS Trust, London, UK.
BMJ Case Rep. 2020 Dec 22;13(12):e237031. doi: 10.1136/bcr-2020-237031.
As our population ages, the demand for surgical services in older people is increasing exponentially. Shown to be indispensable in the care of medical patients, use of the comprehensive geriatric assessment (CGA) is also growing in the perioperative setting. We present the case of a previously independent 82-year-old man who underwent a standard preoperative assessment and surgical aortic valve replacement. In the 7 months that followed, prior to his death, he suffered a rapid functional decline contributed to by slow postoperative recovery, delirium and recurrent falls. Post-mortem revealed cardiac amyloid deposition and extensive small vessel disease in the brain. This case highlights the importance of the CGA in the perioperative management of older patients, especially in identification and optimisation of geriatric syndromes and consideration of less-invasive alternative treatments. We review the existing literature on CGA use in cardiothoracic and vascular surgical settings, drawing on experiences learnt from the above case.
随着人口老龄化，老年人对手术服务的需求呈指数级增长。综合老年评估（CGA）在医疗患者的护理中被证明是不可或缺的，在围手术期的应用也在不断增加。我们介绍了一位 82 岁的先前独立的男性患者的病例，他接受了标准的术前评估和外科主动脉瓣置换术。在接下来的 7 个月里，在他去世之前，他的功能迅速下降，这归因于术后恢复缓慢、谵妄和反复跌倒。尸检显示心脏淀粉样蛋白沉积和大脑广泛的小血管疾病。这个病例强调了 CGA 在老年患者围手术期管理中的重要性，特别是在识别和优化老年综合征以及考虑采用创伤更小的替代治疗方法方面。我们回顾了 CGA 在心胸血管外科手术中的应用的现有文献，借鉴了上述病例中获得的经验。
