Department of Geriatric Medicine, Concord Hospital, Sydney, Australia.
Faculty of Medicine and Health, Concord Clinical School, University of Sydney, Sydney, Australia.
Age Ageing. 2022 Feb 2;51(2). doi: 10.1093/ageing/afab245.
Older adults undergoing surgery have high perioperative morbidity and mortality. Age-related physiological changes and prevalence of geriatric syndromes such as frailty increase the risk of adverse postoperative outcomes. Geriatricians utilise comprehensive geriatric assessment (CGA) and management to identify and manage geriatric syndromes, and deliver patient-centred perioperative care. Perioperative models of CGA are established for older patients undergoing hip fracture surgery. Recent trials support the benefits of perioperative models of CGA for non-orthopaedic surgery, and have influenced current care recommendations for older surgical patients. Areas for further action include addressing the implementation gap between recommended evidence-based perioperative care and routine perioperative care, evaluating the clinical and cost-effectiveness of perioperative models of CGA for patients living with frailty, and embedding routine use of patient-reported outcome measures to inform quality improvement.
老年人在接受手术时，围手术期发病率和死亡率较高。与年龄相关的生理变化和衰弱等老年综合征的流行增加了不良术后结局的风险。老年医学专家利用综合老年评估（CGA）和管理来识别和管理老年综合征，并提供以患者为中心的围手术期护理。针对接受髋部骨折手术的老年患者建立了围手术期 CGA 模型。最近的试验支持了非骨科手术围手术期 CGA 模型的益处，并影响了当前对老年手术患者的护理建议。进一步采取行动的领域包括解决推荐的基于证据的围手术期护理和常规围手术期护理之间的实施差距，评估围手术期 CGA 模型对患有衰弱的患者的临床和成本效益，并嵌入常规使用患者报告的结果措施以告知质量改进。
