Long-term outcomes in elderly surgical patients

Abstract

Anesthesia has developed to the point where long-term outcomes are important endpoints. Elderly patients are becoming an increasingly large part of most surgical practices, consistent with demographic shifts. Long-term outcomes are particularly important for this group. In this review, we discuss functional outcomes in the elderly. We describe the areas of cognitive change and frailty, both of which are specific to the elderly. We also discuss prevention of surgical infections and emerging evidence around hemodynamic alterations in the operating room and their impact on long-term outcomes.

Figure 1

Rates of dependency in individual Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) activities. (used with permission from : Journal of the American College of Surgeons, 2004; 199, : 762–772).

Figure 2

(A) American Society of Anesthesiologists (ASA), (B) Lee, and (C) Eagle risk indices. Each panel shows the area under the receiver operator characteristics (ROC) curve to demonstrate the ability of the specific risk index to predict surgical complications and discharge to an assisted or skilled nursing facility. Frailty was added to the risk index scoring to demonstrate the combined ability of these indices to predict discharge disposition. (used with permission from Journal of the American College of Surgeons, 2010; 210: 901–908)