Monitoring operative risk in the elderly

L. R. Del Guercio and J. D. Cohn

To reduce operative mortality in elderly patients, a system of preoperative staging, based on invasive monitoring, was developed. All of the 148 consecutive patients studied had been cleared for surgery by standard assessment, but only 13.5% had normal measured, hemodynamic, respiratory, and oxygen transport function. Mild physiologic aberrations, not requiring a delay in surgery, or more severe abnormalities, indicative of high operative risk, were found in 63.5% of the patients. Advanced and incorrigible functional defects found in the remaining 23% made them unacceptable risks for major surgery under general anesthesia, and all who underwent the planned operation in spite of the warning died. Invasive preoperative assessment of elderly patients discloses a high percentage of serious physiologic abnormalities requiring a delay in some and cancellation of the operation in others.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

The Pulmonary Artery Catheter in Anesthesia Practice in 2007: An Historical Overview With Emphasis on the Past 6 Years
Leibowitz and Oropello
SEMIN CARDIOTHORAC VASC ANESTH 2007;11:162-176.
ABSTRACT  

Priorities in Perioperative Geriatrics
Cook and Rooke
Anesth. Analg. 2003;96:1823-1836.
FULL TEXT  

A Randomized, Controlled Trial of the Use of Pulmonary-Artery Catheters in High-Risk Surgical Patients
Sandham et al.
NEJM 2003;348:5-14.
ABSTRACT | FULL TEXT  

Endoscopic surgery with use of a laryngeal mask and a fiberoptic flexible bronchoscope
Okada et al.
J. Thorac. Cardiovasc. Surg. 2001;121:1196-1197.
FULL TEXT  

Endoscopic Retreatment Compared with Surgery in Patients with Recurrent Bleeding after Initial Endoscopic Control of Bleeding Ulcers
Lau et al.
NEJM 1999;340:751-756.
ABSTRACT | FULL TEXT  

The Impact of Age and Medical Comorbidities on the Outcome Following Severe Trauma: Cullinane DC, Morns JA The Impact of Age and Medical Comorbidities on the Outcome Following Severe Trauma J Intensive Care Med 1999,14 86-94
Cullinane and Morris
J Intensive Care Med 1999;14:86-94.
 

The Role of Pulmonary Artery Catheterization in the Management of Cardiothoracic Surgical Patients
Colombo and Tuman
SEMIN CARDIOTHORAC VASC ANESTH 1998;2:46-51.
ABSTRACT  

Electrical impedance tomography can monitor dynamic hyperinflation in dogs
Adler et al.
J. Appl. Physiol. 1998;84:726-732.
ABSTRACT | FULL TEXT  

Swan song for the Swan-Ganz catheter?
Soni
BMJ 1996;313:763-764.
FULL TEXT