Study of preoperative assessment of geriatric patients of Telangana

 

 

Abstract               Background: Geriatric patients represent fastest growing sector of society. Apart from health problems, they must be treated for cognition, psychiatric aspects also. Methods: The older patients above 65 years of age admitted for surgery were studied pre-operative. The routine blood and urine examination, x-ray, USG, nutritional status, previous history of illness was also recorded, physical fitness was certified by physician and cardiologist. Results: The clinical implication for anesthesia was 17(19%) had susceptible hypotension, 15(16.8%) susceptible to Hypercarbia and Hypoxemia 11(12.3%) had increased intra-operative Hyperglycemia, 7(7.86%) had increased risk of hypothermia, 13(14.6%) had anemia. The post operative check list was 25(28%) had delirium, 22(24.7%) had preoperative acute pain,12(13.4%) had pulmonary complications, 9(10%) ability maintain adequate nutrition, 11(12.3%) had UTI, 10(11.2%) had pressure ulcer, types of anesthesia given was 58(65.1%) patients received regional anesthesia, 18(20.2%) epidural and local anesthesia, 13(14.6%) thoracic epidural anesthesia.

Key Words: Cognitive, Delirium nutrition, Epidural, Local anesthesia, Telangana

 

 

INTRODUCTION

Geriatric patients with their increased incidence of co morbidities and deficits seen with aging, require special preoperative consideration like neuro-cognitive function, Sensory impairment, frailty, nutrition and medication. Delirium and preoperative acute pain were common preoperative complications ¹.As older persons often have multiple co-morbid conditions that limit their functional capacity and recovery and increase risk of mortality. An initial complication is much more likely to lead other complication, failure of one organ to function adequately is more likely to lead failure of other organs². Hence these growing evidence base that many of these post-operative complication could be predicted through proactive understanding and management of their risk factors ^3,4. Further geriatric patients require a different approach to their care, that is multidimensional and takes account of functional, cognitive, psychoactive and medical aspects of care in order to formulate a treatment and rehabilitation, plan involving team of medical faculty and family members of the patients.⁵ Hence attempt was made to study; the geriatric patients admitted for surgery, with age related complications with suitable anesthetic treatment and prevent the morbidity and mortalities.

 

MATERIAL AND METHODS

89 Geriatric patients above 65 years of age (aged between 65 to 90 year) admitted at Mediciti Institute of Medical Sciences Hospital, Ghanpur – Medchal, Telangana were selected for study.

Inclusion criteria- The patients consented for surgery, average to good nutritional status with normal mental status and physical examination was certified by physician were included in the study.

Methods- The patients agreed to undergo surgery. Their routine blood exam, X-ray pond USG of the required region for surgery. The patients suffering with type-II D.M and Asthma were controlled pre-operatively. Their cardiac – evaluation was also recorded. Previous history of any surgery trauma illness was also noted. The duration of this study was about 4 years (2014 to 2018)

Exclusion criteria – The patients having malignancy, immune- compromised, grade IV malnourished. The patients had history of mental- illness and under treatment anti depressants and anti-anxiety were excluded from the study.

Statistical analysis- The clinical implication for anesthesia in geriatric patients were classified with percentage, post-operative check-list in post-operative patients were classified with percentage. A type of anesthesia given in different surgery in geriatric was classified with percentage. The ratio of the male and females was 2:1.

OBSERVATION AND RESULTS

Table-1. Clinical implication for Anesthesia in geriatric patients 17(19.1%) were susceptible to Hypotension 15(16.8%) were susceptible to Hypercarbia and Hypoxemia 11(12.3%) had increased intro-operative hyperglycemia 7(7.86%) had increased risk of 13(14.6%) were anemic.

Table-2. Post-operative check-list in Geriatric patients- 25(28%) had delirium 22 (24.7%) had preoperative acute pain, 12(13.4%) had pulmonary complications 9(10%) were ability to maintain adequate nutrition, 11(12.3%) had UTI post-surgically. 10(11.2%) had pressure ulcer.

 Table-3. Types of Anesthesia in Geriatric patients- 58(65%) had regional anesthesia included repair hipbone, knee Arthroplasty and lower limb revascularization. 18(20.2%) had epidural with local anesthesia for abdominal surgery including abdominal aortic aneurysm repair, 13 (14.6%) had Thoracic epidural anesthesia for cardiac and pulmonary surgeries.

Table 1: Clinical Implication for Anesthesia In Geriatric Patients (No of Patients -89)

 

Table 2: Post-operative check-list in Geriatric patients(No of Patients -89)

 

Table 3: Types of Anesthesia in Geriatric patients(No of Patients -85)

 

DISCUSSION

In the present study of preoperative Assessment of Geriatric patients of Telangana- The clinical implication were 17(19%) were susceptible to hypotension, 15(16.8%) susceptible to hypercarbia and hypoxemia 11(12.3%) had intraoprative hyperglycemia 7(7.86%) increased risk of hypothermia, 13(14.6%) had Anemia (Table-1). In post-operative check list study - 25(28%) had delirium 22 (24.7%) had preoperative acute pain, 12(13.4%) had pulmonary complications 9(10%) were ability to maintain adequate nutrition, 11(12.3%) had UTI post-surgically. 10(11.2%) had pressure ulcer. (Table-2) Types of Anesthesia in Geriatric patients- 58(65%) had regional anesthesia included repair hipbone, knee arthroplasty and lower limb revascularization. 18(20.2%) had epidural with local anesthesia for abdominal surgery including abdominal aortic aneurysm repair, 13(14.6%) had Thoracic epidural anesthesia for cardiac and pulmonary surgery (Table-3) These finding were more or less in agreement with previous studies^6,7,8.Delirium was the multi factorial disorder characterized by impaired attention and disorganized thinking that frequently occurs in the preoperative setting in geriatrics, which increased length of hospital stay increased health care cost, post-operative cognitive physiologic change in a geriatric patients that may impact drug response includes impaired gastro-intestinal absorption, decreased hepatic and renal blood flow, increased adipose tissue decreased total body water and decreased muscle mass. These factors impact drug Pharmacokinetics and Pharmacodynamics leading to adverse perioperatve events¹⁰. Surgery and the recovery process create a hyper metabolic state that taxis the reserve any patients but can be particularly dangerous in geriatric patients. The mal nutritious patients especially geriatrics had increased risk of infection, poor would healing, wound break down, lengthier hospital stay and mortality ¹¹. In addition to this the medical histories of geriatric patients include physical social and neuropsychological condition. It was also reported that trails examining improving muscle mass with angiotension enzymes converting inhibitors hormones such as testosterone or supplements like vitamin D have not resulted in the expected benefits. Hence risk and benefits of the surgery should be predicted before surgical approach in geriatric patients.

 

SUMMARY AND CONCLUSION

The present comparative study of preoperative assessment of geriatric patients will be useful to surgeons, and anesthetists for decisions making for rational treatment choice after considering one’s medical conditions the desired procedure, potential benefits and potential risk should be evaluated because nowadays reputation of medical profession is at stake.

 

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