Preop risk stratification & postop management in elderly cancer patients
|
|
- Cory Robinson
- 6 years ago
- Views:
Transcription
1 Preop risk stratification & postop management in elderly cancer patients laudia Spies Klinik für Anästhesiologie und Intensivmedizin ampus Virchow-Klinikum und ampus harité Mitte U N I V E R S I T Ä T S M E HARITÉ D I Z I N B E AMPUS R L I N VIRHOW-KLINIKUM und AMPUS HARITÉ MITTE K L I N I K F Ü R A N Ä S T H E S I O L O G I E
2 Elderly Patients Aged 65 yrs Most rapidly growing ancer: Incidence 2/3 of solid tumors 69% of cancer deaths Perioperatively: pts. receive substandard care before surgery, risk assessment is not adequate prognostic: severity of preop. co-morbidities (1) Statistik.php (2) oebergh. Eur J ancer, 2001 (3) Fentiman IS, Anna Oncol, 1996 (4) Enger J lin Oncol, HARITÉ AMPUS VIRHOW-KLINIKUM und AMPUS HARITÉ MITTE K L I N I K F Ü R A N Ä S T H E S I O L O G I E
3 PAE- Preoperative Assessment of ancer in the Elderly Surgical risk - American Society for anaesthesiologist scale (ASA) - Physiological & Operative Severity Score for Enumeration of Mortality and Morbidity (Possum) Functional status Activities of daily living ADL Instrumental activities of daily living IADL EOG performance status PS Mental Health Mini-mental state inventory MMS Geriatric depression scale GDS Brief fatigue inventory BFI omorbidity Satariano's index of co-morbidities SI Audisio R et al. Supportive ancer Therapy 1(2003)pp HARITÉ AMPUS VIRHOW-KLINIKUM und AMPUS HARITÉ MITTE K L I N I K F Ü R A N Ä S T H E S I O L O G I E
4 PAE Results - hospital stay N=460 patients elective surgery for solid tumors under general anaesthesia omponent of PAE Rra 95%I MMS abnormal (<24) ADL dependent (>0) 2.01* IADL dependent (<8) 1.58* GDS depressed (>4) BFI mod/severe fatigue (>3) ASA abnormal ( 2) PS abnormal (>1) 1.64* Satariano's index (1) Satariano's index (2+) * P < 0,05 Audisio RA rit Rev Hematol Oncol 2008 HARITÉ AMPUS VIRHOW-KLINIKUM und AMPUS HARITÉ MITTE K L I N I K F Ü R A N Ä S T H E S I O L O G I E
5 PreoperativeRisk Evaluation 15 ASA PS 4 Probability for major complications ASA PS 3 ASA PS 1, 2 Total complication rate Age (years) Prough J Am oll Surg 2005 HARITÉ AMPUS VIRHOW-KLINIKUM und AMPUS HARITÉ MITTE K L I N I K F Ü R A N Ä S T H E S I O L O G I E
6 PAE Results - 30-day morbidity omponent of PAE Any complication Major complication RRa 95% I RRa 95% I MMS abnormal (< 24) ADL dependent (> 0) IADL dependent (< 8) 1.43* GDS depressed (> 4) BFI mod/severe fatigue (> 3) 1.52* ASA abnormal ( 2) * PS abnormal (> 1) 1.64* Satariano's index (1) Satariano's index (2+) * P < 0,05 Audisio RA rit Rev Hematol Oncol 2008 HARITÉ AMPUS VIRHOW-KLINIKUM und AMPUS HARITÉ MITTE K L I N I K F Ü R A N Ä S T H E S I O L O G I E
7 Elderly Surgical IU Patients aged 65 y 6-months mortality (n =16) Alive at 6 months (n = 91) p Frailty Age (yr) ognition (Mini- og) Weight loss (10 Ibs) Body mass index Albumin (g/dl) Falls (#) Depression Hematocrit (%) 76.1 ± ± 1.3 3/16 (26 %) 23.8 ± ± ± 1.6 3/16 (18.8 %) 35.0 ± ± ± /88 (13.6 %) 26.7 ± ± ± /90 (34.4 %) 41.0 ± < Disability Average ADL 3.2 ± ± omorbidity harlson index ASA score Medications (#) 5.1 ± ± ± ± ± ± Robinson et al. Annals of Surgery 2009 HARITÉ AMPUS VIRHOW-KLINIKUM und AMPUS HARITÉ MITTE K L I N I K F Ü R A N Ä S T H E S I O L O G I E
8 Elderly Surgical IU Patients aged 65 y Frailty Age (yr) ognition (Mini- og) Weight loss(10 Ibs) Body mass index Albumin (g/dl) Falls (#) Depression Hematocrit (%) Discharged to an institution (n =27) 75.9 ± ± 1.4 7/27 (20 %) 26.8 ± ± ± /27 (37.0 %) 36.5 ± 5.3 Discharged to home (n = 78) 73.5 ± ± 1.6 8/76 (10.5 %) 26.3 ± ± ± /77 (31.2 %) 41.6 ± 5.1 p < < Disability Average ADL 3.8 ± ± omorbidity harlson index ASA score Medications (#) 4.7 ± ± ± ± ± ± Robinson et al. Annals of Surgery 2009 HARITÉ AMPUS VIRHOW-KLINIKUM und AMPUS HARITÉ MITTE K L I N I K F Ü R A N Ä S T H E S I O L O G I E
9 Predictor Predictors of One Year Mortality Univariate analysis Relative risk (odds ratio) (95 % I) P value harlson omorbidity Score (3+ versus 0 2) ( ) < ASA physical status lass 3, 4 versus lass ( ) Age (65+ versus yr) ( ) Predictor Multivariate analysis Relative risk (odds ratio) (bootstrapped 95 % I) P value harlson omorbidity Score (3+ versus 0 2) ( ) < umulative deep hypnotic time (per h) ( ) Systolic blood pressure < 80 mm Hg (per min) ( ) Monk TG, et al.; Anesthesiology 2008 HARITÉ AMPUS VIRHOW-KLINIKUM und AMPUS HARITÉ MITTE K L I N I K F Ü R A N Ä S T H E S I O L O G I E
10 7.0 Volume Management Liter difference: ~2,5 l oral fluid iv-saline 0.9% iv-glucose 0.5% iv-haes 6 % iv-other or unspecified R S R S R S R S R S R S R S Brandstrup, B. et al., Ann Surg, 2003 HARITÉ AMPUS VIRHOW-KLINIKUM und AMPUS HARITÉ MITTE K L I N I K F Ü R A N Ä S T H E S I O L O G I E
11 Restrictive Volume Management Number of patients with complications (per-protocol analysis) Blinded assessment Restricted Standard p group group value Overall complications Major complications Minor complications Tissue-healing complications ardiopulmonary complications Brandstrup, B. et al., Ann Surg, 2003 HARITÉ AMPUS VIRHOW-KLINIKUM und AMPUS HARITÉ MITTE K L I N I K F Ü R A N Ä S T H E S I O L O G I E
12 Knowledge Management Hemicolectomy - Occult Hypovolemia Initial values after establishing EDM: ABP: 110/60 mmhg I: 2.1 l/min/m² HF: 67 /min HF: BIS: 29 HARITÉ AMPUS VIRHOW-KLINIKUM und AMPUS HARITÉ MITTE K L I N I K F Ü R A N Ä S T H E S I O L O G I E
13 Early postoperative recovery of elderly patients Patients not oriented (%) P< BIS titrated Standard practice Time after discontinuation of anaesthetics (min) Standard practice (n=31) BIS titrated (n=29) Awakening (min) 4.9 ± ± 2.1 Orientation (min) 13.1 ± ± 3.1* Aldrete score of 10 (min) 19.1 ± ± 2.2* PAU discharge (min) 123 ± ± 30 *P <0.05. Wong et al., AN J ANESTH 2002 HARITÉ AMPUS VIRHOW-KLINIKUM und AMPUS HARITÉ MITTE K L I N I K F Ü R A N Ä S T H E S I O L O G I E
14 Postoperative Delirium (PD) Emergence Delirium Delirium POD Dementia Emergence Delirium Postoperative Delirium Mild neurocognitive disorder POD Dementia (first 30 min. after surgery) (hours days after surgery) (weeks to month after surgery) (years) HARITÉ AMPUS VIRHOW-KLINIKUM und AMPUS HARITÉ MITTE K L I N I K F Ü R A N Ä S T H E S I O L O G I E
15 recovery room Delirium: 45% postoperative Delirium: 36% RR-Delirium is predictive for postoperative delirium with a sensitivity of 100% und specificity of 85% Sharma PT et al.; Anesth Analg 2005 HARITÉ AMPUS VIRHOW-KLINIKUM und AMPUS HARITÉ MITTE K L I N I K F Ü R A N Ä S T H E S I O L O G I E
16 Postoperative Delirium (PD) Preoperative risk factors: dementia, further chronic impaired cognitive function, and physical debilitation physical restraints age malnutrition addition of more than three medications bladder catheter Inouye et al Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationsship with baseline vulnerability JAMA, p HARITÉ AMPUS VIRHOW-KLINIKUM und AMPUS HARITÉ MITTE K L I N I K F Ü R A N Ä S T H E S I O L O G I E
17 Risk Factors for Early Postoperative Delirium (at D/ from RR) Duration of Surgery 1.00; 95 % I: ( ); p = Site 2.09; 95 % I: ( ); p = Intraop. Opioids 2.27; 95 % I: ( ); p = Anaesthetic 1.37; 95 % I: ( ); p = Preop. Fasting (solids) 1.27; 95 % I: ( ); p = Preop. Fasting (fluids) 10.57; 95 % I: ( ); p = Gender 1.36; 95 % I: ( ); p = Age 1.02; 95 % I: ( ); p = (multiple logistic regression: odds ratios with 95%-I) Radtke, Spies et al, EJA 2009, in press HARITÉ AMPUS VIRHOW-KLINIKUM und AMPUS HARITÉ MITTE K L I N I K F Ü R A N Ä S T H E S I O L O G I E
18 Early Postoperative Delirium and LOS Delirium on day 1 after surgery 5.524; 95 % I: ( ); p < Age 0.062; 95 % I: ( ); p < Gender 0.089; 95 % I: ( ); p = Preop. Fasting (fluids) 0.28; 95 % I: ( ); p = Preop. Fasting (solids) 0.798; 95 % I: ( ); p = Anaesthetic 307; 95 % I: ( ); p = Intraop. Opioids 0.628; 95 % I: ( ); p = Site ; 95 % I: ( ); p = Duration of Surgery 0.022; 95 % I: ( ); p < (multiple linear regression: regression coefficients with 95% I) Radtke, Spies al, EJA 2009 in press HARITÉ AMPUS VIRHOW-KLINIKUM und AMPUS HARITÉ MITTE K L I N I K F Ü R A N Ä S T H E S I O L O G I E
19 Postoperative Delirium (PD) Perioperative factors Intraoperative blood loss, postoperative hematocrit < 30% physical restraints electrolyte abnormalities sepsis Marcantonio et al The association of intraoperative factors with the development of postoperative delirium Am J Med, p HARITÉ AMPUS VIRHOW-KLINIKUM und AMPUS HARITÉ MITTE K L I N I K F Ü R A N Ä S T H E S I O L O G I E
20 Rudolph et al., Anaesthesia, 2008 HARITÉ AMPUS VIRHOW-KLINIKUM und AMPUS HARITÉ MITTE K L I N I K F Ü R A N Ä S T H E S I O L O G I E
21 Postoperative ognitive Dysfunction (POD) 80 Percentage (%) of patients with POD * * * control young middle-aged elderly 0 Early Late Postoperative cognitive testing session Monk TG, et al.; Anesthesiology; 2008 HARITÉ AMPUS VIRHOW-KLINIKUM und AMPUS HARITÉ MITTE K L I N I K F Ü R A N Ä S T H E S I O L O G I E
22 Postoperative Delirium 100 no dementia dementia (40% more delirum) 86.1 umulative delirium rate (%) at admission d/c IU post-iu McNicoll et al. J Am Geriatr Soc 2003 HARITÉ AMPUS VIRHOW-KLINIKUM und AMPUS HARITÉ MITTE K L I N I K F Ü R A N Ä S T H E S I O L O G I E
23 Intervention Delirium 50% vs. 32% Adequate NS O 2 -transport Pain Management Avoid unnecessary drugs Regulate bladder-/bowel function Nutrition Early mobilisation Monitoring postoperative complications Adequate Stimuli (z.b. glasses, hearing aids, clock, calendar) Therapy of delirium Inouye SK et al. New Engl J Med 1999 HARITÉ AMPUS VIRHOW-KLINIKUM und AMPUS HARITÉ MITTE K L I N I K F Ü R A N Ä S T H E S I O L O G I E
24 Antipsychotics for delirium Haloperidol (<3.5mg/d), Risperidone, and Olanzapine were equally effective in treating delirium, with few adverse effects. Parkinsonian adverse effects were common with higher dose haloperidol (>4.5mg/d) compared with olanzapine Pre-operative haloperidol decreased severity and duration of post-surgery delirium All studies were small and should be repeated. Level of evidence: Antipsychotics for delirium (Review), Lonergan et al., 2007 HARITÉ AMPUS VIRHOW-KLINIKUM und AMPUS HARITÉ MITTE K L I N I K F Ü R A N Ä S T H E S I O L O G I E
25 Haloperidol Prophylaxis in Elderly Patients after Hip Surgery with Increased Risk DRS-R Placebo (n=36) Haloperidol 3 times 0,5 mg (n=32) Postop days Kalisvaart KJ et al. JAGS 2005 HARITÉ AMPUS VIRHOW-KLINIKUM und AMPUS HARITÉ MITTE K L I N I K F Ü R A N Ä S T H E S I O L O G I E
26 Pablo Picasso: Musical Instruments HARITÉ AMPUS VIRHOW-KLINIKUM und AMPUS HARITÉ MITTE K L I N I K F Ü R A N Ä S T H E S I O L O G I E
Anaesthesia for the Over 75s. Chris Edge
Anaesthesia for the Over 75s Chris Edge Topics to be Covered Post-operative cognitive management Morbidity and mortality General anaesthesia a good idea or not? Multiple comorbidities and assessment of
More informationThe Long-term Prognosis of Delirium
The Long-term Prognosis of Jane McCusker, MD, DrPH, Professor, Epidemiology and Biostatistics, McGill University; Head, Clinical Epidemiology and Community Studies, St. Mary s Hospital, Montreal, QC. Nine
More informationTransfusion & Mortality. Philippe Van der Linden MD, PhD
Transfusion & Mortality Philippe Van der Linden MD, PhD Conflict of Interest Disclosure In the past 5 years, I have received honoraria or travel support for consulting or lecturing from the following companies:
More informationDelirium assessment and management. Dr Kim Jeffs Northern Health
Delirium assessment and management Dr Kim Jeffs Northern Health What do you need to know? Epidemiology How big is the problem? Who is at risk? Assessment Tools for diagnosis Prevention Evidence base Management
More informationDavid A Scott Lis Evered. Department of Anaesthesia and Acute Pain Medicine St Vincent s Hospital, Melbourne University of Melbourne
David A Scott Lis Evered Department of Anaesthesia and Acute Pain Medicine St Vincent s Hospital, Melbourne University of Melbourne This talk will include live polling so please be sure to have the meeting
More informationPerioperative Care of Older Adults
Perioperative Care of Older Adults SARAH A. WINGFIELD, MD AND THOMAS O. DALTON, MD UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER DIVISION OF GERIATRIC MEDICINE We have no disclosures. Objectives -Recognize
More informationPerioperative Care of Older Adults
Perioperative Care of Older Adults SARAH A. WINGFIELD, MD AND THOMAS O. DALTON, MD UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER DIVISION OF GERIATRIC MEDICINE We have no disclosures. Objectives -Recognize
More informationDisclosures. Post operative Delirium. Set up audience participation. Delirium Definitions. Incidence of Delirium
Post operative Delirium Disclosures IP for monitoring technology licensed to Medtronic Ken Brady, MD Pediatrics, Anesthesia, Critical Care Texas Children s Hospital Baylor College of Medicine Set up audience
More informationUpdate - Delirium in Elders
Update - Delirium in Elders Impact Recognition Prevention, and Management Michael J. Lichtenstein, MD F. Carter Pannill, Jr. Professor of Medicine Chief, Division of Geriatrics, Gerontology and Palliative
More informationWhy Target Delirium for Surgical Quality Improvement?
Why Target Delirium for Surgical Quality Improvement? Tom Robinson MD FACS thomas.robinson@ucdenver.edu July 22, 2018 Disclosures Tom Robinson has no disclosures. Who Cares About the Brain? Acute Organ
More informationPostoperative Delirium in a General Surgery- Geriatric Medicine Service
Open Journal of Geriatrics Volume 1, Issue 1, 2018, PP: 15-20 Postoperative Delirium in a General Surgery- Geriatric Medicine Service Dr. Si Ching LIM, MB. ChB, MRCP 1, Dr. Peter CHOW, MB. ChB (CUHK),
More informationPostoperative cognitive dysfunction a neverending story
Postoperative cognitive dysfunction a neverending story Adela Hilda Onuţu, MD, PhD Cluj-Napoca, Romania adela_hilda@yahoo.com No conflict of interest Contents Postoperative cognitive dysfunction (POCD)
More informationCare of older people in surgery (COPS)
Care of older people in surgery (COPS) Who, what, and does it make a difference Professor Jacqueline Close Geriatrician - POWH Clinical Director Falls, Balance and Injury Research Centre Early Mobilisation
More informationSummary of Delirium Clinical Practice Guideline Recommendations Post Operative
Summary of Delirium Clinical Practice Guideline Recommendations Post Operative Intensive Care Unit Clinical Practice Guideline for Postoperative Clinical Practice Guidelines for the Delirium in Older Adults;
More informationPERIOPERATIVE ANESTHETIC RISK IN THE GERIATRIC PATIENT
PERIOPERATIVE ANESTHETIC RISK IN THE GERIATRIC PATIENT Susan H. Noorily, M.D. Clinical Professor of Anesthesiology Medical Director University Preoperative Medicine Center IMPORTANCE Half of all currently
More informationDelirium in the Elderly
Delirium in the Elderly ELITE 2017 Liza Genao, MD Division of Geriatrics Why should we care about delirium? It is: common associated with high mortality associated with increased morbidity Very much under-recognized
More informationDelirium in the Elderly
Delirium in the Elderly ELITE 2015 Mamata Yanamadala M.B.B.S, MS Division of Geriatrics Why should we care about delirium? It is: common associated with high mortality associated with increased morbidity
More informationPreventing Postoperative Cognitive Decline in the Elderly
Preventing Postoperative Cognitive Decline in the Elderly Alex Bekker, M.D., Ph.D Professor and Chair Department of Anesthesiology Rutgers New Jersey Medical School "My brain, that's my second favorite
More informationBelow is summarised some of the tools and papers that are worth looking at if you have an interest in the area.
What happens to the high risk patients who don t die? Perioperative SIG meeting PBLD Noosa 2015 Nicola Broadbent, Auckland, NZ In the process of writing this problem based learning discussion I have read
More informationDelirium in the hospitalized patient
Delirium in the hospitalized patient Jennifer A. Tarin, M.D. Department of Hospital Medicine Geriatric Health Safety Chair Colorado Permanente Medical Group UCLA Reynolds Scholar Delirium Preventing delirium
More informationGeriatric Grand Rounds
Geriatric Grand Rounds Prevalence and Risk Factors of Delirium in Older Patients Admitted to a Community Based Acute Care Hospital Tuesday, October 27, 2009 12:00 noon Dr. Bill Black Auditorium Glenrose
More informationStrategies to minimize delirium for hip fracture patients
Strategies to minimize delirium for hip fracture patients Stephen L Kates, M.D. Professor and Chairman Department Date of Orthopaedic Surgery Delirium incidence Up to 61% of hip fracture patients get delirium
More informationHospitalization- Associated Disability
Hospitalization- Associated Disability Deborah Villarreal, MD Assistant Professor Geriatric and Palliative Medicine An Unfortunately Common Scenario Mrs.G 70 y/o BF DM type II, HTN, s/p CVA, OA, OP admitted
More informationDELIRIUM. Sabitha Rajan, MD, MSc, FHM Scott &White Healthcare Texas A&M Health Science Center School of Medicine
DELIRIUM Sabitha Rajan, MD, MSc, FHM Scott &White Healthcare Texas A&M Health Science Center School of Medicine Disclosure Milliman Care Guidelines - Editor Objectives Define delirium Epidemiology Diagnose
More informationDelirium and Dementia. Summary
Delirium and Dementia Paul Kettl, M.D., M.H.A. Summary DELIRIUM Acute brain failure Identify cause (meds, infection) Treat sx Poor prognostic sign DEMENTIA Chronic brain failure AD most common cause Often
More informationDelirium and cognitive impairment in the perioperative
Delirium and cognitive impairment in the perioperative period Richard Sztramko Assistant Professor, McMaster University Divisions of Geriatrics and General Internal Medicine Disclosures Chief Medical Officer
More informationIn 2009, more than 37% of all interventional and
CE 2.5 HOURS Continuing Education Postoperative Delirium in Elderly Patients A review of risk factors, assessment tools, and strategies to minimize this frequent surgical complication. OVERVIEW: Nearly
More informationA SAFE AND EFFECTIVE WAY TO OPTIMIZE ANESTHESIA DURING SURGERY
Clinical Evidence Guide A SAFE AD EFFECTIVE WAY TO OPTIMIZE AESTHESIA DURIG SURGERY Bispectral Index (BIS) Complete Monitoring System This guide will help you review the clinical evidence that supports
More informationAcute Care of Older Surgical Patients. Dr Shane O Hanlon Consultant Geriatrician St Vincent s University Hospital IHFM 8 th Nov 2017
Acute Care of Older Surgical Patients Dr Shane O Hanlon Consultant Geriatrician St Vincent s University Hospital IHFM 8 th Nov 2017 NCEPOD 2010 overall care % 50 45 40 35 30 25 20 15 10 5 0 Good practice
More informationThe role of the Geriatrician
Post-operative management of the older adults with cancer The role of the Geriatrician Sofia Duque Hospital Beatriz Ângelo Geriatric University Unit Faculty of Medicine of Lisbon Geriatrics Study Group
More informationACS-NSQIP Geriatric Collaborative. Thomas Robinson MD MS FACS Associate Professor, Surgery University of Colorado
ACS-NSQIP Geriatric Collaborative Thomas Robinson MD MS FACS Associate Professor, Surgery University of Colorado Disclosures The following planner, speaker and panelist of this CME activity has no relevant
More informationOptimal Perioperative Management of the Geriatric Patient: A Best Practices Guideline from the ACS NSQIP/American Geriatrics Society
Optimal Perioperative Management of the Geriatric Patient: A Best Practices Guideline from the ACS NSQIP/American Geriatrics Society Sanjay Mohanty, MD; Ronnie A. Rosenthal, MS,MD; Marcia M. Russell, MD;
More informationA Perioperative Physician s Perspective. SAAPM 25 th October 2016
A Perioperative Physician s Perspective SAAPM 25 th October 2016 Avoid hypoxia, Avoid hypotension Consider a spinal! What is a Perioperative Physician A physician who addresses the medical care of the
More informationThe Agitated. Older Patient: old. What To Do? Michelle Gibson, MD, CCFP Presented at Brockville General Hospital Rounds, May 2003
Focus on CME at Queen s University Focus on CME at Queen s University The Agitated The Older Patient: What To Do? Michelle Gibson, MD, CCFP Presented at Brockville General Hospital Rounds, May 2003 Both
More informationBreast cancer in the elderly - is there a role for the geriatrician?
Breast cancer in the elderly - is there a role for the geriatrician? Workshop in Breast Cancer Surgery Aarhus 18 May 2016 Lone Winther Lietzen MD, PhD Department of Geriatrics, Geriatricians? Internal
More informationPredicting Short Term Morbidity following Revision Hip and Knee Arthroplasty
Predicting Short Term Morbidity following Revision Hip and Knee Arthroplasty A Review of ACS-NSQIP 2006-2012 Arjun Sebastian, M.D., Stephanie Polites, M.D., Kristine Thomsen, B.S., Elizabeth Habermann,
More informationIncidence and Risk Factors for Cognitive Dysfunction in Patients with Severe Systemic Disease
The Journal of International Medical Research 2012; 40: 612 620 Incidence and Risk Factors for Cognitive Dysfunction in Patients with Severe Systemic Disease FM RADTKE 1,a, M FRANCK 1,a, TS HERBIG 1, N
More informationManagement of Delirium in the Elderly Patients: A Review of Evidence
Review Article imedpub Journals http://journals.imedpub.com Journal of Drug Abuse 2471-853X DOI: 10.21767/2471-853X.10006 Abstract Management of Delirium in the Elderly Patients: A Review of Evidence Delirium
More informationGeriatric screening tools in older patients with cancer
Geriatric screening tools in older patients with cancer Pr. Elena Paillaud Henri Mondor hospital, Créteil, France University Paris-Est Créteil CONFLICT OF INTEREST DISCLOSURE I have the following potential
More informationNew York City Development of the Geriatric Collaborative
New York City - 2014 Development of the Geriatric Collaborative The Clinical Problem More than 50% persons age 65 years will have some surgical procedure in the remainder of his or her lifetime Outcome
More informationCOGNITIVE IMPAIRMENT IN
COGNITIVE IMPAIRMENT IN THE HOSPITAL SETTING Professor Len Gray April 2014 Some key questions How common is cognitive impairment among hospitalised older patients? Which cognitive syndromes are associated
More informationEnhanced Recovery After Discharge: does it happen?
Enhanced Recovery After Discharge: does it happen? Nader K Francis ERAS-UK Southampton 14 th November 2014 BJS 2014 Functional / symptoms Length of hospital stay 37 Readmission 29 Pain 16 Fatigue 9 BJS
More information9/19/2018. Common Medical Issues and Management in the Geriatric Trauma Patient. Disclosures. Objectives. I have no financial disclosures
Common Medical Issues and Management in the Geriatric Trauma Patient 2018 UW Medicine EMS & Trauma Conference September 17, 2018 Joe C. Huang, M.D. Clinical Instructor Medical Director, Geriatrics-Palliative
More informationPreoperative Assessment Guidelines in the Elderly
Preoperative Assessment Guidelines in the Elderly How Are They Helping? Mark R. Katlic, M.D., M.M.M. Chairman, Department of Surgery Director, Center for Geriatric Surgery Sinai Hospital Baltimore, Maryland
More informationCan Depth of Anesthesia Monitoring Alter the Incidence of Mortality, POCD or Delirium?
Can Depth of Anesthesia Monitoring Alter the Incidence of Mortality, POCD or Delirium? John C. Drummond, M.D., FRCPC Professor of Anesthesiology, University of California, San Diego; Staff Anesthesiologist,
More informationFluid management. Dr. Timothy Miller Assistant Professor of Anesthesiology Duke University Medical Center
Fluid management Dr. Timothy Miller Assistant Professor of Anesthesiology Duke University Medical Center Disclosure Consultant and research funding Edwards Lifesciences Goals of fluid therapy 1. Maintain
More informationGeriatrics and Cancer Care
Geriatrics and Cancer Care Roger Wong, BMSc, MD, FRCPC, FACP Postgraduate Dean of Medical Education Clinical Professor, Division of Geriatric Medicine UBC Faculty of Medicine Disclosure No competing interests
More information5 older patients become delirious every minute
Management of Delirium: Nonpharmacologic and Pharmacologic Approaches Sharon K. Inouye, M.D., M.P.H. Professor of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Milton and Shirley
More informationQuality Care for the Hospitalized Older Adult
Quality Care for the Hospitalized Older Adult Quality Care for the Hospitalized Older Adult Shelley R McDonald, DO, PhD May 19 th, 2018 Objectives To define why the hospital is a dangerous place for older
More informationDelirium in Older Persons: An Investigative Journey
Delirium in Older Persons: An Investigative Journey Sharon K. Inouye, M.D., M.P.H. Professor of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Milton and Shirley F. Levy Family Chair
More informationDelirium. Dr. John Puxty
Delirium Dr. John Puxty Learning Objectives By the end of the workshop participants will be able to: Appreciate the main diagnostic criteria for delirium. Describe common risk factors, causes and main
More informationDelirium Pilot Project
CCU Nurses: Delirium Pilot Project Our unit has been selected to develop and implement a delirium assessment and intervention program. We are beginning Phase 1 with education and assessing for our baseline
More informationDelirium. Approach. Symptom Update Masterclass:
Symptom Update Masterclass: Delirium Jason Boland Senior Clinical Lecturer and Honorary Consultant in Palliative Medicine Wolfson Centre for Palliative Care Research Hull York Medical School University
More informationPOCD: What is it and do the anesthetics play a role?
POCD: What is it and do the anesthetics play a role? Deborah J. Culley, M.D. Associate Professor Harvard Medical School Brigham & Women s Hospital Conflicts of Interest NIH/NIGMS/NIA ABA: Director ABMS:
More informationDr. Stuart McCorkell BSc FRCA FFICM Anaesthetic Department, Guy s & St. Thomas s NHS Foundation Trust 2017 POPS
Dr. Stuart McCorkell BSc FRCA FFICM Anaesthetic Department, Guy s & St. Thomas s NHS Foundation Trust Why assess (estimate) risk? Patient information and informed consent (patient, surgeon) Stratify resource
More informationThe Elusive Frailty Formula: Shining the geriatric light on the 1-5% Dr John Puxty
The Elusive Frailty Formula: Shining the geriatric light on the 1-5% Dr John Puxty puxtyj@providencecare.ca Health Care use is not uniform by Seniors How common is Frailty? Approximately10% of all individuals
More informationDelirium in Older Persons
Objectives Delirium in Older Persons ELITE 2018 Liza Isabel Genao, MD Division of Geriatrics Describe rate, cost, complications of delirium Effectively diagnose the syndrome Describe multicomponent model
More informationDelirium. Delirium. Delirium Etiology and Pathophysiology. Fall 2018
Three most common cognitive problems in adults 1. (acute confusion) 2. Dementia 3. Depression These problems often occur together Can you think of common stimuli for each? 1 1 State of temporary but acute
More informationChapter 01 Introduction
Chapter 01 Introduction Defining the Elderly There is no universally accepted age cut-off defining elderly. This reflects the fact that chronological age itself is less important than biological events
More informationORIGINAL ARTICLE. Adverse Outcomes of Geriatric Patients Undergoing Abdominal Surgery Who Are at High Risk for Delirium
ORIGINAL ARTICLE Adverse Outcomes of Geriatric Patients Undergoing Abdominal Surgery Who Are at High Risk for Delirium Sabha Ganai, MD; K. Francis Lee, MD, MPH; Andrea Merrill, BS; Maggie H. Lee, MS; Sandra
More informationIf you reduce variability in volume administration, HOW. you can reduce post-surgical complications, LOS and associated costs 1-4
A large body of clinical evidence* demonstrates If you reduce variability in volume administration, you can reduce post-surgical complications, LOS and associated costs 1-4 Complications Too Dry Too Wet
More informationSaman Arbabi M.D., M.P.H., F.A.C.S. Kathleen O'Connell M.D. Bryce Robinson M.D., M.S., F.A.C.S., F.C.C.M
Form "EAST Multicenter Study Proposal" Study Title Primary investigator / Senior researcher Email of Primary investigator / Senior researcher Co-primary investigator Are you a current member of EAST? If
More information譫妄症 (Delirium) Objectives. Epidemiology. Delirium. DSM-5 Diagnostic Criteria. Prognosis 台大醫院老年醫學部陳人豪 2016/8/28
譫妄症 (Delirium) 台大醫院老年醫學部陳人豪 2016/8/28 Objectives Delirium Epidemiology Etiology Diagnosis Evaluation and Management Postoperative delirium Delirium (and acute problematic behavior) in the longterm care
More informationFrailty Assessment: Simplifying the Complex
Frailty Assessment: Simplifying the Complex Natalie Sanders, DO Internal Medicine, Geriatrics Rocky Mountain Geriatrics Conference 2017 U N I V E R S I T Y O F U T A H H E A L T H, 2 0 1 7 OBJECTIVES Define
More informationActualités sur le remplissage peropératoire. Philippe Van der Linden MD, PhD
Actualités sur le remplissage peropératoire Philippe Van der Linden MD, PhD Fees for lectures, advisory board and consultancy: Fresenius Kabi GmbH B Braun Medical SA Perioperative Fluid Volume Administration
More informationENHANCED RECOVERY PROTOCOLS FOR KNEE REPLACEMENT
ENHANCED RECOVERY PROTOCOLS FOR KNEE REPLACEMENT Jeff Gadsden, MD, FRCPC, FANZCA Associate Professor Duke University Department of Anesthesiology Regional Anesthesia and Acute Pain Medicine DISCLOSURES
More informationDelirium after fast-track hip and knee arthroplasty
British Journal of Anaesthesia 108 (4): 607 11 (2012) Advance Access publication 24 January 2012. doi:10.1093/bja/aer493 Delirium after fast-track hip and knee arthroplasty L. Krenk 1,2,3 *, L. S. Rasmussen
More informationDelirium. A Plan to Reduce Use of Restraints. David Wensel DO, FAAHPM Medical Director Midland Care
Delirium A Plan to Reduce Use of Restraints David Wensel DO, FAAHPM Medical Director Midland Care Objectives Define delirium Describe pathophysiology of delirium Understand most common etiologies Define
More informationDelirium in the Elderly
Delirium in the Elderly Jeffrey M. Burock, MD Division Director/ Psychiatry / Miriam Hospital Clinical Assistant Professor Warren Alpert School Of Medicine Learning Objectives Identify the symptoms of
More informationSimone Targa. Impact of an ERAS Colorectal Program on clinical outcomes and costs
Impact of an ERAS Colorectal Program on clinical outcomes and costs Simone Targa U.O. di Clinica Chirurgica Azienda Ospedaliero-Universitaria di Ferrara Arcispedale S. Anna ERAS Protocol ENHANCED RECOVERY
More informationJacinta Lucke Resident Emergency Medicine PHD Gerontology & Geriatrics
Jacinta Lucke Resident Emergency Medicine PHD Gerontology & Geriatrics TAKE HOME MESSAGE When managing confusion in older patients: Routinely screen for impaired cognition Patients with impaired cognition
More informationBeta Blockers for ENT Surgery
Beta Blockers for ENT Surgery Dr. Giuliano Michelagnoli U.O. Anestesia e Rianimazione Nuovo Ospedale di Prato Perioperative Beta-Blockade 1. Reduction of perioperative cardiovascular risk 2. Multimodal
More informationFalls Prevention Best Practice
Falls Prevention Best Practice Prepared by Denise Tomassini Falls Prevention A case study : Mr Tony Topples ISLHD Clinical Quality Manager Clinical Governance Unit November 2011 Falls Prevention Best Practice
More informationRisk of Venous Thromboembolism Outweighs Post-Hepatectomy Bleeding Complications: Analysis of 5,651 NSQIP Patients
Risk of Venous Thromboembolism Outweighs Post-Hepatectomy Bleeding Complications: Analysis of 5,651 NSQIP Patients Ching-Wei D. Tzeng, MD Matthew H. G. Katz, MD; Jason B. Fleming, MD; Peter W. T. Pisters,
More informationBackground Information
Background Information Age plays an important role in patients selection for spinal surgeries as it is associated with increased morbidity and mortality Consequences of suffering postoperative complications
More informationDo benzos, opioids, or strong anticholinergics cause delirium? Lisa Burry
Do benzos, opioids, or strong anticholinergics cause delirium? Lisa Burry Delirium in the ICU Occurs in up to 85% of MICU/SICU MV patients 20-50% of lower severity ICU patients develop delirium Hypoactive
More information2018 ABG QCDR Measure Specifications. (changes to old measures from 2017 in red font)
2018 ABG QCDR Measure Specifications (changes to old measures from 2017 in red font) Calculations Reporting Rate = Performance Met + Performance Not Met + Denominator Exceptions + Denominator Exclusions
More informationStellenwert der prä- und postoperativen Sicht des Chirurgen
Interdisziplinäre Chirurgie Stellenwert der prä- und postoperativen Ernährung Sicht des Chirurgen Kantonsspital Luzern 24.11.2005 Prof. L. Krähenbühl Chirurgische Klinik Hôpital Cantonal Fribourg Problems
More informationGeriatric Hip Fracture Co-Management. Pannida Wattanapanom, M.D., FACP.
Geriatric Hip Fracture Co-Management Pannida Wattanapanom, M.D., FACP. An 80 year old man with a hip fracture The General Medicine approach: Medical clearance for surgery Role of Geriatrician Assess caused
More informationPREVENT COMPLICATIONS IN MAJOR SURGERY
PREVENT COMPLICATIONS IN MAJOR SURGERY Dept of Anesthesia and ICM (Prof. G. Della Rocca) Azienda Ospedaliero-Universitaria University of Udine. Udine, Italy CLINICAL TRIAL OF SURVIVORS CARDIORESPIRATORY
More informationWho are we enrolling into postoperative delirium intervention studies and what interventions are we testing?
Who are we enrolling into postoperative delirium intervention studies and what interventions are we testing? Frederick Sieber Professor Anesthesiology and Critical Care Medicine Johns Hopkins Medical Institutions
More informationPre-operative Assessment of the Frail Elderly Person at Addenbrookes Hospital. Dr Fay J Gilder Consultant Anaesthetist
Pre-operative Assessment of the Frail Elderly Person at Addenbrookes Hospital Dr Fay J Gilder Consultant Anaesthetist Frailty Models A multidimensional state of increased vulnerability Phenotype model
More informationDelirium in Hospital Care
Delirium in Hospital Care Dr John Puxty 1 Learning Objectives By the end of the workshop participants will be able to: Appreciate the main diagnostic criteria for delirium. Describe common risk factors,
More informationImproving Colectomy Outcomes in the Enhanced Recovery In NSQIP (ERIN) Pilot
Improving Colectomy Outcomes in the Enhanced Recovery In NSQIP (ERIN) Pilot Julia R. BerianMD; Kristen A. Ban MD; Sanjay MohantyMD,MS; Jennifer L. ParuchMD,MS; Clifford Y. KoMD,MS,MSHS; Julie K. Thacker
More informationPerioperative Myocardial Infarction
Perioperative Myocardial Infarction Which patient should UNDERGO CORONARY ANGIOGRAPHY? The Cardiologists view Hans Rickli, St.Gallen 1 Experience Standards Risk stratification Team approach.. Tightrope
More informationLearning Objectives. Delirium. Delirium. Delirium. Terminal Restlessness 3/28/2016
Terminal Restlessness Dr. Christopher Churchill St. Cloud VA Health Care System EC&R Service Line Director & Medical Director Hospice & Palliative Care March 31, 2016 Learning Objectives Different Terminology
More informationRole and impact of orthogeriatric service in the hip fracture care pathway: 15-year experience
Role and impact of orthogeriatric service in the hip fracture care pathway: 15-year experience AA Fisher, MW Davis Department of Geriatric Medicine, The Canberra Hospital, and Australian National University
More informationImproving the quality of care of patients with delirium
Improving the quality of care of patients with delirium Alasdair MacLullich MRCP(UK), PhD Professor of Geriatric Medicine University of Edinburgh Scotland How are we doing now? We are doing badly. Difficult
More informationMusic medicine: A post-operative adjunct
Music medicine: A post-operative adjunct Anesthesia Research Rounds January 8 th, 2013 Aaron Lau CC3 Marko Erak CC3 Outline Overview of current literature Identified research opportunity Proposed pilot
More informationg Prevention, Diagnosis, and Management in Palliative Care
8/3/2012 Improving p g Prevention, Diagnosis, g and Management in Palliative Care MN Rural Palliative Care Networking Group Quarterly Education Session June 27,2012 Sandra W. Gordon-Kolb, MD, MMM, CPE
More informationSurgery in Frail Elders. Emily Finlayson, MD, MS Department of Surgery University of California, San Francisco September, 2011
Surgery in Frail Elders Emily Finlayson, MD, MS Department of Surgery University of California, San Francisco September, 2011 What we re going to cover Mortality after surgery in the elderly Fact v Fantasy
More informationEvaluating Functional Status in Hospitalized Geriatric Patients. UCLA-Santa Monica Geriatric Medicine Didactic Lecture Series
Evaluating Functional Status in Hospitalized Geriatric Patients UCLA-Santa Monica Geriatric Medicine Didactic Lecture Series Case 88 y.o. woman was admitted for a fall onto her hip. She is having trouble
More informationThe Geriatrician in the Trauma Service. Trauma Quality Improvement Program (TQIP) Annual Scientific Meeting and Training 2013
The Geriatrician in the Trauma Service Trauma Quality Improvement Program (TQIP) Annual Scientific Meeting and Training 2013 Challenges of the Geriatric Trauma Patient Challenges of the Geriatric Patient
More informationAs the proportion of the elderly in the
CANCER When the cancer patient is elderly, how do you weigh the risks of surgery? Marguerite Palisoul, MD Dr. Palisoul is Fellow in the Department of Obstetrics and Gynecology, Division of Gynecologic
More informationCigdem Benlice, Ipek Sapci, T. Bora Cengiz, Luca Stocchi, Michael Valente, Tracy Hull, Scott R. Steele, Emre Gorgun 07/23/2018
Does preoperative oral antibiotic or mechanical bowel preparation increase Clostridium difficile colitis after colon surgery? An assessment from ACS-NSQIP procedure-targeted database Cigdem Benlice, Ipek
More informationCharles Bernick, MD, MPH Cleveland Clinic Lou Ruvo Center for Brain Health June 2, 2018
Charles Bernick, MD, MPH Cleveland Clinic Lou Ruvo Center for Brain Health June 2, 2018 Delirium common Prolongs hospitalization Worsens dementia ( if you survive) Increased risk of institutionalization
More informationObjectives. Preoperative Assessment of the Geriatric Patient
Preoperative Assessment of the Geriatric Patient Kelsey Walker, MD Geriatric Grand Rounds May 21, 2015 Objectives Introduction: why does it matter? Review traditional tools to assess preoperative risk:
More informationA case-control study of readmission to the intensive care unit after cardiac surgery
DOI: 0.2659/MSM.88384 Received: 202.04.24 Accepted: 203.0.25 Published: 203.02.28 A case-control study of readmission to the intensive care unit after cardiac surgery Authors Contribution: Study Design
More informationDo you know. Assessment of Delirium. What is Delirium? Which syndrome occurs more commonly in elderly populations? a. Delirium b.
Assessment of Delirium Marianne McCarthy, PhD, GNP, PMHNP Arizona State University College of Nursing and Health Innovation What is Delirium? Delirium is a common clinical syndrome characterized by: Inattention
More informationFrailty. Nicholas Butler MD, MBA Department of Family Medicine University of Iowa
Frailty Nicholas Butler MD, MBA Department of Family Medicine University of Iowa Doris 84 yo female who comes into your clinic with her daughter. She complains of feeling increasingly fatigued and just
More information