Preoperative communication with older patients and their families about high-risk surgical outcomes

Berian JR, et al. Association of Loss of Independence With Readmission and Death After Discharge in Older Patients After Surgical Procedures. JAMA Surg. 2016 Sep 21;151(9): e161689.

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Results: Of the 5077 patients included in this study, 2736 (53.9%) were female and 3876 (76.3%) were white, with a mean (SD) age of 75 (7) years. For this cohort, LOI increased with age; LOI occurred in 1386 of 2780 patients (49.9%) aged 65 to 74 years, 1162 of 1726 (67.3%) aged 75 to 84 years, and 479 of 571 (83.9%) 85 years and older (P < .001). Readmission occurred in 517 patients (10.2%). In a risk-adjusted model, LOI was strongly associated with readmission (odds ratio, 1.7; 95% CI, 1.4-2.2) and postoperative complication (odds ratio, 6.7; 95% CI, 4.9-9.0). Death after discharge occurred in 69 patients (1.4%). After risk adjustment, LOI was the strongest factor associated with death after discharge (odds ratio, 6.7; 95% CI, 2.4-19.3). Postoperative complication was not significantly associated with death after discharge.


Seib CD, Finlayson E. Invasive Procedures to Improve Function in Frail Older Adults: Do Outcomes Justify the Intervention? JAMA Intern Med. 2019 Mar 1;179(3):391-393.

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“As the number of older adults with severe AS increases, discussing the anticipated risks, benefits, and functional outcomes of treatment options, including TAVR, is essential to ensure appropriate patient care and decision making. Standard evaluation by multidisciplinary heart teams should include a robust discussion of each patient’s goals and priorities. As a part of shared decision making, these goals should be weighed against a realistic assessment of whether they will be achieved with TAVR or SAVR according to a patient’s preoperative frailty and functional status. If anticipated outcomes are not acceptable, alternative strategies to address symptom management would benefit this vulnerable patient population. 8 In addition, further research evaluating the feasibility and functional outcomes of prehabilitation or perioperative interventions that reduce both delirium and complications on functional recovery is needed to optimize outcomes in older adults who elect to undergo invasive cardiovascular procedures.”


More PubMed results for preoperative discussions with high-risk geriatric patients.

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