Quick tweetorial on perioperative care of the frail patient. You might do things differently, I would love to know what you do!
@TomVargheseJr @aoglasser @KurtPfeifer @SPAQIedu @ASER_hq @Jeanna_BlitzMD @BobbieJeanSwei1 @afedwardMD @uabmedicine @UABSurgery @UAB_Anesthesia
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@TomVargheseJr @aoglasser @KurtPfeifer @SPAQIedu @ASER_hq @Jeanna_BlitzMD @BobbieJeanSwei1 @afedwardMD @uabmedicine @UABSurgery @UAB_Anesthesia
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Older patients and frail patients require adjustments in perioperative care.
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All patients should be screened for frailty! Older patients are especially at high risk for frailty!
UAB PACT uses cognitive function, nutrition, and mobility screening to identify at risk patients.
PACT = Preoperative Assessment, Consultation, and Treatment Clinic
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UAB PACT uses cognitive function, nutrition, and mobility screening to identify at risk patients.
PACT = Preoperative Assessment, Consultation, and Treatment Clinic
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The Six Item Screen and Mini-Cog are common tools to identify patients at risk. UAB PACT used the 6IS because the floors were already using it.
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UAB PACT uses Nestle Mini-Nutritional Assessment. The Duke perioperative nutrition screen (PONS) is another easy to use tool. @Paul_Wischmeyer
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Activities of daily living can be assessed with the Katz Screening Tool.
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Another quick screening tool for frailty is the Clinical Frailty Scale. --very easy to use.
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Frail patients will often need to walk as much as they can before surgery, increase their protein intake, and perform pulmonary exercises. --multiple ways to accomplish this.
Starts with identifying the frail patient and giving them recommendations.
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Starts with identifying the frail patient and giving them recommendations.
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Immunonutrition and certain supplements should be considered for frail patients preoperatively. @Paul_Wischmeyer has a wealth of information on this topic.
[no financial relationship]
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[no financial relationship]
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Creating a preoperative pathway will ensure you do all the steps. Communication is KEY!!
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Intraoperative pathways will involve adjustment of anesthesia and medications.
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Depth of anesthesia may be problematic for geriatric patients and maybe for frail patients.
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Surveillance of the frail patient postoperatively is important! Anticipate complications and attempt to prevent them. Start discharge planning early!
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UAB PACU has cognitive aide boxes intended to reduce postoperative delirium.
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The ACS Geriatric Management recommendations are a must read.
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