Unplanned Hospitalization .34 .29
Death
.02 .01
Total
3.13 3.13
Value of Preoperative Testing Before Low Risk Surgery
Schein. N Engl J Med 2000; 342:168
“Tests should be ordered only when
– Age may = disease when > 85 yrs – Increase ASA PS when > 85 yrs
Preoperative Considerations
• Preoperative Assessment
– No routine preoperative testing – Statin myopathic syndromes – Diastolic dysfunction
老年病人的麻醉管理
Hayflick’s View of Aging
“Because modern humans, unlike feral
animals, have learned how to escape death long after reproductive success, we have revealed a process that, teleologically, was never intended for us to experience.”
Fleisher. Anesth Analg 1999; 89:849
25% 20% 15% 10%
5% 0%
<65 66-70 71-75 76-80 81-85 >85 yrs
aortic infrainquinal
Perioperative Complication Rates in Medicare Patients
• GENERAL ANESTHETIC 113
– Br J Anaesth 2000; 84:260
Life Expectancy at birth USA - 1997
WOMEN Caucasian
79.9 yrs
African-American 74.7
MEN Caucasian
74.3
African-American 67.2
• Diabetes Mellitus
– Tighter glucose control with insulin – Stop oral hypoglycemic agents
Why Obtain Preoperative Tests?
• Screening – NO with one exception
67-80
– Premature death (trauma, disease)
Oldest Surgical Patient?
Oliver. Br J Anaesth 2000; 84:260
• Woman, 113 yrs, femoral fracture • General anesthesia • CVP, no arterial-line • Extubation in ICU after 5h • Hospital discharge POD 23
Life Expectancy, Life Span, & Maximum Length of Life
• Maximum Length of Life
> 120 yrs
• Life Span
85-100
– Natural death (no trauma or disease)
• Life Expectancy (USA)
# Anesthetics per 100 Population?
Clergue. Anesthesiology 1999; 91:1509 (France)
Ages (yrs) Men
Women
35 – 44
8.9
13.2
55 - 64
17.7
14.6
75 - 84
30.2
23.6
Vascular Surgery – Mortality vs Age
Age & Perioperative Outcome
• With advancing age
– More surgery – Morbidity increases – Mortality increases
• Cause - disease vs age ?
– Disease > age when < 85 yrs
– Urinalysis if hip surgery or acutely ill – Cook & Rooke, Anesth Analg 2003; 96:1823
• Treatment effectiveness - YES • Baseline – MAYBE, but overused • Risk Assessment - YES
# Older Americans
> 65 yrs > 80 yrs
2000 2030 12.4% 19.6% 35 mil 71 mil 9.3 mil 19.5 mil
The Oldest…..
• MAN
120 yrs
• WOMAN
– Guinness Book of Records
122
• Intermediate Risk Surgery - 42%
– Silber, Anesthesiology 2000; 93:152 – 217,440 general & orthopedic surgery
• Low Risk Surgery - 3%
– Schein, N Engl J Med 2000; 342:168 – 18,901 cataract surgery
Value of Preoperative Testing Before Low Risk Surgery
Schein. N Engl J Med 2000; 342:168
Rate/100
Untested Tested
Medical Event: Intraop
1.87 1.94
stop
.92 .94