Geriatrische Probleme im perioperativ-chirurgischen Management

 

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Zusammenfassung

Verbesserte Gesundheitsfürsorge und damit höhere Lebenserwartung bewirken einerseits eine wachsende Patientenzahl entsprechenden Alters bzw. die „Gesundung” eines konkret zu betrachtenden Alters und andererseits ein durchschnittlich älter werdendes Patientenklientel mit einem breiteren Spektrum komplikationsträchtiger physischer, psychischer und funktioneller Alterationen, Vor- und Begleiterkrankungen, laufender Medikationen und verschiedenartigster periinterventioneller Betreuungsverhältnisse. Dies setzt eine kompetente Betreuung und Versorgung durch den behandelnden Chirurgen mit mehr denn je zu fordernden Spezialkenntnissen auch im geriatrischen Bereich voraus. Neben der Einhaltung der etablierten Diagnostik- und Therapiestandards auch in der diskutierten geriatrischen Kohorte von Patienten sind erhöhte Anforderungen, insbesondere an Operationstechnik (z. B. aufgrund von Voroperationen, morphologischer Spezifika usw.), Narkoseführung (intraoperative Kreislaufdepression und kardiale Insuffizienz, verminderte Organreservekapazität) und Intensivmedizin (häufigere kardiopulmonale und -zirkulatorische Überwachungspflicht, postoperatives hirnorganisches Psychosyndrom) gegeben. Eine interdisziplinäre Zusammenarbeit im Vorfeld, periinterventionell als auch für die Rekonvaleszenz, Nachbetreuung bzw. Rehabilitation ist gefordert. Der vorliegende Artikel umreißt neben einleitenden epidemiologischen Betrachtungen ausgewählte Erkrankungen und Befundkonstellationen, Betreuungsansätze und Auswirkungen. Die morphologischen, pathophysiologischen und funktionellen Spezifika des älteren chirurgischen Patienten werden dargestellt.

Abstract

Improved healthcare and longer life expectancy have led to more and overall, healthier older patients. As a consequence, we now see more surgical complications attributable to an ever-increasing spectrum of the physiologic changes of aging. These include functional decline, psychiatric as well as medical co-morbidities, medication effects and peri-operative environmental changes. To maintain high patient care standards in geriatric operative patients, surgeons face challenges in peri-operative care (co-morbidities), anesthesia (intra-operative circulatory depression, cardiac insufficiency and limited organ reserve), and intensive care (cardiopulmonary surveillance and delirium). In contrast to the normally temporary surgical period, interdisciplinary approaches are essential during extended peri-operative, convalescent, rehabilitation and follow-up phases of care in the geriatric patient. This will require competency in the realm of geriatrics, on behalf of the treating surgeon who, as a result, will become increasingly more specialized in the future. This article addresses current epidemiology and symptomatology of particular diseases, and as well, offers treatment suggestions with explanations of geriatric pathophysiology and functional decline from a clinically relevant perspective. This review highlights the increased difficulty in treatment of multiple disease processes in the elderly as a result of natural decline in function of all organ systems.

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Irene HamrickMD 

Brody School of Medicine at East Carolina University · Brody 4N-72A

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Greenville, NC 27858

U.S.A.

Phone: 0 01/2 52/7 44/24 50

Email: hamricki@mail.ecu.edu