Abstract

HERRERA-LANDERO, Alejandro  and  D´HYVER DE LAS DESES, Carlos. Preoperative evaluation of the elderly. Rev. Fac. Med. (Méx.) [online]. 2018, vol.61, n.4, pp.43-55. ISSN 2448-4865.

The aging population has generated the need to adequate the preoperative evaluation for this population group. In the older adult, in addition to the physiological alterations resulting from aging, the high comorbidity and the presence of geriatric syndromes were added. These should be considered for the estimation of surgical risk in order to reduce postoperative complications and help in the reintegration to their social environment in the shortest time possible and with the highest degree of independence.

The preoperative assessment should identify in the anamnesis all the comorbidities and geriatric syndromes that could impact the perioperative period. Only indispensable laboratory and cabinet studies should be requested to measure the severity of known diseases or establish a pre-surgical baseline level and in no way does age justify extensive tests.

As in young adults, the cardiovascular disease has the most prevalent comorbidity and its adequate quantification is essential.. An important aspect is to determine the risk of developing an acute renal failure, and the preventive measures should be emphasized to limit this complication. A condition associated with cardiovascular diseases is the use of antiplatelet agents or oral anticoagulants. This condition should not delay the surgical procedures. Therefore, their adequate correction should improve the postoperative outcome.

Finally, the geriatric risk should be oriented to an adequate nutritional evaluation for an early implementation of adequate food consumption. We must determine the baseline state of the functionality to initiate an early rehabilitation. Neuropsychological assessment should include the identification of risk factors for delirium, depression, cognitive impairment and alterations of the sleep pattern. It is essential to identify fragility in the elderly, to evaluate and limit polypharmacy.

Keywords : Non-hearth surgical procedures; old aged; aged; preoperative evaluation.