The complexity of risk stratification in older patient candidate to non-cardiac surgery

Samuele Baldasseroni, Francesco Orso, Alessandra Pratesi, Alice Foschini, Andrea Giosafat Marella, Nadia Bartoli, Ilaria Bracali, Alessando Antenore, Francesca Tarantini, Costanza Burgisser, Niccolò Marchionni
  • Samuele Baldasseroni
    Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatrics, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy | pesine@libero.it
  • Francesco Orso
    Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatrics, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
  • Alessandra Pratesi
    Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatrics, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
  • Alice Foschini
    Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatrics, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
  • Andrea Giosafat Marella
    Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatrics, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
  • Nadia Bartoli
    Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatrics, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
  • Ilaria Bracali
    Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatrics, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
  • Alessando Antenore
    Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatrics, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
  • Francesca Tarantini
    Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatrics, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
  • Costanza Burgisser
    Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatrics, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
  • Niccolò Marchionni
    Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatrics, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

Abstract

During the last decades the older patients who are candidates for surgery have grown esponentially due to the increase in life expectancy and the surgery technique improvement. Despite this, the mortality remains high and our ability to predict the surgery outcomes continues to be low in the elderly. The main reason is related to different difficulties; we are unable to differentiate properly the chronological from the biological age, and the current surgery and cardiology risk scores are poorly geriatric-oriented. We must underline how the measure of comorbidity during the preoperative evaluation is often limited to a simple count of comorbid conditions, without a more detailed assessment of their severity. On the other hand different comorbidity scores have been validated in geriatric populations showing a good correlation with prognosis, such as the Index of Coexisting Disease-ICED or the Geriatric Index of Comorbidity-GIC. Our predictive deficiency about the outcomes is linked to poor attention for identifying the frail patients that are already at high risk of disability. Recently, the evaluation of frailty is a key target for geriatric medicine, and geriatricians have developed various methods for measuring this parameter and suggesting the physical performance indexes as a reliable surrogate of frailty. Surrogate frailty measures, such as the “gait speed” or the “Short Physical Performance Battery-SPPB” seem to be the valid tools for evaluating older surgery patients due to their simplicity and short administration time. We think that the future challenge will be their widespread use in this specific clinical setting.

Keywords

non cardiac surgery, risk stratification, elderly, preoperative care, frailty.

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Submitted: 2015-12-01 15:03:30
Published: 2015-12-01 15:30:03
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Copyright (c) 2015 Samuele Baldasseroni, Francesco Orso, Alessandra Pratesi, Alice Foschini, Andrea Giosafat Marella, Nadia Bartoli, Ilaria Bracali, Alessando Antenore, Francesca Tarantini, Costanza Burgisser, Niccolò Marchionni

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