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  • Print publication year: 2018
  • Online publication date: January 2018

14 - Major Surgery in the Elderly

from Section 3 - Intraoperative Considerations
1.DeVol, R, Bedroussian, A. An Unhealthy America: The Economic Burden of Chronic Disease. Santa Monica, CA, Miliken Institute, 2007.
2.Bodenheimer, T, Chen, E, Bennett, HD. Confronting the growing burden of chronic disease: can the U.S. health care workforce do the job? Health Aff (Millwood). 2009; 28(1):6474.
3.Thorpe, KE, Howard, DH, Galactionova, K. Differences in disease prevalence as a source of the U.S.-European health care spending gap. Health Aff (Millwood). 2007; 26(6):w678w686.
4.Kinsella, K, He, W. An Aging World: 2008, International Population Reports, P95/09-1. Suitland, MD, US Census Bureau, 2009.
5.Administration on Aging. A profile of older Americans: 2013. Washington, DC, US Department of Health and Human Services, 2014.
6.Turrentine, FE, Wang, H, Simpson, VB, Jones, RS. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006; 203(6):865877.
7.Story, DA. Postoperative complications in elderly patients and their significance for long-term prognosis. Curr Opin Anaesthesiol. 2008; 21(3):375379.
8.Story, DA. Postoperative mortality and complications. Best Pract Res Clin Anaesthesiol. 2011; 25(3):319327.
9.Story, DA, Leslie, K, Myles, PS, et al. Complications and mortality in older surgical patients in Australia and New Zealand (the REASON study): a multicentre, prospective, observational study. Anaesthesia. 2010; 65(10):10221030.
10.Kowdley, GC, Merchant, N, Richardson, JP, et al. Cancer surgery in the elderly. Sci World J. 2012; 2012:9.
11.Al-Refaie, WB, Parsons, HM, Henderson, WG, et al. Major cancer surgery in the elderly: results from the American College of Surgeons National Surgical Quality Improvement Program. Ann Surg. 2010; 251(2):311318.
12.Kwok, AC, Semel, ME, Lipsitz, SR, et al. The intensity and variation of surgical care at the end of life: a retrospective cohort study. Lancet. 2011; 378(9800):14081413.
13.Kehlet, H, Wilmore, DW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002; 183(6):630641.
14.Kehlet, H, Wilmore, DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008; 248(2):189198.
15.Wilmore, DW, Kehlet, H. Management of patients in fast track surgery. BMJ. 2001; 322(7284):473476.
16.Varadhan, KK, Lobo, DN, Ljungqvist, O. Enhanced recovery after surgery: the future of improving surgical care. Crit Care Clin. 2010; 26(3):527547, x.
17.Ljungqvist, O. ERAS – Enhanced Recovery After Surgery: moving evidence-based perioperative care to practice. JPEN J Parenter Enteral Nutr. 2014; 38(5):559566.
18.Segelman, J, Nygren, J. Evidence or eminence in abdominal surgery: recent improvements in perioperative care. World J Gastroenterol. 2014; 20(44):1661516619.
19.Gustafsson, UO, Scott, MJ, Schwenk, W, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS(R)) Society recommendations. Clin Nutr. 2012; 31(6):783800.
20.Fearon, KC, Ljungqvist, O, Von Meyenfeldt, M, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005; 24(3):466477.
21.Lassen, K, Soop, M, Nygren, J, et al. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg. 2009; 144(10):961969.
22.Gillissen, F, Hoff, C, Maessen, JM, et al. Structured synchronous implementation of an enhanced recovery program in elective colonic surgery in 33 hospitals in The Netherlands. World J Surg. 2013; 37(5):10821093.
23.Miller, TE, Thacker, JK, White, WD, et al. Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol. Anesth Analg. 2014; 118(5):10521061.
24.Findlay, JM, Gillies, RS, Millo, J, et al. Enhanced recovery for esophagectomy: a systematic review and evidence-based guidelines. Ann Surg. 2014; 259(3):413431.
25.Blom, RL, van Heijl, M, Bemelman, WA, et al. Initial experiences of an enhanced recovery protocol in esophageal surgery. World J Surg. 2013; 37(10):23722378.
26.Lee, J, Jeon, H. The clinical indication and feasibility of the enhanced recovery protocol for curative gastric cancer surgery: analysis of 147 consecutive experiences. Dig Surg. 2014; 31(4-5):318323.
27.Mortensen, K, Nilsson, M, Slim, K, et al. Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS(R)) Society recommendations. Br J Surg. 2014; 101(10):12091229.
28.Lassen, K, Coolsen, MM, Slim, K, et al. Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS(R)) Society recommendations. Clin Nutr. 2012; 31(6):817830.
29.Kagedan, DJ, Ahmed, M, Devitt, KS, Wei, AC. Enhanced recovery after pancreatic surgery: a systematic review of the evidence. HPB (Oxford). 2015; 17(1):1116.
30.Page, AJ, Ejaz, A, Spolverato, G et al. Enhanced recovery after surgery protocols for open hepatectomy–physiology, immunomodulation, and implementation. J Gastrointest Surg. 2015; 19(2):387399.
31.Hughes, MJ, McNally, S, Wigmore, SJ. Enhanced recovery following liver surgery:a systematic review and meta-analysis. HPB (Oxford). 2014; 16(8):699706.
32.Nygren, J, Thacker, J, Carli, F, et al. Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS(R)) Society recommendations. Clin Nutr. 2012; 31(6):801816.
33.Cerantola, Y, Valerio, M, Persson, B, et al. Guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced Recovery After Surgery (ERAS(R)) society recommendations. Clin Nutr. 2013; 32(6):879887.
34.Mir, MC, Zargar, H, Bolton, DM, Murphy, DG, Lawrentschuk, N. Enhanced Recovery After Surgery protocols for radical cystectomy surgery: review of current evidence and local protocols. ANZ J Surg. 2015; 85(7–8):514520. Groot, JJ, van Es, LE, Maessen, JM, et al. Diffusion of Enhanced Recovery principles in gynecologic oncology surgery: is active implementation still necessary? Gynecol Oncol. 2014; 134(3):570575.
36.Nelson, G, Kalogera, E, Dowdy, SC. Enhanced recovery pathways in gynecologic oncology. Gynecol Oncol. 2014; 135(3):586594.
37.Hughes, M, Coolsen, MM, Aahlin, EK, et al. Attitudes of patients and care providers to enhanced recovery after surgery programs after major abdominal surgery. J Surg Res. 2015; 193(1):102110.
38.Bakker, N, Cakir, H, Doodeman, HJ, Houdijk, AP. Eight years of experience with Enhanced Recovery After Surgery in patients with colon cancer: impact of measures to improve adherence. Surgery. 2015; 157(6):11301136.
39.McLeod, RS, Aarts, MA, Chung, F, et al. Development of an Enhanced Recovery After Surgery guideline and implementation strategy based on the knowledge-to-action cycle. Ann Surg. 2015; 262(6):10161025.
40.Stowers, MD, Lemanu, DP, Hill, AG. Health economics in Enhanced Recovery After Surgery programs. Can J Anaesth. 2015; 62(2):219230.
41.Bagnall, NM, Malietzis, G, Kennedy, RH, et al. A systematic review of enhanced recovery care after colorectal surgery in elderly patients. Colorectal Dis. 2014; 16(12):947956.
42.Scharfenberg, M, Raue, W, Junghans, T, Schwenk, W. “Fast-track” rehabilitation after colonic surgery in elderly patients – is it feasible? Int J Colorectal Dis. 2007; 22(12):14691474.
43.Wang, Q, Suo, J, Jiang, J, et al. Effectiveness of fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for elderly patients: a randomized trial. Colorectal Dis. 2012; 14(8):10091013.
44.Baek, SJ, Kim, SH, Kim, SY, et al. The safety of a “fast-track” program after laparoscopic colorectal surgery is comparable in older patients as in younger patients. Surg Endosc. 2013; 27(4):12251232.
45.Jia, Y, Jin, G, Guo, S, et al. Fast-track surgery decreases the incidence of postoperative delirium and other complications in elderly patients with colorectal carcinoma. Langenbecks Arch Surg. 2014; 399(1):7784.
46.Carli, F, Charlebois, P, Stein, B, et al. Randomized clinical trial of prehabilitation in colorectal surgery. Br J Surg. 2010; 97(8):11871197.
47.Li, C, Carli, F, Lee, L, et al. Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study. Surg Endosc. 2013; 27(4):10721082.
48.Bouras, AF. Hospital discharge of elderly patients after surgery: fast-track recovery versus the need for convalescence. J Visc Surg. 2014; 151(2):8990.
49.Biffl, WL, Biffl, SE. Rehabilitation of the geriatric surgical patient: predicting needs and optimizing outcomes. Surg Clin North Am. 2015; 95(1):173190.
50.Carli, F, Brown, R, Kennepohl, S. Prehabilitation to enhance postoperative recovery for an octogenarian following robotic-assisted hysterectomy with endometrial cancer. Can J Anaesth. 2012; 59(8):779784.
51.Cheema, FN, Abraham, NS, Berger, DH, et al. Novel approaches to perioperative assessment and intervention may improve long-term outcomes after colorectal cancer resection in older adults. Ann Surg. 2011; 253(5):867874.
52.Mayo, NE, Feldman, L, Scott, S, et al. Impact of preoperative change in physical function on postoperative recovery: argument supporting prehabilitation for colorectal surgery. Surgery. 2011; 150(3):505514.
53.Gillis, C, Li, C, Lee, L, et al. Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology. 2014; 121(5):937947.
54.Holte, K, Nielsen, KG, Madsen, JL, Kehlet, H. Physiologic effects of bowel preparation. Dis Colon Rectum. 2004; 47(8):13971402.
55.Gustafsson, UO, Scott, MJ, Schwenk, W, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS(R)) Society recommendations. World J Surg. 2013; 37(2):259284.
56.Jung, B, Lannerstad, O, Pahlman, L, et al. Preoperative mechanical preparation of the colon: the patient's experience. BMC Surg. 2007; 7:5.
57.Jung, B, Pahlman, L, Nystrom, PO, Nilsson, E; Mechanical Bowel Preparation Study G. Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection. Br J Surg. 2007; 94(6):689695.
58.Brady, M, Kinn, S, Stuart, P. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev. 2003(4):CD004423.
59.American Society of Anesthesiologists Committee. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology. 2011; 114(3):495511.
60.Nygren, J. The metabolic effects of fasting and surgery. Best Pract Res Clin Anaesthesiol. 2006; 20(3):429438.
61.Shoemaker, WC, Appel, PL, Kram, HB. Tissue oxygen debt as a determinant of lethal and nonlethal postoperative organ failure. Crit Care Med. 1988; 16(11):11171120.
62.Holte, K, Sharrock, NE, Kehlet, H. Pathophysiology and clinical implications of perioperative fluid excess. Br J Anaesth. 2002; 89(4):622632.
63.Nicholau, D. The postanesthesia care unit. In: Miller, RD, ed., Miller's Anesthesia, 7th edn. Philadelphia, PA, Elsevier, 2010; 27082728.
64.Griffiths, R, Beech, F, Brown, A, et al. Peri-operative care of the elderly 2014: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia. 2014; 69(Suppl 1):8198.
65.Kaye, AD, Riopelle, JM. Intravascular fluid and electrolyte physiology. In: Miller, RD, ed., Miller's Anesthesia, 7th edn. Philadelphia, PA, Elsevier, 2010; 17051735.
66.Brandstrup, B, Tonnesen, H, Beier-Holgersen, R, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg. 2003; 238(5):641648.
67.Brandstrup, B, Svendsen, PE, Rasmussen, M, et al. Which goal for fluid therapy during colorectal surgery is followed by the best outcome: near-maximal stroke volume or zero fluid balance? Br J Anaesth. 2012; 109(2):191199.
68.Nisanevich, V, Felsenstein, I, Almogy, G, et al. Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology. 2005; 103(1):2532. Aguilar-Nascimento, JE, Diniz, BN, do Carmo, AV, Silveira, EA, Silva, RM. Clinical benefits after the implementation of a protocol of restricted perioperative intravenous crystalloid fluids in major abdominal operations. World J Surg. 2009; 33(5):925930.
70.Chappell, D, Jacob, M, Hofmann-Kiefer, K, Conzen, P, Rehm, M. A rational approach to perioperative fluid management. Anesthesiology. 2008; 109(4):723740.
71.Shoemaker, WC. Oxygen consumption as an outcome predictor. Intensive Care Med. 1988; 15(1):6466.
72.Shoemaker, WC, Appel, PL, Kram, HB, Waxman, K, Lee, TS. Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest. 1988; 94(6):11761186.
73.Grocott, MP, Dushianthan, A, Hamilton, MA, et al. Perioperative increase in global blood flow to explicit defined goals and outcomes following surgery. Cochrane Database Syst Rev. 2012(11):CD004082.
74.Corcoran, T, Rhodes, JE, Clarke, S, Myles, PS, Ho, KM. Perioperative fluid management strategies in major surgery: a stratified meta-analysis. Anesth Analg. 2012; 114(3):640651.
75.Fawcett, WJ, Baldini, G. Optimal analgesia during major open and laparoscopic abdominal surgery. Anesthesiol Clin. 2015; 33(1):6578.
76.Vadivelu, N, Mitra, S, Narayan, D. Recent advances in postoperative pain management. Yale J Biol Med. 2010; 83(1):1125.
77.Gritsenko, K, Khelemsky, Y, Kaye, AD, Vadivelu, N, Urman, RD. Multimodal therapy in perioperative analgesia. Best Pract Res Clin Anaesthesiol. 2014; 28(1):5979.
78.Lovich-Sapola, J, Smith, CE, Brandt, CP. Postoperative pain control. Surg Clin North Am. 2015; 95(2):301318.
79.Buvanendran, A, Kroin, JS. Multimodal analgesia for controlling acute postoperative pain. Curr Opin Anaesthesiol. 2009; 22(5):588593.
80.Tan, M, Law, LS, Gan, TJ. Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways. Can J Anaesth. 2015; 62(2):203218.
81.White, PF. Multimodal analgesia: its role in preventing postoperative pain. Curr Opin Investig Drugs. 2008; 9(1):7682.
82.Joshi, GP, Schug, SA, Kehlet, H. Procedure-specific pain management and outcome strategies. Best Pract Res Clin Anaesthesiol. 2014; 28(2):191201.
83.Joshi, GP, Kehlet, H. Procedure-specific pain management: the road to improve postsurgical pain management? Anesthesiology. 2013; 118(4):780782.
84.Moraca, RJ, Sheldon, DG, Thirlby, RC. The role of epidural anesthesia and analgesia in surgical practice. Ann Surg. 2003; 238(5):663673.
85.Popping, DM, Elia, N, Van Aken, HK, et al. Impact of epidural analgesia on mortality and morbidity after surgery: systematic review and meta-analysis of randomized controlled trials. Ann Surg. 2014; 259(6):10561067.
86.Sun, Y, Li, T, Wang, N, Yun, Y, Gan, TJ. Perioperative systemic lidocaine for postoperative analgesia and recovery after abdominal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum. 2012; 55(11):11831194.
87.Golembiewski, J, Dasta, J. Evolving role of local anesthetics in managing postsurgical analgesia. Clin Ther. 2015; 37(6):13541371.
88.Trabold, B, Metterlein, T. Postoperative delirium: risk factors, prevention, and treatment. J Cardiothorac Vasc Anesth. 2014; 28(5):13521360.
89.Sieber, FE, Zakriya, KJ, Gottschalk, A, et al. Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair. Mayo Clin Proc. 2010; 85(1):1826.
90.Rasmussen, LS, Steentoft, A, Rasmussen, H, Kristensen, PA, Moller, JT. Benzodiazepines and postoperative cognitive dysfunction in the elderly. ISPOCD Group. International Study of Postoperative Cognitive Dysfunction. Br J Anaesth. 1999; 83(4):585589.
91.Marcantonio, ER, Juarez, G, Goldman, L, et al. The relationship of postoperative delirium with psychoactive medications. Jama. 1994; 272(19):15181522.
92.Pandharipande, P, Shintani, A, Peterson, J, et al. Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology. 2006; 104(1):2126.
93.Pisani, MA, Murphy, TE, Araujo, KL, et al. Benzodiazepine and opioid use and the duration of intensive care unit delirium in an older population. Crit Care Med. 2009; 37(1):177183.
94.Avidan, MS, Zhang, L, Burnside, BA, et al. Anesthesia awareness and the bispectral index. N Engl J Med. 2008; 358(11):10971108.
95.Punjasawadwong, Y, Phongchiewboon, A, Bunchungmongkol, N. Bispectral index for improving anaesthetic delivery and postoperative recovery. Cochrane Database Syst Rev. 2014(6):CD003843.
96.Chan, MT, Cheng, BC, Lee, TM, Gin, T, Group, CT. BIS-guided anesthesia decreases postoperative delirium and cognitive decline. J Neurosurg Anesthesiol. 2013; 25(1):3342.
97.Wong, J, Song, D, Blanshard, H, Grady, D, Chung, F. Titration of isoflurane using BIS index improves early recovery of elderly patients undergoing orthopedic surgeries. Can J Anaesth. 2002; 49(1):1318.
98.Radtke, FM, Franck, M, Lendner, J, et al. Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction. Br J Anaesth. 2013; 110(Suppl 1):i98i105.
99.Kehlet, H. Enhanced Recovery After Surgery (ERAS): good for now, but what about the future? Can J Anaesth. 2015; 62(2):99104.