Why the study?
Does preoperative staging based on invasive monitoring identify high operative risk and predict operative mortality in elderly patients cleared for surgery by standard assessment?
Does preoperative staging based on invasive monitoring identify high operative risk and predict operative mortality in elderly patients cleared for surgery by standard assessment?
Invasive preoperative monitoring in elderly patients cleared by standard assessment reveals a high rate of severe physiologic abnormalities that strongly predict operative mortality.
Identifies occult high-risk defects predicting operative death in elderly patients; leaves open whether invasive staging should guide decisions beyond standard assessment.
To reduce operative mortality in elderly patients, a system of preoperative staging, based on invasive monitoring, was developed. All of the 148 consecutive patients studied had been cleared for surgery by standard assessment, but only 13.5% had normal measured, hemodynamic, respiratory, and oxygen transport function. Mild physiologic aberrations, not requiring a delay in surgery, or more severe abnormalities, indicative of high operative risk, were found in 63.5% of the patients. Advanced and incorrigible functional defects found in the remaining 23% made them unacceptable risks for major surgery under general anesthesia, and all who underwent the planned operation in spite of the warning died. Invasive preoperative assessment of elderly patients discloses a high percentage of serious physiologic abnormalities requiring a delay in some and cancellation of the operation in others. (JAMA243:1350-1355, 1980)
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Louis R. M. Del Guercio (1980) studied this question.
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