13. AGE and OBESITY
*Overall surgical mortality for all adults under 65 is 0.9% as compared to 5-10% in patients 65 to 80 and 10-20% in patients over 80; however, these statistics do not take into account any surgical risk factors apart from age. Older patients are more likely to have underlying medical conditions, and it is felt that these conditions-and not the age-account for the majority of the increased surgical risk. Normal aging itself as a surgical risk factor remains controversial. Studies that control for underlying disease have failed to show an independent effect of age on surgical risk, and mortality among older patients free of disease is very low.
SPECIFIC CONCERNS IN THE ELDERLY:
*Obese patients do have a higher risk of surgical complications, although mortality is NOT significantly increased due to obesity alone. (Comorbid conditions, however, are common in obese patients and can increase perioperative morbidity/mortality themselves.)
SPECIFIC CONCERNS IN OBESE PATIENTS:
prophylaxis is essential for hospitalized obese patients.
wound prophylaxis is generally given; should also consider other measures for
high-risk wounds (such as aggressive intraoperative warming and tight glycemic
control if diabetic).
lung disease at baseline. Obese
patients need to sit up in bed and get up to a chair as soon as possible postop
to maximize lung expansion. Incentive
spirometer is essential; suctioning device may also be needed to avoid
Sleep apnea—nasal CPAP
should be continued if patient is already using.
Ideally, patient should have his/her own CPAP machine brought from
home to use while in-house.
patient has only suspected sleep apnea by history (but not documented) or if
patient with known sleep apnea does not tolerate CPAP, then recommended measures
include head of bed elevation (60 to 90 degrees), continuous pulse oximeter
while in bed (especially overnight), and supplemental oxygen to maintain 02
A trial of nasal CPAP can also be attempted for patients who experience
desaturation overnight despite supplemental oxygen.
diabetes, cardiac disease, etc.