A community-dwelling 80-year-old patient comes to the physician for preoperative assessment prior to elective hip replacement. Which of the following would be the best metric for determining the likelihood of 30-day post-operative complications and discharge to a nursing facility?

Question

A community-dwelling 80-year-old patient comes to the physician for preoperative assessment prior to elective hip replacement.  Which of the following would be the best metric for determining the likelihood of 30-day post-operative complications and discharge to a nursing facility?

Quizplus · Accepted Answer

11ec193a_991c_c5c8_853d_f1a756281c08_MD0002_00 Preoperative assessment of geriatric patients has proved challenging. While all of the above options can be helpful, recent studies indicate that the presence of frailty is strongly associated with adverse post-operative outcomes. A commonly used frailty index is presented in the above table. One point is assigned for each criteria a patient meets, up to a maximum of 5 points. Scoring is as follows: 4-5 points - frail2-3 points - intermediately frail0-1 points - non-frail 4-5 points - frail 2-3 points - intermediately frail 0-1 points - non-frail There is a progressive increase in length of stay and 30-day post-operative complications with an increasing number of points. Individuals classified as frail have an odds ratio of 20 when compared with non-frail patients for discharge to a nursing facility. (Choices A and B) Determination of the likelihood of post-operative complications has traditionally been centered around the degree of dysfunction of key organ systems. These classification schemes still have value, but may be less useful in older patients. (Choice D) Impaired cognitive function as determined by Mini-Mental Status Exam evaluation is associated with an increased risk of developing post-operative delirium. Impaired cognitive function is one of several important determinants of post-operative complications; however, it is best used in conjunction with additional assessment tools. (Choice E) The medication list can often estimate the co-morbidity burden of a patient and, as such, is one of several factors that can be used to assess the likelihood of adverse post-operative outcomes. Educational objective: Determination of the presence and degree of frailty is helpful in assessing the likelihood of adverse post-operative outcomes in older patients. __________ References: Frailty as a predictor of surgical outcome in older patients. (http://www.ncbi.nlm.nih.gov/pubmed/20510798) Frailty is associated with post-operative complications in older adult patients with medical problems. (http://www.ncbi.nlm.nih.gov/pubmed/18068828)

A Community-Dwelling 80-Year-Old Patient Comes to the Physician for Preoperative