Optimal Preoperative Assessment of the Geriatric Surgical Patient: A Best Practices Guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society
Optimal Preoperative Assessment of the Geriatric Surgical Patient: A Best Practices Guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society
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DOI：
10.1016/j.jamcollsurg.2012.06.017
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发表时间：
2012-10-01
影响因子：
5.2
通讯作者：
Esnaola, Nestor F.
中科院分区：
文献类型：
--
作者：
Chow, Warren B.;Rosenthal, Ronnie A.;Esnaola, Nestor F.
美国（US）的人口正在增长和老龄化。美国人口普查局预计，2010 年至 2050 年间，65 岁及以上美国人的数量将增加一倍以上。到 2030 年，65 岁及以上美国人占总人口的比例将从 13% 增长到 20% 以上，而该群体中增长最快的部分（85 岁及以上人口）预计在未来 40 年中将增加两倍。美国人口年龄结构的这些变化主要是由于人们寿命延长以及“婴儿潮一代”在 2011 年跨入 65 岁及以上年龄段。1 这种人口结构变化将如何影响医疗保健系统？全国医院出院调查显示，老年人对医院的利用率不断提高。 1970 年，65 岁及以上的人占人口的 10%，2 他们占出院人数的 20% 和护理天数的 33%。 3 到 2007 年，65 岁及以上人口的比例小幅增长至 13%，但他们的住院使用率急剧上升至出院人数的 37% 和护理天数的 43%。 4 与其他年龄组相比，老年人每人群接受住院和门诊手术及非手术治疗的比率明显更高。 3-5 2006年，老年患者接受住院手术的比例为35.3%，门诊手术的比例为32.1%。 3, 5 随着美国人口持续老龄化，将对外科服务提出更高的要求。 6 必须制定策略来满足这些不断增长的需求并确保为老年外科患者提供更高质量的护理。老年外科专家小组认识到提高老年外科护理质量的必要性，美国外科医生学会国家外科质量改进计划 (ACS NSQIP) 和美国老年病学会 (AGS) 合作制定了围绕老年外科手术最佳护理的最佳实践指南 老年外科患者（此处介绍的指南侧重于这些患者的最佳术前评估）。组成了一个由 21 名成员组成的多学科小组，代表 2 个医疗保健专业协会、ACS 老年外科工作组、14 个医疗中心以及来自多个专业的代表：肿瘤外科、胃肠外科、结直肠外科、心胸外科、内分泌外科、高级腹腔镜外科、泌尿科、麻醉科和老年医学。
The population of the United States (US) is growing and aging. The US Census Bureau projects that the number of Americans age 65 years and older will more than double between 2010 and 2050. The percentage of Americans 65 and older will grow from 13% to more than 20% of the total population by 2030, and the fastest growing segment of this group (individuals 85 years and older) is expected to triple in number over the next 4 decades. These changes in the age demographics of the US population are largely due to people living longer and the “baby boomer” generation crossing into the 65 and older age bracket in 2011. 1 How will this demographic change affect the health care system? The National Hospital Discharge Survey has demonstrated increasing hospital utilization by elderly persons. In 1970, individuals 65 and older represented 10% of the population, 2 and they accounted for 20% of hospital discharges and 33% of the days of care. 3 By 2007, the percentage of persons 65 and older grew modestly to 13%, yet their hospital use increased drastically to 37% of hospital discharges and 43% of the days of care. 4 The older individuals have significantly higher rates per population of both inpatient and outpatient surgical and nonsurgical procedures compared with other age groups. 3-5 In 2006, elderly patients underwent 35.3% of inpatient procedures and 32.1% of outpatient procedures. 3, 5 As the population of the US continues to age, it will place greater demands on surgical services. 6 It is imperative that strategies are developed to meet these growing demands and to ensure higher quality care for geriatric surgical patients.GERIATRIC SURGERY EXPERT PANEL Recognizing the necessity for quality improvement in the geriatric surgical care, the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) and the American Geriatrics Society (AGS) collaborated to create best practices guidelines around optimal perioperative care of the geriatric surgical patient (the guidelines focusing on optimal preoperative assessment of these patients are presented here). A 21-member, multidisciplinary panel was assembled that represented 2 health care professional societies, the ACS Geriatric Surgery Task Force, 14 medical centers, and representatives from multiple specialties: surgical oncology, gastrointestinal surgery, colorectal surgery, cardiothoracic surgery, endocrine surgery, advanced laparoscopic surgery, urology, anesthesiology, and geriatric medicine.