AGING AND PERIOPERATIVE OUTCOMES

描述：(申请人S摘要)预计65周岁以上的人 到本世纪末超过5000万，占总人口的20%。 老年人接受了大约40%的外科手术，总计 每年超过600亿美元的支出。我们以前的工作演示了 接受非手术治疗的80岁以上老年人术后住院并发症发生率 心脏手术的比例为25%。经多因素Logistic回归分析， 神经系统疾病、充血性心力衰竭和心律失常会增加 发生任何不良术后事件的几率。我们在这里的工作重点是 围术期并发症预测因素的确定 老年外科患者随后进行临床试验以改变风险 影响围术期预后的因素(S)。四结合临床 计划进行的研究：1)600人的前瞻性纵向队列研究 连续接受非心脏手术的老年外科患者。这 这项研究旨在确定围手术期并发症对 老年手术患者功能状态与远期生存的关系 测量预先定义的院内不良术后结果，以及 术后两年的功能和生存情况。2)潜在客户 200例老年非心脏手术患者的队列研究。这 本研究旨在确定手术前临床方法的准确性 评估心脏功能与超声心动图的比较；以及 术前舒张期功能不全与预后的关系 术后心力衰竭。3)300例患者的前瞻性队列研究 接受冠状动脉搭桥术。这项研究旨在确定 术中经食道测量左房功能不全 超声心动图对预测心绞痛的发生具有增量价值 术后房颤与常规临床资料比较。 在以后的几年里，我们将进行一项随机的临床试验 500例老年骨科手术患者全身麻醉的对比研究 做手术。本研究旨在确定术后并发症的发生率。 局部麻醉与全身麻醉之间的认知功能障碍和精神错乱 在控制术中麻醉和血流动力学管理后 术后疼痛管理。术后认知功能与精神错乱 将通过标准的神经心理测试和困惑来衡量 评估方法。我们相信，我们的研究将提供重要的结果 最终有助于改善围手术期的结果 老年病患者。

DESCRIPTION: (Applicant s abstract) People > 65 years of age are expected to exceed 50 million or 20% of the total population by the end of the century. The elderly undergo approximately 40% of all surgical procedures, amounting to an annual expenditure of over $60 billion. Our previous work demonstrated the postoperative in-hospital morbidity rate in octogenarians undergoing non- cardiac surgery to be 25%. By multivariate logistic regression, a history of neurological disease, congestive heart failure and arrhythmia increased the odds of developing any adverse postoperative events. Our work here focuses on the identification of the predictors of perioperative complications in geriatric surgical patients followed by clinical trials to modify the risk factor(s) in order to improve perioperative outcome. Four integrated clinical studies are planned: 1) A prospective, longitudinal cohort study of 600 consecutive geriatric surgical patients undergoing non-cardiac surgery. This study aims to determine the impact of perioperative complications on the functional status and long-term survival of the elderly surgical patients by measuring pre-defined in-hospital adverse postoperative outcomes, and functional and survival status at two years postoperatively. 2) A prospective cohort study of 200 geriatric patients undergoing non-cardiac surgery. This study aims to determine the accuracy of preoperative clinical methods of assessing heart function as compared to echocardiography; and also the prognostic relationship between preoperative diastolic dysfunction and postoperative heart failure. 3) A prospective cohort study of 300 patients undergoing coronary artery bypass graft surgery. This study aims to determine if left atrial dysfunction as measured by intraoperative transesophageal echocardiography provides incremental value in predicting the occurrence of postoperative atrial fibrillation when compared with routine clinical data. In later years, we will perform 4) a randomized, clinical trial of regional versus general anesthesia in 500 elderly patients undergoing orthopedic surgery. This study aims to determine the incidence of postoperative cognitive dysfunction and delirium between regional versus general anesthesia after controlling for intraoperative anesthetic and hemodynamic management and postoperative pain management. Postoperative cognitive function and delirium will be measured by standard neuropsychological tests and the Confusion Assessment Method. We believe that our studies will provide important results contributing ultimately to the improvement of perioperative outcomes in geriatric patients.