AGING AND PERIOPERATIVE OUTCOMES

描述：（申请人摘要）年龄> 65岁的人预计将 到世纪末，人口超过五千万，占总人口的百分之二十。 老年人接受了大约40%的外科手术， 每年的支出超过600亿美元。 我们以前的工作表明， 接受非手术治疗的老年人的术后住院发病率 心脏手术的比例是25% 通过多因素Logistic回归， 神经系统疾病、充血性心力衰竭和心律失常增加了 发生任何术后不良事件的几率。 我们的工作重点是 确定围手术期并发症的预测因素， 老年手术患者随后进行临床试验，以修改风险 因素，以改善围手术期结局。 四位一体临床 计划进行的研究：1）一项前瞻性纵向队列研究， 接受非心脏手术的连续老年外科患者。 这 研究旨在确定围手术期并发症对 功能状态和长期生存的老年外科病人， 测量预定义的院内不良术后结局，以及 术后2年的功能和生存状态。 2)一项前瞻性 200例接受非心脏手术的老年患者的队列研究。 这 研究旨在确定术前临床方法的准确性， 与超声心动图相比，评估心脏功能; 术前舒张功能不全与 术后心力衰竭 3)300例患者的前瞻性队列研究 接受冠状动脉搭桥手术 本研究旨在确定 如果通过术中经食管测量左心房功能障碍， 超声心动图提供了预测发生 术后房颤与常规临床数据比较。 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的麻醉与全身麻醉比较 手术 本研究旨在确定术后 区域麻醉与全身麻醉之间的认知功能障碍和谵妄 在控制术中麻醉和血流动力学管理后， 术后疼痛管理 术后认知功能与谵妄 将通过标准神经心理学测试和混乱来测量 评估方法。 我们相信，我们的研究将提供重要的成果， 最终有助于改善围手术期结局， 老年患者。

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.