VCUDEATH AND COMPLICATIONS CONFERENCE

Introduction for Every Case Procedure

Colectomy 12/12/11 Complication

Prolonged ICU stay, abscess/leak Primary Diagnosis

Diverticular bleed

Clinical History

95 y/o 12/8 Transfer from Tappahanock with LGIB. 12u

PRBC at OSH. 3 prior episodes of GI bleeding. PE:

Episodic hypotension Abd soft, ND, NT BRBPR with BM

PMH: CKD, HTN, mild dementia, gout/arthritis, GERD

PSH: ORIF left hip 2011 (coumadin for DVT prophylaxis – INR 1.5)

Clinical History

Past w/u included bleed scan (neg), EGD, negative capsule (in the past), and a recent repeat colonoscopy that show multiple tics throughout the colon (with blood on most recent)

12/9 bleeding scan - ? Bleeding at hepatic flexure 12/9 angio x2 negative 12/12 colectomy

138 pts 63% CA Differences found for elective vs. emergent surgery

according to age, LOS, complications, SICU admission, ASA status, and mortality

Literature

Post op recovery VA hospital – 372 pts colectomy (38%), open AAA repair (24%), and ventral hernia

repair (19%) Data collected on functional status, such as the ability to get

dressed, the ability to ambulate, grip strength, mental status, and depression scores. Some measures, such as dressing, the ability to rise from a chair, and walking, returned within a 6- to 12-week period. But to become fully functional, it took 3-6 months. Hand grip strength, often considered a measure of overall body strength, was still diminished at 6 months.

2 factors having the most impact on postoperative functional status: (1) the preoperative physical status (2) serious postoperative complication. When asked what factors were most helpful to their recovery,

patients reported that family and social support. Other factors mentioned were having a positive outlook and medical advice, especially for walking

Key Points

Increased life expectancy along with the aging of the baby boomer generation will enlarge the group of elderly patients needing surgical care.

Elderly patients have acceptable survival rates after major abdominal surgery, but poorly tolerate complications. Good results are linked to a smooth, uneventful postoperative recovery.

Attention to details is critical. For example, attention to oral hygiene can reduce the frequency of pulmonary complications.

Beta blockers are extremely useful for elderly patients undergoing major noncardiac surgery. A meta-analysis documented a reduction of cardiac mortality from 12% to 2%.

Tight control of glucose levels can reduce infection.