Zeitschrift für Gerontologie und Geriatrie
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There is no difference in medical and nutritional therapy between elderly and young surgical patients. However, based on the high prevalence of malnutrition or a risk for malnutrition and the associated risk for complications, elderly surgical patients should receive special attention. ⋯ Contrary to former approaches, national and international organizations recommend to keep the duration of pre- and postoperative fasting as short as possible. The benefits of nutritional therapy in stabilization and improvement of the nutritional status of surgical patients has already been shown in several patient groups like patients undergoing major abdominal surgeries. For other patients groups, like patients with sepsis, further studies are needed to evaluate the benefit of a perioperative nutritional intervention.
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Review Meta Analysis
Mode of anesthesia, mortality and outcome in geriatric patients.
In older non-cardiac surgery patients, the influence of the mode of anesthesia on late-term outcome (rehabilitation, mobility, independence) is a controversial issue in the medical literature. In light of an aging society, this review assessed the association between regional (RA), local (LA) and general anesthesia (GA) and mortality and morbidity. ⋯ Strictly speaking, true anesthesia-related complications appear to be rare and many adverse outcomes may be multifactorial. Postoperative complications are largely related to the perioperative procedure and not to the anesthesia itself. GA and RA are both useful for older non-cardiac patients, but for some procedures, e.g. hip fracture surgery, RA seems to be the technique of choice. The mode of anesthesia may only play a secondary role in mobility, rehabilitation and discharge destination. In general, due to the many different possible outcomes--which are often very difficult or impossible to compare--no other specific recommendations can be made with regard to the type of anesthesia to be preferred for older non-cardiac patients.