POSTOPERATIVE MEDICAL CAREAND COMMON

COMPLICATIONSIN THE GERIATRIC

FRACTURE PATIENT

Joseph Nicholas, MD, MPHUniversity of Rochester

THE AMERICAN GERIATRICS SOCIETY

Geriatrics Health Professionals.

Leading change. Improving care for older adults.

AGS

OVERVIEW

• Basic guidelines for post-op care

• Common problems/recommendations

• Alcohol-related problems

• CMS “never events”

Slide 2

POSTOPERATIVE CARE:BASIC GUIDELINES (1 of 2)

• Hydration

• Quality pain control

• Early activity

• Remove tethers

• Avoid sedativehypnotics

• Avoid polypharmacy

Slide 3

POSTOPERATIVE CARE:BASIC GUIDELINES (2 of 2)

• Beta-blockers (hold parameters)

• DVT prophylaxis

• Routine labs: Hct > 27 Chemistries (SMA 8) INR

• 24 hours of antibiotics

• Discontinue Foley and IV early

Slide 4

ANTICIPATE POST-OPHYPOTENSION

• Hold some BP meds

• Hold parameters for other BP meds

• Hydration

• Correct anemia

Slide 5

ANTICIPATE POST-OPRENAL INSUFFICIENCY

• Stop ACE inhibitors/NSAIDs preoperatively

• Stop oral diabetes agents

• Hydration

• Judicious resumption of furosemide

• Consider urinary retention once Foley out

• Bladder scan

Slide 6

ANTICIPATE POST-OPDELIRIUM (1 of 2)

• Fix reversible causes O2, fever, pain, BG, urinary retention, constipation

• Supportive environment Get rid of tethers Avoid restraints

Slide 7

ANTICIPATE POST-OPDELIRIUM (2 of 2)

• Remove offending medications Typically anticholinergics

• Continue pre-op chronic psych meds and chronic opiates

• Medications if needed (haloperidol 0.5 mg)

• Be patient, revaluate often, treat pain

Slide 8

OTHER COMMONCOMPLICATIONS (1 of 2)

• Atrial fibrillation

• MI

• Pneumonia

• Hyponatremia — usually SIADH

• Urinary retention

• UTI

Slide 9

OTHER COMMONCOMPLICATIONS (2 of 2)

• Pressure sores

• Aspiration

• DVT

• Stroke

• Ileus

• Hypertension

• Hyper/Hypoglycemia

Slide 10

ALCOHOL-RELATED COMPLICATIONS

• Underdiagnosed

• Community patients

• Hypertension

• Fever

• Tachycardia

• Tremulousness

• Benzodiazepines (lorazepam) more helpful here

Slide 11

CMS “NEVER EVENTS” (1 of 4)

• Surgical events Wrong body part

Wrong patient

Wrong surgical procedure

Retention of foreign object

Intraoperative/perioperative death in a normal healthy (young) patient

12

CMS “NEVER EVENTS” (2 of 4)

• Product/device events causing death/disability Contaminated drugs, devices, or biologics

Intravascular air embolism

Device used inappropriately in patient care

Slide 13

CMS “NEVER EVENTS” (3 of 4)

• Care management events causing death/disability

Medication error

Transfusion reaction (ABO incompatibility)

Hypoglycemia

Stage 3 or 4 pressure ulcers acquired in facility

Slide 14

CMS “NEVER EVENTS” (4 of 4)

• Environmental events resulting in death/disability

Fall

Use of restraints

Slide 15

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