Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Issue's catalogue ➤ КФК. 2024; 21 (2): 89-162 ➤ Анестезиологическая оценка периоперационных рисков у пациентов пожилого и старческого возраста в нейрохирургии

Anesthetic assessment of perioperative risks in elderly patients in neurosurgery

Authors: Kozlova K.А., Shmigelskiy A.V.

Company:
Burdenko National Medical Research Center for Neurosurgery, Moscow, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2024-21-2-127-139

UDC: 616.8-053.9-089.5

Link: Clinical Physiology of Blood Circulaiton. 2024; 21 (2): 127-139

Quote as: Kozlova K.A., Shmigelskiy A.V. Anesthetic assessment of perioperative risks in elderly in neurosurgery. Clinical Physiology of Circulation. 2024; 21 (2): 127–139 (in Russ.). DOI: 10.24022/1814-6910-2024-21-2-127-139

Keywords:  postoperative complications risk scale elderly neurosurgery anesthetic risk laboratory parameters

Received / Accepted:  30.04.2024 / 21.06.2024

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Abstract

Objective. To determine and identify the effectiveness of scales and laboratory tests for assessing the risk of perioperative complications.

Material and methods. The prospective study group included 80 patients. The age of the patients ranged from 70 to 78 years. All patients were divided into 3 groups depending on the underlying pathology: with intracerebral supratentorial brain tumors; pathologies of the spinal cord and spine, patients with stenosis and occlusion of neck vessels. In the preoperative period, a set of scales and laboratory parameters: IADL, TUGT, MMSE, GDS, MNA-SF, CIRS-G, Charlson Index, ASA, MNOAR, Karnofsky, ECOG, MRS, Goldman, Sundt, POSSUM, mFI, erythrocyte count, hemoglobin, hematocrit, d-dimer, lipid profile, plasma glucose, hormones TSH and DHEA, hs-CRP, NT-PROBNP, plasma albumin, plasma creatinine, urine creatinine, urine albumin.

Results. Prognostically significant scales for assessing of the perioperative risk in elderly patients (with brain tumors, pathologies of the spinal cord and spine, and pathologies of the neck vessels) are MMSE (p = 0.020), CIRS-G (p = 0.021), mFI (p = 0.037), Karnovsky (p = 0.004). Prognostically significant laboratory indicators for assessing the risks of the perioperative risk in elderly patients are plasma albumin level (p = 0.023) below 35.00 (32.00, 38.00) g/l, hsCRP (p < 0.001) above 10.20 (4.46, 20.80) mg/l. In the group of patients with pathologies of the neck vessels, the most common complication is neurological deficit (p = 0.024). The most effective scale for determining risk is the Karnofsky scale (p = 0.023), as well as a urine creatinine level above 9564.00 (5982.75, 13201.25) µmol/l (p = 0.023), TSH below 2.51 (1.28, 3.57) mIU/l (p = 0.033), HDL below 1.00 (0.90, 1.13) mmol/l (OR 1034.82, p = 0.034). In the spinal cord and spine pathology group, the most significant factor for predicting pain after surgery is the POSSUM score (% death rate) more than 9.80 (4.30, 15.60) %. In the group of patients with brain tumors, the most significant for assessing of the perioperative risk in elderly patients are POSSUM (p = 0.013), mFI (p = 0.020), as well as laboratory parameters of LDL (p = 0.018) and hsCRP (p = 0.007).

Conclusion. At present, there is no data in the world literature on the generally accepted preoperative comprehensive geriatric assessment (PCGA) in neurosurgical elderly patients. We determined effective scales and laboratory parameters for assessing the risk of predicted perioperative complications, identified combinations of significant scales and laboratory parameters for preoperative assessment of the risk of perioperative complications in elderly with various neurosurgical pathologies. The effectiveness of the compiled set of scales and laboratory parameters will allow to objectify the anesthesiologic assessment and to develop recommendations for PCGA of the risk of perioperative complications in neurosurgical elderly.

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****
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  33. Brown P.J., Roose S.P., Fieo R., Liu X., Rantanen T., Sneed J.R. et al. Frailty and depression in older adults: a high risk clinical population. Am. J. Geriatr. Psychiatry. 2014; 22 (11): 1083–1095. DOI: 10.1016/j.jagp.2013.04.010
  34. Johans S.J., Garst J.R., Burkett D.J., Grahnke K., Martin B., Ibrahim T.F. et al. Identification of preoperative and intraoperative risk factors for complications in the elderly undergoing elective craniotomy. World Neurosurg. 2017; 107: 216–225. DOI: 10.1016/j.wneu.2017.07.177
  35. Robinson T.N., Wu D.S., Stiegmann G.V., Moss M. Frailty predicts increased hospital and six-month healthcare cost following colorectal surgery in older adults. Am. J. Surg. 2011; 202 (5): 511–514. DOI: 10.1016/j.amjsurg.2011.06.017

About Authors

  • Kseniya A. Kozlova, Anesthesiologist-Intensivist; ORCID
  • Aleksandr V. Shmigelskiy, Dr. Med. Sci., Leading Researcher, Anesthesiologist-Intensivist; ORCID

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