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Abstract

 

SCOPO: piuÌ€ del 40% delle procedure chirurgiche sono condotte su soggetti ultrasessantacinquenni; cioÌ€ ha portato alla ribalta il concetto di fragilitaÌ€. Scopo di questo lavoro è compendiare le cono- scenze disponibili in letteratura per meglio comprendere quali siano gli aspetti essenziali della fragi- litaÌ€, quale sia l'impatto che essa ha sugli outcomes chirurgici dell'anziano e quali interventi appli- care per prevenirla.

METODI: EÌ€ stata condotta una revisione narrativa della letteratura utilizzando le principali banche dati bibliografiche di stampo biomedico ed infermieristico.

RISULTATI: Dall'analisi della letteratura è emerso che la fragilitaÌ€ è una sindrome medica con molte- plici cause caratterizzata da ridotte funzionalitaÌ€ fisiologiche e diminuita resistenza allo stress, che causa diversi outcome avversi a seguito degli interventi chirurgici. Negli studi considerati la fragi- litaÌ€, comunque essa venga considerata, è emersa come un indicatore attendibile di aumentata morbilitaÌ€ e mortalitaÌ€, di degenza ospedaliera protratta nel tempo, di istituzionalizzazione post- dimissione e di aumento dei costi sanitari. Per la correzione della fragilitaÌ€, l'intervento di maggior significato clinico è costituito dall'esercizio fisico.

CONCLUSIONI: L'identificazione di un paziente fragile nel preoperatorio consente agli operatori sanitari di trasmettere adeguatamente le informazioni riguardanti i rischi perioperatori individuali: dovrebbe fornire l'occasione di discutere riguardo alle aspettative ed ai desideri del paziente per il quale si prevede un esito postoperatorio sfavorevole. Inoltre, per i soggetti ad alto rischio, è possi- bile prevedere anticipatamente un percorso clinico con un programma di dimissioni ben struttu- rato, per evitare prolungamenti della degenza, diminuendo cosiÌ€ le spese per i ricoveri ospedalieri. PAROLE CHIAVE: FragilitaÌ€, anziano, chirurgia, outcome chirurgici

Elderly and surgery: impact of frailty on surgical outcome. A literature review.

ABSTRACT

AIM: Currently more than 40% of surgical procedures are performed on subjects over65 years. this event has brought to the fore the concept of frailty. The aim of this work is to summarize the knowledge available in the literature in order to better understand what are the essential aspects of frailty, which impact it has on surgical outcomes of the elderly and what action we need to apply to prevent it.

METHODS: A narrative literature review was conducted using the principal bibliographic biome- dical and nursing databases.

RESULTS: Literature analysis revealed that frailty is a medical syndrome with multiple causes characterized by reduced physiological functions and decreased stress resistance, resulting in several adverse outcome following surgery. In the selected studies, frailty has emerged as a reliable indi- cator of increased morbidity and mortality, long-term hospital stay, post-discharge institutionali- zation, and increased healthcare costs. For frailty prevention and treatment, the most important clinical intervention is physical exercise.

CONCLUSION: Identifying a patient like frail in the preoperative period allows the health profes- sional to adequately transmit information about individual perioperative risks. It should provide an opportunity to discuss the expectations and wishes of the patient for whom an adverse posto- perative outcome is expected. In addition, for high risk subjects, a clinical pathway with a well- structured discharge program can be anticipated in order to avoid hospital prolongations, thus reducing hospitalization costs.

KEYWORDS: Frail Elderly, Surgery/Surgical procedure, Outcome assessment

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Ronchi, S., Accardi, R., & Lusignani, M. (2019). Anziano e chirurgia: impatto della fragilità sugli outcome chirurgici. Una revisione della letteratura. PROFESSIONI INFERMIERISTICHE, 72(2). Recuperato da https://www.profinf.net/pro3/index.php/IN/article/view/626
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