Older adult surgical patients; herbal medicine use; blood cell salvage and autotransfusion; antibiotic prophylaxis

AORN Journal, Oct, 2004 by George Allen

Surgery for older adults

American Journal of Obstetrics and Gynecology May 2004

Individuals older than 65 years of age represent the fastest-growing segment of the US population; consequently, an increasing number of older adult patients require surgical interventions. The purpose of this retrospective study was to evaluate how older women tolerated indicated surgical interventions. (1)

Researchers reviewed the medical records of 62 surgical patients 80 years of age or older who underwent gynecological procedures between Jan 1, 1995, and Sept 30, 2000. Data evaluated included complete medical history, type of surgical procedure, length of hospital stay, and discharge disposition.

Findings. The mean age of patients was 83.6 years (range 80-94 years). Seventy-seven surgical procedures were performed, ranging from total abdominal hysterectomy to cystoscopy and stent placement. The majority (ie, 64%) of the procedures were listed as major surgical procedures.

Patients had an average of 3.73 concurrent medical illnesses. Nine percent of the patients were diabetic, 59% had hypertension, and 40% had arthritis.

Nearly all of the patients (ie, 97%) were discharged home. Two patients were discharged to a nursing home. Overall, the length of hospital stay averaged 3.6 days.

There were 11 perioperative complications, including two incidents of combativeness/disorientation and one incident each of fever, ileus, oliguria, elevated blood pressure, congestive heart failure exacerbation, atrial fibrillation, acute myocardial infarction, pneumonia, and bleeding requiring re-exploration. There were no deaths.

Clinical implications. This study revealed that octogenarian and nonagenarian patients tolerated both major and minor gynecological procedures with minimal morbidity despite their advanced age. Additionally, the study demonstrated that older adult patients should not be denied surgical interventions based solely on perceived risks generally associated with advanced age. As the population continues to age, perioperative nurses should be prepared to encounter more older adults undergoing major surgical procedures. Perioperative managers should consider incorporating education sessions focusing on older adult patients in their continuing education plans.

Surgical patients' use of herbal medications

Journal of the American College of Surgeons April 2004

The increasing popularity of alternative medical therapies in the general population has resulted in increased use of herbal medicine in surgical patients, but health care workers do not always elicit information about or document their use. This increases the likelihood that the use of herbal medicines will result in serious adverse reactions in surgical patients. The purpose of this study was to assess surgical patients' use of herbal medicine and their willingness to reveal their herbal medicine use to perioperative staff members. (2)

A self-administered questionnaire was given to all surgical patients 18 years of age and older who presented for elective surgery during a 10-week period. The questionnaire had four sections. Section I determined characteristics of the respondents, including demographics and the planned surgical procedure. Section II elicited information on health status and patients' perception of their own health, including the presence of current medical problems (eg, diabetes, hypertension, high cholesterol). Section III asked for information about current, past, or lifetime use of herbal medications (eg, echinacea, ephedra, garlic, ginkgo biloba, ginseng, kava kava, herbal vitamin supplements, St John's wort, cod liver oil, primrose oil). The final section asked about disclosure of herbal medicine use to health care staff members (eg, surgeon, anesthesia care provider, nurse). Univariate and multivariate analysis techniques were used to analyze the data.

Findings. Of the 2,186 patients who completed the survey, 57% reported using herbal medicine at some point in their lives, 38% had consumed herbal medicines in the two years before surgery, and 16% continued to use herbal medicines during the month the surgery took place. Patients often consumed more than one type of product. Patients reported using

* herbal tea (53.3%);

* cod liver oil (15.2%);

* herbal vitamins (15%);

* primrose oil (11.2%); and

* other herbal supplements (11.3%).

Herbal medicine use was significantly higher among patients undergoing gynecologic surgery (odds ratio [OR] 1.68; 95% confidence interval [CI] 1.29-2.18) and among patients with a better perception of their own health (OR 1.32, 95% CI 1.04-1.69). Patients who reported having diabetes mellitus or pulmonary symptoms and patients undergoing vascular procedures were significantly less likely to use herbal medicines. Patients who reported that they had a primary physician and African American patients also were significantly less likely to use herbal medicines. Of the 833 patients who were taking herbal medicines, only 7% volunteered that information to health care staff members. Herbal medicine history was obtained by a surgeon for 17% of the patients, by an anesthesia care provider for 4% of the patients, and by another health care staff member for 10% of the patients.