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Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52(11/12): 785-797
DOI: 10.1055/s-0043-104685
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Georg Thieme Verlag KG Stuttgart · New York

Wie können postoperative Komplikationen bei Patienten mit Frailty vermieden werden?

How to Reduce the Rate of Postoperative Complications in Frail Patients?
Rudolf Mörgeli   *
,
Tobias Wollersheim   *
,
Claudia Spies
,
Felix Balzer
,
Susanne Koch
,
Sascha Treskatsch
Further Information

Publication History

Publication Date:
20 November 2017 (online)

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Zusammenfassung

Patienten mit Frailty sind anfälliger dafür, Komplikationen während und nach einer Operation zu entwickeln. Bei steigender Prävalenz dieses Syndroms werden das Erkennen sowie das spezielle Management von gebrechlichen Patienten in der perioperativen Phase wichtiger und könnte dazu beitragen, das perioperative Outcome dieser Patienten zu verbessern. Basierend auf aktueller Literatur und Leitlinien, präsentieren wir eine Zusammenstellung von grundlegenden Strategien, die eingesetzt werden können, um postoperative Komplikationen bei Patienten mit Frailty zu reduzieren. Aufgrund ihrer eingeschränkten Anpassungsmechanismen auf Stressoren werden besonders für Patienten mit Frailty potenzielle perioperative Gefahren identifiziert und diskutiert. Dazu gehören das Risiko von Dehydratation, Hypothermie, kardiovaskulärer Dekompensation, ungewöhnlicher Arzneimittelreaktionen und Delirium. Ebenso wird auf die Notwendigkeit von früher Mobilisierung und Ernährungsunterstützung eingegangen. Wenn Frailty präoperativ erkannt und dem Behandlerteam die erhöhte Komplikationsgefahr bewusst wird, gibt es Strategien, die in der perioperativen Versorgung umgesetzt werden können, um die Chancen einer erfolgreichen Erholung des Patienten zu erhöhen.

Patienten mit Frailty sind aufgrund eingeschränkter Kompensationsmechanismen anfälliger dafür, während und nach einer Operation Komplikationen zu entwickeln. Ein spezielles Management dieser Patientengruppe wird immer bedeutender für die Behandlungsergebnisse. Dieser Artikel präsentiert Strategien, die dazu beitragen können, das Risiko von postoperativen Komplikationen in diesem besonders anfälligen Patientenkollektiv zu reduzieren.

Abstract

Frail patients are more prone to develop complications during and after surgery. As the syndrome becomes more common, recognition and special management of frail patients in the perioperative setting is becoming crucial to improve short- and long-term outcomes. Based on current literature and guidelines, we present a compilation of strategies that could be employed to reduce postoperative complication rates in frail patients. Due to their impaired response to stressors, potential perioperative hazards to frail patients are identified and discussed. This includes the risk of dehydration, hypothermia, cardiovascular decompensation, unusual drug reactions, and delirium. The benefits of early mobilization and nutritional support are also discussed. If frailty is detected preoperatively, thus alerting the team about the increased risk of complications, strategies can be implemented in the perioperative setting to improve the chances of successful recovery.

Kernaussagen

  • Frailty beschreibt einen Zustand reduzierter physiologischer Reserven und kann in eine physische, kognitive und soziale Domäne unterteilt werden.

  • Aufgrund der eingeschränkten Kompensationsfähigkeit ist das intraoperative Ziel, jedwede Schwankungen/Störungen der Homöostase zu vermeiden (Blutdruck, Temperatur etc.).

  • Patienten mit Frailty sind anfälliger für eine Vielzahl von perioperativen Komplikationen. Zur Vorbeugung ist daher eine engmaschige Überwachung (Hämodynamik, Narkosetiefe, Delir etc.) indiziert.

  • Eine Aktivierung der sozialen Netzwerke, frühe Mobilisierung und Ernährungsberatung in der postoperativen Phase können helfen, akuten und langfristigen Komplikationen vorzubeugen.

Schlüsselwörter

Frailty - postoperative Komplikationen - Strategien

Key words

frailty - postoperative complications - strategies

* geteilte Erstautorenschaft


 

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