POSTOPERATIVE CARE
Preoperative and postoperative management of pulmonary problems
is of particular importance (see Chapter
71
). In general surgical patients 65 years and older, the incidence of
common postoperative morbidities is 17% for atelectasis, 12% for acute bronchitis,
10% for pneumonia, 6% for heart failure or myocardial infarction (or both), 7% for
delirium, and 1% for new focal neurologic signs.[162]
In higher-risk procedures such as vascular surgery, the incidence of major postoperative
pulmonary complications is 15.2%.[163]
Numerous
predictors of postoperative pulmonary complications in elective noncardiac surgery
have been identified ( Table 62-7
),
[164]
[165]
and
risk
indices have been developed to forecast the development of postoperative pneumonia.
[130]
Of note, elderly patients may be at higher
risk for aspiration secondary to the progressive decrease in laryngopharyngeal sensory
discrimination that occurs with aging.[166]
In
addition, dysfunctional swallowing predisposes the elderly to aspiration. After
cardiac operations, dysfunctional swallowing occurs in 4% of patients and is more
common in older patients. Swallowing dysfunction after cardiac surgery is closely
associated with the intraoperative use of transesophageal echocardiography and carries
with it a 90% rate of pulmonary aspiration and pneumonia.[167]
