Comparative Studies on Complications Occurring during and after Surgery in Elderly Patients with and without Cardiovascular Disorders

Abstract

Comparative studies of the differences in elderly patients with and without cardiovascular disorders were made in regard to complications occurring during and after operation. The subjects included 38 patients (6 men and 32 women) aged 70 to 99 years (mean: 84 years) at Nagoya City Kouseiin Geriatric Hospital who had orthopedic surgery under general anesthesia, between March 1990 and October 1992. Diseases identified in these subjects were sequelae of cerebrovascular disease (38 subjects), heart disease (22 subjects), hypertension (9 subjects), senile dementia (6 subjects), Parkinson’s disease (5 subjects), malignant disease (3 subjects) and diabetes mellitus (2 subjects). They were initially divided into 2 groups according to ultrasonic cardiography: a normal group comprising 20 patients without cardiovascular abnormalities, and a disorder group comprising 18 patients with reduction of left ventricule function, left ventricular hypertrophy and/or valvular disease (more than moderate). All subjects were examined with regard to age, weight, the nutrition index proposed by Onodera, activity of daily living (ADL), cardiac output, left ventricular ejection fraction, serum level of BUN and albumin etc. Moreover, the disorder group subjects were divided into 2 groups according to the presence or absence of heart failure occurring after surgery. In addition to the above-mentioned, we also studied the duration of surgery and anesthesia, and water balance during and after surgery. Results showed that the ADL and nutrition index in the disorder group were lower compared to the normal group. Although incidence of complications during surgery was not significantly different between the normal group and the disorder group, postoperative complications were higher in the disorder group and almost complications were heart failure. Our study also indicated that patients who suffered heart failure after operation did not have significantly lower cardiac function, but they had mild anemia, longer duration of anesthesia and excessive postoperative water balance. In summary, to prevent postoperative complications in patients with cardiovascular disorder, it is important to correct anemia before surgery and to conduct deliberate management of water balance during and after surgery. © 1993, The Japan Geriatrics Society. All rights reserved.