(Applicant s abstract) People > 65 years of age are expected to exceed 50 million or 20% of the total population by the end of the century. The elderly undergo approximately 40% of all surgical procedures, amounting to an annual expenditure of over $60 billion. Our previous work demonstrated the postoperative in-hospital morbidity rate in octogenarians undergoing non- cardiac surgery to be 25%. By multivariate logistic regression, a history of neurological disease, congestive heart failure and arrhythmia increased the odds of developing any adverse postoperative events. Our work here focuses on the identification of the predictors of perioperative complications in geriatric surgical patients followed by clinical trials to modify the risk factor(s) in order to improve perioperative outcome. Four integrated clinical studies are planned: 1) A prospective, longitudinal cohort study of 600 consecutive geriatric surgical patients undergoing non-cardiac surgery. This study aims to determine the impact of perioperative complications on the functional status and long-term survival of the elderly surgical patients by measuring pre-defined in-hospital adverse postoperative outcomes, and functional and survival status at two years postoperatively. 2) A prospective cohort study of 200 geriatric patients undergoing non-cardiac surgery. This study aims to determine the accuracy of preoperative clinical methods of assessing heart function as compared to echocardiography; and also the prognostic relationship between preoperative diastolic dysfunction and postoperative heart failure. 3) A prospective cohort study of 300 patients undergoing coronary artery bypass graft surgery. This study aims to determine if left atrial dysfunction as measured by intraoperative transesophageal echocardiography provides incremental value in predicting the occurrence of postoperative atrial fibrillation when compared with routine clinical data. In later years, we will perform 4) a randomized, clinical trial of regional versus general anesthesia in 500 elderly patients undergoing orthopedic surgery. This study aims to determine the incidence of postoperative cognitive dysfunction and delirium between regional versus general anesthesia after controlling for intraoperative anesthetic and hemodynamic management and postoperative pain management. Postoperative cognitive function and delirium will be measured by standard neuropsychological tests and the Confusion Assessment Method. We believe that our studies will provide important results contributing ultimately to the improvement of perioperative outcomes in geriatric patients.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Midcareer Investigator Award in Patient-Oriented Research (K24)
Project #
1K24AG000948-01A2
Application #
6262464
Study Section
National Institute on Aging Initial Review Group (NIA)
Program Officer
Premen, Andre J
Project Start
2001-03-01
Project End
2006-02-28
Budget Start
2001-03-01
Budget End
2002-02-28
Support Year
1
Fiscal Year
2001
Total Cost
$126,243
Indirect Cost
Name
University of California San Francisco
Department
Anesthesiology
Type
Schools of Medicine
DUNS #
073133571
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Long, L Stephen; Shapiro, William A; Leung, Jacqueline M (2012) A brief review of practical preoperative cognitive screening tools. Can J Anaesth 59:798-804
Leung, Jacqueline M; Sands, Laura P (2009) Long-term cognitive decline: is there a link to surgery and anesthesia? Anesthesiology 111:931-2
Leung, Jacqueline M; Sands, Laura P; Paul, Sudeshna et al. (2009) Does postoperative delirium limit the use of patient-controlled analgesia in older surgical patients? Anesthesiology 111:625-31
Nakai, Toshiko; Chandy, Joby; Nakai, Kazuhiko et al. (2007) Histologic assessment of right atrial appendage myocardium in patients with atrial fibrillation after coronary artery bypass graft surgery. Cardiology 108:90-6
Leung, Jacqueline M; Sands, Laura P; Wang, Yun et al. (2007) Apolipoprotein E e4 allele increases the risk of early postoperative delirium in older patients undergoing noncardiac surgery. Anesthesiology 107:406-11
Wang, Yun; Sands, Laura P; Vaurio, Linnea et al. (2007) The effects of postoperative pain and its management on postoperative cognitive dysfunction. Am J Geriatr Psychiatry 15:50-9
Vaurio, Linnea E; Sands, Laura P; Wang, Yun et al. (2006) Postoperative delirium: the importance of pain and pain management. Anesth Analg 102:1267-73
Leung, J M; Sands, L P; Vaurio, L E et al. (2006) Nitrous oxide does not change the incidence of postoperative delirium or cognitive decline in elderly surgical patients. Br J Anaesth 96:754-60
Fong, Harold K; Sands, Laura P; Leung, Jacqueline M (2006) The role of postoperative analgesia in delirium and cognitive decline in elderly patients: a systematic review. Anesth Analg 102:1255-66
Leung, J M; Sands, L P; Rico, M et al. (2006) Pilot clinical trial of gabapentin to decrease postoperative delirium in older patients. Neurology 67:1251-3

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