Assessment of preoperative evaluation of geriatric Patients by anaesthetists at the Kenyatta national hospital

Abstract

Geriatric is a term used to refer to any patient aged 65years and above. These patients have special needs when it comes to the practice and conduct of anaesthesia. Physiological changes in various organ systems occuring with age compounded by the high incidence of comorbidities in the elderly affect the conduct of anaesthesia .Currently about 1000 geriatric patients are admitted annually into orthopedic, gynecological and general surgical wards at the Kenyatta National Hospital (KNH) and most of them require some form of surgery. Part of the preparation before surgery includes preanaesthetic evaluation by the anaesthetist who will administer anaesthesia on the day of surgery. Currently there is no anaesthetist with a subspecialization in geriatric anaesthesia at KNH. Objective. The objective of this study was to assess the practice of preanaesthetic evaluation of geriatric patients by the anaesthetists at KNH and compare it with the international guidelines formulated by the American Society of Anaesthesiologists. Methodology. The study was an observational, descriptive, cross- sectional study of preanaesthetic evaluations by anaesthetists at KNH done on 100 geriatric patients scheduled for elective surgery.The study site was the KNH general surgical, orthopedic and gynecological wards.The eligible patients who formed the basis of a preanaesthetic review and the anaesthetists were required to fill a consent form before being recruited. Data was collected using a questionnaire from the patients' medical records .The data collected included demographic information,risk assessment,whether functional/mental status was assessed,presence of co-morbidities and if preoperative optimization and medical consultation was requested for 7 Results. Data from the medical records of 100 geriatric patients scheduled for elective surgery was collected with focus on the preanaesthetic evaluation.The ages ranged from 65 - 92 years with a mean of 72.6 years.90% of the patients in the study had a preanaesthetic evaluation done by anaesthetists of different cadres. Most of the patients (81%) were evaluated on the day before surgery.57.8% of the patients were found to have at least one co-morbid condition.ASA physical status was used for risk stratification in all patients although the functional and mental status of the patients was only evaluated in 8.9% of those evaluated.Prepoerative tests were mainly used routinely without considering the patients co-morbidities or the type of surgery.Preoperative optimization of geriatric patients at KNH was requested for by anaesthetists but requests for medical consultation were made for only 11.1% of the evaluated patients. Conclusions. The preoperative evaluation of geriatric patients at KNH does not meet the international standards as per guidelines formulated by the ASA.