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CHICAGO – A national, non-scientific survey from the American Society of Anesthesiologists (ASA) finds that more than 96% of respondents treated a patient 65 or older in 2018. However, despite guidelines, more than 80% physician anesthesiologists rarely or never perform preoperative screening for cognitive impairment or frailty for older surgical patients.
The survey results, published in a recent edition of Perioperative Medicine, looked to address a knowledge gap regarding current anesthesia practices for older surgical patients. Major medical organizations in the U.S. and Europe have published guidelines and benchmarking efforts for the care of older adults during the entire surgical episode, however, there is no report regarding implementation in health care systems and institutions.
Adherence to recommended guidelines for patients 65 and older varied across the items assessed:
• Over 80% of anesthesiologists screen for frailty, dementia or pre-existing cognitive impairment never or rarely (less than 10% of the time).
• Over 80% of physician anesthesiologists reported screening for delirium after surgery never or rarely (less than 10% of the time).
• 47% of respondents used multimodal analgesia 90% of the time.
“The findings are really a call to action for physician anesthesiologists,” said Stacie G. Deiner, M.D., vice chair for clinical activities of the ASA Ad Hoc Committee on Perioperative Brain Health Initiative and lead author. “It seems more of us are comfortable providing multimodal analgesia during surgery to decrease opioids and improve cognitive recovery, which is positive, but we need to become active partners in the pre- and postoperative phases of surgery. Patients with cognitive impairment and frailty can have better recovery and fewer complications if the condition is recognized and used to tailor their perioperative care.
When asked to identify priority initiatives to help improve the care of older patients, 80% of respondents requested development of practice guidelines; 68% requested web-based resources and 50% requested assistance with implementing best practices at the local level through quality improvement and novel practice management models.
The survey was a web-based questionnaire developed by the ASA Committee on Geriatric Anesthesia and the ASA Perioperative Brain Health Initiative. It was distributed to all U.S.-based physician anesthesiologists. Responses were collected between May and June 2018.
THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 54,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.
For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/WhenSecondsCount. Like ASA on Facebook, follow ASALifeline on Twitter.
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