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THE AMERICAN GERIATRICS SOCIETY Geriatrics Health Professionals.

POSTOPERATIVE MEDICAL CARE AND COMMON COMPLICATIONS IN THE GERIATRIC FRACTURE PATIENT Joseph Nicholas, MD, MPH University of Rochester. AGS. THE AMERICAN GERIATRICS SOCIETY Geriatrics Health Professionals. Leading change. Improving care for older adults. Overview.

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THE AMERICAN GERIATRICS SOCIETY Geriatrics Health Professionals.

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  1. POSTOPERATIVE MEDICAL CAREAND COMMON COMPLICATIONSIN THE GERIATRIC FRACTURE PATIENTJoseph Nicholas, MD, MPHUniversity of Rochester AGS THE AMERICAN GERIATRICS SOCIETY Geriatrics Health Professionals. Leading change. Improving care for older adults.

  2. Overview • Basic guidelines for post-op care • Common problems/recommendations • Alcohol-related problems • CMS “never events”

  3. Postoperative Care:Basic Guidelines (1 of 2) • Hydration • Quality pain control • Early activity • Remove tethers • Avoid sedativehypnotics • Avoid polypharmacy

  4. Postoperative Care:Basic Guidelines (2 of 2) • Beta-blockers (hold parameters) • DVT prophylaxis • Routine labs: • Hct > 27 • Chemistries (SMA 8) • INR • 24 hours of antibiotics • Discontinue Foley and IV early

  5. ANTICIPATE POST-OPHYPOTENSION • Hold some BP meds • Hold parameters for other BP meds • Hydration • Correct anemia

  6. ANTICIPATE POST-OPRENAL INSUFFICIENCY • Stop ACE inhibitors/NSAIDs preoperatively • Stop oral diabetes agents • Hydration • Judicious resumption of furosemide • Consider urinary retention once Foley out • Bladder scan

  7. ANTICIPATE POST-OPDELIRIUM (1 of 2) • Fix reversible causes • O2, fever, pain, BG, urinary retention, constipation • Supportive environment • Get rid of tethers • Avoid restraints

  8. ANTICIPATE POST-OPDELIRIUM (2 of 2) • Remove offending medications • Typically anticholinergics • Continue pre-op chronic psych meds and chronic opiates • Medications if needed (haloperidol 0.5 mg) • Be patient, revaluate often, treat pain

  9. Other COMMONComplications (1 of 2) • Atrial fibrillation • MI • Pneumonia • Hyponatremia — usually SIADH • Urinary retention • UTI

  10. Other COMMONComplications (2 of 2) • Pressure sores • Aspiration • DVT • Stroke • Ileus • Hypertension • Hyper/Hypoglycemia

  11. Alcohol-Related Complications • Underdiagnosed • Community patients • Hypertension • Fever • Tachycardia • Tremulousness • Benzodiazepines (lorazepam) more helpful here

  12. CMS “Never Events” (1 of 4) • Surgical events • Wrong body part • Wrong patient • Wrong surgical procedure • Retention of foreign object • Intraoperative/perioperative death in a normal healthy (young) patient

  13. CMS “Never Events” (2 of 4) • Product/device events causing death/disability • Contaminated drugs, devices, or biologics • Intravascular air embolism • Device used inappropriately in patient care

  14. CMS “Never Events” (3 of 4) • Care management events causing death/disability • Medication error • Transfusion reaction (ABO incompatibility) • Hypoglycemia • Stage 3 or 4 pressure ulcers acquired in facility

  15. CMS “Never Events” (4 of 4) • Environmental events resulting in death/disability • Fall • Use of restraints

  16. Thank you for your time! Visit us at: www.americangeriatrics.org Facebook.com/AmericanGeriatricsSociety Twitter.com/AmerGeriatrics linkedin.com/company/american-geriatrics-society

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