The Geriatric Community and Post Operative Complications

The Geriatric Community and Post-Operative Complications
With the elderly population increasing, orthopaedic surgical procedures have also
increased (Gjorgjievski & Ristevski, 2020). With frailty being a factor of the elderly, they are at
a higher risk of post operative complications (Gjorgjievski & Ristevski, 2020). Some adverse
reactions are short term, while some are long term.
Delirium is a significant post-operative complication in the elderly community
(Gjorgjievski & Ristevski, 2020). It is associated with increased mortality, worse surgical
outcomes, functional decline, increased hospital stay time, and increased institutionalization rates
(Gjorgjievski & Ristevski, 2020). This also causes an increase in costs and resource use
(Gjorgjievski & Ristevski, 2020).
Minimizing analgesics provided to the elderly is a goal in post-operative care
(Gjorgjievski & Ristevski, 2020). This can be completed by the administration of scheduled
Tylenol, using regional anaesthetics, or multi-modal analgesic control (Gjorgjievski & Ristevski,
2020). Avoiding medications such as barbiturates, benzodiazepines, hypnotics, pentazocine, and
meperidine is essential in controlling post-operative delirium and complications.
Respiratory complications in the elderly include atelectasis, hospital-acquired pneumonia,
and acute respiratory failure (Gjorgjievski & Ristevski, 2020). To avoid respiratory
complications, any pre-existing respiratory illnesses should be reviewed, along with smoking
history, anaesthetic use, control of nausea and vomiting, and mobility limitations (Gjorgjievski &
Ristevski, 2020).
Post-operatively, falls within the elderly are more common because of anaesthetic on the
body. Visual, cognitive, and motor abilities are impaired post operatively, and with frailty, it is
more difficult to maintain balance in the elderly (Gjorgjievski & Ristevski, 2020). P0ost-
operative falls can be reduced by maintaining a safe environment, including bed rails raised, the
call bell within reach, the bed in lowest position, and by monitoring the patient frequently.
Optimizing nutrition post-operatively is essential for wound healing, fluid and electrolyte
balance, and in preventing post-operative complications. With the elderly having decreased GI
motility, hunger decreases and constipation increases post-operatively. Poor nutrition increases
mortality rate, infection risk, pressure ulcers, and increased hospital stay length (Gjorgjievski &
Ristevski, 2020).
Urinary tract infections are the most common infections in older adults, most linked to
catheterization use (Gjorgjievski & Ristevski, 2020). Catheterization is used in post-operative
elderly patients to decrease fall risk, delirium, and intermittent catheterization. Proper hygiene
and sterile technique should be utilized when handling catheters in older adults (Gjorgjievski &
Ristevski, 2020). Staff should be educated on the proper use of catheters and on creating and
using a bathroom schedule to promote voiding post-operatively.
Pressure ulcers are common post-operatively due to: advanced age, abnormal positioning,
edema, increased co-morbidities, incontinence, increased infections, limited mobility, sensation
loss, shearing, fragility, increased moisture exposure, and unrelieved pressure (Gjorgjievski &
Ristevski, 2020). Prevention is the primary goal, by optimizing nutrition, turning patients every 2
hours, increasing mobility and time sitting upright versus in a chair, and placing the patient on a
bathroom schedule to reduce incontinence and moisture (Gjorgjievski & Ristevski, 2020).
Overall, post-operative care in the elderly is complex due to their low physiologic and
functional controls. Special considerations must be followed post-operatively to ensure safety
and promote well-being and quality care. Determining frailty guides which post-operative
considerations must be applied (Gjorgjievski & Ristevski, 2020).

References
Gjorgjievski, M., & Ristevski, B. (2020). Postoperative management considerations of the
elderly patient undergoing orthopaedic surgery. Injury, 51 Suppl 2, S23–S27.
https://doi.org/10.1016/j.injury.2019.12.027

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The Geriatric Community and Post-Operative Complications

reactions are short term, while some are long term.

Delirium is a significant post-operative complication in the elderly community

(Gjorgjievski & Ristevski, 2020).

Minimizing analgesics provided to the elderly is a goal in post-operative care

2020). Avoiding medications such as barbiturates, benzodiazepines, hypnotics, pentazocine, and

meperidine is essential in controlling post-operative delirium and complications.

Respiratory complications in the elderly include atelectasis, hospital-acquired pneumonia,

catheterization use (Gjorgjievski & Ristevski, 2020). Catheterization is used in post-operative

using a bathroom schedule to promote voiding post-operatively.

edema, increased co-morbidities, incontinence, increased infections, limited mobility, sensation

functional controls. Special considerations must be followed post-operatively to ensure safety

considerations must be applied (Gjorgjievski & Ristevski, 2020).

Gjorgjievski, M., & Ristevski, B. (2020). Postoperative management considerations of the

elderly patient undergoing orthopaedic surgery. Injury, 51 Suppl 2, S23–S27.

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