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Enhanced Recovery for Elderly Surgical Patients Receiving General Anesthesia
Nearly 30 percent of surgeries are performed on elderly adults (age 60 and older). Consequently, 11 percent to 51 percent of this rapidly growing patient population will develop postoperative delirium (POD), and 12 percent will likely develop long-term postoperative cognitive dysfunction (POCD). Prior to implementing this project, the Naval Medical Center San Diego Anesthesia Department did not utilize a standardized protocol that specifically addressed POCD and POD occurrence in the elderly. Clinical Question: Will introducing an enhanced recovery after surgery (ERAS) protocol aimed at decreasing the rate of POD and POCD in elderly surgical patients undergoing general anesthesia change the practice of anesthesia providers? Project Design: An ERAS protocol was created based on a review of current evidence-based guidelines. Staff education was conducted prior to departmental implementation. Electronic medical records (EMRs) were reviewed from 3-months prior to protocol introduction and 3-months afterward to observe the frequency in which providers used intraoperative processed electroencephalography (EEG), meperidine, morphine, dexmedetomidine, and midazolam. The utilization of pre and postoperative neurocognitive assessments was also measured. Analysis of the Results: 646 EMRs met the criteria for review. Group A (n=306) was a collection of EMRs from the three months prior to protocol introduction, and group B (n=340) consisted of EMRs from three months afterward. The latter showed a clinically significant increased use of four ERAS interventions with statistical significance in two. These interventions include preoperative cognitive assessments (p less than 0.001), postoperative cognitive assessments (p=0.386), processed EEG use (p less than 0.001), and intraoperative dexmedetomidine administration (p=0.163). Organizational Impact: Increased utilization of an evidence-based ERAS protocol to address the risk of POD and POCD in the elderly population at NMCSD.
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