Scientific Subcommittee 15 – Geriatric Anaesthesiology

Scientific Subcommittee 15 – Geriatric Anaesthesiology

  • Issue 72

Marc Coburn, Chair SSC15

mcoburn@ukaachen.de

SC 15 includes Mark Coburn, University Hospital Aachen, Medical Faculty, RWTH Aachen, Germany; Ulf Guenther, Department of Anaesthesia, Intensive Care, Emergency and Pain, Medical Campus University Oldenburg, Oldenburg, Germany; Peter Lee, Cork University Hospital, Cork, Ireland; Jacob Steinmetz, Department of Anaesthesia, Rigshospitalet, Copenhagen, Denmark; and Idit Matot Division of Anaesthesiology, Pain, and Intensive Care, Tel-Aviv Medical Center, Sackler School of Medicine, Tel-Aviv, Israel.

The Geriatric Anaesthesiology Subcommittee (SC) performed successfully this year in different levels to promote the knowledge on perioperative management of the elderly. Activities include the ESA Focus Meeting, Editorial in the EJA1 and papers in other journals,2,3 designing an international pan-European study focusing on the elderly, which is granted as ESA research that has already started recruiting, putting together the guidelines for delirium4 plus participating in yet another guideline committee. All this is an add-on to the rich and diverse programme presented at the ESA meetings, which not only was scored very high by the participants but also was well attended.

The ESA Focus Meeting ‘The Ageing Patient’ in Lisbon last November, which was organised by Idit Matot on behalf of the SC Geriatric Anaesthesiology, was a great success. It was the best attended ESA Focus Meeting thus far. This underlines the urgent need to provide an update for delegates on aspects of anaesthesiology, critical care medicine, pain, and emergency medicine pertinent to the elderly.

We furthermore aim to provide up-to-date evidence on all aspects of geriatric anaesthesiology during the ESA meetings. We have begun to expand beyond ESA meetings, and use editorials as a tool to reach out to all anaesthesiologists with an interest in the field of geriatric anaesthesiology. The aim of our first editorial was to shed some light on recent developments in the perioperative care of elderly hip fracture patients based on literature published in the last two years – as well as those challenges that remain unaddressed.1 For the ESA Meeting in Copenhagen we are excited to offer joint sessions with the SC in Ethics and Neuroanaesthesiology, focusing on challenges in the perioperative management of patients suffering from dementia, and on postoperative cognitive dysfunction and postoperative delirium. We will also shed some light on perioperative management and outcomes of the super-elderly, and on pain management in the elderly patient. Members of the Scientific Subcommittee are involved in the development of ESA guidelines, such as the ‘European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium’4 and the up-date of the guideline ‘Preoperative evaluation of the adult patient undergoing non-cardiac surgery: guideline from the European Society of Anaesthesiology’.

The Geriatric Anaesthesiology subcommittee has also recently initiated the ‘Peri-interventional Outcome Study in the Elderly (POSE)’ trial. The continuously increasing elderly population (≥80 years) in Europe suggests a dramatic growth in the number of elderly patients undergoing a variety of surgical and non-surgical interventional procedures. Little is known about the peri-interventional mortality rates and outcome in this specific elderly population. The aim of the POSE trial is to determine the peri-interventional (surgical and non-surgical) all-cause mortality rate on day 30. Secondary outcome parameters assessed will include an array of post-interventional major complications and functional and cognitive outcome until post-interventional day 30. This European multi-centre, prospective observational cohort study aims to include 7500 patients. The recruitment period for each centre will be 30 days (chosen by each centre) within an overall study recruitment period of one year. The follow-up period per patient is 30 days after intervention. Patients meeting the following criteria are eligible for inclusion: age ≥ 80 years, written informed consent prior to study participation, all consecutive patients undergoing surgical and non-surgical interventions (e.g., radiological, neuroradiological, cardiological, gastroenterological) with anaesthesia care (performed by an anaesthetist) within the selected inclusion period of 30 days, elective and emergency procedures, and in-patient and out-patient procedures. The only exclusion criteria will be people who are institutionalized by court or administrative order or patients with re-intervention within the 30-day recruitment period who were already enrolled in this study. Thus far 76 centres have registered to participate in the POSE study. We are looking for further centres to participate; see Figure 1. The POSE study was designated an ESA Study Group on the 18th of September 2017.

Figure 1. POSE-Trial ESA Research Group.

References

  1. Coburn M, Sanders R, Neuman M, Rossaint R, Matot I. We may have improved but we must get better still: the never-ending story of the elderly with fractured neck of femur. Eur J Anaesthesiol 2017;34:115-7.
  2. Shem Tov L, Matot I. Frailty and anesthesia. Curr Opin Anaesthesiol 2017;30:409-17.
  3. Bilotta F, Qeva E, Matot I. Anesthesia and cognitive disorders: a systematic review of the clinical evidence. Expert Rev Neurother 2016;16:1311-20.
  4. Aldecoa C, Bettelli G, Bilotta F, et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol 2017;34:192-214.