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

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

3. POSTOPERATIVE CARE: BASIC GUIDELINES (1 of 2) Hydration Quality pain control Early activity Remove tethers Avoid sedative  hypnotics Avoid polypharmacy Slide 3

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 Slide 4

5. ANTICIPATE POST-OP HYPOTENSION Hold some BP meds Hold parameters for other BP meds Hydration Correct anemia Slide 5

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

7. ANTICIPATE POST-OP DELIRIUM (1 of 2) Fix reversible causes  O 2, fever, pain, BG, urinary retention, constipation Supportive environment  Get rid of tethers  Avoid restraints Slide 7

8. ANTICIPATE POST-OP DELIRIUM (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 Slide 8

9. OTHER COMMON COMPLICATIONS (1 of 2) Atrial fibrillation MI Pneumonia Hyponatremia — usually SIADH Urinary retention UTI Slide 9

10. OTHER COMMON COMPLICATIONS (2 of 2) Pressure sores Aspiration DVT Stroke Ileus Hypertension Hyper/Hypoglycemia Slide 10

11. ALCOHOL-RELATED COMPLICATIONS Underdiagnosed Community patients Hypertension Fever Tachycardia Tremulousness Benzodiazepines (lorazepam) more helpful here Slide 11

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 12

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 Slide 13

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 Slide 14

15. CMS “NEVER EVENTS” (4 of 4) Environmental events resulting in death/disability  Fall  Use of restraints Slide 15

16. Visit us at: Facebook.com/AmericanGeriatricsSociety Twitter.com/AmerGeriatrics www.americangeriatrics.org THANK YOU FOR YOUR TIME! linkedin.com/company/american-geriatrics- society Slide 16