1. Siddiqi N, Harrison JK, Clegg A, et al. Interventions for preventing delirium in hospitalised non-ICU patients. Coch Data Syst Rev. 2016;3 Cd005563. [PubMed] [Google Scholar]
2. Lin HS, Watts JN, Peel NM, Hubbard RE. Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatrics. 2016;16 [PMC free article] [PubMed] [Google Scholar]
3. Watt J, Tricco AC, Talbot-Hamon C, et al. Identifying older adults at risk of harm following elective surgery: a systematic review and meta-analysis. BMC Med. 2018;16 [PMC free article] [PubMed] [Google Scholar]
4. Birkelbach O, Morgeli R, Balzer F, et al. [Why and How Should I Assess Frailty? A guide for the preoperative anesthesia clinic] AINS. 2017;52:765–776. [PubMed] [Google Scholar]
5. De Hert S, Staender S, Fritsch G, et al. Pre-operative evaluation of adults undergoing elective noncardiac surgery: updated guideline from the European Society of Anaesthesiology. EJA. 2018;35:407–465. [PubMed] [Google Scholar]
6. Barberan-Garcia A, Ubre M, Roca J, et al. Personalised prehabilitation in high-risk patients undergoing elective major abdominal surgery: a randomized blinded controlled Trial. Ann Surg. 2018;267:50–56. [PubMed] [Google Scholar]
7. Valkenet K, van de Port IG, Dronkers JJ, de Vries WR, Lindeman E, Backx FJ. The effects of preoperative exercise therapy on postoperative outcome: a systematic review. Clin Rehabil. 2011;25:99–111. [PubMed] [Google Scholar]
8. Gillis C, Buhler K, Bresee L, et al. Effects of nutritional prehabilitation, with and without exercise, on outcomes of patients who undergo colorectal surgery: a systematic review and meta-analysis. Gastroenterology. 2018;155:391–410e4. [PubMed] [Google Scholar]
9. Statistisches Bundesamt, editor. Gesundheit im Alter, 2012. www.destatis.de/DE/Publikationen/Thematisch/Gesundheit/Gesundheitszustand/GesundheitimAlter0120006109004.pdf?__blob=publicationFile (last accessed on 8 January 2019) [Google Scholar]
10. Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Deutsche Gesellschaft für Innere Medizin (DGIM), Deutsche Gesellschaft für Chirurgie (DGCH), Zwissler B. Präoperative Evaluation erwachsener Patienten vor elektiven, nicht herz-thoraxchirurgischen Eingriffen. Gemeinsame Empfehlung der DGAI, DGCH und DGIM. Anästh Intensivmed. 2017;58:349–364. [Google Scholar]
11. Sprung J, Roberts RO, Weingarten TN, et al. Postoperative delirium in elderly patients is associated with subsequent cognitive impairment. Br J Anaesth. 2017;119:316–323. [PubMed] [Google Scholar]
12. Aldecoa C, Bettelli G, Bilotta F, et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. EJA. 2017;34:192–214. [PubMed] [Google Scholar]
13. Kalbe E, Kessler J, Calabrese P, et al. DemTect: a new, sensitive cognitive screening test to support the diagnosis of mild cognitive impairment and early dementia. Int J Geriatr Psychiatry. 2004;19:136–143. [PubMed] [Google Scholar]
14. Kwan E, Straus SE. Assessment and management of falls in older people. CMAJ. 2014;186:E610–E621. [PMC free article] [PubMed] [Google Scholar]
15. Osteologie D. Leitlinie Osteoporose. www.dv-osteologie.org/uploads/Leitlinie%202017/Finale%20Version%20Leitlinie%20Osteoporose%202017_end.pdf (last accessed on 8 January 2019) [Google Scholar]
16. Kaiser MJ, Bauer JM, Ramsch C, et al. Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status. J Nutr Health Aging. 2009;13:782–788. [PubMed] [Google Scholar]
17. Volkert DBJ, Frühwald T, Gehrke I, et al. Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) in Zusammenarbeit mit der GESKES, der AKE und der DGG: Klinische Ernährung in der Geriatrie. Aktuel Ernahrungsmed. 2013;38:e1, e48. [Google Scholar]
18. Volkert D, Beck AM, Cederholm T, et al. ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr (Edinburgh, Scotland) 2018:1–38. [PubMed] [Google Scholar]
19. Holt S, Schmiedl S, Thurmann PA. Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int. 2010;107:543–551. [PMC free article] [PubMed] [Google Scholar]
20. American Geriatrics Society. Updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63:2227–2246. [PubMed] [Google Scholar]
21. Mohanty S, Rosenthal RA, Russell MM, et al. Optimal perioperative management of the geriatric patient: a best practices guideline from the American College of Surgeons NSQIP and the American Geriatrics Society. J Am Coll Surg. 2016;222:930–947. [PubMed] [Google Scholar]
22. Chow WB, Rosenthal RA, Merkow RP, Ko CY, Esnaola NF. Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg. 2012;215:453–466. [PubMed] [Google Scholar]
23. Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010;138:1093–1100. [PubMed] [Google Scholar]
24. Douketis JD, Spyropoulos AC, Kaatz S, et al. Perioperative bridging anticoagulation in patients with atrial fibrillation. N Engl J Med. 2015;373:823–833. [PMC free article] [PubMed] [Google Scholar]
25. Denkinger MK, Grünewald M, Kiefmann R. Antikoagulation bei alterstraumatologischen Patienten Weissbuch Alterstraumatologie: Antikoagulation und Thromboseprophylaxe. OUP. In: Liener UC, Becker C, Rapp K, editors. Dienst am Buch Vertriebsgesellschaft mbH. 1. Stuttgart: 2018. pp. 34–39. [Google Scholar]
26. Association of Anaesthetists of Great Britain and Ireland. Peri-operative care of the elderly 2014. Anaesthesia. 2014;69:81–98. [PubMed] [Google Scholar]
27. Mohanty S, Rosenthal R, Russell M, Neuman M, Ko C, Esnaola N. Optimal perioperative management of the geriatric patient: a best practices guideline. J Am Coll Surg. 2016;222:930–947. [PubMed] [Google Scholar]
28. Radtke FM, Franck M, MacGuill M, et al. Duration of fluid fasting and choice of analgesic are modifiable factors for early postoperative delirium. EJA. 2010;27:411–416. [PubMed] [Google Scholar]
29. Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e. V. und Berufsverband Deutscher Anästhesisten e. V. Entschließungen, Empfehlungen, Vereinbarungen. Ebelsbach: Aktiv Druck & Verlag GmbH. 2011 [Google Scholar]
30. Smith MD, McCall J, Plank L, Herbison GP, Soop M, Nygren J. Preoperative carbohydrate treatment for enhancing recovery after elective surgery. Coch Data Syst Rev. 2014 CD009161. [PubMed] [Google Scholar]
31. Amer MA, Smith MD, Herbison GP, Plank LD, McCall JL. Network meta-analysis of the effect of preoperative carbohydrate loading on recovery after elective surgery. Br J Surg. 2017;104:187–197. [PubMed] [Google Scholar]
32. Clegg A, Young JB. Which medications to avoid in people at risk of delirium: a systematic review. Age Ageing. 2011;40:23–29. [PubMed] [Google Scholar]
33. Loh A, Simon D, Kriston L, Härter M. [Shared decision making in medicine] Dtsch Arztebl Int. 2007;104 (21 A):1483–1488. [Google Scholar]
34. McIsaac DI, Bryson GL, van Walraven C. Association of frailty and 1-year postoperative mortality following major elective noncardiac surgery: a population-based cohort study. JAMA Surgery. 2016;151:538–545. [PubMed] [Google Scholar]
35. Schuld J, Glanemann M. Chirurgische Therapie des kolorektalen Karzinoms im Alter. Chirurg. 2017;88:123–130. [PubMed] [Google Scholar]
36. Chen CC, Li HC, Liang JT, et al. Effect of a modified hospital elder life program on delirium and length of hospital stay in patients undergoing abdominal surgery: a cluster randomized clinical trial. JAMA Surgery. 2017;152:827–834. [PMC free article] [PubMed] [Google Scholar]
37. National Institute for Health and Care Excellence (NICE) Delirium: prevention, diagnosis and management. www.nice.org.uk/guidance/cg103 (last accessed on 8 January 2019) [Google Scholar]
38. Weimann A, Breitenstein S, Breuer JP, et al. S3-Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) in Zusammenarbeit mit der GESKES, der AKE, der DGCH, der DGAI und der DGAV: Klinische Ernährung in der Chirurgie. Aktuel Ernahrungsmed. 2013;38:e155–e197. [Google Scholar]
39. Weimann A, Braga M, Carli F, et al. ESPEN guideline: clinical nutrition in surgery. Clinical Nutrition (Edinburgh, Scotland) 2017;36:623–650. [PubMed] [Google Scholar]
E1. Statistisches Bundesamt. Fallpauschalenbezogene Krankenhausstatistik (DRG-Statistik). Operationen und Prozeduren der vollstationären Patientinnen und Patienten in Krankenhäusern. Wiesbaden. Statistisches Bundesamt. 2017 [Google Scholar]
E2. Fong TG, Tulebaev SR, Inouye SK. Delirium in elderly adults: diagnosis, prevention and treatment. Nat Rev Neurol. 2009;5:210–220. [PMC free article] [PubMed] [Google Scholar]
E3. Anastasiadis K, Argiriadou H, Kosmidis MH, et al. Neurocognitive outcome after coronary artery bypass surgery using minimal versus conventional extracorporeal circulation: a randomised controlled pilot study. Heart (British Cardiac Society) 2011;97:1082–1088. [PubMed] [Google Scholar]
E4. Dasgupta M, Dumbrell AC. Preoperative risk assessment for delirium after noncardiac surgery: a systematic review. J Am Geriatr Soc. 2006;54:1578–1589. [PubMed] [Google Scholar]
E5. Neuman HB, Weiss JM, Leverson G, et al. Predictors of short-term postoperative survival after elective colectomy in colon cancer patients = 80 years of age. Ann Surg Oncol. 2013;20:1427–1435. [PMC free article] [PubMed] [Google Scholar]
E6. Covinsky KE, Justice AC, Rosenthal GE, Palmer RM, Landefeld CS. Measuring prognosis and case mix in hospitalized elders The importance of functional status. J Gen Intern Med. 1997;12:203–208. [PMC free article] [PubMed] [Google Scholar]
E7. Davis RB, Iezzoni LI, Phillips RS, Reiley P, Coffman GA, Safran C. Predicting in-hospital mortality The importance of functional status information. Med Care. 1995;33:906–921. [PubMed] [Google Scholar]
E8. Buigues C, Juarros-Folgado P, Fernandez-Garrido J, Navarro-Martinez R, Cauli O. Frailty syndrome and pre-operative risk evaluation: a systematic review. Arch Gerontol Geriatr. 2015;61:309–321. [PubMed] [Google Scholar]
E9. Shem Tov L, Matot I. Frailty and anesthesia. Curr Opin Anaesthesiol. 2017;30:409–417. [PubMed] [Google Scholar]
E10. Schmidt M, Eckardt R, Altmeppen S, Wernecke KD, Spies C. Functional impairment prior to major non-cardiac surgery is associated with mortality within one year in elderly patients with gastrointestinal, gynaecological and urogenital cancer: a prospective observational cohort study. J Geriatr Oncol. 2018;9:53–59. [PubMed] [Google Scholar]
E11. Oakland K, Nadler R, Cresswell L, Jackson D, Coughlin PA. Systematic review and meta-analysis of the association between frailty and outcome in surgical patients. Ann R Coll Surg Engl. 2016;98:80–85. [PMC free article] [PubMed] [Google Scholar]
E12. Vermeiren S, Vella-Azzopardi R, Beckwee D, et al. Frailty and the prediction of negative health outcomes: a meta-analysis. J Am Med Dir Assoc. 2016;17:1163.e1–1163e17. [PubMed] [Google Scholar]
E13. McIsaac DI, Saunders C, Hladkowicz E, et al. PREHAB study: a protocol for a prospective randomised clinical trial of exercise therapy for people living with frailty having cancer surgery. BMJ Open. 2018;8 e022057. [PMC free article] [PubMed] [Google Scholar]
E14. Steppuhn H KR. Scheidt-Nave C 12-Monats-Prävalenz der bekannten chronisch obstruktiven Lungenerkrankung (COPD) in Deutschland. Journal of Health Monitoring. 2017;2:46–54. [Google Scholar]
E15. Heidemann C, Kuhnert R, Born S, et al. 12-Monats-Prävalenz des bekannten Diabetes mellitus in Deutschland. Journal of Health Monitoring. 2017;2:48–56. [Google Scholar]
E16. Busch MA, Schienkiewitz A, Nowossadeck E, Gosswald A. [Prevalence of stroke in adults aged 40 to 79 years in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1)] Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz) 2013;56:656–660. [PubMed] [Google Scholar]
E17. Fong TG, Davis D, Growdon ME, Albuquerque A, Inouye SK. The interface between delirium and dementia in elderly adults. Lancet Neurology. 2015;14:823–832. [PMC free article] [PubMed] [Google Scholar]
E18. Ahmed S, Leurent B, Sampson EL. Risk factors for incident delirium among older people in acute hospital medical units: a systematic review and meta-analysis. Age Ageing. 2014;43:326–333. [PMC free article] [PubMed] [Google Scholar]
E19. Engels D, Pfeuffer F, Heusinger J, et al. Möglichkeiten und Grenzen selbständiger Lebensführung in stationären Einrichtungen (MuG IV) - Demenz, Angehörige und Freiwillige, Versorgungssituation sowie Beispielen für „Good Practice“ In: Bundesministerium für Familie, Frauen und Jugend, (ed.): Integrierter Abschlussbericht 2007. www.bmfsfj.de/blob/78928/9465bec83edaf4027f25bb5433ea702e/abschlussbericht-mug4-data.pdf (last accessed on 15 January 2019) [Google Scholar]
E20. von Renteln-Kruse W, Neumann L, Klugmann B, et al. Geriatric patients with cognitive impairment. Dtsch Arztebl Int. 2015;112:103–112. [PMC free article] [PubMed] [Google Scholar]
E21. Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. The mini-cog: a cognitive ‚vital signs‘ measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry. 2000;15:1021–1027. [PubMed] [Google Scholar]
E22. Klenk J, Kerse N, Rapp K, et al. Physical activity and different concepts of fall Rrisk estimation in older people—results of the ActiFE-Ulm study. PLOS ONE. 2015;10 e0129098. [PMC free article] [PubMed] [Google Scholar]
E23. Siegrist M, Freiberger E, Geilhof B, et al. Fall prevention in a primary care setting. Dtsch Arztebl Int. 2016;113:365–372. [PMC free article] [PubMed] [Google Scholar]
E24. Konturek PC, Herrmann HJ, Schink K, Neurath MF, Zopf Y. Malnutrition in hospitals: it was, is now, and must not remain a problem! Sci Monit. 2015;21:2969–2975. [PMC free article] [PubMed] [Google Scholar]
E25. Pirlich M, Schutz T, Norman K, et al. The German hospital malnutrition study. Clinical Nutrition (Edinburgh, Scotland) 2006;25:563–572. [PubMed] [Google Scholar]
E26. Phillips P. Grip strength, mental performance and nutritional status as indicators of mortality risk among female geriatric patients. Age Ageing. 1986;15:53–56. [PubMed] [Google Scholar]
E27. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clinical Nutrition (Edinburgh, Scotland) 2003;22:321–336. [PubMed] [Google Scholar]
E28. Harstedt M, Rogmark C, Sutton R, Melander O, Fedorowski A. Polypharmacy and adverse outcomes after hip fracture surgery. J Orthop Surg Res. 2016;11 [PMC free article] [PubMed] [Google Scholar]
E29. Kennedy JM, van Rij AM, Spears GF, Pettigrew RA, Tucker IG. Polypharmacy in a general surgical unit and consequences of drug withdrawal. Br J Clin Pharmacol. 2000;49:353–362. [PMC free article] [PubMed] [Google Scholar]
E30. Barnett SR. Polypharmacy and perioperative medications in the elderly. Anesthesiol Clin. 2009;27:377–389. [PubMed] [Google Scholar]
E31. Madsen CM, Jantzen C, Lauritzen JB, Abrahamsen B, Jorgensen HL. Temporal trends in the use of antithrombotics at admission. Acta Orthop. 2016;87:368–373. [PMC free article] [PubMed] [Google Scholar]
E32. Oprea AD, Noto CJ, Halaszynski TM. Risk stratification, perioperative and periprocedural management of the patient receiving anticoagulant therapy. J Clin Anesth. 2016;34:586–599. [PubMed] [Google Scholar]
E33. Lip GY, Frison L, Halperin JL, Lane DA. Comparative validation of a novel risk score for predicting bleeding risk in anticoagulated patients with atrial fibrillation: the HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) score. J Am Coll Cardiol. 2011;57:173–180. [PubMed] [Google Scholar]
E34. Douketis JD, Healey JS, Brueckmann M, et al. Perioperative bridging anticoagulation during dabigatran or warfarin interruption among patients who had an elective surgery or procedure. Substudy of the RE-LY trial. Thromb Haemost. 2015;113:625–632. [PubMed] [Google Scholar]
E35. Meyer-Frießem C, Pogatzki-Zahn E. Postoperative Schmerztherapie Praxis der Anästhesiologie: konkret - kompakt - leitlinienorientiert. In: Wilhelm W, editor. Springer. Berlin: 2018. [Google Scholar]
E36. Deutsche Hauptstelle für Suchtfragen e. V. DHS Jahrbuch Sucht. Lengerich: Pabst Science Publishers. 2018 [Google Scholar]
E37. Vaurio LE, Sands LP, Wang Y, Mullen EA, Leung JM. Postoperative delirium: the importance of pain and pain management. Anesth Analg. 2006;102:1267–1273. [PubMed] [Google Scholar]
E38. Scottish Intercollegiate Guidelines Network (SIGN) A national clinical guideline 2008, updated 2014. www.sign.ac.uk/assets/sign104.pdf (last accessed on 8 January 2019) [Google Scholar]
E39. Olufajo OA, Reznor G, Lipsitz SR, et al. Preoperative assessment of surgical risk: creation of a scoring tool to estimate 1-year mortality after emergency abdominal surgery in the elderly patient. Am J Surg. 2017;213:771–777e1. [PubMed] [Google Scholar]
E40. Werther SFJ, Mayr E. Interdisziplinäres Management im Zentrum für geriatrische Traumatologie. Orthopädie und Unfallchirurgie up2date. 2014;9:387–406. [Google Scholar]
E41. Boettger S, Nunez DG, Meyer R, et al. Delirium in the intensive care setting: A reevaluation of the validity of the CAM-ICU and ICDSC versus the DSM-IV-TR in determining a diagnosis of delirium as part of the daily clinical routine. Palliat Support Care. 2017:1–9. [PubMed] [Google Scholar]
E42. Gavinski K, Carnahan R, Weckmann M. Validation of the delirium observation screening scale in a hospitalized older population. J Hosp Med. 2016;11:494–497. [PMC free article] [PubMed] [Google Scholar]
E43. Hargrave A, Bastiaens J, Bourgeois JA, et al. Validation of a nurse-based delirium-screening tool for hospitalized patients. Psychosomatics. 2017;58:594–603. [PMC free article] [PubMed] [Google Scholar]
E44. Adamis D, Sharma N, Whelan PJ, Macdonald AJ. Delirium scales: a review of current evidence. Aging Ment Health. 2010;14:543–555. [PubMed] [Google Scholar]
E45. Wong CL, Holroyd-Leduc J, Simel DL, Straus SE. Does this patient have delirium? Value of bedside instruments. JAMA. 2010;304:779–786. [PubMed] [Google Scholar]
E46. Faught DD. Delirium: The nurse‘s role in prevention, diagnosis, and treatment. Medsurg Nurs. 2014;23:301–305. [PubMed] [Google Scholar]
E47. Marcantonio ER, Flacker JM, Wright RJ, Resnick NM. Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc. 2001;49:516–522. [PubMed] [Google Scholar]
E48. Kratz T, Heinrich M, Schlauss E, Diefenbacher A. Preventing postoperative delirium. Dtsch Arztebl Int. 2015;112:289–296. [PMC free article] [PubMed] [Google Scholar]
E49. Olotu C. Eckart J, Jaeger K, Möllhof T, editors. Anästhesiologische Behandlungspfade für ältere Patienten Kompendium Anästhesiologie. Landsberg am Lech. Ecomed-Storck. 2018:1–14. 60.Erg.-Lfg. 11/18. [Google Scholar]
Page 2
Assessment of evidence from relevant studies and guidelines
| Perioperative significance of frailty (first author, source) | ||
| Schmidt et al. 2018 (e10) | Prospective cohort study;131 patients; follow-up: 1 year postoperatively | Higher 1-year mortality in patients with frailty(OR: 4.5; 95% CI: [1.2; 18.3]).Cognitive impairment associated with increased 1-year mortality (OR: 0.6; 95% CI: [0.4; 0.95]). Evidence level: moderate |
| Oakland et al. 2016 (e11) | Meta-analysis; 12 studies, 7960 patients | Frailty increases hospital mortality and (OR: 2.78; 95% CI: [1.6; 4.7]) 1-year mortality (OR: 1.99; 95% CI: [1.5; 2.7]). Evidence level: moderate–high |
| Watt et al. 2018 (3) | Meta-analysis; 44 studies, 12 281 patients | Frailty (OR: 2.2; 95% CI: [1.3; 3.6]) and cognitive impairments (OR: 2.01; 95% CI: [1.4; 2.8]) are associated with the development of postoperative complications. Evidence level: moderate–high |
| Delirium | ||
| Aldecoa et al. 2017 (12) | Guideline | Preoperative identification of risk factors and implementation of POD preventive measures recommended. Evidence level: high |
| Siddiqi et al. 2016 (1) | Meta-analysis (Cochrane); 39 studies, 16 082 patients | Multicomponent programs are effective in POD prevention (versus standard care: RR: 0.69; 95% CI: [0.6; 0.8]). Evidence level: moderate–high |
| NICE Clinical Guideline 2010 (37) | Guideline | Old age, cognitive impairment, and multimorbidity are significant risk factors for the development of POD. Evidence level: high |
| Perioperative nutrition | ||
| Weimann et al. 2013Weimann et al. 2017 (38, 39) | S3 Guidelines | Unnecessary perioperative fasting should be avoided, carbohydrate-containing drinks advisable preoperatively, perioperative nutritional therapy recommended in patients with malnutrition. Evidence level: high |
| Volkert et al. 2013, 2018 (17, 18) | S3 Guideline | Malnutrition and frailty increase the postoperative complication rate and mortality, perioperative nutrition concepts recommended. Evidence level: high |
| Polypharmacy | ||
| Chow et al. 2012Mohanty et al. 2016 (22, 27) | Guidelines | Non-essential medication should be discontinued perioperatively in order to avoid medication-induced complications. Evidence level: moderate–high |
| Holt et al. 2010 (19) | Qualitative literature analysis;expert group (Delphi) | Identification of 83 drugs as potentially inappropriate medications (PIM) for the elderly. Evidence level: moderate |
| AGS 2015 (20) | Systematic literature search;expert group (Delphi) | Identification of drugs as potentially inappropriate medications (PIM) in the elderly. Evidence level: moderate–high |
| Anticoagulation | ||
| Douketis et al. 2015 (24) | RCT (multicenter), 1813patients, follow-up: 37 days postoperatively | Reduction in postoperative risk of bleeding (RR: 0.4; 95% CI: [0.2; 0.8]) and no increase in thromboembolic events when “bridging” with LMWH was forgone in patients with atrial fibrillation. Evidence level: high |