Abstract
Parkinson's disease is the second most common neurodegenerative disease worldwide,
leading to a wide range of disability and medical complications. Managing patients
with Parkinson's disease in the perioperative hospital setting can be particularly
challenging. Suboptimal management can lead to medical complications, prolonged hospital
stays, and delayed recovery. This review aims to address the most important issues
related to caring for patients with Parkinson's disease perioperatively who are undergoing
emergent or planned general surgery. It also intends to help hospitalists, internists,
and other health care providers mitigate potential in-hospital morbidity and prevent
prolonged recovery. Challenges in managing patients with Parkinson's disease in the
perioperative hospital setting include disruption of medication schedules, “nothing
by mouth” status, reduced mobility, and medication interactions and their side effects.
Patients with Parkinson's disease are more prone to immobility and developing dysphagia,
respiratory dysfunction, urinary retention, and psychiatric symptoms. These issues
lead to higher rates of pneumonia, urinary tract infections, deconditioning, and falls
compared with patients without Parkinson's disease, as well as prolonged hospital
stays and a greater need for post-hospitalization rehabilitation. Steps can be taken
to decrease these complications, including minimizing nothing by mouth status duration,
using alternative routes of drugs administration when unable to give medications orally,
avoiding drug interactions and medications that can worsen parkinsonism, assessing
swallowing ability frequently, encouraging incentive spirometry, performing bladder
scans, avoiding Foley catheters, and providing aggressive physical therapy. Knowing
and anticipating these potential complications allow hospital physicians to mitigate
nosocomial morbidity and shorten recovery times and hospital stays.
Keywords
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Article info
Publication history
Published online: December 12, 2013
Footnotes
Funding: None.
Conflict of Interest: None.
Authorship: Both authors had access to the data and played a role in writing this manuscript.
Identification
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© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
