As our patients' age progresses, so should our definition of 'recovery'. In this episode of BackTable OBGYN, Dr. Mary Ackenbom, associate professor of urogynecology and reconstructive pelvic surgery at the University of Michigan, is welcomed by host Dr. Amy Park to discuss improving outcomes for older surgical patients.

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SYNPOSIS

Dr. Ackenbom shares her journey from studying finance at Ohio State to ultimately specializing in urogynecology. The conversation mainly focuses on perioperative cognitive health, particularly in aging populations, and how conditions like frailty and comorbidities impact surgical risk and recovery. Dr. Ackenbom highlights the importance of individualized patient care, early mobility, enhanced recovery protocols, and prehabilitation in improving postoperative outcomes. The episode also explores the prevalence of postoperative cognitive decline and offers practical insights on counseling and managing older patients undergoing urogynecologic surgery.

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TIMESTAMPS

00:00 - Introduction
02:18 - Dr. Ackenbom’s Journey to Urogynecology
04:47 - Research on Brain Fog
06:18 - Personal Support and Hobbies
09:54 - Age vs Frailty in Surgery
13:05 - Procedures with Perioperative Complexity
16:11 - Counseling on Operative Risk
20:10 - ERAS and Earlier Discharge
23:35 - Patient Goals and Tradeoffs
27:53 - Surgical Clearance and Preop Consults
33:30 - Prehabilitation Basics
36:24 - Minimally Invasive Surgery Benefits
37:15 - Surgical Cognitive Complications with Age
41:42 - Finding the Surgery Window
46:05 - Cognitive and Frailty Screening
50:01 - Guidelines for Perioperative Care
52:52 - Future Research
54:07 - Conclusion

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RESOURCES

Incidence of postoperative cognitive dysfunction in older women undergoing pelvic organ prolapse surgery
https://pubmed.ncbi.nlm.nih.gov/32827107/

ACS NSQIP/AGS Optimal Perioperative Care of the Geriatric Patient
https://www.facs.org/media/y5efmgox/acs-nsqip-geriatric-2016-guidelines.pdf