Perioperative Management of Older Women in Urogynecologic Surgery

Abstract

Preoperative measurements of frailty and mobility predict surgical outcomes in older patients better than measurements of medical comorbidities or American Society of Anesthesiologists (ASA) status alone. The purpose of this review is to summarize updated evidence for optimal preoperative assessment, perioperative management, and postoperative care for elective gynecologic surgery in older women. Two joint best-practice guideline statements from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and the American Geriatrics Society (AGS) focus on preoperative (2012) and perioperative care (2016) of the geriatric patient. Preoperative identification of frailty, cognitive impairment, and functional disability in older women may be an important way to improve outcomes. Preoperative identification has the potential to allow surgeons to better counsel patients about unique postoperative risks, tailor the aggressiveness of the surgical approach, and facilitate shared decision-making. Finally, preoperative identification can help identify patients who need extra support at hospital discharge with transitions of care. Future research is necessary to assess the impact of preoperative geriatric screening for frailty, cognitive impairment, and mobility disorders with treatment success and postoperative outcomes in older women undergoing surgical correction of pelvic floor disorders (PFDs) and other elective gynecologic procedures.