Preoperative Evaluation of the Older Patient

Susan E Wozniak,Joann Coleman

doi:10.4172/2471-9870.1000103

Abstract

As the number of surgical procedures performed on geriatric patients continues to grow, it is essential to realize the unique needs of the older surgical population. With this in mind best practice guidelines were developed by leaders in the field of geriatric surgery. These best practice guidelines, “Optimal Preoperative Assessment of the Geriatric Surgical Patient,” are a comprehensive assessment addressing domains likely to impact older surgical candidates. Examples of these domains include: cognition, pre-operative physical baseline, social support, functionality, nutrition, frailty, and polypharmacy. While such a comprehensive “geriatric screening” may not always be practical, a more limited geriatric tailored preoperative assessment is still highly recommended. It allows the surgical team to proactively involve a nutritionist, physical or occupational therapist, social worker and other vital members of the postoperative care team.

Highlights

IntroductionThe spectrum of health care continues to change, especially with regard to the growth in “oldest old,” those over 85 years
The spectrum of health care continues to change, especially with regard to the growth in “oldest old,” those over 85 years. This is paralleled by an increase in conditions commonly encountered in older patients such as peripheral vascular disease, degenerative joint disease, cataracts, and coronary artery disease
Overwhelming evidence suggests that quality of life can be maintained or improved following surgery [4,5,6,7]. Despite these positive results, age remains a risk factor for postoperative morbidity [8,9] and mortality [10,11]. This reminds us that there is room for quality improvement, a large part of which involves careful preoperative assessment and interventions uniquely fitted to the needs of geriatric surgical patients

Summary

Introduction

The spectrum of health care continues to change, especially with regard to the growth in “oldest old,” those over 85 years. Overwhelming evidence suggests that quality of life can be maintained or improved following surgery [4,5,6,7] Despite these positive results, age remains a risk factor for postoperative morbidity [8,9] and mortality [10,11]. This reminds us that there is room for quality improvement, a large part of which involves careful preoperative assessment and interventions uniquely fitted to the needs of geriatric surgical patients. The final guidelines summarize evidence-based recommendations for improving preoperative assessment of geriatric patients [13]

Best Practice Versus Reality

Implementing Best Practices

Conclusion