Abstract
BackgroundOlder surgical patients have a higher risk of postoperative mortality and morbidity compared to younger patients. Timely identification of high-risk patients facilitates comprehensive preoperative evaluation, optimization, and resource allocation to help reduce this risk. This review aims to identify a preoperative screening tool for older patients undergoing elective surgery predictive of poor short-term postoperative outcomes.MethodsA scoping review was conducted. An Ovid MEDLINE search was used to identify systematic reviews or meta-analyses comprising older elective patients in at least two different surgical settings. International guidelines were reviewed for recommendations regarding preoperative tools in this population.ResultsOver 50 screening tools were identified. The majority showed a positive association with short-term postoperative mortality and morbidity in older patients. The most commonly described tools were the American Society of Anesthesiologists Physical Status (ASA-PS), frailty tools and domain-specific tools administered as part of comprehensive geriatric assessment (CGA). Due to heterogeneity in outcome measures and statistical methodology the predictive capacity between tools could not be compared. International guidelines described a comprehensive preoperative approach incorporating domain-specific tools rather than recommending a screening tool.ConclusionMultiple tools were associated with poor short-term postoperative outcomes in older elective surgical patients. No single superior tool could be identified. Frailty, cognitive and/or functional tools were most frequently utilized.
Highlights
Older surgical patients have a higher risk of postoperative mortality and morbidity compared to younger patients
The inclusion of international guidelines was deemed necessary after the literature search of systematic reviews and meta-analyses lacked a clear consensus on which screening tools were best to use in the population of interest
The American Society of Anesthesiologists Physical Status (ASA-PS) tool, several frailty tools and domain-specific tools included as part of comprehensive geriatric assessment (CGA) were most frequently reported
Summary
Older surgical patients have a higher risk of postoperative mortality and morbidity compared to younger patients. This review aims to identify a preoperative screening tool for older patients undergoing elective surgery predictive of poor short-term postoperative outcomes. Conclusion Multiple tools were associated with poor short-term postoperative outcomes in older elective surgical patients. Older patients are more likely to suffer from multi-morbidity, frailty, cognitive and functional impairment [3]. As a result, they have poorer postoperative outcomes including higher mortality and complication rates, a prolonged length of stay and increased likelihood of discharge to supported accommodation compared to younger patients [4, 5]. Important measures of recovery, such as health-related quality of life, are infrequently reported and poorly defined [6].
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