Prompted by statistical findings that the growing population of seniors in the U.S. is aging increasingly with complex and advanced medical conditions, the American College of Surgeons and the American Geriatrics Society developed a set of 13 guidelines to steer the preoperative care of surgical patients age 65 and older.
Among the key preoperative issues that surgeons should evaluate are cognitive function—looking out for signs of cognitive impairment or dementia—and decision-making capacity as well as alcohol or substance abuse and risk for post-operative delirium. Surgeons also should assess cardiac function; pulmonary function; mobility and fall risk; frailty; nutritional status; medication management; patient counseling; preoperative testing; and the patient's family and social support system.
"Although this comprehensive evaluation may require more resources and time to complete compared with the conventional assessment, the authors and the expert panel strongly believe that additional steps are justified by the benefits from identifying high-risk patients, improving communication between the surgeon and patients and potentially preventing perioperative adverse events," the introduction to the guidelines stated. "In addition, whether the surgeon completes the entire evaluation or delegates aspects to other physicians, the surgeon must understand the components of the geriatric preoperative assessment and be able to interpret the results." The guidelines were developed over two years by the ACS and AGS' multidisciplinary panel of experts and are published in the Journal of the American College of Surgeons
Comorbidities, medications and risk for heart failure call for special surgical strategies, Dr. Clifford Ko, director of the ACS National Surgical Quality Improvement Program, said in a news release
"Surgeons have to plan and deal with these comorbidities simultaneously while the patient is undergoing a surgical procedure," said Ko, who is also a professor of surgery at University of California, Los Angeles and director of UCLA's Center for Surgical Outcomes and Quality. "There is no single magic bullet for rendering this level of surgical care. Each of the 13 issues covered by the guidelines is very important, comprehensive and difficult to prioritize."