Reviews in Clinical Gerontology

Review Article

Peri-operative management of older people undergoing surgery

DJH Shipwaya1 c1, D Hararia1a2 and JK Dhesia1

a1 Proactive Care of Older Patients Undergoing Surgery (POPS), Department of Ageing and Health, Guy's and St Thomas’ NHS Foundation Trust, UK

a2 Proactive Care of Older Patients Undergoing Surgery (POPS), Division of Social and Health Service Research, Kings College London, UK

Summary

Increasing numbers of older people are undergoing both emergency and elective surgery. However, they remain at increased risk of adverse outcome in comparison with younger patients. This may relate to the association of ageing with physiological deterioration, multi-morbidity and geriatric syndromes such as frailty, all of which are independent predictors of adverse post-operative outcome. Although there is an emerging evidence base for the identification and management of these predictors, this has not yet translated into routine clinical practice. Older patients undergoing surgery often receive sub-optimal care and surgical pathways are not well suited to complex older patients with multi-pathology. Evidence is emerging for alternative models of care that incorporate the evolving evidence base for optimal peri-operative management of the older surgical patient, including risk assessment and optimization. This article aims to provide a practical overview of the literature to all disciplines working in this field.

(Online publication November 20 2013)

Key words:

  • older adults;
  • geriatric assessment;
  • surgery;
  • pre-operative care;
  • post-operative complications

Correspondence

c1 Address for correspondence: Dr DJH Shipway, Older Persons Assessment Unit, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK. Email: Shipway@doctors.net.uk