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surgery in the elderly; geriatric surgery

Epidemiology: - ~ 40% of sugeries in the U.S. are performed on patients >= 65 years [1] Laboratory: - see preoperative laboratory testing Complications: - 14% of older adults die within a year of undergoing major surgery - risk factors for death within 1 year of major surgery include: - probable dementia* (33%) - frailty* (28%) - emergency surgery (22%) - elderly >= 90 years* are 6x as likely to die than those age 65-70 years - other risk factors - heart disease - kidney disease - self-care issues - mobility issues - 30% of elderly do not return to baseline function 6 months after major surgery - those most likely to recover have elective surgery with preparation in advance - other postoperative complications - postoperative delirium - postoperative cognitive impairment - postoperative respiratory failure * 9% of elderly >= 90 years undergo major surgery * 12% of frail elderly undergo major surgery * 12% of elderly with probable dementia undergo major surgery [3] Management: - see general surgery for general guidelines & postoperative complications for specific guidelines - prevention of postoperative delirium & postoperative cognitive impairment - preoperative screening for frailty & dementia - American College of Surgeons Geriatric Surgery Verification Program Standards has formalized guidelines for care of geriatric surgery patient [5,6] - in addition to the above - geriatric surgery nurse, education of nurses & providers - geriatric-friendly rooms - shared decision-making - discussion of life-sustaining treatments every 3 days for ICU patients - access to & return of hearing aids, eye glasses & dentures - provide water-tight container for these items - nutrition & medication plan - rescreening for vulnerabilties prior to transition of care - plan for follow-up - communication with primary care provider - implementation of the Geriatric Surgery Verification Program - reduces length of hospital stay [7,8] - reduces loss of indendence (RR=0.26) [8] - reduces major complications (RR= 0.63) [8]

Related

Geriatric Surgery Verification (GSV) Program

General

surgery

References

  1. Graham J Should Older Seniors Risk Major Surgery? New Research Offers Guidance. Medscape. Nov 28, 2022 https://www.medscape.com/viewarticle/984658 - Gill TM, Vander Wyk B, Leo-Summers L et al Population-Based Estimates of 1-Year Mortality After Major Surgery Among Community-Living Older US Adults. JAMA Surg. Published online October 19, 2022 PMID: 36260323 https://jamanetwork.com/journals/jamasurgery/fullarticle/2797666
  2. Berian JR, Rosenthal RA, Baker TL et al Hospital Standards to Promote Optimal Surgical Care of the Older Adult: A Report From the Coalition for Quality in Geriatric Surgery. Ann Surg. 2018 Feb;267(2):280-290 PMID: 28277408
  3. Becher RD, Vander Wyk B, Leo-Summers L et al The Incidence and Cumulative Risk of Major Surgery in Older Persons in the United States. Ann Surg. 2021 Jul 14;10.1097/SLA.0000000000005077 PMID: 34261884 PMCID: PMC8758792 (available on 2023-01-14)
  4. Graham J Should Older Adults Risk Major Surgery? New Research Offers Guidance. Annals of Long-Term Care. Nov 29, 2022 https://www.hmpgloballearningnetwork.com/site/altc/news/should-older-seniors-risk-major-surgery-new-research-offers-guidance
  5. Berian JR, Rosenthal RA, Baker TL et al Hospital Standards to Promote Optimal Surgical Care of the Older Adult: A Report From the Coalition for Quality in Geriatric Surgery. Ann Surg. 2018 Feb;267(2):280-290. PMID: 28277408
  6. Katlic MR Let It Rain: The American College of Surgeons Geriatric Surgery Verification Program. J Am Geriatr Soc 2020. Nov 12. PMID: 33184851 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.16928
  7. Jones TS, Jones EL, Richardson V et al Preliminary data demonstrate the Geriatric Surgery Verification program reduces postoperative length of stay. J Am Geriatr Soc. 2021 Jul;69(7):1993-1999. PMID: 33826150
  8. Ehrlich AL, Owodunni OP, Mostales JC et al Early Outcomes following Implementation of a Multispecialty Geriatric Surgery Pathway. Ann Surg. 2022 Jul 15. PMID: 35837966
  9. American College of Surgeons Accreditation & Verification Geriatric Surgery Verification Advancing Care of older adult patients https://www.facs.org/quality-programs/accreditation-and-verification/geriatric-surgery-verification/
  10. List of hospitals participating in Geriatric Surgery Verification Programs https://www.facs.org/quality-programs/accreditation-and-verification/geriatric-surgery-verification/participating-gsv-hospitals/