Geriatric Preoperative Optimization: A Review - 15/12/21
, Serena Wong, MD b, Mitchell T. Heflin, MD b, c, Shelley R. McDonald, DO b, c, Robert Sickeler, MD d, Michael Devinney, MD, PhD e, Jeanna Blitz, MD e, Sandhya Lagoo-Deenadayalan, MD, PhD f, Miles Berger, MD, PhD eAbstract |
This review summarizes best practices for the perioperative care of older adults as recommended by the American Geriatrics Society, American Society of Anesthesiologists, and American College of Surgeons, with practical implementation strategies that can be readily implemented in busy preoperative or primary care clinics. In addition to traditional cardiopulmonary screening, older patients should undergo a comprehensive geriatric assessment. Rapid screening tools such as the Mini-Cog, Patient Health Questionnaire-2, and Frail Non-Disabled Survey and Clinical Frailty Scale, can be performed by multiple provider types and allow for quick, accurate assessments of cognition, functional status, and frailty screening. To assess polypharmacy, online resources can help providers identify and safely taper high-risk medications. Based on preoperative assessment findings, providers can recommend targeted prehabilitation, rehabilitation, medication management, care coordination, and/or delirium prevention interventions to improve postoperative outcomes for older surgical patients. Structured goals of care discussions utilizing the question-prompt list ensures that older patients have a realistic understanding of their surgery, risks, and recovery. This preoperative workup, combined with engaging with family members and interdisciplinary teams, can improve postoperative outcomes.
Le texte complet de cet article est disponible en PDF.Keywords : Delirium, Frailty, Older adults, Optimization, Perioperative
Plan
| Funding: None. |
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| Conflicts of Interest: This was an unfunded study. MB acknowledges support from National Institutes of Health (NIH) grants P30-AG028716, UH3-AG056925, K76-AG057022, and the Alzheimer's Drug Discovery Foundation. He also acknowledges receiving material support (an electroencephalogram monitor loan), from Masimo, Inc. (Irvine, Calif) for an unrelated study. He has received consulting fees from Masimo Inc. and legal consulting fees related to postoperative cognition in older adults. MD acknowledges a payment from the Foundation for Anesthesia Education and Research and loaned equipment from ResMed, Inc. for an unrelated study. SRM reports salary support from the NIH, US Highbush Blueberry Council, the National Dairy Council, and The American Egg Board. She also receives consultant fees from Guidepoint Consultant. The other authors have no conflicts of interest to report. |
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| Authorship: All authors participated in the literature review and preparation of this manuscript. |
Vol 135 - N° 1
P. 39-48 - janvier 2022 Retour au numéro
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