Geriatric dermatologic surgery part II: Peri- and intraoperative considerations in the geriatric dermatologic surgery patient - 18/12/24

Doi : 10.1016/j.jaad.2024.02.060

Kevin T. Savage, MD ^a, Jeffrey Chen, BA ^b, Kathryn Schlenker, DO ^c, Melissa Pugliano-Mauro, MD ^a, Bryan T. Carroll, MD, PhD ^d,^e,^f,^⁎
^a Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
^b University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
^c Department of Medicine, University of Washington Medical Center - Montlake, Seattle, Washington
^d Department of Dermatology, University Hospitals, Cleveland Medical Center, Cleveland, Ohio
^e Case Western Reserve University School of Medicine, Cleveland, Ohio
^f Department of Pharmacology, University of Pittsburgh, Pittsburgh, Pennsylvania

^∗Correspondence to: Bryan T. Carroll, MD, PhD, Department of Dermatology, University Hospitals, Cleveland Medical Center, 11100 Euclid Ave, Lakeside Building 3500, Cleveland, OH 44106.Department of DermatologyUniversity HospitalsCleveland Medical Center11100 Euclid Ave, Lakeside Building 3500ClevelandOH44106

Abstract

Geriatric patients compose a growing proportion of the dermatologic surgical population. Dermatologists and dermatologic surgeons should be cognizant of the unique physiologic considerations that accompany this group to deliver highly effective care. The purpose of this article is to discuss the unique preoperative, intraoperative, and postoperative considerations geriatric patients present with to provide goal-concordant care. Preoperative considerations include medication optimization and anxiolysis. Intraoperative considerations such as fall risk assessment and prevention, sundowning, familial support, and pharmacologic interactions will be discussed. Lastly, effective methods for optimizing postoperative wound care, home care, and follow-up are reviewed.

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Key words : ambulatory surgery, fall risk assessment, geriatric surgery, health literacy, home support, intraoperative considerations, perioperative considerations, polypharmacy, postoperative considerations, wound care instructions

Abbreviations used : BDZ, INR, NSAID

Plan

Introduction

Preoperative considerations

Key points

Preoperative pharmacologic considerations: Anticoagulation

Preoperative pharmacologic considerations: Anxiolysis

Pharmacologic options for anxiolysis

Nonpharmacologic anxiolysis

Potential medication interactions

Fall risk assessment and fall prevention strategies

Intraoperative considerations in geriatric dermatologic surgery patients

Key points

Postoperative considerations in geriatric Mohs patients

Key points

Conclusion

	Dr Savage and Author Chen contributed equally to this work.
	Funding sources: None.
	Patient consent: Not applicable.
	IRB approval status: Not applicable.
	Date of release: January 2025.
	Expiration date: January 2028.