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Optimizing Pre-Op Assessments of Geriatric Surgical Patients

Optimizing Pre-Op Assessments of Geriatric Surgical Patients

The percentage of Americans aged 65 and older is projected to more than double between 2010 and 2050. In 2006, 35% of inpatient and 32% of outpatient surgical procedures were performed in the elderly, percentages that will likely increase as the older population continues to expand. Caring for the elderly is different in many respects from taking care of younger patients, according to Clifford Y. Ko, MD, FACS. “The elderly tend to have more comorbidities and take more medications than younger patients,” he says. “They also tend to have disproportionately longer lengths of stay in the hospital following inpatient surgery.” A Systematic Approach to Preoperative Evaluations of the Elderly In 2012, a guideline was released by the American College of Surgeons (ACS) and the American Geriatrics Society (AGS) to help physicians with preoperative evaluations for elderly patients. A key recommendation from the guideline is that multiple clinical features be reviewed during preoperative evaluations of elderly patients. “Several areas should be reviewed more deeply before surgery in older patients, including heart, lung, and kidney function,” says Dr. Ko, who was a co-author of the guidelines. “With older patients, physicians have a greater likelihood of uncovering issues that need to be addressed prior to surgery.” The guidelines also recommend that clinicians explore social situations and transportation issues. Furthermore, elderly patients should be assessed for vision and hearing challenges and ambulatory function prior to surgery. The ACS/AGS guidelines recommend and specify 13 key issues of preoperative care for the elderly (Table 1). Each area is explored in depth in the full guideline. Dr. Ko notes that all items described in the guideline recommendations...
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