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Peri-operative management of older people undergoing surgery

Published online by Cambridge University Press:  20 November 2013

DJH Shipway ,
D Harari  and
JK Dhesi
DJH Shipway*
Affiliation:
Proactive Care of Older Patients Undergoing Surgery (POPS), Department of Ageing and Health, Guy's and St Thomas’ NHS Foundation Trust, UK
D Harari
Affiliation:
Proactive Care of Older Patients Undergoing Surgery (POPS), Department of Ageing and Health, Guy's and St Thomas’ NHS Foundation Trust, UK Proactive Care of Older Patients Undergoing Surgery (POPS), Division of Social and Health Service Research, Kings College London, UK
JK Dhesi
Affiliation:
Proactive Care of Older Patients Undergoing Surgery (POPS), Department of Ageing and Health, Guy's and St Thomas’ NHS Foundation Trust, UK
*
Address for correspondence: Dr DJH Shipway, Older Persons Assessment Unit, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK. Email: [email protected]
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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.

Keywords

older adultsgeriatric assessmentsurgerypre-operative carepost-operative complications
Type
Review Article
Information
Reviews in Clinical Gerontology , Volume 24 , Issue 1 , February 2014 , pp. 78 - 92
Copyright
Copyright © Cambridge University Press 2013 

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