J Korean Med Assoc.  2017 May;60(5):364-370. 10.5124/jkma.2017.60.5.364.

Preoperative assessment of geriatric patients

• Sung TY
• Cho CK

• KMID: 2378967
• DOI: http://doi.org/10.5124/jkma.2017.60.5.364

Abstract

Geriatric patients are vulnerable to stress associated with surgery. The preoperative assessment of elderly patients plays an important role in their perioperative care, in terms of risk identification, preoperative optimization, and the avoidance of postoperative complications. The preoperative assessment of geriatric patients may require multidisciplinary consultation and include a consideration of neurocognitive function, functional status, frailty, nutrition, substance abuse, polypharmacy, and decision-making capacity, as well as a meticulous evaluation of comorbidities. Preoperative laboratory tests should be ordered after a review of the medical charts, history, and physical examination. Any abnormal findings should be well documented. Cardiac and pulmonary complications are common in elderly patients. Risk identification according to surgical invasiveness, the continuation or cessation of medication, and preoperative risk-reduction strategies should be considered. Renal function should be evaluated and the dosage of medications should be adjusted based on the glomerular filtration rate, not serum levels of creatinine alone. Postoperative cognitive dysfunction, delirium, frailty, functional dependence, malnutrition, and polypharmacy are associated with poor postoperative outcomes; risk factors should be screened for and corrected preoperatively, if possible. Delays in the operation and prolonged operative times increase morbidity. Despite its importance, there are still no standardized preoperative assessment guidelines for Korean geriatric patients. Further studies should evaluate the clinical impact and cost-effectiveness of a preoperative geriatric assessment targeting the actual medical environment of Korea. Medical conditions should be optimized and proactive risk-reduction strategies should be used as part of a comprehensive preoperative assessment to improve surgical outcomes while avoiding a functional decline after surgery.

Keyword

Geriatric; Surgery; Preoperative; Perioperative; Risk

MeSH Terms

Aged
Comorbidity
Creatinine
Delirium
Geriatric Assessment
Glomerular Filtration Rate
Humans
Korea
Malnutrition
Operative Time
Perioperative Care
Physical Examination
Polypharmacy
Postoperative Complications
Risk Factors
Substance-Related Disorders
Creatinine

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