[Surgery in older patients].

Abstract

Reflecting on the case of a frail older patient with a complicated postoperative course, we highlight points for optimising care for older patients. Preoperative frailty screening is imperative. When frailty is suspected, a comprehensive geriatric assessment (CGA) is needed to guide treatment decisions and to detect risks for a complicated course, possibly amenable to optimisation. The current health status and treatment goals of the patient, together with estimated risks and benefits of a surgical procedure should be explored and weighted. Alternative treatments should be considered, as surgeons often underestimate the negative impact of a surgical procedure in older patients. The development of postoperative geriatric syndromes greatly influences hospital stay and long-term outcomes. Be aware of tunnel vision and discuss doubts, if present either in physicians or patients. In case of a prolonged course, re-evaluation with a CGA and multidisciplinary discussions, including nurses, are valuable in order to provide tailored treatment.