Perioperative Evaluation and Risk Stratification of the Elderly Patient Undergoing Vascular Intervention

Abstract

The surgical management of elderly patients has become increasingly important as the population ages in the U.S. and globally, and the incidence of cardiovascular risk factors continues to rise. Geriatric surgical patients face heightened surgical risks due to age-related physiological changes, which may extend beyond comorbidities, best described as geriatric syndromes. A thorough geriatric evaluation involves examining risk factors for these syndromes, which includes an extensive review of the patient’s medical history, frailty assessment, nutritional evaluation, medication review, and evaluation of social support. The goal of this assessment is not to deem patients “safe” or “unsafe” for surgery, but to evaluate their risk levels and identify opportunities for prehabilitation prior to surgery. This approach necessitates collaboration between surgical teams and a comprehensive perioperative team that includes geriatricians. This narrative review aims to analyze the components of a geriatric evaluation and identify subsequent actions for patients at increased risk of postoperative complications and identify areas for innovation as it relates to vascular care in aging populations.