The older surgical patient – to operate or not? A state of the art review

Summary The increasing age and subsequent medical complexity of patients presenting for surgery grants the opportunity to examine the processes and delivery of peri‐operative care. There is a need to redesign peri‐operative pathways allowing room for shared decision making and personalised, evidence...

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Bibliographic Details
Published in:Anaesthesia 2020-01, Vol.75 (S1), p.e46-e53
Main Authors: Santhirapala, R., Partridge, J., MacEwen, C. J.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Anesthesia
Clinical decision making
Clinical Decision-Making - methods
Complex patients
Decision making
frailty
Humans
Optimization
Patients
peri‐operative care
peri‐operative medicine
prehabilitation
Redesign
Refusal to Treat
Risk
risk assessment
shared decision making
State-of-the-art reviews
Surgery
Surgical Procedures, Operative
Sustainability
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Summary:Summary The increasing age and subsequent medical complexity of patients presenting for surgery grants the opportunity to examine the processes and delivery of peri‐operative care. There is a need to redesign peri‐operative pathways allowing room for shared decision making and personalised, evidence‐based care. In times of financial constraint, this is no easy task. However, neglecting to transform services now may lead to challenges in the sustainability of the provision of peri‐operative care in the long‐term. Challenges in redesigning peri‐operative care pathways include identification and optimisation of those at highest peri‐operative risk to inform the difficult conversations surrounding the appropriateness of surgery. The moral burden of these conversations on patient and professionals alike is increasingly recognised and managing this issue requires innovative models of collaborative, multidisciplinary and interprofessional working. To operate or not can be a challenging question to answer with a number of different perspectives to consider; not least that of the patient.
ISSN:0003-2409
1365-2044
DOI:10.1111/anae.14910