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Best perioperative practices for geriatric surgical patients released

January 5, 2016
by Nicole Stempak, Associate Editor
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New best practice recommendations were released today for optimal care of adults age 65 and older immediately before, during and after surgical operations, a timeframe known as the perioperative period.

"Optimal Perioperative Management of the Geriatric Patient: A Best Practices Guideline" was jointly  developed by the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) and the American Geriatrics Society’s (AGS) Geriatrics-for-Specialists Initiative (GSI) with support from the John A. Hartford Foundation.

"This new interdisciplinary guideline provides us with another meaningful tool for improving geriatric surgical care," says guideline co-author Clifford Y. Ko, MD, MSHS, FACS, Director of ACS NSQIP and Principal Investigator of the Coalition for Quality in Geriatrics Surgery (CQGS) Project in a press release.

The guideline provides a framework for healthcare professionals working with older adults. The number of older adults living in the United States is expected to nearly double to 89 million by 2050. They are more likely to need surgery, prone to postoperative complications and experience a prolonged recovery.  The authors caution the guideline is "not a substitute for clinical judgment and experience" but does offer tailored, comprehensive geriatrics evaluations.

The guideline is organized into three distinct sections:

  1. Immediate preoperative management addresses patient goals, preferences and advance directives; preoperative fasting; antibiotic prophylaxis; venous thromboembolism prevention; and medication management.
  2. Intraoperative management provides a management checklist during surgery itself, addressing the use of anesthesia in older adults; perioperative analgesia in older adults; perioperative nausea and vomiting; patient safety; strategies to prevent postoperative complications and hypothermia; fluid management; and targeting physiologic parameters
  3. Postoperative management addresses needs considerations after surgery including postoperative delirium; methods for preventing pulmonary complications; fall risk assessment and prevention; postoperative nutrition; ways to prevent urinary tract infections; functional decline; and pressure ulcer prevention and treatment.

The guideline includes appendices that provide examples of tools that can be used to assess risk factors and develop treatment plans and care models.

Download the free guideline here.

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