Title

Optimization of Perioperative Care in Older Adults

Authoring Organization

Publication Month/Year

June 28, 2024

Last Updated Month/Year

July 12, 2024

Document Type

Consensus

Country of Publication

US

Document Objectives

As the population ages, more older adults are presenting for surgery. Age-related declines in physiological reserve and functional capacity can result in frailty and poor outcomes after surgery. Hence, optimizing perioperative care in older patients is imperative. Enhanced Recovery After Surgery (ERAS) pathways and Minimally Invasive Surgery (MIS) may influence surgical outcomes, but current use and impact on older adults patients is unknown. The aim of this study was to provide evidence-based recommendations on perioperative care of older adults undergoing major abdominal surgery. MIS and ERAS are recommended in older adults undergoing major abdominal surgery, with evidence supporting use in colorectal surgery. Though expert opinion supported prehabilitation, there is insufficient evidence supporting use. This work has identified evidence gaps for further studies to optimize older adults undergoing major abdominal surgery.

PICO Questions

  1. Should a prehabilitation (vs. no prehabilitation) program be used in elderly patients undergoing colorectal surgery?

  2. Should a prehabilitation (vs. no prehabilitation) program be used in elderly patients undergoing Upper GI surgery?

  3. Should a prehabilitation (vs. no prehabilitation) program be used in elderly patients undergoing hepatobiliary pancreatic (HPB) surgery?

  4. Should a prehabilitation (vs. no prehabilitation) program be used in elderly patients undergoing Hernia surgery?

  5. Should perioperative optimization (vs. no optimization) of anemia be used in elderly patients undergoing major abdominal surgery (including Colorectal, Upper GI, Hernia, and HPB)?

  6. Should smoking cessation (vs. no smoking cessation) be applied in older adult patients undergoing Colorectal, Upper GI, Hernia, or HPB surgery?

  7. Should alcohol cessation (vs. no alcohol cessation) be applied in older adult patients undergoing Colorectal, Upper GI, Hernia, or HPB surgery?

  8. Should MIS (vs open) Colorectal surgery be used in older adults?

  9. Should MIS (vs open) Upper GI surgery be used in older adults?

  10. Should MIS (vs open) HPB surgery be used in older adults?

  11. Should MIS (vs open) Hernia surgery be used in older adults?

  12. Should ERAS (vs conventional care) be used in elderly patients undergoing Colorectal surgery?

  13. Should ERAS (vs conventional care) be used in elderly patients undergoing Upper GI surgery?

  14. Should ERAS (vs conventional care) be used in elderly patients undergoing HPB surgery?

  15. Should ERAS (vs conventional care) be used in elderly patients undergoing hernia surgery?

Inclusion Criteria

Male, Female, Older adult

Health Care Settings

Ambulatory, Long term care, Outpatient, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management, Prevention, Rehabilitation

Keywords

laparoscopy, ERAS, abdominal surgery, Enhanced recovery after surgery

Source Citation

Keller DS, Curtis N, Burt HA, Ammirati CA, Collings AT, Polk HC Jr, Carrano FM, Antoniou SA, Hanna N, Piotet LM, Hill S, Cuijpers ACM, Tejedor P, Milone M, Andriopoulou E, Kontovounisios C, Leeds IL, Awad ZT, Barber MW, Al-Mansour M, Nassif G, West MA, Pryor AD, Carli F, Demartines N, Bouvy ND, Passera R, Arezzo A, Francis N. EAES/SAGES evidence-based recommendations and expert consensus on optimization of perioperative care in older adults. Surg Endosc. 2024 Jun 28. doi: 10.1007/s00464-024-10977-7. Epub ahead of print. PMID: 38942944.