Skip to main content

Geriatric Preoperative Evaluation of the Older Adult

  • Chapter
  • First Online:
Geriatric Practice

Abstract

As surgical and anesthetic procedures advance, more and more older adults are becoming candidates for surgery. Older adults are at higher risk of developing complications during or after surgery than younger adults due to poorer physiologic reserve. Older adults often have coexisting medical conditions, variable levels of physical functioning, and social supports that play a role in the post-surgical recovery period. Geriatric preoperative assessments evaluate for risk factors that affect the intended outcome and projected recovery following a surgical procedure. The geriatric assessment goes beyond a general medical assessment and includes observation on physical function, social supports, advance care planning, goals of care conversations, transitions in care, and psychological assessment relevant to the post-surgical recovery period.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. McDonald SR, Heflin MT, Whitson HE, Dalton TO, Lidsky ME, Liu P, et al. Association of integrated care coordination with postsurgical outcomes in high-risk older adults: the Perioperative Optimization of Senior Health (POSH) initiative. JAMA Surg. 2018;153(5):454.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Halter J, Ouslander J, Tinetti M, Studenski S, High K, Asthana S. Hazzard’s geriatric medicine and gerontology: New York: McGraw-Hill Prof Med/Tech; 2009.

    Google Scholar 

  3. Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. Circulation. 2014:CIR. 0000000000000106.

    Google Scholar 

  4. Gupta PK, Gupta H, Sundaram A, Kaushik M, Fang X, Miller WJ, et al. Development and validation of a risk calculator for prediction of cardiac risk after surgery. Circulation. 2011; https://doi.org/10.1161/CIRCULATIONAHA.110.015701.

  5. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2017;38(36):2739–91.

    Article  PubMed  Google Scholar 

  6. Thyregod HGH, Steinbrüchel DA, Ihlemann N, Nissen H, Kjeldsen BJ, Petursson P, et al. Transcatheter versus surgical aortic valve replacement in patients with severe aortic valve stenosis: 1-year results from the all-comers NOTION randomized clinical trial. J Am Coll Cardiol. 2015;65(20):2184–94.

    Article  PubMed  Google Scholar 

  7. Douketis JD, Spyropoulos AC, Kaatz S, Becker RC, Caprini JA, Dunn AS, et al. Perioperative bridging anticoagulation in patients with atrial fibrillation. N Engl J Med. 2015;373(9):823–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA, et al. ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: an update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention, 2011 ACCF/AHA guideline for coronary artery bypass graft surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease, 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction, 2014 AHA/ACC guideline for the management of patients with non–ST-elevation acute coronary syndromes, and 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. Circulation. 2016;134(10):e123–e55.

    Article  PubMed  Google Scholar 

  9. Chakos A, Wilson-Smith A, Arora S, Nguyen TC, Dhoble A, Tarantini G, et al. Long term outcomes of transcatheter aortic valve implantation (TAVI): a systematic review of 5-year survival and beyond. Ann Cardiothorac Surg. 2017;6(5):432.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Enright PL, Kronmal RA, Manolio TA, Schenker MB, Hyatt RE. Respiratory muscle strength in the elderly. Correlates and reference values. Cardiovascular Health Study Research Group. Am J Respir Crit Care Med. 1994;149(2):430–8.

    Article  CAS  PubMed  Google Scholar 

  11. Qaseem A, Snow V, Fitterman N, Hornbake ER, Lawrence VA, Smetana GW, et al. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians Reducing Perioperative Pulmonary Complications in Noncardiothoracic Surgery. Ann Intern Med. 2006;144(8):575–80.

    Article  PubMed  Google Scholar 

  12. Canet J, Gallart L, Gomar C, Paluzie G, Valles J, Castillo J, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010;113(6):1338–50.

    Article  PubMed  Google Scholar 

  13. Arozullah AM, Daley J, Henderson WG, Khuri SF, Program NVASQI. Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. Ann Surg. 2000;232(2):242.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Goldman L, Caldera DL, Nussbaum SR, Southwick FS, Krogstad D, Murray B, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med. 1977;297(16):845–50.

    Article  CAS  PubMed  Google Scholar 

  15. Rucker L, Frye EB, Staten MA. Usefulness of screening chest roentgenograms in preoperative patients. JAMA. 1983;250(23):3209–11.

    Article  CAS  PubMed  Google Scholar 

  16. Archer C, Levy AR, McGregor M. Value of routine preoperative chest x-rays: a meta-analysis. Can J Anaesth. 1993;40(11):1022–7.

    Article  CAS  PubMed  Google Scholar 

  17. Smetana GW, Lawrence VA, Cornell JE. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians Preoperative Pulmonary Risk Stratification for Noncardiothoracic Surgery. Ann Intern Med. 2006;144(8):581–95.

    Article  PubMed  Google Scholar 

  18. Apostolakis S, Lane DA, Guo Y, Buller H, Lip GY. Performance of the HEMORR2HAGES, ATRIA, and HAS-BLED bleeding risk–prediction scores in nonwarfarin anticoagulated atrial fibrillation patients. J Am Coll Cardiol. 2013;61(3):386–7.

    Article  PubMed  Google Scholar 

  19. Gage BF, Birman-Deych E, Kerzner R, Radford MJ, Nilasena DS, Rich MW. Incidence of intracranial hemorrhage in patients with atrial fibrillation who are prone to fall. Am J Med. 2005;118(6):612–7.

    Article  PubMed  Google Scholar 

  20. Kagansky N, Knobler H, Rimon E, Ozer Z, Levy S. Safety of anticoagulation therapy in well-informed older patients. Arch Intern Med. 2004;164(18):2044–50.

    Article  PubMed  Google Scholar 

  21. Mant J, Hobbs FR, Fletcher K, Roalfe A, Fitzmaurice D, Lip GY, et al. Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet. 2007;370(9586):493–503.

    Article  CAS  PubMed  Google Scholar 

  22. Goldstein JN, Refaai MA, Milling TJ, Lewis B, Goldberg-Alberts R, Hug BA, et al. Four-factor prothrombin complex concentrate versus plasma for rapid vitamin K antagonist reversal in patients needing urgent surgical or invasive interventions: a phase 3b, open-label, non-inferiority, randomised trial. Lancet. 2015;385(9982):2077–87.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139–51.

    Article  CAS  PubMed  Google Scholar 

  24. Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365(10):883–91.

    Article  CAS  PubMed  Google Scholar 

  25. Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365(11):981–92.

    Article  CAS  PubMed  Google Scholar 

  26. Birnie DH, Healey JS, Wells GA, Verma A, Tang AS, Krahn AD, et al. Pacemaker or defibrillator surgery without interruption of anticoagulation. N Engl J Med. 2013;368(22):2084–93.

    Article  CAS  PubMed  Google Scholar 

  27. Douketis JD. Perioperative anticoagulation management in patients who are receiving oral anticoagulant therapy: a practical guide for clinicians. Thromb Res. 2002;108(1):3–13.

    Article  PubMed  Google Scholar 

  28. Arnesen H, Dahl O, Aspelin T, Seljeflot I, Kierulf P, Lyberg T. Sustained prothrombotic profile after hip replacement surgery: the influence of prolonged prophylaxis with dalteparin. J Thromb Haemost. 2003;1(5):971–5.

    Article  CAS  PubMed  Google Scholar 

  29. Ziser A, Plevak DJ, Wiesner RH, Rakela J, Offord KP, Brown DL. Morbidity and mortality in cirrhotic patients undergoing anesthesia and surgery. Anesthesiology. 1999;90(1):42–53.

    Article  CAS  PubMed  Google Scholar 

  30. Lan S-H, Lu L-C, Yen Y-Y, Hsieh Y-P, Chen J-C, Wu W, et al. Tube feeding among elder in long-term care facilities: a systematic review and meta-analysis. J Nutr Health Aging. 2017;21(1):31–7.

    Article  PubMed  Google Scholar 

  31. Nyengaard J, Bendtsen T. Glomerular number and size in relation to age, kidney weight, and body surface in normal man. Anat Rec. 1992;232(2):194–201.

    Article  CAS  PubMed  Google Scholar 

  32. Weinstein JR, Anderson S. The aging kidney: physiological changes. Adv Chronic Kidney Dis. 2010;17(4):302–7.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Mathew A, Devereaux P, O'hare A, Tonelli M, Thiessen-Philbrook H, Nevis I, et al. Chronic kidney disease and postoperative mortality: a systematic review and meta-analysis. Kidney Int. 2008;73(9):1069–81.

    Article  CAS  PubMed  Google Scholar 

  34. Bastin AJ, Ostermann M, Slack AJ, Diller G-P, Finney SJ, Evans TW. Acute kidney injury after cardiac surgery according to risk/injury/failure/loss/end-stage, acute kidney injury network, and kidney disease: improving global outcomes classifications. J Crit Care. 2013;28(4):389–96.

    Article  PubMed  Google Scholar 

  35. Coca SG, Singanamala S, Parikh CR. Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int. 2012;81(5):442–8.

    Article  PubMed  Google Scholar 

  36. Rahmanian PB, Adams DH, Castillo JG, Vassalotti J, Filsoufi F. Early and late outcome of cardiac surgery in dialysis-dependent patients: single-center experience with 245 consecutive patients. J Thorac Cardiovasc Surg. 2008;135(4):915–22.

    Article  PubMed  Google Scholar 

  37. Couchoud CG, Beuscart J-BR, Aldigier J-C, Brunet PJ, Moranne OP. Development of a risk stratification algorithm to improve patient-centered care and decision making for incident elderly patients with end-stage renal disease. Kidney Int. 2015;88(5):1178–86.

    Article  PubMed  Google Scholar 

  38. Khan NA, Campbell NR, Frost SD, Gilbert K, Michota FA, Usmani A, et al. Risk of intraoperative hypotension with loop diuretics: a randomized controlled trial. Am J Med. 2010;123(11):1059. e1–8.

    Article  CAS  Google Scholar 

  39. Coriat P, Richer C, Douraki T, Gomez C, Hendricks K, Giudicelli J-F, et al. Influence of chronic angiotensin-converting enzyme inhibition on anesthetic induction. Anesthesiology. 1994;81(2):299–307.

    Article  CAS  PubMed  Google Scholar 

  40. Trick WE, Scheckler WE, Tokars JI, Jones KC, Reppen ML, Smith EM, et al. Modifiable risk factors associated with deep sternal site infection after coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2000;119(1):108–14.

    Article  CAS  PubMed  Google Scholar 

  41. Association AD. 14. Diabetes Care in the Hospital: standards of medical care in diabetes—2018. Diabetes Care. 2018;41(Supplement 1):S144–S51.

    Google Scholar 

  42. Clement S, Braithwaite SS, Magee MF, Ahmann A, Smith EP, Schafer RG, et al. Management of diabetes and hyperglycemia in hospitals. Diabetes Care. 2004;27(2):553–91.

    Article  PubMed  Google Scholar 

  43. Sudhakaran S, Surani SR. Guidelines for perioperative management of the diabetic patient. Surg Res Pract. 2015;2015:284063.

    PubMed  PubMed Central  Google Scholar 

  44. Bennett-Guerrero E, Kramer DC, Schwinn DA. Effect of chronic and acute thyroid hormone reduction on perioperative outcome. Anesth Analg. 1997;85(1):30–6.

    CAS  PubMed  Google Scholar 

  45. Langley RW, Burch HB. Perioperative management of the thyrotoxic patient. Endocrinol Metab Clin N Am. 2003;32(2):519–34.

    Article  Google Scholar 

  46. Böhmer AB, Wappler F. Preoperative evaluation and preparation of the morbidly obese patient. Curr Opin Anesthesiol. 2017;30(1):126–32.

    Google Scholar 

  47. Cohendy R, Rubenstein L, Eledjam J. Preoperative nutritional evaluation of elderly patients. Aging Clin Exp Res. 2001;13(4):293–7.

    Article  CAS  Google Scholar 

  48. Mohanty S, Rosenthal RA, Russell MM, Neuman MD, Ko CY, Esnaola NF. Optimal perioperative management of the geriatric patient: a best practices guideline from the American College of Surgeons NSQIP and the American Geriatrics Society. J Am Coll Surg. 2016;222(5):930–47.

    Article  PubMed  Google Scholar 

  49. Colburn JL, Mohanty S, Burton JR. Surgical guidelines for perioperative management of older adults: what geriatricians need to know. J Am Geriatr Soc. 2017;65:1339.

    Article  PubMed  Google Scholar 

  50. Chin RP-H, Ho C-H, Cheung LP-C. Scheduled analgesic regimen improves rehabilitation after hip fracture surgery. Clin Orthop Relat Res. 2013;471(7):2349–60.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Bryson GL, Wyand A. Evidence-based clinical update: general anesthesia and the risk of delirium and postoperative cognitive dysfunction. Can J Anesth. 2006;53(7):669.

    Article  PubMed  Google Scholar 

  52. Rigg JR, Jamrozik K, Myles PS, Silbert BS, Peyton PJ, Parsons RW, et al. Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet. 2002;359(9314):1276–82.

    Article  PubMed  Google Scholar 

  53. Shinozaki M, Usui Y, Yamaguchi S, Okuda Y, Kitajima T. Recovery of psychomotor function after propofol sedation is prolonged in the elderly. Can J Anesth. 2002;49(9):927–31.

    Article  PubMed  Google Scholar 

  54. Jeong YM, Lee E, Kim K-I, Chung JE, Park HI, Lee BK, et al. Association of pre-operative medication use with post-operative delirium in surgical oncology patients receiving comprehensive geriatric assessment. BMC Geriatr. 2016;16(1):134.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  55. Chow WB, Rosenthal RA, Merkow RP, Ko CY, Esnaola NF. Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg. 20120;215(4):453–66.

    Google Scholar 

  56. Kennedy J, Van Rij A, Spears G, Pettigrew R, Tucker I. Polypharmacy in a general surgical unit and consequences of drug withdrawal. Br J Clin Pharmacol. 2000;49(4):353–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Appelbaum PS. Assessment of patients' competence to consent to treatment. N Engl J Med. 2007;357(18):1834–40.

    Article  CAS  PubMed  Google Scholar 

  58. Attri JP, Bala N, Chatrath V. Psychiatric patient and anaesthesia. Indian J Anaesth. 2012;56(1):8.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Tsoi KK, Chan JY, Hirai HW, Wong SY, Kwok TC. Cognitive tests to detect dementia: a systematic review and meta-analysis. JAMA Intern Med. 2015;175(9):1450–8.

    Article  PubMed  Google Scholar 

  60. Fines DP, Severn AM. Anaesthesia and cognitive disturbance in the elderly. Continuing education in Anaesthesia. Crit Care Pain. 2006;6(1):37–40.

    Google Scholar 

  61. Onofrj M, Thomas A. Acute akinesia in Parkinson disease. Neurology. 2005;64(7):1162–9.

    Article  PubMed  Google Scholar 

  62. Audisio RA. Shall we operate? Preoperative assessment in elderly cancer patients (PACE) can help A SIOG surgical task force prospective study. Crit Rev Oncol Hematol. 2008;65:156.

    Article  CAS  PubMed  Google Scholar 

  63. Huisman MG, Van Leeuwen BL, Ugolini G, Montroni I, Spiliotis J, Stabilini C, et al. “Timed up & go”: a screening tool for predicting 30-day morbidity in onco-geriatric surgical patients? A multicenter cohort study. PLoS One. 2014;9(1):e0086863.

    Article  PubMed Central  CAS  Google Scholar 

  64. Beggs T, Sepehri A, Szwajcer A, Tangri N, Arora RC. Frailty and perioperative outcomes: a narrative review. Can J Anaesth/Journal canadien d'anesthésie. 2015;62(2):143–57.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Allen D. Andrade .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Le, S., Haeri, N.S., Andrade, A.D. (2020). Geriatric Preoperative Evaluation of the Older Adult. In: Chun, A. (eds) Geriatric Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-19625-7_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-19625-7_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-19624-0

  • Online ISBN: 978-3-030-19625-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics