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Preoperative assessment and perioperative management 

Preoperative assessment and perioperative management
Chapter:
Preoperative assessment and perioperative management
Author(s):

Jugdeep Dhesi

and Judith Partridge

DOI:
10.1093/med/9780198701590.003.0036
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date: 17 August 2019

The demographic changes in the surgical population pose a new challenge for geriatricians. Despite symptomatic and survival benefits following surgery, older people consistently suffer from excess medical morbidity, mortality, and adverse functional outcomes. This is predominantly related to physiological change, multimorbidity, and geriatric syndromes. For these reasons, geriatricians are increasingly asked for their medical and rehabilitation expertise in the management of elective and emergency surgical patients. This chapter describes the goals of preoperative risk assessment, modification of risk through medical and functional optimization, and presents different models of care which can be employed in older patients. The evidence behind comprehensive geriatric assessment in the surgical setting is presented, including discussion about collaborative decision-making and effective communication involving older patients, their relatives, surgeons, anaesthetists, physicians, and allied health professionals in the perioperative period. The future challenges in terms of research, education, and service development are discussed.

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