Geriatric Surgery and Perioperative Care

1st Edition - November 19, 2024
Editors: Gabriella Bettelli, Riccardo A Audisio
Language: English
Paperback ISBN:
9 7 8 - 0 - 4 4 3 - 2 1 9 0 9 - 2
eBook ISBN:
9 7 8 - 0 - 4 4 3 - 2 1 9 1 0 - 8

Geriatric Surgery and Perioperative Care presents clear evidence to support regulatory and financial decisions in the light of the value-based care principles. The book outlin… Read more

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Geriatric Surgery and Perioperative Care presents clear evidence to support regulatory and financial decisions in the light of the value-based care principles. The book outlines standards of care for elderly patients undergoing surgery as well as minimal requirements for modern management aimed at delivering cost-effective healthcare. It opens with the epidemiology and patho-physiological changes of aging and their impact on anesthesia and surgery. Subsequent chapters guide readers through the surgical process, addressing preoperative optimization, intraoperative procedures and management, and postoperative principles, including ICU care.

The book concludes with ethical principles, care models, and hospital design to support a golden silver surgery using a team-based approach. This title is an important resource for healthcare professionals, practitioners, and others pursuing current strategies and methods for successful perioperative care of the elderly.

Geriatric Surgery and Perioperative Care
Cover image
Title page
Table of Contents
Copyright
Contributors
Preface
Editors biography
Part 1: Preoperative management
Chapter 1 Epidemiological and structural overview
Abstract
Keywords
1 Introduction
2 Demographic and epidemiological overview
2.1 General population aging
2.2 General health patterns of the ancient population
3 Evolution of geriatric medicine in the different countries
3.1 USA
3.2 Europe
3.3 Australia
3.4 China
3.5 India
4 Origins and development of surgery in older persons
4.1 Historical overview
5 Organizational aspects
6 Cost analysis and social impact
7 How can we act to improve the situation?
References
Chapter 2 Aging, pathophysiological changes, and their impact on anesthesia and surgery
Abstract
Keywords
1 Introduction
2 Aging and homeostenosis
3 Organ-related pathophysiological changes and associated conditions
3.1 Cardiovascular system
4 Respiratory system
4.1 Renal system
4.2 Central and peripheral nervous system
4.3 Sensorial systems
4.4 Metabolic functions
4.5 Muscular and skeletal systems
5 Cellular changes related to aging
5.1 Cellular senescence
5.2 Mitochondrial dysfunction and oxidative stress
6 The immune system and the concept of inflammaging
6.1 The innate immune response
6.2 The adaptive immune response
6.3 Inflammaging
7 Conclusion
References
Chapter 3 Preoperative evaluation and optimization: A team-based task
Abstract
Keywords
1 Introduction
1.1 Relevant guidelines on preoperative evaluation of the geriatric patient
1.2 What lesson should be learned from this evolution?
1.3 How to proceed to update the preoperative evaluation process?
2 What targets should be obtained: Comorbidity management, assessment of functional status, sensory optimization, surgical risk evaluation, prehabilitation
2.1 Comorbidity management
2.2 The role of comprehensive geriatric assessment
3 The role of surgeons and their interactions with the other team members
4 The role of anesthesiologists
4.1 What challenges should be overcome to update the preoperative anesthesia consultation?
5 The role of geriatricians and their interactions with the other team members
6 The role of nurses and their interactions with the other team members
6.1 Clinical role: Assessment of bio-psycho-social needs, nursing diagnoses, and tailored interventions
6.2 Patient education: A strategic approach for advancing health literacy
6.3 Empathy in nursing interventions: A key factor in care quality and patient activation
6.4 Effective communication within the perioperative multidisciplinary teams
7 Prehabilitation strategies
7.1 Physical training
7.2 Nutrition intervention
7.3 Psychological support
7.4 Smoking cessation counseling
7.5 Challenges in prehabilitation
8 Conclusion
References
Chapter 4 Decision-making for surgery and hospital admission planning
Abstract
Keywords
1 Introduction
2 Surgical risk assessment
2.1 Risk evaluation scores
2.2 Surgical risk assessment in older patients
3 The geriatric surgical patient: Clinics and expectations
3.1 Associated conditions and frailty
3.2 Functional status
3.3 Patient's expectations
4 The surgical treatment
5 The team-based discussion and the decision-making process
5.1 Patient involvement in the decision process
5.2 Ethical considerations
5.3 Decision-making in persons with cognitive impairment undergoing surgery
6 How nurses should prepare the patient for hospital admission
6.1 How to individuate the best patient allocation in the facility
6.2 Facility introduction to the patient: Ward visit and introduction to the ward nurses
6.3 What objects should the patient bring in?
6.4 Information about where and when patients are expected to arrive
7 Conclusions
References
Chapter 5 Patient allocation and preparation to surgery
Abstract
Keywords
1 Patient allocation in accordance with specific patient's needs
2 Positioning of reorienting tools
3 Risk of fall management
4 The ideal bed for geriatric surgical patients
5 Perioperative medication management
6 Preoperative fasting
7 Relatives’ access management and measures aimed to reduce anxiety before surgery
References
Part 2: Peri- and postoperative management
Chapter 6 Anesthesia techniques, intraoperative management, and early postoperative recovery
Abstract
Keywords
1 Introduction
2 General anesthesia
2.1 General anesthesia agents
3 Locoregional anesthesia
4 Combined anesthesia
5 Sedation
6 Perioperative monitoring to reduce postoperative complications
6.1 Monitoring to reduce delirium and POCD
6.2 Temperature monitoring
6.3 Perioperative pain monitoring
6.4 Pulmonary complications
6.5 Hemodynamic monitoring
6.6 Perioperative feeding
6.7 Pressure injuries
7 Identification of the appropriate postoperative monitoring setting
8 Conclusions
References
Chapter 7 Team-based approach to surgical stress reduction and procedural safety
Abstract
Keywords
1 Pathophysiology of the surgical stress response
1.1 The surgical stress reaction: Endocrine dynamics and effects on the older patient
1.2 The surgical stress reaction: Metabolic response to hormone incretion
1.3 The surgical stress reaction: Immune reaction and cytokine release
1.4 Aging and the surgical stress reaction
2 Measures aimed to minimize SSR
2.1 What surgeons can do to achieve the best results
2.2 What anesthesiologists can do to achieve the best results
2.3 What nurses can do to achieve the best results
3 Entrance in the operative room and measures aimed to reduce anxiety
3.1 Entering the OR
3.2 Patient positioning on the surgical table
4 The WHO safety checklist and implications for the older surgical patient
References
Chapter 8 General principles for optimal postoperative recovery
Abstract
Keywords
1 Aims and purposes of postoperative recovery
1.1 Aspects of recovery
1.2 Short-term
1.3 Intermediate-term
1.4 Long-term
2 Principles and practical protocols of postoperative recovery
2.1 Principles
2.2 Practical protocols
2.3 Postoperative analgesia
2.4 Delirium
References
Chapter 9 Postoperative ICU care
Abstract
Keywords
1 Introduction
2 When is an ICU admission required?
3 Cardiac and respiratory support
3.1 Cardiovascular dysfunction/failure
3.2 Monitoring
3.3 Treatment of CV failure
3.4 Treatment of respiratory failure
4 Nutrition
5 Prevention of delirium
6 Limitation of active treatments and psychological aspects
7 Criteria for discharge to the ward
8 Conclusion
References
Chapter 10 How should an older patient be managed after surgery?
Abstract
Keywords
1 Introduction
1.1 Epidemiological context
1.2 Perioperative geriatric units
1.3 Objectives and care approaches
2 Analgesia and mobilization
3 Nutritional supplementation
4 Medico-surgical complications (Table 1)
4.1 Delirium
4.2 Anemia
4.3 Cardiovascular complications
4.4 Postoperative fever
4.5 Venous thromboembolism
4.6 Acute kidney injury
4.7 Gastrointestinal trouble
4.8 Pressure ulcers
5 Conclusion
References
Chapter 11 The clinical path: Management of hospital discharge and late postoperative recovery
Abstract
Keywords
1 Introduction
2 Team approach to the problem
3 Prehospital social conditions
4 Risk of developing posthospital syndrome
5 Need for extended postdischarge care and rehabilitation
6 Organizational standards
7 Rehabilitation plan
8 Preventing hospital readmission risk
9 Discharge to home: When it's appropriate and when it's not
10 Information for family and caregivers on fall prevention, nutrition, physical activity, social and cognitive stimulation, pharmacological regime, and pain management
11 Transfer to transitional care units: Indications and practice
12 Quality of life after discharge
References
Part 3: Surgical issues
Chapter 12 Surgery for older patients: An overview
Abstract
Keywords
References
Chapter 13 The impact of ERAS in senior surgical patients
Abstract
Keywords
1 General concepts
2 Core items in elderly
3 Elective surgery
4 Emergency surgery
References
Chapter 14 Breast surgery in older women
Abstract
Keywords
References
Chapter 15 Thoracic surgery in elderly patients
Abstract
Keywords
1 Introduction
1.1 Screening guidelines and decision-making for older patients
1.2 Physiologic changes of aging
2 Diagnostic techniques
3 Surgery in the elderly
3.1 Preoperative care
3.2 Surgery
3.3 Organ preservation
3.4 Nonsurgical options
3.5 Postoperative care
4 Conclusion
References
Chapter 16 Emergency general surgery in older adults
Abstract
Keywords
1 Introduction
1.1 An aging population
1.2 Specific management challenges
1.3 Treatment decisions
2 Preoperative considerations
2.1 Preoperative counseling
2.2 Preoperative risk assessment
3 Postoperative management
3.1 End of surgery Sign Out
3.2 Hypothermia
3.3 Analgesia
3.4 Location of care
3.5 Multidisciplinary care
3.6 Recognition and management of complications
4 Future developments
4.1 Enhanced recovery pathways
4.2 Body composition measures
4.3 Formal training in specialty rotations
References
Chapter 17 Supporting older adults safely through abdominal surgery: The impact of prehabilitation and geriatric comanagement
Abstract
Keywords
1 Introduction
2 Defining and intervening upon frailty
2.1 Multidisciplinary assessment and intervention
2.2 Geriatric Comanagement
2.3 Prehabilitation for the frail older adult
2.4 Implementing a prehabilitation program
3 Emphasizing goals of care
4 A single center experience
5 Conclusion
References
Chapter 18 Orthopedic surgery and hip fractures in elderly patients
Abstract
Keywords
Acknowledgment
1 Background
1.1 Epidemiology and impact
1.2 Early mobilization is the key
1.3 Surgery timing
1.4 Orthogeriatric comanagement care
2 Classification
3 Special considerations
3.1 Metastatic hip fractures
3.2 Atypical fractures
4 Surgical intervention
4.1 Principles of fixation
4.2 Intracapsular fracture
4.3 Extracapsular fractures
4.4 Nonoperative management
5 Postoperative management
5.1 Postoperative rehabilitation
5.2 Functional assessment measures and recovery prediction
5.3 Pain management in hip fracture patients
5.4 Prevention of postoperative delirium
5.5 Secondary prevention for fracture
References
Chapter 19 Gallbladder surgery at an advanced age
Abstract
Keywords
1 Introduction
2 Gallstone disease in aged patients: What we know and what we do
2.1 Asymptomatic cholelithiasis
2.2 Biliary colic
2.3 Acute calculous cholecystitis
2.4 Surgical strategies
2.5 How to proceed in case of concomitant choledocholithiasis
2.6 How to select patients suitable for surgery
2.7 Are there alternative treatments for aged patients with ACC who are not suitable for surgery?
3 Other conditions
4 Conclusions
References
Chapter 20 Cataract surgery in the elderly
Abstract
Keywords
1 Introduction
2 Indications for cataract surgery
3 Systemic preoperative assessment
4 Ophthalmic preoperative assessment
5 Anesthesia for cataract surgery
6 Informed consent for cataract surgery
7 Antimicrobial prophylaxis
8 Surgical procedure
9 Cataract surgery complications
10 Considerations over cataract surgery in the elderly population
10.1 Safety of cataract surgery in the elderly
10.2 Effectiveness of cataract surgery in the elderly
11 Satisfaction after cataract surgery in the elderly
12 Conclusions
References
Chapter 21 Presbystasis and vestibular rehabilitation in elderly patients
Abstract
Keywords
1 Introduction
2 Epidemiology
3 Presbystasis: A multifactorial disorder
4 Vestibular aging as a causal factor
5 Therapy for presbystasis: The role of physical rehabilitation
6 Conclusions
References
Chapter 22 Head and neck surgery for older patients
Abstract
Keywords
1 Introduction
2 The complex role of age in surgical outcomes in HNC
2.1 Age-associated risks in the perioperative period
3 Disposition of older patients after surgical discharge
3.1 Prevalence of second thoughts and regret about surgery
4 Differences between frailty and age as well as their influences on surgical outcomes
5 HNC and microvascular reconstructive surgery in the elderly
5.1 Postoperative delirium affects elderly patients undergoing surgery
6 Conclusion
References
Chapter 23 Diverticular disease in older patients
Abstract
Keywords
1 Definition and pathogenesis
2 Clinical manifestations
3 Acute complications
3.1 Diagnosis
4 Medical treatment
5 Surgical treatment
References
Chapter 24 Patient frailty and plastic surgery at an advanced age
Abstract
Keywords
1 Introduction
2 Definition of frailty
3 Recommendations
References
Chapter 25 Outpatient surgery: Day surgery and office-based surgery for senior patients
Abstract
Keywords
1 Introduction
1.1 Considerations for planning day surgery in elderly patients
2 Safety of the procedure: Surgical complications
3 Safety of the procedure: Considering underlying conditions of the patient
4 Feasibility of the surgical procedure
5 Additional factors for consideration
6 Conclusion
References
Chapter 26 Unveiling the dynamics of functional recovery and quality of life in geriatric patients with cancer
Abstract
Keywords
1 Identifying FR with QoL
2 Identifying FR with improved fitness level in terms of physical and nutritional abilities (the prehabilitation strategy)
3 Identifying FR as a composite outcome achieved by the measure of 3 domains, physical ability, ability to perform everyday life tasks, and maintain cognition (the GOSAFE study)
4 Identifying FR as the time spent at home during the first year after a major cancer surgery (AKA, less time in the hospital means a patient being fully recovered)
5 Conclusion
References
Part 4: Recommendations for a better future
Chapter 27 Models of care: Purposes, internal organization, and guiding principles
Abstract
Keywords
1 Purpose
1.1 History and development
2 Structure and organization
2.1 Structure design
2.2 Internal organization
2.3 Patient-centered care
2.4 Value-based care
2.5 Team-based approach
3 Basal MoCs for geriatric surgery
3.1 Geriatric consultation services (GCS)
3.2 Acute care for the elderly (ACE) units
3.3 Comanagement-based MoCs
3.4 Recently developed MoCs
4 Feasibility and effectiveness
5 Conclusion
References
Chapter 28 Toward a “silver architecture”: Hospital design for geriatric surgery
Abstract
Keywords
1 Introduction
2 Hospitals vs “silver hospitals”
3 Understanding the specific needs of older patients with design implications
4 Six shortcomings in design to beat
5 What are the needs of healthcare professionals and older patients?
5.1 Hospital design for efficacy and efficiency
5.2 Functional macroareas
6 Requirements of spaces in silver hospital
6.1 Interrelationships of spaces
6.2 Patient rooms
6.3 Parental support
6.4 Views and electronics
6.5 Staff activities
6.6 Restrooms
6.7 Delirium rooms
7 Spaces for prehabilitation and rehabilitation
8 Hallways and corridors, seating areas
8.1 Escalators, elevators, and lifts
8.2 Other issues
8.3 Space dimensions
9 Conclusion
References
Chapter 29 Toward a “silver architecture”: Patient safety and clinical risk management
Abstract
Keywords
1 Introduction
2 Fall-safe hospital and physical supports
2.1 Flooring
2.2 Single rooms
2.3 Handrails and handles
2.4 Steps and stairs
2.5 Furniture and furnishing
3 Design for delirium and stress/depression prevention
3.1 General considerations
3.2 Tenets for orientation support and wayfinding
3.3 Use of colors
3.4 Reorienting tools
3.5 Lighting and windows
3.6 Noise and disturbance reduction
3.7 Risk of unease
3.8 Continuity with domestic lifestyle
3.9 Safe and nonstressful personal hygiene
3.10 Requirements for general hospitals which are specifically critical for geriatric surgical units
3.11 “Smart” silver hospitals: RFIDS (radio-frequency identification), tracking systems, communication technology
4 Beyond details, two general principles
5 A final consideration: Costs
References
Chapter 30 Ethical principles: Professional duties and patients’ rights in “geriatric surgery and perioperative care”
Abstract
Keywords
1 Introduction
2 Sources of suffering and dissatisfaction
3 Autonomy, beneficence, nonmaleficence, and justice
4 Capacity
5 Medical research
6 Elder abuse and ageism
7 Ethical dilemmas: Surgery in older cognitively impaired patients, surgery and end of life, cardiopulmonary resuscitation, confidentiality
8 Final considerations
References
Chapter 31 Cornerstones for optimal surgical care of the older adult—Current state and moving the needle forward
Abstract
Keywords
1 Keeping the patient at the forefront: Emphasis on goals of care
2 Preoperative screening: Frailty assessment
3 It takes a team approach: Interdisciplinary care and comanagement
4 Systems of care
5 Moving the needle: A path forward
References
Index

Gabriella Bettelli

Gabriella Bettelli is past-Director of the Geriatric Surgical Area and Anesthesia Unit at the INRCA (Italian National Research Centre on Aging, Ancona Italy), specialist in anesthesia, cardiology, and geriatrics (2nd Level University Master). She founded and currently coordinates an international 2nd Level University Master in Perioperative Geriatric Medicine, held in co-partnership by the San Marino University and the Catholic University of Rome. She edited the book Perioperative Care of the Elderly: clinical and organizational aspects (Cambridge University Press, 2017), co-edited various books on safety in anesthesia, and published more than 120 papers, most of them indexed. She is a member of the ESAIC Task Force for Postoperative Delirium GL, currently under updating, and reviewer for Anesthesia & Analgesia, Journal of Gerontology, Journal of Frailty and Aging and Saudi Journal of Anesthesia.

Affiliations and expertise

Past-Director, Geriatric Surgical Area and Anesthesia Unit, INRCA (Italian National Research Centre on Aging), Ancona, Italy

Riccardo A Audisio

Riccardo A. Audisio, MD, PhD (Hon), FRCS, is past-President of SIOG (International Society of Geriatric Oncology), BASO (British Association of Surgical Oncology) and ESSO (European Society of Surgical Oncology). He served as an advisor to the Department of Health, UK and to the All-Party Parliamentary Group on Breast Cancer in Older Women. Professor Audisio sat on the Board of Directors of ECCO (European Cancer Organization). He is past-Chair of the Education & Training Committee of ESSO. Professor Audisio chairs the Surgical Oncology track at the Global Health Catalyst, Harvard Medical School. He has edited 10 books on the management of Elderly Cancer Patients (Springer), co-edited the ESMO Handbook of Cancer in the Senior Patient, and authored over 30 peer reviewed papers on the topic. His clinical research focuses on Breast Cancer, Geriatric Oncology, Education/Certification in Surgical Oncology and the optimization of Surgical Oncology in L/MICs.

Affiliations and expertise

Department of Surgery Institute of Clinical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden

Life Sciences

Physical Sciences & Engineering

Social Sciences & Humanities

Health