Approach to Evaluating the Multimorbid Patient with Cardiovascular Disease Undergoing Noncardiac Surgery

Area of Science:

• Geriatric Medicine
• Perioperative Care
• Clinical Assessment

Background:

• Older adults undergo more procedures and have increased risk of adverse outcomes.
• Current preoperative assessments often focus narrowly on specific diagnoses, neglecting a holistic view.

Purpose of the Study:

• To advocate for an integrated, whole-person preoperative assessment model for older patients.
• To identify evidence gaps in current geriatric preoperative evaluation strategies.

Main Methods:

• Review of existing clinical practice guidelines for preoperative assessment.
• Proposal of a comprehensive, physiologically integrated assessment framework.
• Identification of key domains for holistic patient evaluation.

Main Results:

• Standard guidelines are insufficient for optimizing care in older adults.
• A multi-domain assessment approach is proposed, integrating physical, cognitive, and psychosocial factors.
• Significant gaps exist in the evidence base for comprehensive geriatric preoperative assessment.

Conclusions:

• A holistic, whole-person approach to preoperative assessment is superior for older patients.
• This integrated model addresses frailty, cognition, mood, function, and social determinants.
• Further research is needed to fill evidence gaps and refine this comprehensive assessment strategy.