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Navigating the Surgical Pathway for Frail, Older Adults Undergoing Colorectal Surgery
Ana C De Roo1, Srinivas J Ivatury2
1Division of Colorectal Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin.
Clinics in Colon and Rectal Surgery
|December 30, 2024
Summary
Older adults undergoing colorectal surgery face higher risks. Frailty assessment and specialized care are crucial for managing functional decline and delirium, ensuring goal-concordant care.
Area of Science:
- Geriatric Medicine
- Surgical Outcomes
- Colorectal Surgery
Background:
- Older adults (≥65 years) represent a significant portion of the population and surgical patients.
- Frail older adults require specialized preoperative evaluation, hospital care, and may experience greater physical and cognitive changes.
- Worse perioperative outcomes are documented in older adults undergoing colorectal surgery.
Purpose of the Study:
- To highlight the unique risks and care considerations for older adults undergoing colorectal surgery.
- To emphasize the importance of frailty assessment and management in this population.
- To inform decision-making for goal-concordant care.
Main Methods:
- Review of existing data on frailty measures and perioperative outcomes in older adults.
- Discussion of prehabilitation programs' role in maintaining physical function.
- Identification of common postoperative complications like functional decline and delirium.
Main Results:
- Frailty assessment tools can identify patients at higher risk for adverse outcomes.
- Prehabilitation may aid functional recovery but has not definitively improved surgical outcomes for colorectal surgery.
- Functional decline and delirium are prevalent in frail older surgical patients.
Conclusions:
- Specialized preoperative evaluation and perioperative care are essential for frail older adults undergoing colorectal surgery.
- Addressing frailty and geriatric syndromes with primary care physicians and geriatricians is vital.
- Informed decision-making, considering risks and outcomes, facilitates goal-concordant care for older surgical patients.
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