When your patient needs surgery: how planning can avoid complications

Older patients are at high risk of perioperative morbidity due to cognitive, affective, or functional deficits. As the primary care physician, you can lower the risk of complications by taking the following steps: Eliminate medications known to cause cognitive dysfunction to help prevent postoperative confusion. Screen for postoperative delirium to identify contributing factors such as infection, whose recognition otherwise might be delayed. Assess preoperative nutritional status to identify patients with significant malnutrition, and consider nutritional repletion before elective surgery is performed. After surgery, institute timely physical therapy to prevent loss of independent ambulation or transfer in patients with borderline mobility, who are at great risk for functional decline during hospitalization. Anticipate discharge needs in collaboration with the hospital discharge planner or home health agencies.