New Best-Practices Guidelines for Geriatric Perioperative Care

Representatives from the American College of Surgeons (ACS) and the American Geriatrics Society (AGS) have teamed up to determine the best practices for geriatric perioperative care. Together, they created a document that details their recommended guidelines. This thorough and comprehensive document was published by the American College of Surgeons on January 4, 2016 and can be found here.

Dr. Laurie Barclay, MD of Medscape reports that, “Expert guidance on surgical care for the geriatric population is essential, because older adults living in the United States now exceed 40 million and are expected to increase to 89 million by 2050. Furthermore, postoperative complications and recovery time tend to increase with increasing age.”

The guidelines, which are geared toward surgeons, anesthesiologist and other healthcare professionals who deal with geriatric surgical patients, were developed after reviewing current literature and evidence and determining the most effective practices.

In addition to a wealth of information, the guide provides checklists for immediate preoperative, intraoperative and postoperative management. These checklists read as follows:

Immediate Pre-Operative Management Checklist

• Confirm and document patient goals and treatment preferences, including advance directives
• Confirm and document patient’s health care proxy or surrogate decision-maker
• For patients with existing advance directives, discuss new risks associated with the surgical procedure and an approach for potentially life-threatening problems consistent with the patient’s values and preferences
• Consider shortened fluid fast (clear liquids up to two hours before anesthesia)
• Adhere to existing best practices regarding antibiotic and venous thromboembolism prophylaxis
• Ensure nonessential medications have been stopped and essential medications have been taken

Intraoperative Management Checklist

• Anesthetic approach: Consideration of regional techniques to avoid postoperative complications and improve pain control
• Perioperative analgesic plan, including directed pain history, multi-modal or opioid-sparing techniques, and consideration of regional techniques
• Postoperative nausea risk stratification and prevention strategies
• Patient safety, strategies to pressure ulcers and avoid nerve damage
• Prevention of postoperative pulmonary complications and hypothermia
• Fluid management and physiologic management, including appropriate use of intravenous fluids, appropriate hemodynamic management, and continuation of indicated cardiac medications

Post-Operative Rounding Checklist

Daily evaluation for:

• Delirium/cognitive impairment
• Perioperative acute pain
• Pulmonary complications
• Fall risk
• Ability to maintain adequate nutrition
• UTI prevention
• Functional decline
• Pressure ulcers

You can get a great deal of detail about each of the measures listed in the checklists above as well as additional information regarding care of geriatric surgical patients by reading the full guideline document, Optimal Perioperative Management of the Geriatric Patient: Best Practices Guideline from ACS NSQIP®/American Geriatrics Society, which can be found here.

You can also learn more about the team effort that went into creating these guidelines by reading Medscape’s article, Joint Guideline Addresses Geriatric Perioperative Care.