"Some cold hard steel is probably just what they need."

I love the way surgeons talk. That quote comes from a recent GeriPal blog post about older surgery candidates that was written by Dr. Gretchen Schwarze. While most of her piece focuses on how surgery can be a terrible idea for some—those already at the end of life, for example—going "under the knife" is exactly what's needed and desired for many older patients.

It certainly happens a lot. While people over 65 represent just 13 percent of the U.S. population, they undergo almost 35 percent of all surgical procedures. Fortunately, surgeons have a new tool to help get the best possible outcome for their older patients: the ACS NSQIP AGS Geriatric 2012 Guidelines: Optimal Preoperative Assessment of the Geriatric Surgical Patient.

View a PDF of the ACS NSQIP AGS Geriatric 2012 Guidelines.

The guidelines, now available in the online version of the Journal of the American College of Surgeons (ACS) and to be published in the printed journal this fall, offer the most current and evidence-based recommendations for assessing geriatric patients facing possible surgery. The guidelines focus on 13 key areas, including screening for cognitive impairment, functional status, post-op delirium risk, and frailty.

The guidelines also take into account that older adults are often complex patients with multiple chronic conditions, multiple medications, and need a team approach to care. (Let's please have the surgeon, cardiologist, and primary care provider all on the same page!) And it’s more than just ensuring that any and all physical health issues are assessed before a decision is reached regarding surgery.

One of the most encouraging things about the new guidelines is the emphasis on communication between surgeons, patients, and their family members. Explicit discussions should happen to determine the patient’s preferences and expectations from the treatment, gauge their level of family/social support after discharge, and ensure advanced directives and health care proxies are in place. Regarding the latter, our grantee and co-developer of these guidelines, the American Geriatrics Society (AGS), has useful information for older adults about how to make sure their wishes are known and followed.

The guidelines were made possible with Hartford's funding of a two-year clinical fellowship awarded to Dr. Warren Chow, a general surgery resident at the University of California, Los Angeles. The recommendations were reviewed and approved by a multi-disciplinary expert panel of AGS and ACS members and Dr. Chow's research was overseen by Dr. Cliff Ko, director of the ACS Division of Research and Optimal Patient Care, who was featured last year in our Beyond the Boardroom video series. This work fits nicely with the ACS National Surgical Quality Improvement Program and the development of a geriatric surgery measure that will help hospitals understand and improve the quality of care they provide to their older patients.

With the proportion of older adults growing, the demand for surgical services for this population will only increase. That’s a cold, hard fact. These new guidelines offer the best evidence and tools to help surgeons and their colleagues assess and care for their older patients who face a choice regarding the “cold hard steel” of surgery.

This is the second in an occasional series. See other Health AGEnda posts on Tools You Can Use:

Tools You Can Use: Principles for Treating Patients with Multiple Chronic Conditions