The Frail Surgical Patient

This book explores the transdisciplinary approach to general surgery for the frail patient, promoting the use of a geriatric model of care in general surgical settings and thus proposing a “gerosurgery” approach in frail persons beyond chronological age. Aging, frailty, and surgical needs are increasing dramatically worldwide while surgeons are daily facing with the trouble of the trade-off between short-term outcomes and efficacy of surgery in older persons. However, recent studies have clearly shown that age itself is not a prognostic risk factor for complications after elective surgery in older patients, whereas cognitive or functional frailty is. Neither a referring physician nor an assessing surgeon should deny patients surgery purely based on chronological age. Instead, decisions should be based on a CGA (comprehensive geriatric assessment) with a precise picture of the patient considering the cognitive, functional, nutritional, socioeconomic, and affective status. Recent studies examining the use of preparative CGA in surgical patients showed encouraging results on postoperative outcomes in old and/or frail patients. The most compelling current evidence comes from the orthopaedic community, which has embraced the idea of multidisciplinary team care. Preoperative evaluation, postoperative care, pain control, nutritional support, delirium prevention, mobilization, and rehabilitation are necessary also in general surgery. An expert multidisciplinary team, including geriatricians, anaesthesiologists, specialist nurses, physiotherapists, and nutritionists should mandatorily support surgeons. With this book, the reader will have an exhaustive overview and will gain essential, practical knowledge on how best to manage the surgical and frail patient and how to develop clinical systems that do so reliably.