Surgical Decision-making for Elders: GeriBoards, Prehab, and Other Great Ideas
Alexander Smith, M.D., MPH discusses trends and news ideas about surgical outcomes percolating among thought leaders in the field including Emily Finlayson, M.D., M.S., Associate Professor of Surgery and Health Policy at UCSF, in a post at GeriPal, a geriatrics and palliative care blog.
A while back people realized that outcomes of surgery in older people were probably better than previously believed. This led to a widespread perception that we were being ageist by not being aggressive enough in offering surgery to older adults. We started operating on more older adults. We identified new ways to operate on increasingly elderly and frail patients. If you look into geriatric surgery now, you will mostly find a bunch of stuff about how to optimize surgery for elders. (Example - I was recently asked to review the orthopedic surgeon society's new guidelines on management of hip fracture. It was all about this surgical approach or that approach, this screw or that piece of hardware, with almost nothing about the decision to have surgery or not.)
However, there is a new group of physicians researchers who are concerned that the pendulum has swung too far. They are concerned that we are performing too many surgeries on high risk older adults. These surgeries too frequently result in poor outcomes that older adults care about, like death or loss of functional ability. And too often, these surgeries take place with too little thought and deliberation by the referring physician and surgeon about the decision to have surgery or not.