Consultant Geriatrician, Perioperative Medicine for Older People undergoing Surgery (POPS), Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Honorary Senior Lecturer, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Age Ageing. 2022 Aug 2;51(8). doi: 10.1093/ageing/afac194.
Increasing numbers of older people are undergoing surgery with benefits including symptom relief and extended longevity. Despite these benefits, older people are more likely than younger patients to experience postoperative complications, which are predominantly medical as opposed to surgical. Comprehensive Geriatric Assessment and optimisation offers a systematic approach to risk assessment and risk modification in the perioperative period. Clinical evidence shows that Comprehensive Geriatric Assessment and optimisation reduces postoperative medical complications and is cost effective in the perioperative setting. These benefits have been observed in patients undergoing elective and emergency surgery. Challenges in the implementation of perioperative Comprehensive Geriatric Assessment and optimisation services are acknowledged. These include the necessary involvement of a wide stakeholder group, limited available geriatric medicine workforce and ensuring fidelity to Comprehensive Geriatric Assessment methodology with adaptation to the local context. Addressing these challenges needs a cross-specialty, interdisciplinary approach underpinned by evidence-based medicine and implementation science with upskilling to facilitate innovative use of the extended workforce. Future delivery of quality patient-centred perioperative care requires proactive engagement with national audit, collaborative guidelines and establishment of networks to share best practice.
越来越多的老年人接受手术治疗，其益处包括缓解症状和延长寿命。尽管有这些好处，但老年人比年轻患者更容易发生术后并发症，这些并发症主要是医疗性的，而不是手术性的。全面老年评估和优化提供了一种系统的方法来评估围手术期的风险并进行风险修正。临床证据表明，全面老年评估和优化可减少术后医疗并发症，并在围手术期具有成本效益。这些益处已在接受择期和急诊手术的患者中观察到。围手术期全面老年评估和优化服务的实施面临挑战。这些挑战包括需要广泛的利益相关者群体的参与、有限的老年医学劳动力以及确保全面老年评估方法的保真度，并根据当地情况进行调整。应对这些挑战需要跨专业、跨学科的方法，以循证医学和实施科学为基础，并进行技能提升，以促进对扩展劳动力的创新性使用。未来提供高质量以患者为中心的围手术期护理需要积极参与国家审计、协作制定指南以及建立网络以分享最佳实践。
