Delaying Elective Surgery in Geriatric Patients: An Opportunity for Preoperative Optimization.

Abstract

Deciding whether to pursue elective surgery is a complex process for older adults. Comprehensive geriatric assessment (CGA) can help refine estimates of benefits and risks, at times leading to a delay of surgery to optimize surgical readiness. We describe a cohort of geriatric patients who were evaluated in anticipation of elective abdominal surgery and whose procedures were delayed for any reason. Themes behind the reasons for delay are described, and a holistic framework to guide preoperative discussion is suggested.

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Citation

Published Version (Please cite this version)

10.1213/ane.0000000000004335

Publication Info

Wong, Serena P, Kahli M Zietlow, Shelley R McDonald, Atilio Barbeito, Cathleen S Colon-Emeric, Sandhya A Lagoo-Deenadayalan, Nancy Loyack, Mitchell T Heflin, et al. (2019). Delaying Elective Surgery in Geriatric Patients: An Opportunity for Preoperative Optimization. Anesthesia and analgesia. pp. 1–1. 10.1213/ane.0000000000004335 Retrieved from https://hdl.handle.net/10161/19271.

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Scholars@Duke

Wong

Serena P Wong

Assistant Professor of Medicine
McDonald

Shelley R McDonald

Associate Professor of Medicine
Barbeito

Atilio Barbeito

Associate Professor of Anesthesiology

Healthcare Quality, Perioperative Epidemiology, Cardiac and Thoracic Anesthesiology, Critical Care

Heflin

Mitchell Tod Heflin

Professor of Medicine

I am currently a Professor with Tenure in the Department of Medicine, a Senior Fellow in the Duke Center for the Study of Aging and Human Development, and Associate Dean for Interprofessional Education and Care (IPEC).  My career as a leader in Geriatrics has focused on development, deployment and evaluation of education programs aimed at health professions learners from a variety of disciplines and introduction of innovative models of care with a specific emphasis on community-based and perioperative care of frail older adults.   I served as Geriatrics Fellowship Program Director for 11 years and, over the same span, directed HRSA funded Geriatrics Education Programs at Duke, including our Geriatric Workforce Enhancement Program (GWEP) In that role, I worked with colleagues and community partners to provide IP educational programs in geriatrics and care redesign in primary care practices to improve care for older adults.  Concurrently, I also led the implementation of the Duke Perioperative Optimization of Senior Health (POSH) program and co-directed the VA OAA funded Specialty Care Education Center of Excellence for the VA POSH Program.  In my current role as Associate Dean and Director of the IPEC Center, I am working with educators and clinicians from across the Health System in the design and implementation of educational program aimed at improving our ability to use interprofessional collaborative practice to deliver safe, effective, person-centered care.


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