Setting Expectations: The Role of Preoperative Counselling in High-Risk Surgery for the Older adult

Geriatric patients are especially vulnerable to adverse postoperative outcomes by way of various frailty syndromes. As such, they require care and assessment from a multidisciplinary team to adequately address and optimize any co-morbidities and functional decline and adequately convey the material risks and benefits of surgery, as well as the process of perioperative recovery.

In this review paper, we discuss current trends in the perioperative assessment of frailty and subsequent surgical decision-making. We include discussion of representative clinical case scenarios that involve complex goals of care discussions in general surgery and potential pitfalls in communication and shared decision-making. These scenarios include patients with varying degrees of frailty in trauma, surgical oncology, and emergency general surgery.

Lastly, we discuss tools that are widely available to both surgical and non-surgical providers in the treatment of elderly and frail patients such as risk calculator decision aids, the multidisciplinary preoperative clinic, and communication tools.