Surgical Care

Older adults, those who are 65 years and older, are a growing segment of the population, expected to nearly double by 2050. Based on these projections, an increasing number of older adults will require wide-ranging surgical services. Indeed, half of persons 65 years and older will require surgery over their lifetime. Despite the substantial and increasing number of older adults undergoing surgical procedures, standard perioperative care lacks a person-centered approach that is needed for the management of a complex population. Surgical care in older adults is unique due to the effects of aging physiology, multimorbidity, and baseline cognitive and functional impairments. Older adults are more likely to develop postoperative complications, including cardiovascular events, functional and cognitive decline, loss of independence, and mortality. However, there is growing evidence that improved outcomes can be obtained with organized evidence-based programs, such as orthogeriatric fracture services. This chapter will provide a framework for surgeons, anesthesiologists, and medical professionals to deliver evidence-based, comprehensive, and person-centered care that integrates geriatric principles into surgical care for older adults. The chapter will utilize the Age-Friendly Health System 4Ms principles to frame pre- and postoperative care; provide guidance for anesthesia and intraoperative management in older adults; discuss the two most common elective surgical procedures in older adults, namely, total hip and total knee replacements; and describe the medical management of hip fracture. As the number of surgeries performed worldwide approaches 250 million per year, providing high-quality surgical care is imperative to avoid significant morbidity and mortality in this population.