Perioperative Management of Geriatric Patients

In geriatric patients, fixing the osteoporotic and comminuted fractures are challenging but preparing the geriatric patients for operation is sometimes even more challenging. This is particularly obvious when the geriatric patients are under the care of orthopaedic surgeons, whom are not professionally trained to deal with the multiple comorbidities, polypharmacy as well as borderline cardiac and pulmonary functions. In general, the preoperative management of geriatric patients involves the following areas: pain control, thromboprophylaxis, cardiac function assessment, pulmonary function assessment and central nervous system assessment. Each area has their own challenges because of the continuous advances of modern medicine in managing different medical problems. Our goal of pre-operative optimisation is not to treat the underlying comorbidities but to achieve a physiological state so that the patient could be operated safely and as quickly as possible. This optimisation also helps to minimize surgical risks, both intra-operative and postoperatively. After all, an efficient and well-organised multidisciplinary team involving orthopaedic surgeons, geriatricians and anaesthetists is crucial in achieving this goal.