Short description:

This book explores the transdisciplinary approach to general surgery for the frail patient, promoting the use of a geriatric model of care in general surgical settings and thus proposing a ?gerosurgery? approach in frail persons beyond chronological age.

Aging, frailty, and surgical needs are increasing dramatically worldwide while surgeons are daily facing with the trouble of the trade-off between short-term outcomes and efficacy of surgery in older persons. However, recent studies have clearly shown that age itself is not a prognostic risk factor for complications after elective surgery in older patients, whereas cognitive or functional frailty is. Neither a referring physician nor an assessing surgeon should deny patients surgery purely based on chronological age. Instead, decisions should be based on a CGA (comprehensive geriatric assessment) with a precise picture of the patient considering the cognitive, functional, nutritional, socioeconomic, and affective status. Recent studies examining the use of preparative CGA in surgical patients showed encouraging results on postoperative outcomes in old and/or frail patients. The most compelling current evidence comes from the orthopaedic community, which has embraced the idea of multidisciplinary team care. Preoperative evaluation, postoperative care, pain control, nutritional support, delirium prevention, mobilization, and rehabilitation are necessary also in general surgery. An expert multidisciplinary team, including geriatricians, anaesthesiologists, specialist nurses, physiotherapists, and nutritionists should mandatorily support surgeons.

With this book, the reader will have an exhaustive overview and will gain essential, practical knowledge on how best to manage the surgical and frail patient and how to develop clinical systems that do so reliably.

Long description:

This book explores the transdisciplinary approach to general surgery for the frail patient, promoting the use of a geriatric model of care in general surgical settings and thus proposing a ?gerosurgery? approach in frail persons beyond chronological age.

Aging, frailty, and surgical needs are increasing dramatically worldwide while surgeons are daily facing with the trouble of the trade-off between short-term outcomes and efficacy of surgery in older persons. However, recent studies have clearly shown that age itself is not a prognostic risk factor for complications after elective surgery in older patients, whereas cognitive or functional frailty is. Neither a referring physician nor an assessing surgeon should deny patients surgery purely based on chronological age. Instead, decisions should be based on a CGA (comprehensive geriatric assessment) with a precise picture of the patient considering the cognitive, functional, nutritional, socioeconomic, and affective status. Recent studies examining the use of preparative CGA in surgical patients showed encouraging results on postoperative outcomes in old and/or frail patients. The most compelling current evidence comes from the orthopaedic community, which has embraced the idea of multidisciplinary team care. Preoperative evaluation, postoperative care, pain control, nutritional support, delirium prevention, mobilization, and rehabilitation are necessary also in general surgery. An expert multidisciplinary team, including geriatricians, anaesthesiologists, specialist nurses, physiotherapists, and nutritionists should mandatorily support surgeons.

With this book, the reader will have an exhaustive overview and will gain essential, practical knowledge on how best to manage the surgical and frail patient and how to develop clinical systems that do so reliably.

Table of Contents:

Preface.- PART I Background.- 1. The epidemiology of aging in surgical settings.- 2. Implications of population ageing for societies and governments.- 3. The impact of aging population on general surgical workforce needs.- 4. Aging trajectories and phenotypes.- 5. Understanding aging, frailty, and resilience.- 6. Surgical risk assessment: from chronological age to frailty status.- 7. Integrating geriatics principles into surgical care setting: a "Surgery for Frails" novel model.- 8. The role of a multidisciplinary team for shared strategies in gerosurgery.- PART II Pre-operative management.- 9. Multidimensional Prognostic Index in Surgery: a clinical perspective.- 10. Decision-making of surgical strategy in older and/or frail persons.- 11. The nurse: perioperative care and management.- 12. The nutritionist: malnutrition risk assessment and management.- 13. The importance of hydration and nutritional support.- 14. The geriatrician: from patient-centred perioperative care to geriatric syndromes management.- 15. Open surgery choice: what, why, when, and whom.- 16. Minimally invasive surgery choice: what, why, when, and whom.- 17. Geriatric Trauma.- PART III Post-operative management.- 18. The pain assessment and management.- 19. Post-operative delirium management.- 20. Fluid and Electrolyte Balance.- 21. Post-operative stress, metabolism, and catabolism.- 22. The nutritional support and recovery: the lesson learned form ERAS.- 23. The physiotherapist: The importance of early functional recovery.- 24. The early identification of post-demission setting.- 25. The role of intermediated care: what, why, when, and whom.- 26. The continuity of care: territory and general practitioner.- 27. Decision-Making at the End of Life.- 28. Living with frailty in geriatric patients: psychological stress and special needs to support emotional tension.- 29. Informed consent challenges in frail surgical patients.- 30. Bioethical Issues in Gerosurgery.