The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) and the American Geriatrics Society (AGS) Geriatrics-for-Specialists Initiative, with support from the John A. Hartford Foundation, on January 4 released Optimal Perioperative Management of the Geriatric Patient: A Best Practices Guideline. The consensus-based national guideline addresses perioperative care for patients ages 65 and older as defined by Medicare regulations. This population continues to grow, with more than 40 million older adults now living in the U.S., a number that is expected to more than double to 89 million by 2050.*
The new guideline has been published on the Journal of the American College of Surgeons (JACS) website and will run later this year in the print version of JACS and the Journal of the American Geriatrics Society. In addition, the ACS and AGS posted a freestanding volume of this perioperative guideline online.
A framework for excellence
The guideline provides a framework for addressing the complex issues facing patients of advanced age, who are more likely to experience postoperative complications and prolonged recovery. The ACS/AGS Geriatric Surgery Task Force developed the guideline with an expert multidisciplinary panel, which evaluated current evidence and best practices in the medical literature to produce expert recommendations for surgeons, anesthesiologists, and allied health care professionals who work with older adults. This consensus-based guideline is “not a substitute for clinical judgment and experience,” the authors explain, but it can support tailored, comprehensive geriatric evaluations.
“It’s inspiring to see our collaboration achieve this next milestone. This new interdisciplinary guideline provides us with another meaningful tool for improving geriatric surgical care. We now have expert recommendations in place for older patients that range from preoperative assessment to perioperative management,” said guideline co-author Clifford Y. Ko, MD, MS, MSHS, FACS, Director of ACS NSQIP, and Principal Investigator of the Coalition for Quality in Geriatric Surgery (CQGS) Project.
“Representing more than 6,000 health professionals committed to high-quality, person-centered care for older adults, the AGS recognizes that expanding geriatrics expertise means ensuring that all health care professionals—not just geriatrics experts—know and can employ principles of excellence in elder care,” added Nancy E. Lundebjerg, MPA, chief executive officer of the AGS. “This collaboration builds on the legacy of our Geriatrics-for-Specialists Initiative, which itself underscores the unique importance of geriatrics awareness for surgeons and related medical specialists.”
“More than ever, 80-, 90-, and even 100-year olds are undergoing surgery,” said Terry Fulmer, PhD, RN, FAAN, president of The John A. Hartford Foundation. “Our exciting partnership with ACS and AGS has produced another tool that will result in safer care and better outcomes for the growing number of older surgical patients.”
“We searched the medical literature in developing this guideline to find the best available evidence and the most relevant peer-developed position statements,” said guideline co-author Ronnie Rosenthal, MD, MS, FACS, Chair of the Geriatric Surgery Task Force; Co-Principal Investigator, CQGS Project; and chief of surgery at the Veterans Affairs Connecticut Healthcare System, West Haven. “We also included several appendices that provide examples of tools that can be used to assist the clinician in assessing risk factors and developing treatment plans and care models. In doing so, we feel that we’ve developed a fully comprehensive resource that is now readily accessible via the Web and can be used immediately by all clinicians and caregivers who treat and work with older surgical patients.”
“As a start, this guideline functions as an unprecedented educational resource, one that organizes all of the components of perioperative care of the older adult in one place,” concluded guideline co-author Sanjay Mohanty, MD, a general surgery resident at Henry Ford Hospital, Detroit, MI, and an ACS/AGS James C. Thompson Geriatrics Surgical Fellow. “Perhaps it will one day play an important role in informing us about process and providing us with insightful metrics on outcomes for geriatric surgical patients.”
*U.S. Department of Commerce Economics and Statistics Administration. U.S. Census Bureau. The next four decades: The older population in the United States: 2010 to 2050. Available at: www.census.gov/prod/2010pubs/p25-1138.pdf. Accessed January 11, 2016.