Older people are at increased risk of undergoing emergency surgery, complications and poor outcomes.
There are a number of factors that make safe surgery for older people complex and challenging. Resources outlining successful existing multi-disciplinary interventions to improve surgical safety, factors which improve peri-operative harm and improving pathways for emergency care are covered in this section.
The complexities of older people undergoing surgery
Characteristics of older people receiving surgery for fractured neck or femurs (FNOF):
- the median age of patients admitted with FNOF is 84 years
- one in three of these patients have dementia
- one in three suffer delirium during their hospital stay
- one in three never return to their former residence.1
Reducing perioperative harm
Surgical interventions have associated risks both physiologically – for example managing temperature and glycaemic control – and systemically, around human factors and effective team working. The National Patient Safety Agency's 'Patient Safety First' campaign produced a guide to reducing perioperative harm, Reducing harm in perioperative care.
Frail older people are at increased risk of undergoing emergency surgery and are more likely to subsequently have complications and receive critical care. The higher risk general surgical patient – towards improved care for a forgotten group (a report from the Royal College of Surgeons, England and the Department of Health) makes recommendations to improve the emergency surgical pathway for these patients.
Although elective surgery may pose less risk to frail older people than emergency surgery, there is still great potential to reduce harm and optimise care for elective procedures. The 'POPS' (Proactive Care of the Older Patient undergoing Surgery) team at Guy's and St Thomas's Hospital, London have produced a report of their intervention to reduce harm in this group: Proactive care of older people undergoing surgery (‘POPS’): Designing, embedding, evaluating and funding a comprehensive geriatric assessment service for older elective surgical patients. The report describes their method and makes recommendations for practical implementation of the POPS model in other healthcare organisations.
- The Care of Patients with Fragility Fracture. London: British Orthopaedic Association/British Geriatrics Society, 2007.