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.
CONTENTS:
Background
The Epidemiology of Aging in Surgical Settings
Implications of Population Aging for Societies and Governments
The Impact of Aging Population on General Surgical Workforce Needs
Aging Trajectories and Phenotypes
Understanding Aging, Frailty, and Resilience
Surgical Risk Assessment: From Chronological Age to Frailty Status
Integrating Geriatrics Principles into Surgical Care Setting: A "Surgery for Frails" Novel Model
The Role of a Multidisciplinary Team for Shared Strategies in Gerosurgery
Pre-operative Management
Multidimensional Prognostic Index in Surgery: A Clinical Perspective
Decision Making of Surgical Strategy in Older and/or Frail Persons
The Nurse: Perioperative Care and Management
The Nutritionist: Malnutrition Risk Assessment and Management
The Importance of Hydration and Nutritional Support
The Geriatrician: From Patient-Centered Perioperative Care to Geriatric Syndromes Management
Open Surgery: What, Why, When, and Whom
Minimally Invasive Surgery Choice: What, Why, When, and Whom
Geriatric Trauma
Pain Assessment and Management
Postoperative Delirium
Fluid and Electrolyte Balance
Postoperative Stress, Metabolism, and Catabolism
Nutritional Support and Recovery: Lesson Learned from ERAS
The Physiotherapist: The Importance of Early Functional Recovery
Early Identification of Post-Demission Setting
Continuity of Care: A Multidimensional Vision for the Frail Patient
Continuity of Care: Territory and General Practitioner
Shared Decision-Making at the End of Life
Living with Frailty: Psychological Stress and Support for Emotional Tension
Informed Consent Challenges in Frail Surgical Patients
Bioethical Issues in Gerosurgery
