How Hospitals are Working to Prepare At-Risk Older Patients for Surgery
Older patients undergo major surgery on a regular basis. However, a number of these patients are at risk for experiencing complications, functional decline and loss of independence after surgery.
With this in mind, Emily Finlayson, MD, professor of surgery and health policy at University of California - San Francisco Medical Center, set out to determine how to improve outcomes for at-risk older patients.
She began by looking at whether patients are undergoing interventions that will help them reach their overall health goals. In other words, should some patients receive other types of less invasive treatment besides surgery? Part of that decision involves assessing the patient's fitness for surgery, but another part involves understanding what the patient hopes to get out of the procedure, says Dr. Finlayson. Some patients may aim to live a longer life regardless the cost, while others may seek to maintain a high level of function and independence for as long as they can.
"So, sort of meeting patients where they are," she says. "I thought we needed to beef [that] up. I think surgeons currently aren't trained to have those granular conversations as well as some other specialists. Also, considering the time constraints and the clinic culture, the throughput doesn't really lend itself to that conversation."
Additionally, she says, hospitals are good at screening for major medical risk factors such as heart disease before surgery, but they don't routinely look for frailty components such as functional disability and poor social support.
Ultimately, after thinking about those issues, Dr. Finlayson helped start, and now directs, the UCSF Center for Surgery in Older Adults. The center includes UCSF's Surgery Wellness program, which is designed to help older patients get physically, mentally and logistically prepared for an operation.