Providing per-operative care for older patients with can present major challenges as these patients often have multiple comorbidities, the deterioration of any one of which may increase the surgical risk. A careful balance has to be achieved between minimizing the time before operation and spending time to optimize their medical status. The program presented offers insights into preoperative patient assessment and optimization in this group of patients for surgery. A more prompt and integrated approach to managing these patients will reduce time in the hospital and last minute cancellations. Major thoracic ( pnemonectomy, heart surgery) and abdominal ( open AAA repair ) present risk that often requires a more extensive cardiovascular assessment, however many surgeries ( hip Fx repair laparoscopic cholecystectomy can represent minimal risk with the primary disease often creating more risk for the patient than the operation.
System changes that streamlines and improves the evaluation and optimization of hospitalized patients before surgery reduces time to operating room and complications associated with longer hospitalization. The program presented offers insights into breaking down the barriers that lead to delays in surgery. A prompt and integrated approach to managing preoperative patients reduces time in the hospital and last minute cancellations as many surgeries present less risk to the patient than the disease for which the surgery is planned i.e. hip fracture repair or laparoscopic cholecystectomy. In more complex elective operations i.e. open AAA repairs or pnemonectomy present significant cardiac risk and frequently necessitates a more thorough evaluation.