AGS STATEMENT: American College of Surgeons, American Geriatrics Society, and the John A. Hartford Foundation Publish First Ever Best Practice Surgical Guidelines for Older Adults

October 18th, 2012

NEW YORK – New comprehensive guidelines the preoperative care of older adults have been issued by the American College of Surgeons (ACS) and the American Geriatrics Society (AGS) with support from the John A. Hartford Foundation.  The joint guidelines—published in the October issue of the Journal of the American College of Surgeons—apply to every patient who is 65 years and older as defined by Medicare regulations. The guidelines are the culmination of two years of research and analysis by a multidisciplinary expert panel representing the ACS and AGS, as well as by expert representatives from a range of medical specialties.  

While people over the age of 65 account for only 12 percent of the U.S. population, they undergo almost 40 percent of all surgical procedures.  Additionally, older adults are more likely to suffer a range of post-operative complications than any other age group.  The ACS/AGS Best Practices Guideline provides evidence-based recommendations that will identify high-risk patients, improve communication between surgeons and patients, and potentially prevent perioperative adverse events in older adults.  While this best practice guideline is meant to help surgical teams, proceduralists, and anesthesiologists in their care of older patients, it is not a substitution for clinical judgment and experience. 

The guidelines recommend and specify 13 key issues of preoperative assessment for seniors:

• Cognitive impairment and dementia
• Decision-making capacity
• Postoperative delirium
• Alcohol and substance abuse
• Cardiac evaluation
• Pulmonary evaluation
• Functional status, mobility, and fall risk
• Frailty
• Nutritional status
• Medication management
• Patient counseling
• Patient-family and social support system
• Preoperative testing.

The development of the ACS/AGS Best Practices Guideline was made possible through a two-year clinical outcomes research fellowship, overseen by the AGS Geriatrics-for-Specialists Initiative (GSI) and funded by the John A. Hartford Foundation.