• Karina Gritsenko, Erik Helander, Michael P K Webb, Chikezie N Okeagu, Farees Hyatali, Jordan S Renschler, Fallon Anzalone, Elyse M Cornett, Richard D Urman, and Alan D Kaye.
• Family & Social Medicine, and Physical Medicine & Rehabilitation. Program Director, Regional Anesthesia and Acute Pain Medicine Fellowship, Montefiore Medical Center, Montefiore Multidisciplinary Pain Program. Department of Anesthesiology. 1250 Waters Place, Tower II, 8th Floor, Bronx, NY 10461, USA. Electronic address: kgritsen@montefiore.org.
• Best Pract Res Clin Anaesthesiol. 2020 Jun 1; 34 (2): 199-212.

AbstractImportant elements of the preoperative assessment that should be addressed for the older adult population include frailty, comorbidities, nutritional status, cognition, and medications. Frailty has emerged as a plausible predictor of adverse outcomes after surgery. It is present in older patients and is characterized by multisystem physiologic decline, increased vulnerability to stressors, and adverse clinical outcomes. Preoperative preparation may include a prehabilitation program, which aims to address nutritional insufficiencies, modify chronic polypharmacy, and enhance physical and respiratory conditions prior to hospital admission. Special considerations are taken for particularly high-risk patients, where the approach to prehabilitation can address specific, individual risk factors. Identifying patients who are nutritionally deficient allows practitioners to intervene preoperatively to optimize their nutritional status, and different strategies are available, such as immunonutrition. Previous studies have shown an association between increased frailty and the risk of postoperative complications, morbidity, hospital length of stay, and 30-day and long-term mortality following general surgical procedures. Evidence from numerous studies suggests a potential benefit of including a standard assessment of frailty as part of the preoperative workup of older adult patients. Studies addressing validated frailty assessments and the quantification of their predictive capabilities in various surgeries are warranted.Published by Elsevier Ltd.

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