Management of Pancreaticobiliary Disease in the Geriatric Patient Population

Abstract

Although benign biliary disorders are commonly treated in the acute care surgery setting, the geriatric population can present a unique challenge given the anatomic and physiologic changes that evolve with increased age. Advancements in health care have afforded increased longevity in populations worldwide, thus creating a scenario in which these patients have complicated histories that include treated and untreated comorbidities, prior medical and surgical interventions, and considerations of polypharmacy. Additionally, biliary diseases in the geriatric population can present insidiously, and these patients are at high risk for acute decompensation if their pathology is not recognized and treated promptly. Each biliary disorder requires an individualized and multidisciplinary approach that is focused on defining the patient’s goals of care and aligning the patient’s treatment plan accordingly. Ideally, geriatric patients undergoing surgery complete a thorough preoperative assessment and optimization prior to intervention; however, the acute care setting does not always afford such a benefit if the initial presentation includes bleeding, obstruction, or perforation. Acute pancreatitis is one of the most common gastrointestinal disorders requiring hospitalization worldwide and patients in the geriatric population are particularly susceptible to this syndrome and its complications. The principles of management of geriatric patients with acute pancreatitis are securing the diagnosis, risk stratification of the patient, implementing appropriate treatment, and minimizing surgical interventions. It is imperative for the acute care surgeon to be able to rapidly assess the geriatric patient’s surgical risk factors and employ strategies to optimize the patient’s resuscitation without exacerbating underlying comorbidities prior to surgical intervention if indicated.