Pre-Operative Management

  • Helen WilsonEmail author
Part of the Practical Issues in Geriatrics book series (PIG)


The pre-operative assessment of frail older patients is complex. It requires time and skills in information gathering. An understanding of the implications of each co-morbidity, a recognition of frailty, knowledge of pharmacology and pharmacodynamics are essential, together with an awareness of the likely impact of trauma, anaesthesia and surgery on an individual.

Pre-operative management involves comprehensive geriatric assessment (CGA) or geriatric evaluation and management (GEM). This is both interdisciplinary and multidimensional, recognising medical conditions in the context of functional impairment, environmental and social issues. This approach generates a problem list for which goal-driven interventions may be agreed.

Predicting likely complications and implementing preventative strategies form the basis of pre-operative medical management. In some, complications will inevitably occur, so pre-operative assessment should also include setting expectations and appropriate ceilings of care and ensuring these are agreed and understood by all the healthcare professionals involved, the patient and their families and carers.

Predicting likely functional outcome, care needs and support enables pre-operative discussion about likely length of hospitalisation and early identification of requirements for discharge planning.

Excellent pre-operative management is essential to support a smooth intra-operative and post-operative course that should then enable the best possible outcome for the patient.


Chronic Kidney Disease Fragility Fracture Fluid Overload Comprehensive Geriatric Assessment Implantable Cardiac Defibrillator 
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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Royal Surrey County HospitalGuildfordUK

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