Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus
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CONSENSUS DOCUMENT
Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus Paola Aceto1,2 · Raffaele Antonelli Incalzi3 · Gabriella Bettelli4 · Michele Carron5 · Fernando Chiumiento6 · Antonio Corcione7 · Antonio Crucitti1,2 · Stefania Maggi8 · Marco Montorsi9 · Maria Caterina Pace10 · Flavia Petrini11 · Concezione Tommasino12 · Marco Trabucchi13 · Stefano Volpato14 on behalf of Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI), Società Italiana di Gerontologia e Geriatria (SIGG), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia Geriatrica (SICG) and Associazione Italiana di Psicogeriatria (AIP) Received: 3 March 2020 / Accepted: 3 June 2020 © Springer Nature Switzerland AG 2020
Abstract Background Surgical outcomes in geriatric patients may be complicated by factors such as multiple comorbidities, low functional performance, frailty, reduced homeostatic capacity, and cognitive impairment. An integrated multidisciplinary approach to management is, therefore, essential in this population, but at present, the use of such an approach is uncommon. The Perioperative Management of Elderly patients (PriME) project has been established to address this issue. Aims To develop evidence-based recommendations for the integrated care of geriatric surgical patients. Methods A 14-member Expert Task Force of surgeons, anesthetists, and geriatricians was established to develop evidencebased recommendations for the pre-, intra-, and postoperative care of hospitalized older patients (≥ 65 years) undergoing elective surgery. A modified Delphi approach was used to achieve consensus, and the strength of recommendations and quality of evidence was rated using the U.S. Preventative Services Task Force criteria. Results A total of 81 recommendations were proposed, covering preoperative evaluation and care (30 items), intraoperative management (19 items), and postoperative care and discharge (32 items). Conclusions These recommendations should facilitate the multidisciplinary management of older surgical patients, integrating the expertise of the surgeon, the anesthetist, the geriatrician, and other specialists and health care professionals (where available) as needed. These roles may vary according to the phase and setting of care and the patient’s conditions. Keywords Older patients · Anesthesia · Surgery · Perioperative care · Frail older · Analgesia · Comprehensive geriatric assessment
* Stefano Volpato [email protected]
7
Monaldi-Ospedale Dei Colli, Naples, Italy
8
CNR, Institute of Neuroscience, Aging Branch, Padua, Italy
1
Humanitas University and Research Hospital IRCCS, Milan, Italy
Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
9
Università Cattolica del Sacro Cuore, Rome, Italy
10
Università degli Studi “Luigi Vanvitelli”, Naples, Italy
Policlinico Universitario Campus Biomedico, Rome, Italy
11
Università degli Studi G.d’Annunzio, Chieti, Italy
Past Director Geriatric Sur
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