Towards integrated perioperative medicine: a survey of general practitioners' attitudes, beliefs and behaviours regarding perioperative medicine for older people.

Background: Perioperative optimisation can improve outcomes for older people having surgery. Integration with primary care could improve quality and reduce variability in access to preoperative optimisation.

Aim: Our aim was to explore attitudes, beliefs and behaviours of general practitioners (GPs) regarding the perioperative pathway, and evaluate enablers and barriers to GP-led preoperative optimisation.

Perioperative Medicine for Older People.

Global demographic changes have resulted in an older, frailer surgical population with significant multimorbidity causing higher frequency of adverse postoperative outcomes. The need for restructuring of perioperative care pathways to address this issue has been recognised. Comprehensive geriatric assessment (CGA) and optimisation are emerging as innovative perioperative pathways.

Frailty in the perioperative setting.

The frailty syndrome is defined as a decrease in physiological reserve across multiple organ systems leading to increased vulnerability to external stressors. Studies across surgical subspecialties and in emergency and elective settings have identified frailty as an independent predictor of adverse postoperative clinician-reported, patient-reported and process-related outcomes. Although frailty is not specific to the older population, it is associated with ageing and therefore is increasingly observed in the ageing surgical population.

Scaling up perioperative medicine for older people undergoing surgery (POPS) services; use of a logic model approach.

Perioperative medicine for older people undergoing surgery (POPS) services are gaining traction, in acknowledgment of the poorer outcomes experienced by older surgical patients. In response to the NHS' growing focus on scaling innovation, a logic model of the POPS service at Guy's and St Thomas' NHS Foundation Trust was developed to articulate a founding centre's experience. The logic model was applied as a means of service evaluation and to guide implementation of a new POPS service at a district general trust.

Perioperative medicine for older patients: how do we deliver quality care?

The demand for surgical intervention in older people is rising due to the growing older population with multimorbidity. Yet older people continue to have reduced access to surgery and have more adverse postoperative outcomes than younger people. Current models of preoperative risk assessment and optimisation are poorly suited to this complex surgical population.