Perioperative Evaluation and Management of Frailty Among Older Adults Undergoing Colorectal Surgery

Publication Date: March 28, 2022
Last Updated: March 31, 2022

Summary of Recommendations

Treatment recommendations regarding colorectal surgery should consider patients’ degree of frailty (ie, physiological age) rather than chronological age. (1A)
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Frailty screening in the ambulatory setting identifies vulnerable and frail older adults. (1A)
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Treatment plans for frail older adults should align with patients’ goals of care and should be based on a discussion regarding realistic outcomes. (1C)
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Cognitive function should be assessed preoperatively in frail older adults. (1C)
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Frail older adults should be screened for postoperative signs and symptoms of delirium and treated appropriately. (1B)
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Frail older adults may benefit from preoperative, multimodality optimization (ie, prehabilitation). (1B)
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Frail patients may benefit from a multidisciplinary approach to perioperative care that includes a health care provider with geriatric expertise. (1C)
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Frail older adults should be screened for social vulnerabilities and offered support. (1C)
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Frail older adults should be managed with enhanced recovery protocols after surgery with modifications, as needed. (1A)
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Minimally invasive techniques should be considered for frail older adults undergoing colorectal surgery. (1B)
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In older adults, patient-centered postoperative functional outcomes should be considered in addition to traditional postsurgical outcomes. (1B)
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Recommendation Grading

Overview

Title

Perioperative Evaluation and Management of Frailty Among Older Adults Undergoing Colorectal Surgery

Authoring Organization

American Society of Colon and Rectal Surgeons

Publication Month/Year

March 28, 2022

Last Updated Month/Year

August 29, 2024

Document Type

Guideline

Country of Publication

US

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory, Outpatient, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Management

Diseases/Conditions (MeSH)

D003107 - Colorectal Surgery, D019990 - Perioperative Care

Keywords

perioperative care, Colorectal Surgery, perioperative management

Source Citation

Saur NM, Davis BR, Montroni I, Shahrokni A, Rostoft S, Russell MM, Mohile SG, Suwanabol PA, Lightner AL, Poylin V, Paquette IM, Feingold DL; Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Perioperative Evaluation and Management of Frailty Among Older Adults Undergoing Colorectal Surgery. Dis Colon Rectum. 2022 Apr 1;65(4):473-488. doi: 10.1097/DCR.0000000000002410. PMID: 35001046.

Supplemental Methodology Resources

Data Supplement

Methodology

Number of Source Documents
166
Literature Search Start Date
December 31, 2013
Literature Search End Date
November 23, 2021