Common themes in geriatric emergency general surgery: a narrative review
Accepted: May 21, 2024
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Population aging is a growing phenomenon. The geriatric patient is defined by physical, psychological, and social characteristics associated with aging that make him or her more fragile and susceptible. An older patient is usually fragile: frailty has a linear, if not unambiguous, relationship with age. With this background, the concept of futility emerges in emergency surgery, which refers to having a goal but being almost certain of failure in achieving it. A narrative review of the literature was carried out using PubMed, Google Scholar, and Cochrane to identify pertinent publications. Inclusion criteria included: i) an emergency setting in geriatric general surgery, ii) frailty in emergency surgery, and iii) futility in emergency surgery. The study identified valid assessment scores for older and frail patients, as well as imaging tools that may aid in the evaluation of frailty, demonstrating the potential futility of surgical treatment. The review addressed the most common acute surgical situations that affect geriatric patients. Older patients are more fragile and vulnerable than the general population, even though geriatric age does not always correlate with frailty. Several fragility scores have been developed to perform an accurate preoperative assessment of the urgent elderly surgical patient, to estimate treatment futility and perioperative risk, and to guide the surgeon to the most appropriate therapeutic or palliative action.
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