Studies on Perioperative Care for Frail Patients:focused on Gynecology

The population undergoing surgery is getting older. Surgery poses a higher risk in older people compared to younger people. Older patients may have specific health threats, but being old does not necessarily mean one has a decreased health status. A substantial part of the older population is still living active and healthy. Biological age seems to be a more important risk factor for negative health outcomes than chronological age. It is therefore essential to identify older people who are at risk of adverse health outcomes after surgery, to correct modifiable risk factors and to adapt their care if necessary.The aim of this thesis was to study how, through better perioperative care, we can improve postoperative outcomes for older patients. The focus lay on patients undergoing gynecological surgery. We concentrated on three areas: ‘identifying the high-risk group for worse postoperative outcomes’, ‘preoperative care optimization through prehabilitation’, and ‘postoperative delirium prevention’.In order to improve postoperative outcomes for older patients we should target on education and awareness of clinicians on frailty and preoperative risk assessment. Identified frail patients can be offered a comprehensive geriatric assessment and a personalized care program, including prehabilitation, led by a multidisciplinary team. Developing specific prehabilitation programs per specialty does not seem to be necessary, because gynecological patients have much in common with other older patients undergoing abdominal surgery. This thesis suggests that adequate anemia management should be part of the personalized care program for the frail patient, as part of a delirium prevention strategy