Authors: Tjeertes EKM et al.
Source: European Journal of Anaesthesiology. 43(2):93–102, February 2026. DOI: 10.1097/EJA.0000000000002257
Summary:
This narrative review addresses the increasingly common challenge of caring for geriatric patients in the perioperative setting, as demographic shifts lead to a growing number of older adults undergoing surgery. While surgery in older patients can provide meaningful benefits—such as symptom relief, preservation of function, and prolonged survival—it also carries a heightened risk of perioperative complications, especially in those who are frail.
The authors emphasize that chronological age alone is a poor predictor of surgical outcomes. Instead, age-related anatomical and physiological changes across multiple organ systems—including cardiovascular, pulmonary, renal, neurologic, and immune systems—interact with comorbidities to influence surgical stress responses, recovery trajectories, and vulnerability to adverse events. Frailty emerges as a central concept, representing a cumulative decline in physiologic reserve that strongly correlates with postoperative morbidity, mortality, functional decline, and institutionalization.
A key focus of the review is the importance of distinguishing between fit and frail older patients during preoperative assessment. Comprehensive geriatric evaluation, including frailty screening, cognitive assessment, nutritional status, and functional capacity, is critical for risk stratification and shared decision-making. Importantly, the authors highlight evidence that preoperative optimization—such as addressing anemia, malnutrition, polypharmacy, and deconditioning—can improve outcomes even in very old patients.
Patient-centered care is presented as a cornerstone of high-quality perioperative management in geriatrics. This includes integrating patient values, goals, and expectations into surgical decision-making, particularly when outcomes such as functional independence, quality of life, or symptom control may be more important than longevity alone. Multidisciplinary collaboration among anesthesiologists, surgeons, geriatricians, nurses, physiotherapists, and palliative care teams is emphasized as essential to delivering coordinated, individualized care.
The review also addresses scenarios in which surgery may be deemed non-beneficial or futile. In such cases, early discussions about goals of care, advance care planning, and end-of-life preferences are critical. The authors underscore the role of perioperative clinicians in supporting patients and families through difficult decisions, ensuring that care remains compassionate, dignified, and aligned with patient wishes when curative or life-prolonging interventions are unlikely to succeed.
What You Should Know:
Frailty—not age—is a dominant predictor of perioperative risk in older adults. Structured geriatric assessment, shared decision-making, and multidisciplinary care can meaningfully improve outcomes and help align surgery with patient-centered goals.
Key Points:
Older surgical patients represent a highly heterogeneous population, ranging from fit to severely frail.
Frailty assessment is essential for predicting perioperative risk and postoperative recovery.
Preoperative optimization may improve outcomes even in advanced age.
Shared decision-making and advance care planning are central to ethical, patient-centered perioperative care.
When surgery is futile, multidisciplinary support can promote comfort, dignity, and meaningful end-of-life care.
Thank you to the European Journal of Anaesthesiology for publishing this thoughtful and timely review on optimizing perioperative care for the growing population of geriatric surgical patients.