Perioperative Geriatric Management

It is well established that older adults undergoing major surgery are at higher risk for complications and poor outcomes. This is related to a combination of decline in organ function, increased comorbidities, presence of geriatric syndromes, and reduced ability to compensate for stress. Despite overall worse outcomes, a higher proportion of people over 65 years of age are undergoing elective procedures as the population ages. It is imperative for hospitalists to be familiar with evidence-based approaches to assessment and optimization of the geriatric patient prior to surgery as well as best practices for care in the postoperative period. The American Geriatrics Society & American College of Surgeons have collaborated to create comprehensive perioperative practice standards for older adults that can be succinctly organized into a ‘Four M’ approach to ‘Age-Friendly’ care. This module reviews core principles of such care and outlines interventions shown to improve outcomes.

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Availability

On-Demand

Expires on Jul 31, 2028

Cost

Member: $0.00

Non-Member: $95.00

Credit Offered

2 CME Credits

2 ABIM-MOC Points

2 Participation Credits

Overview
Faculty
Accreditation
Recommended

Learning Objectives

After completing this activity, learners should be able to:

Describe the impact of age and frailty on surgical outcomes
Assess cognitive status and delirium risk
Perform a frailty screen and discuss evidence-based risk reduction strategies for frail patients
Manage medications for older adults in the perioperative period
Delineate common postoperative complications in older adults and how to approach management
Elicit patient values and healthcare goals to inform shared decision-making around surgery
Summarize how interdisciplinary teams and care models improve outcomes for older adults undergoing surgery

Faculty

Edie P. Shen, MD, FHM
Jenny Shen, MD
Susan Wlodarczyk, MD
Heather E. Nye, MD, PhD, SFHM, FACP
Kurt Pfeifer, MD, FACP, SFHM, DFPM
Leonard Feldman, MD, FACP, FAAP, MHM

Faculty Disclosures
The faculty and planners of these activities have no relevant relationships to disclose. All relevant relationships were mitigated prior to the start of this activity.

Conflict of Interest Disclosure Policy
In accordance with the ACCME Standards for Commercial Support, SHM requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any commercial interest. SHM mitigates all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational programs. All relevant financial relationships shall be disclosed to participants prior to the start of the activity.

Furthermore, SHM seeks to verify that all scientific research referred to, reported, or used in a continuing medical education (CME) activity conforms to the generally accepted standards of experimental design, data collection, and analysis. SHM is committed to providing its learners with high-quality CME activities that promote improvements in healthcare and not those of a commercial interest.

Accreditation Statement
The Society of Hospital Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

CME Credit Statement
The Society of Hospital Medicine designates this online activity for a maximum of 2.00 AMA PRA Category 1 Credit^TM. Physicians should claim only credit commensurate with the extent of their participation in the activity.

MOC Credit Statement
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 2.00 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

SHM Consults: Perioperative and Consultative Medicine

As hospitalist roles surge, mastering consultative and perioperative care has become a career essential. Gain the proven frameworks and clinical confidence to navigate complex surgical co-management and specialist consultations, leading to safer patients and smoother workflows.

Multiple Credits

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SHM Consults Core Curriculum

Hospitalists are the fastest growing portion of the physician work force. Some estimate there will be 50,000 hospitalists needed in the next 10 years. As the number of hospitalists grows, so too will the clinical settings in which we practice. Consultative medicine is a service provided by many hospitalists, and a future in which almost all surgical patients are co-managed by hospitalists is already a reality for some. For many of us, our training in consultative medicine during residency was limited. We hope this curriculum will help you to feel more confident about your knowledge and skills and will lead to better patient outcomes. We welcome your comments and suggestions for future topics.

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Perioperative Medication Management

Although general internists and subspecialists are familiar with prescribing and managing medications in typical outpatient and inpatient venues, the perioperative period represents a challenging and often unfamiliar setting. This activity will outline the principles, available evidence, and expert opinion to be considered when making perioperative management recommendations for some of the most commonly prescribed medications.

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Management Of Patients With Hip Fractures

Hip fractures are a frequent cause of hospitalization in the elderly population. As the population continues to age, the incidence is expected to increase. Since many patients with hip fracture suffer from multiple medical comorbidities, hospitalists play a critical role in their care. Management of these patients requires knowledge of multiple consultative medicine topics including preoperative cardiac and pulmonary risk stratification and reduction strategies, venous thromboembolism prevention, and diagnosis and management of common postoperative complications. Open lines of communication between the hospitalist, surgeon, and anesthesiologist are essential to optimize patient care.

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SHM Consults Advanced Curriculum

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Anesthesia for Internists

The goal of anesthesia is to facilitate a surgical procedure both for patient and surgeon. Not only does an anesthesia team relieve and prevent pain and anxiety due to surgical procedures, but it also expedites the conduct of procedures and optimizes surgical conditions by preventing patient movement and ensuring hemodynamic stability. While some procedures require a small amount of sedation, others require general anesthesia and/or regional anesthesia. This activity discusses the basic types of surgical anesthesia as well as the indications and contraindications for each. Additionally, the most commonly used medications will be reviewed, including mechanism of action and side effects. An overview of the American Society of Anesthesiologists Physical Classification Status System is presented along with considerations that may prompt an anesthesiologist to delay or cancel a surgical procedure.

Multiple Credits

$0.00 - $95.00

Prevention of Surgical Site Infections

Surgical site infections (SSIs) are a major cause of postoperative illness, longer hospitalization, and increased healthcare costs, making the prevention and treatment of SSIs an important aspect of patient care for hospitalists. The following activity outlines patient and procedural factors that increase the risk of SSIs, examines the basic principles of antimicrobial prophylaxis for SSI, reviews nonantibiotic interventions to lessen the risk of SSI, and outlines evaluation for and treatment of an SSI. In addition, a discussion of the controversy surrounding preoperative decolonization of Staphylococcus aureus is provided.

Multiple Credits

$0.00 - $95.00

Reversal and Reinitiation of Anticoagulation

Anticoagulation therapy is associated with increased risk of bleeding, including intracranial hemorrhage (ICH) and gastrointestinal (GI) bleeding, which occurs in up to 7% per patient years with an estimated overall mortality rate of 9%.¹ Additionally, urgent surgery with increased bleeding complications in patients on oral anticoagulation appears to be common but has not been well studied.² In this activity, we review strategies to manage potentially life-threatening ICH and GI bleeding and minimize the risk of bleeding with urgent surgery in patients on oral anticoagulation.

Multiple Credits

$0.00 - $95.00