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 individuals in control of content for this activity have no relevant relationships with ACCME-defined ineligible companies to disclose unless listed here. Any relevant relationships were mitigated prior to the start of this activity.

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 enduring material for a maximum of 2.00 AMA PRA Category 1 Credit(s)^TM. Physicians should claim only the 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

$0.00 - $599.00

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.

Multiple Credits

$0.00 - $399.00

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

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

Venous Thromboembolism Prophylaxis in Surgical Patients

Prophylaxis for deep vein thrombosis (DVT) and pulmonary embolism (PE), together referred to as venous thromboembolism (VTE), must be addressed for every patient going to the operating room. Multiple guidelines are available to assist choosing the correct prophylactic agent for each patient and type of surgery. The American College of Physicians (ACCP) guidelines have been one of the standards for hospitalist for decades but was last updated in 2012¹ and recommendations and suggestions are based on the type of surgery. The American Society of Hematology (ASH), which put forth their first guideline in this field in 2019², took a broader and slightly more universal approach to prevention strategies. The authors of this activity bring forth a blended approach of these two guidelines with an emphasis on the newer guideline.

Multiple Credits

$0.00 - $95.00

Perioperative Infections and Fever

Perioperative fever has multiple possible etiologies, including infections such as pneumonia, fungal infections, central-line associated infections, and urinary infections. By understanding the typical time frame and common risk factors for each etiology, hospitalists and other perioperative consultants can develop a differential diagnosis for perioperative fever. The following activity will provide a general approach for determining the differential diagnosis in patients with a perioperative fever, as well as an outline of the diagnostic and treatment modalities.

Multiple Credits

$0.00 - $95.00

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.

Multiple Credits

$0.00 - $95.00

Perioperative Management of Anticoagulant Therapy

Anticoagulant medications are commonly prescribed to patients in the United States for a number of medical problems. Interruptions in anticoagulation can result in severe adverse outcomes, including permanent disability and death, from arterial and venous thromboembolism. These medications can also be associated with serious perioperative bleeding events. In fact, both bleeding and thromboembolic risks are amplified in the periprocedural period. Many patients undergo routine and emergent procedures, thus it is critical for hospitalists, who are routinely asked to manage medically complex surgical patients, to understand the periprocedural management of anticoagulation. There are many nuances to consider: not all patients are at the same risk of thromboembolism, not all procedures are associated with the same risk of bleeding, and the indications for “reversal agents” are complex. This activity will guide the participant on the perioperative timing of anticoagulant interruption, the potential need for perioperative bridging anticoagulation, and address these nuances to better equip hospitalists for managing perioperative reversal.

Multiple Credits

$0.00 - $95.00