Photo Credit: iStock.com/Prostock-Studio

Seven actions can help primary care clinicians optimize their older surgical patients’ perioperative care, according to researchers at the University of Utah.

Seven actions can help primary care clinicians optimize their older surgical patients’ perioperative care, researchers at the University of Utah reported in JAMA Network Open.

“This comprehensive approach—the first-ever framework primary care clinicians can use when considering sending older patients for a surgical consultation—can dramatically enhance the care of older adults before, during, and after surgery,” says lead author Molly E. Leonard, MD.

Dr. Leonard and colleagues conducted a qualitative study using semi-structured, one-on-one, online interviews with a sample of geriatricians from across the United States in 2022. The researchers used directed content analysis to examine how primary care clinicians can optimally support older patients throughout the perioperative process.

Of the 24 geriatricians interviewed, 16 (67%) were women, the median time in practice was 12.4 years, and 11 (46%) worked at an academic or tertiary referral center.

“Beyond just preoperative clearance, our study identified seven key ways that primary care providers can support these patients through the entire surgical process. This includes conducting a thorough risk-benefit analysis of surgery, engaging in clear and open communication about the patient’s goals, preparing both the patient and their family for the surgical consultation, setting realistic expectations, assisting in decision-making, advocating for the patient, and coordinating postoperative care,” Dr. Leonard explains.

Dr. Leonard and senior author Jessica N. Cohan, MD, talked with Physician’s Weekly (PW) about their research and how their framework can improve care for older adults.

PW: What was surprising about your results?

Dr. Cohan: While I anticipated identifying valuable strategies to support older adults perioperatively, I was surprised by the sheer number of actionable steps that geriatricians are already taking to assist their older surgical patients.

Most existing guidelines focus on the basics, like preoperative clearance and advance care planning. Our study uncovered a much broader spectrum of support that primary care clinicians can provide—support that goes beyond the basics and truly addresses the nuanced needs of older adults, including communication, advocacy, and decision-making assistance.

Why is it important for primary care clinicians to have access to a care framework like this?

Dr. Cohan: Primary care clinicians are often the first point of contact for older adults who need surgery, but most do not have formal training in geriatrics. As the population ages, more older adults with frailty and multiple comorbidities are being considered for major surgery.

Our study fills a significant gap in guidance for primary care clinicians, offering them a practical framework to navigate surgical care. This framework ensures that older adults receive the kind of nuanced, patient-centered care they deserve, particularly when surgical decisions are involved. 

How do you anticipate your findings will affect the perioperative care of older adults?

Dr. Cohan: We hope these findings will be widely disseminated, not only to practicing primary care clinicians but also to those in training. By equipping primary care clinicians with a clearer understanding of how they can play an active role throughout the surgical continuum, we anticipate improvements in the quality of perioperative care for older and frail adults. This could lead to better surgical outcomes, more informed decision-making, and a better QOL [quality of life] for patients.

Are any strengths or limitations of the study especially noteworthy?

Dr. Leonard: One limitation often associated with qualitative research is the smaller sample size. However, our study was intentionally designed to address this limitation by ensuring that we conducted enough interviews to reach thematic saturation—meaning we kept interviewing until we stopped hearing new ideas.

We also made a deliberate effort to recruit geriatricians from diverse geographic regions and practice types, ensuring our findings reflect a wide range of perspectives. This diversity strengthens the applicability of our framework across different practice environments.

What questions remain unanswered for you? What further related research are you planning?

Dr. Cohan: We are interviewing geriatricians to explore how similar frameworks could be developed to improve surgeons’ perioperative care. This work provides a foundation for disseminating geriatric care principles to ensure that older adults receive consistent, comprehensive, and high-quality care across clinical settings.

We are also interested in improving healthcare delivery for older adults more broadly. The University of Utah is engaged in several initiatives to enhance care for the aging population, including our active engagement in the Institute for Healthcare Improvement’s Age-Friendly System-Wide Spread Collaborative. Our participation in this collaborative has been valuable as we develop strategies to integrate optimal geriatric care into the broader healthcare context, moving toward a sustainable system that can adapt to the evolving needs of the aging population.

What else should clinicians keep in mind when considering surgical options for their older patients?

Dr. Cohan: We encourage clinicians to remember that the preoperative process for older adults is not just about assessing the risks of surgery but about preparing the patient and their family for the journey ahead. By embracing a more holistic approach that includes clear communication, realistic expectation setting, and robust support throughout the surgical process, we can truly make a difference in the outcomes for these patients.

We hope to see primary care clinicians continue to expand their role in the perioperative space and incorporate these strategies into their routine care for older adults.