The Frail Surgical Patient : A Geriatric Approach Beyond Age

This book explores the transdisciplinary approach to general surgery for the frail patient, promoting the use of a geriatric model of care in general surgical settings and thus proposing a “gerosurgery” approach in frail persons beyond chronological age.

Aging, frailty, and surgical needs are increasing dramatically worldwide while surgeons are daily facing with the trouble of the trade-off between short-term outcomes and efficacy of surgery in older persons. However, recent studies have clearly shown that age itself is not a prognostic risk factor for complications after elective surgery in older patients, whereas cognitive or functional frailty is. Neither a referring physician nor an assessing surgeon should deny patients surgery purely based on chronological age. Instead, decisions should be based on a CGA (comprehensive geriatric assessment) with a precise picture of the patient considering the cognitive, functional, nutritional, socioeconomic, and affective status. Recent studies examining the use of preparative CGA in surgical patients showed encouraging results on postoperative outcomes in old and/or frail patients. The most compelling current evidence comes from the orthopaedic community, which has embraced the idea of multidisciplinary team care. Preoperative evaluation, postoperative care, pain control, nutritional support, delirium prevention, mobilization, and rehabilitation are necessary also in general surgery. An expert multidisciplinary team, including geriatricians, anaesthesiologists, specialist nurses, physiotherapists, and nutritionists should mandatorily support surgeons.

With this book, the reader will have an exhaustive overview and will gain essential, practical knowledge on how best to manage the surgical and frail patient and how to develop clinical systems that do so reliably.

Virginia Boccardi earned her MD in 2007 and completed her residency in Geriatrics in 2012, followed by a PhD in Metabolism and Aging in 2015, all at the University of Campania Luigi Vanvitelli, Italy. She is currently a Professor of Geriatric Medicine at the University of Perugia. Throughout her career, she spent nearly two years as a research fellow at the University of Medicine and Dentistry of New Jersey (USA), where she focused on cellular senescence and telomere biology. Her research spans multiple projects investigating the molecular and metabolic aspects of aging, with a particular focus on frailty, cognitive impairment, diabetes and the development of intervention strategies. Dr. Boccardi has published over 150 peer-reviewed articles in esteemed journals and contributed to several books and book chapters. She has been serving as an editorial board member of several internationally recognized Medical Journals.

Luigi Marano, MD, PhD, is a Professor of Surgery at the Academy of Applied Medical and Social Sciences (AMiSNS) in Elblag, Poland, and a Visiting Professor at Dnipro State Medical University, Ukraine. He earned his MD in 2007, completed his residency in General Surgery in 2014, and obtained a PhD in Biotechnologies Applied to Medical and Surgical Sciences in 2016 from the University of Campania "Luigi Vanvitelli," Italy. From 2019 to 2022, he served as an Assistant Professor of Surgery at the University of Siena, before advancing to Associate Professor from 2022 to 2024. Prof. Marano has held leadership roles, including serving as the National Coordinator for the Young Section of the Italian Society of Surgical Oncology and as a Steering Committee Member of the European Young Surgeons and Alumni Club (EYSAC). He is currently a member of the Education and Training Committee (Upper GI) of the European Society of Surgical Oncology (ESSO) and contributes to the committees of the European Federation of the International Society for Digestive Surgery (EFISDS) and The RObotic Global Surgical Society (TROGSS). Prof. Marano's research focuses on robotic and minimally invasive surgical techniques, preoperative management, prehabilitation, and a multidisciplinary approach to gastrointestinal cancer. He aims to enhance surgical outcomes through individualized perioperative strategies. He has authored nearly 150 peer-reviewed articles and contributed to numerous books and chapters. Additionally, Prof. Marano serves on the editorial boards of several prominent medical journals, underscoring his contributions to surgical science and education.