Head To Head

Should physicians routinely be involved in the care of elderly surgical patients? Yes

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1070 (Published 04 March 2011) Cite this as: BMJ 2011;342:d1070
  1. Kathy Wilkinson, consultant anaesthetist1,
  2. Helen Wilson, consultant in geriatric medicine2
  1. 1Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich NR4 7UY, UK
  2. 2Royal Surrey County Hospital, Guildford, UK
  1. kathy.wilkinson{at}nnuh.nhs.uk

Standards of care for elderly people in hospital have come under the spotlight. Kathy Wilkinson and Helen Wilson believe that geriatricians can help improve the management of surgical patients, but Barbara Herd (doi:10.1136/bmj.d1072) is concerned that the dilution of resources will harm those who most need specialist attention

Older people are the greatest users of acute hospital services in the UK, accounting for 45% of total NHS expenditure. Many present acutely to surgical teams, and some require major operations. In a large, recent, multicentre study of surgical patients aged over 70 from Australia and New Zealand,1 a fifth had at least one complication and 1 in 20 died. The recent National Confidential Enquiry into Perioperative Deaths (NCEPOD) report, An Age Old Problem, reviewed cases of patients aged over 80 who died within 30 days of surgery.2 In only 37.5% (295/756) was care described as “good” by a peer group of seniors who assessed the cases (“good” being the standard they would accept for themselves or their trainees). Surgeons acknowledge that this population poses a particular challenge when they require surgery …

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