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

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 …