An electronic health record is optimal for the location of testing results, as it is accessible by all throughout the patient’s perioperative course. If the database is constructed with discrete fields, it may be queried subsequently for research or quality improvement purposes. A paper form which follows the patient is also possible, as is a simple addendum to the dictated history and physical examination.

Allowing access to the geriatric preoperative assessment allows not only the surgical management team but also physical therapy, occupational therapy, nursing and social workers to understand more clearly the patient’s baseline. Physical and occupational therapy are able to better gauge a patient’s preoperative activity status as physician admission notes often do not contain important information regarding details covered in a geriatric preoperative assessment. Social workers can often anticipate in advance what additional services may need to be obtained for the patient prior to discharge.

Recognizing that this comprehensive evaluation would require significant time and resources, the authors nevertheless believe that those burdens would be offset by the benefits of identifying high-risk individuals, improving communication between surgeon and patient, and potentially preventing adverse events.

The Sinai Center for Geriatric Surgery is a new initiative. Currently data about its impact and improvement of surgical outcomes is accumulating, is being entered into national databases, and ultimately will be submitted for publication. However, early impressions about the benefit of this program can be shared. Selected observations follow:

The older preoperative patient benefits from an assessment that includes more than a routine physical examination and electrocardiogram . Such an assessment includes domains likely to affect the elderly: cognition, functionality, frailty, polypharmacy, nutrition, and social support. This fosters decisions based on functional age rather than chronologic age and on each patient as a unique individual.

One such assessment is that promulgated by the ACS NSQIP/AGS Best Practices Guideline. If this comprehensive evaluation is considered impractical for an institution or surgeon’s office, a limited dataset of tests will still be valuable. Any opportunity to improve results in the growing population of older surgical patients should not be missed.