Goals of Care in Emergency Abdominal Surgery in the Elderly and Frail Patient

Elderly and frail patients are often those at highest risk during surgical procedures both in terms of intraoperative complications and postoperative outcome. It is clear that the best therapeutic result in the elderly and frail patient can be obtained through multidisciplinary management of the problem. In the management of elderly and frail patients undergoing to emergency surgery, we can make a series of considerations that guide our decision-making process. First, correct diagnosis can be difficult because of the impaired cognitive and physical status of the patient or other clinical conditions and medications that mask signs and symptoms. Second, the choice of the treatment to be carried out, surgical or nonoperative, must be tailored to the patient and often is different from what would be done in a young fitter patient. Third, even if age is not a contraindication to surgery, the outcomes change. In elderly patients, it would be more appropriate to evaluate the best treatment to ensure a good quality of life, rather than performing surgical procedures aimed at ensuring the best results in terms of long-term survival.