Perioperative Considerations for Orthopedic Surgery in a Geriatric Population.

BACKGROUND: With more than half of orthopedic surgeries performed on patients aged ≥ 65 years, optimizing perioperative care in this population is essential. Age-related physiologic changes, multimorbidity, and frailty significantly increase surgical risks, including infection, venous thromboembolism, impaired wound healing, delirium, and prolonged recovery. Effective perioperative management strategies are essential to reduce morbidity and improve functional outcomes. OBSERVATIONS: Using tools such as the Fracture Risk Assessment Tool and the Comprehensive Geriatric Assessment, frailty screening aids in identifying high-risk patients and guiding perioperative care. Preoperative strategies focus on controlling comorbidities, such as optimizing glycemic control for patients with diabetes to reduce the risk of postoperative complications. Assessing the mechanism of injury can provide valuable information about underlying conditions. Comprehensive nutritional evaluation is essential for geriatric patients undergoing orthopedic surgery, since malnutrition is common in this population and may impair recovery and increase morbidity. Postoperative management emphasizes early mobilization, delirium prevention, infection control, and anticoagulation management to reduce complications and improve recovery. CONCLUSIONS: Perioperative management of geriatric orthopedic patients requires a proactive, multidisciplinary approach that integrates preoperative risk assessment, intraoperative vigilance, and targeted postoperative care. Identifying and addressing frailty, optimizing nutrition, and implementing structured plans for screening and rehabilitation are essential to reduce complications and enhancing recovery.