What is perioperative medicine — and why it matters for older adults
Most people have heard of surgeons and anaesthetists. Far fewer have heard of perioperative medicine — yet for older patients, it's often the specialty that determines how safely they get through surgery and how well they recover from it.
The gap perioperative medicine fills
A surgeon's expertise is the operation itself. An anaesthetist's expertise is keeping the patient safe and comfortable during it. Perioperative medicine sits around both of these — managing everything else that affects how a patient copes with surgery: their chronic conditions, their medications, their cognitive state, their physical reserve, and their recovery afterwards.
For a fit 40-year-old, this gap rarely matters. For a frail 85-year-old with heart disease, diabetes, and five regular medications, it can be the difference between a smooth recovery and a serious complication.
Why age changes the equation
Older adults tolerate the physiological stress of surgery differently to younger patients. Reduced organ reserve, multiple chronic conditions, polypharmacy, and a higher baseline risk of delirium all mean that the same operation carries more risk — and that risk is heavily influenced by factors that can be identified and managed in advance, rather than simply accepted.
This is the core idea behind perioperative medicine: rather than treating fitness for surgery as fixed, it treats much of it as modifiable.
What a perioperative physician actually does
- Assesses overall fitness for the specific procedure planned, not just general health
- Reviews and adjusts medications in the lead-up to surgery
- Identifies and addresses risk factors for delirium, falls, and functional decline
- Works alongside the surgical and anaesthetic teams, rather than in isolation
- Plans for recovery and rehabilitation before the operation, not after
A specialty built for an ageing population
Perioperative medicine has grown as a distinct field largely because of demographic change — more people are living longer with more complex health needs, and more of them are having surgery later in life. A geriatrician with specific perioperative training brings both halves of this together: expertise in the medical complexity of older age, combined with formal training in managing that complexity around the demands of surgery.
What this means for patients and families
If you or a family member are being considered for surgery later in life, a perioperative assessment is not a sign that something is wrong — it's a structured way of making sure surgery goes ahead as safely as possible, with risks identified and managed in advance rather than discovered along the way.
To understand which patients typically benefit from this kind of assessment, see When to refer an older patient for perioperative assessment, or read more about what's involved in optimising a frail older patient before surgery.