Perioperative medicine

When to refer an older patient for perioperative assessment

Dr Sheila Rahman, Compass Geriatrics

Age alone is not a referral trigger. Plenty of healthy, independent 80-year-olds sail through elective surgery without specialist input. The patients who benefit from perioperative assessment are the ones where age, frailty, comorbidity, or the surgery itself combine to raise real risk — and the challenge for GPs and surgeons is recognising that combination early enough for it to matter.

Here is a practical set of triggers, followed by what assessment actually changes.

Refer when any of these are present

Frailty, not just age. A patient who has slowed down, lost weight unintentionally, become more dependent on others, or had a fall in the past year is a stronger signal than chronological age on its own.
Multiple comorbidities on multiple medications. Five or more regular medications, or overlapping chronic conditions (cardiac, renal, diabetic, cognitive), increases the chance that something will be missed in a routine pre-admission clinic.
Cognitive impairment or a history of delirium. Patients with known dementia, mild cognitive impairment, or a previous episode of post-operative delirium are at significantly higher risk of delirium recurring — and this is one of the most preventable complications when anticipated in advance.
Reduced functional reserve. Difficulty with stairs, reduced mobility, or recent hospital admissions for any reason suggest the physiological reserve to tolerate surgical stress may be limited.
Major or emergency surgery in an older patient. Hip fracture, bowel resection, and other higher-risk procedures in patients over 70–75 generally warrant assessment regardless of how well they otherwise present.
Uncertainty about fitness for surgery. If a GP or surgeon is unsure whether a patient will tolerate a planned procedure, that uncertainty is itself a reason to refer — it is far easier to optimise a patient over several weeks than to manage a complication after the fact.

What perioperative assessment actually involves

This is not a single pre-admission tick-box clinic visit. A geriatrician-led perioperative assessment typically covers:

A comprehensive review of comorbidities and how they interact with the planned procedure and anaesthetic
Medication review, including deprescribing where appropriate before surgery
Cognitive screening, to establish a baseline and flag delirium risk
Functional and frailty assessment, to guide realistic expectations around recovery
A coordinated plan shared with the surgical and anaesthetic teams, rather than a standalone report

Why earlier referral matters

The value of perioperative assessment drops sharply the closer it happens to the date of surgery. Medication changes, optimisation of chronic conditions, and realistic conversations with patients and families all take time. Referral at the point a procedure is being considered — not the week before admission — gives the most room to actually change the outcome, rather than simply documenting risk.

How to refer

Referrals are accepted from GPs and surgeons via HealthLink (ID: compassg) or by email, with urgent perioperative referrals triaged directly through reception. Full details and downloadable referral forms are available on the How to Refer page.

If you're uncertain whether a particular patient meets the threshold for referral, that uncertainty is usually answer enough — a short conversation is often all it takes to clarify whether formal assessment is warranted.