Strategies for optimizing outcomes in the surgical treatment of elderly patients with small and large bowel diseases

INTRODUCTION: In recent decades, the global geriatric population has been increasing. Surgical treatment for elderly patients with small and large bowel diseases is associated with an increased risk of perioperative morbidity and functional decline, necessitating the implementation of targeted optimization strategies. Frailty is the strongest predictor of these poor outcomes, requiring a shift in the approach to these patients.OBJECTIVE: To create a comprehensive overview of best practices, this review utilizes publications from the PubMed database, as well as expert consensus documents and clinical guidelines from leading international surgical and geriatric organizations.METHODS: The review focuses on the three main pillars of optimization: Comprehensive Geriatric Assessment (CGA), multimodal prehabilitation, and the implementation of modified ERAS (Enhanced Recovery After Surgery) protocols.RESULTS: Comprehensive Geriatric Assessment, especially frailty screening, is a fundamental tool for risk stratification and identifying high-risk groups requiring preoperative optimization. Prehabilitation has been proven to increase physiological reserve and functional capacity, allowing the body to withstand the stress of surgery. The integration of modified ERAS protocols, adequate anesthetic care, and the introduction of minimally invasive surgical techniques leads to reduced perioperative morbidity and mortality, shorter hospital stays, faster recovery, and preservation of quality of life following surgical intervention.CONCLUSION: The application of this integrated, multidisciplinary approach is key to achieving optimal surgical outcomes and maintaining functional independence in elderly patients. Despite a strong evidence base supporting optimization strategies, literature and experts consistently emphasize the need for further research focused on the specific needs of geriatric patients.