INTRODUCTION Recently there has been a significant increase in age in the United States. It is necessary to better understand the physiological and surgical needs of these patients in order to optimize outcomes. The vast majority of procedures performed in adult patients are low-risk operations, such as laparoscopic cholecystectomy. Our aim is to investigate the outcomes, including length of stay, morbidity, mortality, re-admission and discharge disposition of the elderly population (>80) undergoing low-risk operations in our tertiary community hospital. METHODS A retrospective chart review was done at a tertiary community hospital. The time frame utilized was 2011-2015. Patients were excluded only on the basis of their age (< 80) at the time of operation. RESULTS There were a total of 30 patients who underwent laparoscopic cholecystectomy from 2011 to 2015. 21 patients (70%) were female and 9 (30%) were male. No patients were converted to an open procedure. The average age was 86.4 years and average ASA classification prior to surgery was 2.88. Higher ASA class, specifically those that were class III/IV were more likely to have an increased length of stay that was statistically significant. Overall age greater than 80 was an independent risk factor for transfer to a higher level of care upon discharge (SNF, LTAC, etc.), a surrogate marker for physical decompensation following surgery. CONCLUSIONS Routine surgery, such as the laparoscopic cholecystectomy, effects the elderly population in a more substantial way, and early recognition coupled with increased education for physicians regarding geriatric patients can help to reduce length of stay, morbidity, and overall physical and mental deconditioning.

Delirium is the most common complication after major surgeries, with incidence rates ranging from 50% to 87%. Fortunately, postoperative delirium is preventable in up to 50% of patients, with the best preventive strategy being non-pharmacological interventions. However, these therapeutic approaches often face scalability challenges due to the complexity and high variability of their delivery, low patient engagement, and the existing clinical workforce constraints in the hospital setting. Cognitive stimulation is a non-pharmacological intervention with the potential to overcome the scalability and sustainability challenges of other non-pharmacological approaches, but evidence supporting its use is limited, especially in older adults at high risk for delirium. This narrative literature review examines evidence-based cognitive stimulation techniques being used as a non-pharmacological approach to prevent delirium in hospital settings.

Cancer patients undergoing major interventions face numerous challenges, including the adverse effects of cancer and the side effects of treatment. Cancer rehabilitation is vital in ensuring cancer patients have the support they need to maximise treatment outcomes and minimise treatment-related side effects and symptoms. The Active Together service is a multi-modal rehabilitation service designed to address critical support gaps for cancer patients. The service is located and provided in Sheffield, UK, an area with higher cancer incidence and mortality rates than the national average. The service aligns with local and regional cancer care objectives and aims to improve clinical and quality of life outcomes of cancer patients by using lifestyle behaviour change techniques to address their physical, nutritional, and psychological needs. This paper describes the design and initial implementation of the Active Together service, highlighting its potential to support and benefit cancer patients.

Crohn’s disease is a chronic inflammatory bowel disease and despite an increase in the available drug treatments, many patients still require surgery at some point in their disease course. Stricturing and penetrating phenotypes of Crohn’s disease are less likely to respond to our current medical treatment and therefore, surgical intervention may be required. This is most commonly elective, planned surgery, thereby affording the opportunity to optimise medications, nutritional and inflammatory status, steroid use. Poor nutritional status and previous surgery increase the risk of postoperative complications. Preoperative optimisation has three main goals: reduction of postoperative complications, reduction of reoperation rates and reduction of postoperative recurrence rates. In this narrative review, we examine the role of nutritional intervention, medical optimisation pre- and postoperatively and the role of personalised prehabilitation in the reduction of postoperative complications.