Management of older adult emergency general surgery patients in the intensive care unit: What you need to know.

Abstract

Older adults undergoing emergency general surgery represent a rapidly growing and clinically vulnerable population frequently requiring perioperative management in the surgical intensive care unit. Age-associated physiologic decline, multimorbidity, frailty, and reduced cognitive and functional reserve contribute to the increased susceptibility to surgical and nonsurgical complications, prolonged surgical intensive care unit length of stay, cognitive and functional decline, and mortality of the critically ill older adult. Despite the high acuity and complexity of this population, geriatric-specific guidelines for surgical intensive care management remain limited. This review provides a comprehensive, evidence-informed framework for the critical care management of older adults undergoing emergency surgery, emphasizing the clinical implications of aging physiology on organ failure within current surgical intensive care practice. By integrating principles of prognostication, organ system support, interdisciplinary collaboration, ethical decision making, and goal-concordant care, this review highlights opportunities to improve outcomes and align treatment strategies with the needs and values of this high-risk population.