Geriatric Evaluation Before Abdominal Wall Reconstruction Provides Numerous Patient Benefits

Holland AM, Devane MC, Scarola GT, et al. Preoperative Geriatric Medicine Evaluation in a Multidisciplinary Abdominal Wall Reconstruction Clinic and Outcomes in Geriatric Patients. J Am Coll Surg. January 2026.

As surgeons increasingly perform complex abdominal wall reconstruction (AWR) in elderly patients with substantial comorbidity and frailty burden, accurate perioperative risk stratification and optimization are critical. Holland and colleagues evaluated whether formal preoperative geriatric medicine consultation within a multidisciplinary AWR clinic was associated with improved surgical outcomes in geriatric patients.

The authors analyzed geriatric patients undergoing elective AWR managed in a multidisciplinary clinic, comparing those who received structured preoperative geriatric medicine evaluation with those who did not. Geriatric consultation emphasized assessment of frailty, functional and cognitive status, nutritional risk, and polypharmacy, with implementation of targeted prehabilitation, medication adjustment, and medical optimization prior to surgery.

Patients evaluated by geriatric medicine were significantly more likely to undergo preoperative optimization interventions, including nutritional support, medication reconciliation, and functional conditioning. Despite additional preoperative evaluation, there was no delay in operative repair. Importantly, from a surgical outcomes perspective, geriatric consultation was associated with lower overall postoperative complication rates, fewer medical complications, and improved discharge disposition, with a higher likelihood of discharge to home rather than skilled nursing facilities. Length of stay and readmission rates were also favorably impacted in the geriatric-evaluated cohort.

The authors conclude that routine incorporation of geriatric medicine into multidisciplinary AWR clinics provides surgeons with actionable risk modification strategies that translate into improved perioperative outcomes without compromising operative access. These findings support the integration of geriatric assessment into surgical planning and shared decision-making for elderly patients undergoing complex abdominal wall reconstruction.