# A comprehensive operative risk assessment driving the application of major and emergency surgery in octogenarians

## TL;DR

This paper presents a case showing that assessing octogenarians' overall health, not just age, leads to better surgical decisions.

## Contribution

The paper introduces a comprehensive function-based assessment approach for surgical decision-making in elderly patients.

## Key findings

- A multidimensional assessment improved therapeutic strategy for an 83-year-old with esophageal cancer.
- Prehabilitation and tailored surgery led to successful outcomes despite the patient's frailty.
- Systematic evaluation helps identify functional optimization areas in fragile elderly patients.

## Abstract

Medical decisions driving the clinical management of octogenarians who require either major or urgent surgery still depend on the patient's age rather than individual functions. This report created the privileged opportunity to illustrate the clinical effectiveness of a comprehensive function‐based assessment. This was the case of an 83‐year‐old gentleman presenting with severe malnutrition and debility due to esophageal cancer. Multidimensional assessments were systematically performed to design the best‐tailored therapeutic strategy, including prehabilitation, elective esophagectomy, and emergency laparotomy with ileocolic resection for postoperative hemorrhagic shock due to an occult colonic tumor. This clinical case highlights the need for a systematic and comprehensive assessment of fragile octogenarians, allowing accurate patient evaluation, identification of areas of functional optimization, and establishment of the most appropriate therapeutic decisions.