A narrative review of video-assisted thoracic surgery for geriatric patients: optimizing organ function and perioperative recovery

Background and Objective: With rising numbers of elderly individuals undergoing video-assisted thoracic surgery (VATS)-and given the physiologic changes of aging that make major surgery more perilous for geriatric populations-it is more important than ever to implement best practices that may improve perioperative outcomes. A thoracoscopic approach offers well-characterized advantages in elderly patients, but uniform recommendations around the optimal care of elderly surgical candidates for VATS have not been defined. This review aims to identify and summarize evidence-based recommendations that may be employed to improve the perioperative recovery of geriatric patients undergoing VATS. Methods: A narrative review of the literature was conducted using combinatorial terms including "VATS" or "thoracoscopy", "elderly" or "aging" or "geriatric", "thoracic surgery", "outcomes", "pulmonary complications" or "respiratory complications", "neurologic complications", and "brain health". A reverse lookup of relevant citing articles was performed to broaden the search parameters. Included studies were published after 1995 and were available in English. Key Content and Findings: A growing number of studies exist to indicate that neurocognitive and pulmonary complications are of particular concern in elderly patients undergoing thoracic procedures. While VATS reduces the incidence of specific complications compared to open thoracotomy, a variety of preoperative, intraoperative, and postoperative measures may confer additional benefit with respect to organ function and overall recovery following surgery. We summarize these measures here. Conclusions: Despite heterogeneity in the strength of the evidence, a working set of best practices can be identified in the perioperative management of geriatric patients undergoing VATS, particularly with respect to optimizing perioperative neurocognitive function and reducing pulmonary complications. However, there is an ongoing need for clinical investigation and multidisciplinary collaboration to improve the care of elderly patients requiring thoracoscopic procedures.