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Background Surgeons, other healthcare professionals, and patients may identify different health-related concerns related to the quality of life of patients undergoing major surgery. Methods Semistructured interviews were conducted with surgeons (n =14), other healthcare professionals (n =19), and patients undergoing major elective surgery (n = 52). Themes were extracted by content analysis and organized into major domains. The frequencies with which specific themes were mentioned were compared among groups. Results A total of 85 themes were extracted from the interviews, 15 of which were mentioned by 50% or more of participants in each group, representing 5 of the 6 domains. The greatest differences were observed in the domains of social well-being, wherein 5 themes were mentioned less often by surgeons than other groups, and spiritual well-being, wherein 2 themes were mentioned more often by patients than other groups. Differences in the physical, emotional, cognitive preparation, and concern about quality of care domains were minimal. Conclusions Surgeons, other healthcare professionals, and patients identified many similar concerns related to the well-being of patients undergoing major surgery. However, the importance of social and spiritual themes to patients may be underestimated by surgeons.

Elderly individuals will continue to make up a major portion of patients requiring critical care. Age and chronic disease-related factors blunt the reserves with which the elderly can meet the demands of critical surgical illness. The clinician must remain vigilant to subtle changes in the patient's course which may indicate a developing complication and must pay attention to all the details of comprehensive critical care management. With careful attention and timely physiologic support, the elderly patient has as good a chance of surviving as a similarly ill younger patient, although his or her course may be more prolonged. The priorities are the same. Thus, the primary disease must be addressed: necrotic tissue débrided, pus drained, wounds closed, fractures set. Cardiopulmonary performance (oxygen delivery) must be maintained sufficiently to meet the heightened oxygen needs associated with critical illness. This may require invasive hemodynamic monitoring and pharmacologic support. Gas exchange in the lungs must be maintained without compromising cardiovascular function or exhausting the patient. Patients should be kept warm, pain free, and calm. Intravascular volume and the composition of the extracellular fluid must be maintained. Nutritional support should be provided early in amounts sufficient to meet the patient's basal nutritional requirements and increased needs associated with the critical illness. If at all possible, some or all of this nutritional support should be provided via the gastrointestinal tract. The use of specialized nutrients or of agents designed to minimize the catabolism of critical illness or to enhance anabolism is an area of active investigation. The indications for these therapeutic strategies in the elderly should become clearer in the years ahead.