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Chapter 40 - Surgery in the elderly

from Section 12 - Surgery in the Elderly

Published online by Cambridge University Press:  05 September 2013

By
Yelena Melyakova  and
Michael F. Lubin
Edited by
Michael F. Lubin ,
Thomas F. Dodson  and
Neil H. Winawer
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Neil H. Winawer
Affiliation:
Emory University, Atlanta
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Summary

Introduction

Surgical and anesthetic care have improved markedly in the last half century. It is likely that the greatest benefit of this improvement has been for the elderly population. Older patients can benefit from surgery that would not have been contemplated in the past; thus, patients are living longer and with a better quality of life than ever before.

The literature in surgical care of the elderly patient is extensive and growing rapidly, and indicates that with careful planning and care, the elderly can undergo surgery safely and with approximately the same risk as many younger patients. This section discusses the following topics as they pertain to the elderly population: (a) physiologic decrements of aging; (b) risks of surgery; (c) preoperative evaluation; (d) anesthesia; (e) common surgical procedures; and (f) postoperative care.

Physiologic decrements of aging

Although physicians see many elderly patients who appear old and sick with many underlying health problems, a large percentage of the elderly population is quite well. These people can function entirely normally and have no limitations to their activities. Despite this degree of functional normality, however, all older people experience various decrements in physiologic function that are of importance in planning their care, particularly when they are under stresses such as surgery [1]. These decrements make even healthy older patients more fragile and more likely to suffer postoperative complications and death than their younger counterparts [2–4]. Physicians must take these factors into account in their evaluations.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
 , pp. 425 - 440
Publisher: Cambridge University Press
Print publication year: 2013

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References

Boss, GR, Seegmiller, JE.Age-related physiological changes and their clinical significance. West J Med 1981; 135: 434–40.Google ScholarPubMed
Brown, NA, Zenilman, ME.The impact of frailty in the elderly on the outcome of surgery in the aged. Adv Surg 2010; 44: 229–49.CrossRefGoogle ScholarPubMed
Polanczyk, CA, Marcantonio, E, Goldman, L et al. Impact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery. Ann Intern Med 2001; 134: 637–43.CrossRefGoogle ScholarPubMed
Abrass, IB.The biology and physiology of aging. West J Med 1990; 153: 641–5.Google ScholarPubMed
Safar, ME.Arterial aging – hemodynamic changes and therapeutic options. Nat Rev Cardiol 2010; 7: 442–9.CrossRefGoogle ScholarPubMed
Wang, L, Green, FH, Smiley-Jewell, SM, Pinkerton, KE.Susceptibility of the aging lung to environmental injury. Semin Respir Crit Care Med 2010; 31: 539–53.CrossRefGoogle ScholarPubMed
Sorbini, CA, Grassi, V, Solinas, E, Muiesan, G.Arterial oxygen tension in relation to age in healthy subjects. Respiration 1968; 25: 3–13.CrossRefGoogle ScholarPubMed
Muiesan, G, Sorbini, CA, Grassi, V.Respiratory function in the aged. Bull Physiopathol Respir (Nancy) 1971; 7: 973–1009.Google ScholarPubMed
Sharma, G, Goodwin, J.Effect of aging on respiratory system physiology and immunology. Clin Interv Aging 2006; 1: 253–60.CrossRefGoogle ScholarPubMed
Klotz, U.Pharmacokinetics and drug metabolism in the elderly. Drug Metab Rev 2009; 41: 67–76.CrossRefGoogle ScholarPubMed
El Nahas, M.Cardio-kidney-damage: a unifying concept. Kidney Int 2010; 78: 14–18.CrossRefGoogle ScholarPubMed
Abdelhafiz, AH, Brown, SH, Bello, A, El Nahas, M.Chronic kidney disease in older people: physiology, pathology or both?Nephron Clin Pract 2010; 116: c19–24.CrossRefGoogle ScholarPubMed
Cockcroft, DW, Gault, MH.Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16: 31–41.CrossRefGoogle ScholarPubMed
Syed, FA, Ng, AC.The pathophysiology of the aging skeleton. Curr Osteoporos Rep 2010; 8: 235–40.CrossRefGoogle ScholarPubMed
Creditor, MC.Hazards of hospitalization of the elderly. Ann Intern Med 1993; 118: 219–23.CrossRefGoogle ScholarPubMed
Gill, TM, Allore, HG, Gahbauer, EA, Murphy, TE.Change in disability after hospitalization or restricted activity in older persons. J Am Med Assoc 2010; 304: 1919–28.CrossRefGoogle ScholarPubMed
Cusack, BJ.Pharmacokinetics in older persons. Am J Geriatr Pharmacother 2004; 2: 274–302.CrossRefGoogle ScholarPubMed
Ochsner, A.Is risk of indicated operation too great in the elderly?Geriatrics 1967; 22: 121–30.Google ScholarPubMed
Gilbert, T, Orr, W, Banning, AP.Surgery for aortic stenosis in severely symptomatic patients older than 80 years: experience in a single UK centre. Heart 1999; 82: 138–42.CrossRefGoogle Scholar
Rosengart, TK, Finnin, EB, Kim, DY et al. Open heart surgery in the elderly: results from a consecutive series of 100 patients aged 85 years or older. Am J Med 2002; 112: 143–7.CrossRefGoogle ScholarPubMed
Alexander, KP, Anstrom, KJ, Muhlbaier, LH et al. Outcomes of cardiac surgery in patients > or = 80 years: results from the National Cardiovascular Network. J Am Coll Cardiol 2000; 35: 731–8.CrossRefGoogle ScholarPubMed
Pofahl, WE, Pories, WJ.Current status and future directions of geriatric general surgery. J Am Geriatr Soc 2003; 51 (7 Suppl): S351–4.CrossRefGoogle ScholarPubMed
Liu, LL, Leung, JM.Predicting adverse postoperative outcomes in patients aged 80 years or older. J Am Geriatr Soc 2000; 48: 405–12.CrossRefGoogle ScholarPubMed
Keating, HJ. Major surgery in nursing home patients: procedures, morbidity, and mortality in the frailest of the frail elderly. J Am Geriatr Soc 1992; 40: 8–11.CrossRefGoogle ScholarPubMed
Katlic, MR.Surgery in centenarians. J Am Med Assoc 1985; 253: 3139–41.CrossRefGoogle ScholarPubMed
Bridges, CR, Edwards, FH, Peterson, ED, Coombs, LP, Ferguson, TB.Cardiac surgery in nonagenarians and centenarians. J Am Coll Surg 2003; 197: 347–56; discussion 356–7.CrossRefGoogle ScholarPubMed
Linn, BS, Linn, MW, Wallen, N.Evaluation of results of surgical procedures in the elderly. Ann Surg 1982; 195: 90–6.CrossRefGoogle ScholarPubMed
Goldman, L, Caldera, DL, Nussbaum, SR et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med 1977; 297: 845–50.CrossRefGoogle ScholarPubMed
Sikes, ED, Detmer, DE.Aging and surgical risk in older citizens of Wisconsin. Wis Med J 1979; 78: 27–30.Google ScholarPubMed
Turnbull, AD, Gundy, E, Howland, WS, Beattie, EJ. Surgical mortality among the elderly. An analysis of 4,050 operations (1970–1974). Clin Bull 1978; 8: 139–42.Google Scholar
Turrentine, FE, Wang, H, Simpson, VB, Jones, RS.Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg 2006; 203: 865–77.CrossRefGoogle ScholarPubMed
Seymour, DG, Pringle, R.A new method of auditing surgical mortality rates: application to a group of elderly general surgical patients. Br Med J (Clin Res Ed) 1982; 284: 1539–42.CrossRefGoogle ScholarPubMed
Sheridan, BC, Stearns, SC, Rossi, JS et al. Three-year outcomes of multivessel revascularization in very elderly acute coronary syndrome patients. Ann Thorac Surg 2010; 89: 1889–94; discussion 1894–5.CrossRefGoogle ScholarPubMed
Alonso-Perez, M, Segura, R, Pita, S, Cal, L.Operative results and death predictors for nonruptured abdominal aortic aneurysms in the elderly. Ann Vasc Surg 2001; 15: 306–11.CrossRefGoogle ScholarPubMed
Conti, B, Brega Massone, PP, Lequaglie, C, Magnani, B, Cataldo, I.Major surgery in lung cancer in elderly patients? Risk factors analysis and long-term results. Minerva Chir 2002; 57: 317–21.Google ScholarPubMed
Port, JL, Kent, M, Korst, RJ et al. Surgical resection for lung cancer in the octogenarian. Chest 2004; 126: 733–8.CrossRefGoogle ScholarPubMed
Reiss, R, Deutsch, AA, Nudelman, I.Abdominal surgery in elderly patients: statistical analysis of clinical factors prognostic of mortality in 1,000 cases. Mt Sinai J Med 1987; 54: 135–40.Google ScholarPubMed
Beaupre, LA, Jones, CA, Saunders, LD et al. Best practices for elderly hip fracture patients. A systematic overview of the evidence. J Gen Intern Med 2005; 20: 1019–25.CrossRefGoogle Scholar
Susini, T, Scambia, G, Margariti, PA et al. Gynecologic oncologic surgery in the elderly: a retrospective analysis of 213 patients. Gynecol Oncol 1999; 75: 437–43.CrossRefGoogle ScholarPubMed
Dunlop, WE, Rosenblood, L, Lawrason, L, Birdsall, L, Rusnak, CH.Effects of age and severity of illness on outcome and length of stay in geriatric surgical patients. Am J Surg 1993; 165: 577–80.CrossRefGoogle ScholarPubMed
Andersen, B, Ostberg, J.Long-term prognosis in geriatric surgery: 2–17 year follow-up of 7922 patients. J Am Geriatr Soc 1972; 20: 255–8.CrossRefGoogle ScholarPubMed
Hosking, MP, Warner, MA, Lobdell, CM, Offord, KP, Melton, LJ. Outcomes of surgery in patients 90 years of age and older. J Am Med Assoc 1989; 261: 1909–15.CrossRefGoogle ScholarPubMed
Salem, R, Devitt, P, Johnson, J, Firmin, R.Emergency geriatric surgical admissions. Br Med J 1978; 2: 416–17.CrossRefGoogle ScholarPubMed
Seymour, DG, Pringle, R.Surgical emergencies in the elderly: can they be prevented?Health Bull (Edinb) 1983; 41: 112–31.Google ScholarPubMed
Keller, SM, Markovitz, LJ, Wilder, JR, Aufses, AH. Emergency and elective surgery in patients over age 70. Am Surg 1987; 53: 636–40.Google ScholarPubMed
Schoon, IM, Arvidsson, S. Surgery in patients aged 80 years and over. A retrospective comparative study from 1981 and 1987. Eur J Surg 1991; 157: 251–5.Google Scholar
Akinbami, F, Askari, R, Steinberg, J, Panizales, M, Rogers, SO. Factors affecting morbidity in emergency general surgery. Am J Surg 2011; 201: 456–62.CrossRefGoogle ScholarPubMed
Reiss, R.Moral and ethical issues in geriatric surgery. J Med Ethics 1980; 6: 71–7.CrossRefGoogle ScholarPubMed
Palmberg, S, Hirsjarvi, E.Mortality in geriatric surgery. With special reference to the type of surgery, anaesthesia, complicating dieeases, and prophylaxis of thrombosis. Gerontology 1979; 25: 103–12.CrossRefGoogle ScholarPubMed
Wilder, RJ, Fishbein, RH.The widening surgical frontier. Postgrad Med 1961; 29: 548–51.Google ScholarPubMed
Samiy, AH.Clinical manifestations of disease in the elderly. Med Clin North Am 1983; 67: 333–44.CrossRefGoogle ScholarPubMed
Adesanya, AO, Lee, W, Greilich, NB, Joshi, GP.Perioperative management of obstructive sleep apnea. Chest 2010; 138: 1489–98.CrossRefGoogle ScholarPubMed
Heijmeriks, JA, Dassen, W, Prenger, K, Wellens, HJ.The incidence and consequences of mental disturbances in elderly patients post cardiac surgery – a comparison with younger patients. Clin Cardiol 2000; 23: 540–6.CrossRefGoogle ScholarPubMed
Jankowski, CJ, Trenerry, MR, Cook, DJ et al. Cognitive and functional predictors and sequelae of postoperative delirium in elderly patients undergoing elective joint arthroplasty. Anesth Analg 2011; 112: 1186–93.CrossRefGoogle ScholarPubMed
Papon, MA, Whittington, RA, El-Khoury, NB, Planel, E.Alzheimer's disease and anesthesia. Front Neurosci 2011; 4: 272.CrossRefGoogle ScholarPubMed
Feldblum, I, German, L, Castel, H, Harman-Boehm, I, Shahar, DR.Individualized nutritional intervention during and after hospitalization: the nutrition intervention study clinical trial. J Am Geriatr Soc 2011; 59: 10–17.CrossRefGoogle ScholarPubMed
Mullen, JL, Buzby, GP, Matthews, DC, Smale, BF, Rosato, EF.Reduction of operative morbidity and mortality by combined preoperative and postoperative nutritional support. Ann Surg 1980; 192: 604–13.CrossRefGoogle ScholarPubMed
Corish, CA.Pre-operative nutritional assessment in the elderly. J Nutr Health Aging 2001; 5: 49–59.Google ScholarPubMed
Kaminski, MV, Nasr, NJ, Freed, BA, Sriram, K.The efficacy of nutritional support in the elderly. J Am Coll Nutr 1982; 1: 35–40.CrossRefGoogle ScholarPubMed
Lindgren, M, Unosson, M, Krantz, AM, Ek, AC.Pressure ulcer risk factors in patients undergoing surgery. J Adv Nurs 2005; 50: 605–12.CrossRefGoogle ScholarPubMed
Harvey, S, Harrison, DA, Singer, M et al. Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial. Lancet 2005; 366 (9484): 472–7.CrossRefGoogle ScholarPubMed
Dzankic, S, Pastor, D, Gonzalez, C, Leung, JM.The prevalence and predictive value of abnormal preoperative laboratory tests in elderly surgical patients. Anesth Analg 2001; 93: 301–8.Google ScholarPubMed
Seymour, DG, Pringle, R, MacLennan, WJ.The role of the routine pre-operative electrocardiogram in the elderly surgical patient. Age Ageing 1983; 12: 97–104.CrossRefGoogle ScholarPubMed
Liu, LL, Dzankic, S, Leung, JM.Preoperative electrocardiogram abnormalities do not predict postoperative cardiac complications in geriatric surgical patients. J Am Geriatr Soc 2002; 50: 1186–91.CrossRefGoogle Scholar
Tornebrandt, K, Fletcher, R.Pre-operative chest x-rays in elderly patients. Anaesthesia 1982; 37: 901–2.CrossRefGoogle ScholarPubMed
Campbell, JC.Detecting and correcting pulmonary risk factors before operation. Geriatrics 1977; 32: 54–7.Google ScholarPubMed
Smetana, GW.Preoperative pulmonary assessment of the older adult. Clin Geriatr Med 2003; 19: 35–55.CrossRefGoogle ScholarPubMed
Del Guercio, LR, Cohn, JD.Monitoring operative risk in the elderly. J Am Med Assoc 1980; 243: 1350–5.CrossRefGoogle ScholarPubMed
Schrader, LL, McMillen, MA, Watson, CB, MacArthur, JD.Is routine preoperative hemodynamic evaluation of nonagenarians necessary?J Am Geriatr Soc 1991; 39: 1–5.CrossRefGoogle ScholarPubMed
Wickstrom, I, Holmberg, I, Stefansson, T.Survival of female geriatric patients after hip fracture surgery. A comparison of 5 anesthetic methods. Acta Anaesthesiol Scand 1982; 26: 607–14.CrossRefGoogle ScholarPubMed
Hole, A, Terjesen, T, Breivik, H.Epidural versus general anaesthesia for total hip arthroplasty in elderly patients. Acta Anaesthesiol Scand 1980; 24: 279–87.CrossRefGoogle ScholarPubMed
Zuo, C, Zuo, Z.Spine surgery under general anesthesia may not increase the risk of Alzheimer's disease. Dement Geriatr Cogn Disord 2010; 29: 233–9.CrossRefGoogle Scholar
Lien, CA.Regional versus general anesthesia for hip surgery in older patients: does the choice affect patient outcome?J Am Geriatr Soc 2002; 50: 191–4.Google ScholarPubMed
Detsky, AS, Abrams, HB, McLaughlin, JR et al. Predicting cardiac complications in patients undergoing non-cardiac surgery. J Gen Intern Med 1986; 1: 211–19.CrossRefGoogle ScholarPubMed
Gerson, MC, Hurst, JM, Hertzberg, VS et al. Prediction of cardiac and pulmonary complications related to elective abdominal and noncardiac thoracic surgery in geriatric patients. Am J Med 1990; 88: 101–7.CrossRefGoogle ScholarPubMed
Eagle, KA, Berger, PB, Calkins, H et al. ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery – executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). J Am Coll Cardiol 2002; 39: 542–53.CrossRefGoogle Scholar
Easo, J, Holzl, PP, Horst, M et al. Cardiac surgery in nonagenarians: Pushing the boundary one further decade. Arch Gerontol Geriatr 2011; 53: 229–32.CrossRefGoogle ScholarPubMed
Krane, M, Voss, B, Hiebinger, A et al. Twenty years of cardiac surgery in patients aged 80 years and older: risks and benefits. Ann Thorac Surg 2011; 91: 506–13.CrossRefGoogle ScholarPubMed
Hoff, SJ, Ball, SK, Coltharp, WH et al. Coronary artery bypass in patients 80 years and over: is off-pump the operation of choice?Ann Thorac Surg 2002; 74: S1340–3.CrossRefGoogle Scholar
Hoff, SJ, Ball, SK, Leacche, M.Results of completion arteriography after minimally invasive off-pump coronary artery bypass. Ann Thorac Surg 2011; 91: 31–6; discussion 36–7.CrossRefGoogle ScholarPubMed
Demaria, RG, Carrier, M, Fortier, S et al. Reduced mortality and strokes with off-pump coronary artery bypass grafting surgery in octogenarians. Circulation 2002; 106 (12 Suppl 1): I5–I10.Google ScholarPubMed
Olsson, M, Granstrom, L, Lindblom, D, Rosenqvist, M, Ryden, L.Aortic valve replacement in octogenarians with aortic stenosis: a case-control study. J Am Coll Cardiol 1992; 20: 1512–16.CrossRefGoogle ScholarPubMed
Pasic, M, Carrel, T, Laske, A et al. Valve replacement in octogenarians: increased early mortality but good long-term result. Eur Heart J 1992; 13: 508–10.CrossRefGoogle ScholarPubMed
Rajani, R, Buxton, W, Haworth, P et al. Prognostic benefit of transcatheter aortic valve implantation compared with medical therapy in patients with inoperable aortic stenosis. Catheter Cardiovasc Interv 2010; 75: 1121–6.Google ScholarPubMed
ElBardissi, AW, Shekar, P, Couper, GS, Cohn, LH.Minimally invasive aortic valve replacement in octogenarian, high-risk, transcatheter aortic valve implantation candidates. J Thorac Cardiovasc Surg 2011; 141: 328–35.CrossRefGoogle ScholarPubMed
Goldsmith, I, Lip, GY, Kaukuntla, H, Patel, RL.Hospital morbidity and mortality and changes in quality of life following mitral valve surgery in the elderly. J Heart Valve Dis 1999; 8: 702–7.Google ScholarPubMed
Henebiens, M, Vahl, A, Koelemay, MJ.Elective surgery of abdominal aortic aneurysms in octogenarians: a systematic review. J Vasc Surg 2008; 47: 676–81.CrossRefGoogle ScholarPubMed
Ommer, A, Pillny, M, Grabitz, K, Sandmann, W.Reconstructive surgery for carotid artery occlusive disease in the elderly – a high risk operation?Cardiovasc Surg 2001; 9: 552–8.CrossRefGoogle ScholarPubMed
Le Manach, Y, Ibanez Esteves, C, Bertrand, M et al. Impact of preoperative statin therapy on adverse postoperative outcomes in patients undergoing vascular surgery. Anesthesiology 2011; 114: 98–104.CrossRefGoogle ScholarPubMed
Sieber, FE, Zakriya, KJ, Gottschalk, A et al. Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair. Mayo Clin Proc 2010; 85: 18–26.CrossRefGoogle ScholarPubMed
Ekelund, A, Rydell, N, Nilsson, OS.Total hip arthroplasty in patients 80 years of age and older. Clin Orthop Relat Res 1992; 281: 101–6.Google Scholar
Phillips, TW, Grainger, RW, Cameron, HS, Bruce, L.Risks and benefits of elective hip replacement in the octogenarian. Can Med Assoc J 1987; 137: 497–500.Google ScholarPubMed
Margiotta, SJ, Horwitz, JR, Willis, IH, Wallack, MK.Cholecystectomy in the elderly. Am J Surg 1988; 156: 509–12.CrossRefGoogle ScholarPubMed
Harness, JK, Strodel, WE, Talsma, SE.Symptomatic biliary tract disease in the elderly patient. Am Surg 1986; 52: 442–5.Google ScholarPubMed
Kuwabara, K, Matsuda, S, Ishikawa, KB, Horiguchi, H, Fujimori, K.Comparative quality of laparoscopic and open cholecystectomy in the elderly using propensity score matching analysis. Gastroenterol Res Pract. 2010; 2010: 490147.Google Scholar
Pessaux, P, Tuech, JJ, Derouet, N et al. Laparoscopic cholecystectomy in the elderly: a prospective study. Surg Endosc 2000; 14: 1067–9.Google ScholarPubMed
Smithy, WB, Wexner, SD, Dailey, TH.The diagnosis and treatment of acute appendicitis in the aged. Dis Colon Rectum 1986; 29: 170–3.CrossRefGoogle ScholarPubMed
Kirshtein, B, Perry, ZH, Mizrahi, S, Lantsberg, L.Value of laparoscopic appendectomy in the elderly patient. World J Surg 2009; 33: 918–22.CrossRefGoogle ScholarPubMed
Faiz, O, Warusavitarne, J, Bottle, A et al. Laparoscopically assisted vs. open elective colonic and rectal resection: a comparison of outcomes in English National Health Service Trusts between 1996 and 2006. Dis Colon Rectum 2009; 52: 1695–704.CrossRefGoogle ScholarPubMed
Tei, M, Ikeda, M, Haraguchi, N et al. Postoperative complications in elderly patients with colorectal cancer: comparison of open and laparoscopic surgical procedures. Surg Laparosc Endosc Percutan Tech 2009; 19: 488–92.CrossRefGoogle ScholarPubMed
Richter, HE, Goode, PS, Kenton, K et al. The effect of age on short-term outcomes after abdominal surgery for pelvic organ prolapse. J Am Geriatr Soc 2007; 55: 857–63.CrossRefGoogle ScholarPubMed
Mains, LM, Magnus, M, Finan, M.Perioperative morbidity and mortality from major gynecologic surgery in the elderly woman. J Reprod Med 2007; 52: 677–84.Google ScholarPubMed
Toglia, MR, Nolan, TE.Morbidity and mortality rates of elective gynecologic surgery in the elderly woman. Am J Obstet Gynecol 2003; 189: 1584–7; discussion 1587–9.CrossRefGoogle ScholarPubMed
Dillman, RO, Zusman, DR, McClure, SE.Surgical resection and long-term survival for octogenarians who undergo surgery for non-small-cell lung cancer. Clin Lung Cancer 2009; 10: 130–4.CrossRefGoogle ScholarPubMed
Takamochi, K, Oh, S, Matsuoka, J, Suzuki, K.Risk factors for morbidity after pulmonary resection for lung cancer in younger and elderly patients. Interact Cardiovasc Thorac Surg 2011; 12: 739–43.CrossRefGoogle ScholarPubMed
Birim, O, Zuydendorp, HM, Maat, AP et al. Lung resection for non-small-cell lung cancer in patients older than 70: mortality, morbidity, and late survival compared with the general population. Ann Thorac Surg 2003; 76: 1796–801.CrossRefGoogle ScholarPubMed
Heerdt, PM, Park, BJ.The emerging role of minimally invasive surgical techniques for the treatment of lung malignancy in the elderly. Anesthesiol Clin 2008; 26: 315–24, vi–vii.CrossRefGoogle ScholarPubMed
Cattaneo, SM, Park, BJ, Wilton, AS et al. Use of video-assisted thoracic surgery for lobectomy in the elderly results in fewer complications. Ann Thorac Surg 2008; 85: 231–5; discussion 235–6.CrossRefGoogle ScholarPubMed
Fitzgerald, SD, Longo, WE, Daniel, GL, Vernava, AM. Advanced colorectal neoplasia in the high-risk elderly patient: is surgical resection justified?Dis Colon Rectum 1993; 36: 161–6.CrossRefGoogle ScholarPubMed
Patel, SA, Zenilman, ME.Outcomes in older people undergoing operative intervention for colorectal cancer. J Am Geriatr Soc 2001; 49: 1561–4.CrossRefGoogle ScholarPubMed
Law, WL, Chu, KW, Tung, PH.Laparoscopic colorectal resection: a safe option for elderly patients. J Am Coll Surg 2002; 195: 768–73.CrossRefGoogle ScholarPubMed
Sugimachi, K, Inokuchi, K, Ueo, H et al. Surgical treatment for carcinoma of the esophagus in the elderly patient. Surg Gynecol Obstet 1985; 160: 317–19.Google ScholarPubMed
Xijiang, Z, Xizeng, Z, Xishan, H, Hongjing, J.Surgical treatment for carcinoma of the esophagus in the elderly patient. Ann Thorac Cardiovasc Surg 1999; 5: 182–6.Google ScholarPubMed
Endo, S, Yoshikawa, Y, Hatanaka, N et al. Treatment for gastric carcinoma in the oldest old patients. Gastric Cancer 2011; 14: 139–43.CrossRefGoogle ScholarPubMed
Gandhi, S, Verma, S.Early breast cancer in the older woman. Oncologist 2011; 16: 479–85.CrossRefGoogle ScholarPubMed
Chatzidaki, P, Mellos, C, Briese, V, Mylonas, I.Perioperative complications of breast cancer surgery in elderly women (≥80 Years). Ann Surg Oncol 2011; 18: 923–31.CrossRefGoogle Scholar
Daneshvar, DA, Czer, LS, Phan, A, Trento, A, Schwarz, ER.Heart transplantation in the elderly: why cardiac transplantation does not need to be limited to younger patients but can be safely performed in patients above 65 years of age. Ann Transplant 2010; 15: 110–19.Google Scholar
Cooper, M, Forland, CL.The elderly as recipients of living donor kidneys, how old is too old?Curr Opin Organ Transplant 2011; 16: 250–5.CrossRefGoogle ScholarPubMed
Heymann, AD.The effect of incidental hypothermia on elderly surgical patients. J Gerontol 1977; 32: 46–8.CrossRefGoogle ScholarPubMed
Hodkinson, HM.Mental impairment in the elderly. J R Coll Physicians Lond 1973; 7: 305–17.Google ScholarPubMed
Marcantonio, ER, Flacker, JM, Wright, RJ, Resnick, NM.Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc 2001; 49: 516–22.CrossRefGoogle ScholarPubMed

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