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37 - Surgery in the elderly

Published online by Cambridge University Press:  12 January 2010

By
Michael F. Lubin
Edited by
Michael F. Lubin ,
Robert B. Smith ,
Thomas F. Dodson ,
Nathan O. Spell  and
H. Kenneth Walker
Michael F. Lubin
Affiliation:
Emory University, School of Medicine, Atlanta, GA
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Robert B. Smith
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Nathan O. Spell
Affiliation:
Emory University, Atlanta
H. Kenneth Walker
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, 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. These decrements make even healthy older patients more fragile and more likely to suffer postoperative complications and death than their younger counterparts. Physicians must take them into account in their evaluations.

The cardiovascular system has been studied and reviewed extensively.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
 , pp. 445 - 464
Publisher: Cambridge University Press
Print publication year: 2006

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