A Review of Risk Factor in the Elderly Candidate for Surgery and Anesthesia

Abstract

The proportion of elderly people in the population has markedly increased in this century, leading to an increase in the number of elderly patients undergoing surgery and anesthesia. However, the special problems posed by surgery and anesthesia in the elderly have received little attention in the current anesthesiology literature; most of the existing information comes from the fields of surgery, internal medicine, and geriatrics. There appears to be a good correlation between operative mortality in the aged and the physical status classification developed by the American Society of Anesthesiologists. Among the few studies in this area, one found that in patients with a mean age of 75 years, postoperative mortality was 6% for those in Class 2, 20% in Class 3, and 58% in Class 4. A more recent study of patients with a mean age of 68 years indicated that postoperative mortality was 6% in Class 2, 12% in Class 3, and 22% in Class 4. This study also suggests that for patients with uncorrectable advanced functional deficits, cancellation or modification of surgery should be considered and local rather than general anesthesia used. Emergency surgery in the aged may be particularly hazardous; available data indicate that between 25% and 33% of elderly patients die following emergency surgery and anesthesia. Additional risks include advanced age, malnutrition, overt psychoses and dementia, and complicating systemic diseases, particularly those of the cardiovascular system. The duration of the surgical procedure is considered by some to affect the outcome, whereas the sex of the patient may be a factor only in certain specific operations. Surgery and Anesthesia. 1983; 3(3): 179-184 G Davies, A Review of Risk Factor in the Elderly Candidate for