Perioperative care of the elderly patient

Abstract

Surgical risk increases with age, primarily from loss of cardiac and pulmonary reserve. Complications are tolerated poorly by the elderly, emphasizing the importance of their prediction and prevention. Surgical risk in this population is significant, but with careful preoperative assessment and perioperative management acceptable morbidity and mortality are possible. This review proposes a general approach to the elderly surgical patient and applies it to the most significant sources of morbidity and mortality: pulmonary and cardiac complications. Risk assessment based on validated tools is utilized, and perioperative management recommendations based on the state of the art are examined. In addition, pulmonary embolism and postoperative confusion are examined separately with the same overall strategy.

Probable risk factors for postoperative delirium in patients undergoing spinal surgery

“…Brown reported approximately one-quarter of adults aged 65 and older experience delirium during hospitalization [3]. Ergina suggested that this may be because older adults have disproportionably more operations than younger adults, and also because the elderly population is growing [7]. All of the patients in our study were under general anesthesia, and one potential candidate mechanism of cognitive impairment is general anesthesia itself [6].…”

Surgical Procedures, Complications, and Prognosis for Gastric Cancer in the Very Elderly (^|^gt;85): A Retrospective Study

“…The safety of these treatments has increased due to improvements in preoperative evaluations, perioperative care, minimally invasive surgical procedures, and other advances in medical technology [3]. However, many elderly individuals suffer from major organ function deterioration as well as cardiovascular and respiratory comorbidity [4,5], and surgery and postoperative complications in such patients can therefore be fatal. The immediate postoperative fatality rate ranges from 5-20% [6].…”

Psychometric properties of the Patient Activation Measure among individuals presenting for elective lumbar spine surgery

“…Variability has also been observed across multiple patient-reported outcome domains (e.g., reduction in pain severity and improvement in quality of life) and other clinical outcomes (e.g., change in spinal flexion, improvement in muscle power, or change in neurological status). Previous work, which focused on identifying patient and surgical/ medical management factors that may contribute to this variation in outcomes, found there were several relevant biological factors (e.g., increased age [3][4][5][6], minority race/ ethnicity [7][8][9][10][11][12], and comorbid conditions [13][14][15]) and social factors (e.g., low socioeconomic status [16,17] and poor social support [18]). The presence of depressive symptoms has also been related to poor recovery.…”