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Key Principles in Geriatric Surgery

Key Principles in Geriatric Surgery

The continued aging of the population will be perhaps the greatest force affecting healthcare. Conditions that often require surgery—atherosclerosis, degenerative joint disease, prostate disease, among others—increase in incidence with advancing age. With a few exceptions, it’s time for all surgeons to consider themselves geriatric surgeons. Guidance for Surgeons Treating the Elderly Several general principles can help guide surgeons who treat the elderly. First, the clinical presentation of surgical problems in the elderly may be subtle or somewhat different from that of the general population. This may lead to delays in diagnosis. In appendicitis, for example, a classic presentation occurs in less than one-third of elderly patients, resulting in perforation in over half of patients before surgery. Second, the elderly handle normal stress satisfactorily but handle severe stress poorly because of lack of organ system reserve. Optimal preoperative preparation is essential. Hypovolemia, hypertension, bronchitis, and severe anemia should be corrected. When preparation is suboptimal or insufficient time is allotted for adequate preparation, perioperative risk increases. The results of elective surgery in the elderly are good in many centers. Results of emergency surgery are poorer but better than non-operative treatment for most conditions. The risk of emergency surgery may be many times that of similar elective surgery. “Scrupulous attention to detail yields great benefit because the elderly tolerate complications poorly.” Scrupulous attention to detail yields great benefit because the elderly tolerate complications poorly. Perioperative blood loss, for example, is the factor over which surgeons have the most control. Postoperative complications are stronger risk factors for hospital deaths than preoperative comorbidities and procedural variables. Ageism Is Unjustified A patient’s age should be...
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