Excerpt from Perioperative Management of the Geriatric Patient
Synonyms, Key Words, and Related Terms: geriatrics, geriatric care, elder care, surgical risk quantification, risk assessment, dementia, neuropsychiatric disorders, Parkinson disease, Parkinson's disease, parkinsonism, thromboembolic disease, diabetes mellitus, renal disease, cardiovascular disease, myocardial infarction, MI, congestive heart failure, CHF, pulmonary disease, hypertension, cardiovascular complications, surgical complications, surgical risk, risk management
Advances in surgical and anesthetic techniques combined with sophisticated perioperative monitoring are factors that have contributed to an expanding number of older adults undergoing surgery. A preoperative assessment is useful to identify factors associated with increased risks of specific complications and to recommend a management plan that minimizes the risks. Each person should be assessed individually, and judgments should be based on an individual's problem and physiologic status, not on age alone. According to estimates, 50% of older Americans will have an operation when older than 65 years.
Older persons often have multiple comorbid conditions that limit their functional capacity and recovery and increase the risk of death. An initial complication is much more likely to lead to other complications; failure of one organ to function adequately is more likely to lead to failure of other organs.
In one study, the mortality rate for patients older than 70 years undergoing elective cholecystectomy was nearly 10 times that for younger patients. In a study of abdominal operations, the mortality rate for patients aged 80-84 years was 3%; the rate was 9% for patients aged 85-89 years and 25% for those older than 90 years.
Advanced age, poor functional status at baseline, impaired cognition, and limited support at home are risk factors for adverse outcomes. However, when age and severity of illness are directly compared, severity of illness is a much better predictor of outcome compared to age. Emergency operations carry a greater risk compared to elective operations in all age groups, particularly elderly persons.
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