TY - CHAP M1 - Book, Section TI - Surgical Considerations in the Elderly A1 - Hardin, Rosemarie E. A1 - Zenilman, Michael E. A2 - Brunicardi, F. Charles A2 - Andersen, Dana K. A2 - Billiar, Timothy R. A2 - Dunn, David L. A2 - Hunter, John G. A2 - Matthews, Jeffrey B. A2 - Pollock, Raphael E. PY - 2015 T2 - Schwartz's Principles of Surgery, 10e AB - Frailty, dementia, and geriatric syndromes have recently been identified as major factors in the development of postoperative complications in the elderly.Emergency surgery in the elderly carries a mortality rate that is 3 to 4 times that seen after elective surgery.Impaired cardiac function is responsible for more than half of the postoperative deaths in elderly patients, so careful attention must be paid to intravascular volume status in the perioperative period.In elderly patients with acute appendicitis or acute cholecystitis, one-third lack fever, one-third lack an elevated white blood cell count, and one-third lack physical findings of peritonitis.Physiologic age, not chronologic age, is the consequence of diminished functional reserve due to comorbid conditions, and is the major predictor of perioperative morbidity and mortality in the elderly.Laparoscopic approaches to surgical management, including the use of exploratory laparoscopy to rule out surgical disease, are associated with fewer complications and more rapid recovery in the elderly.New tools exist to help assess perioperative risk in geriatric patients, in addition to medical comorbidities. They include identification of geriatric syndromes, frailty indicators. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accessmedicine.mhmedical.com/content.aspx?aid=1117755431 ER -