RT Book, Section
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.
SR Print(0)
ID 1117755431
T1 Surgical Considerations in the Elderly
T2 Schwartz's Principles of Surgery, 10e
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 9780071796743
LK accessmedicine.mhmedical.com/content.aspx?aid=1117755431
RD 2024/04/19
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.