Perioperative care of the elderly patient.
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.
Ergina
P L
PL
Department of Medicine, McGill University, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Quebec, Canada.
Gold
S L
SL
Meakins
J L
JL
D000368:Aged; D003221:Confusion / Q000503:physiopathology; D015577:Geriatric Assessment; D006331:Heart Diseases / Q000503:physiopathology; D006801:Humans; D007430:Intraoperative Care; D008173:Lung Diseases, Obstructive / Q000503:physiopathology; D009102:Multiple Organ Failure / Q000503:physiopathology; D011183:Postoperative Complications; D011300:Preoperative Care; D012307:Risk Factors; D012308:Risk Management; D013514:Surgical Procedures, Operative