Surgery in elderly patients

The important aspects of surgery in elderly patients can be summarised for the preoperative, operative and postoperative period. Preoperative care includes a detailed medical and social history, physical assessment for co-existing medical conditions and appraisal of the present physical state. This will determine which investigations are appropriate. Following this the risk involved with surgery can be estimated, and any medical conditions or co-existing diseases that need to be corrected prior to surgery identified (e.g. hypertension, diabetes control, cardiac arrhythmias, poor nutrition). The type of surgical procedure and anaesthetic should be tailored to each patient. Optimum operative care includes careful peri-operative monitoring and maintenance of a stable haemodynamic status. Variations in blood pressure, hypoxia and hypothermia should be prevented. Wherever possible, consideration should be given to using local or regional anaesthesia. Postoperative care includes nutritional support, prevention of delirium, thromboembotic prophylaxis and effective pain control. Wherever possible early mobilisation should be encouraged to avoid the adverse effects of recumbency. (C) 2004 Elsevier Ltd. All rights reserved.