Surgery at the extremes of age : Common problems in the elderly

February 23, 2013 | By | Reply More

Surgery at the extremes of age : Common problems in the elderly

Surgery is increasingly used in older and older patients and the range of procedures available to surgeons for both the very elderly and the very young and neonates is increasing. Minimally invasive surgery is increasingly being offered to older patients at risk from open surgery. Both these groups need particular attention and have specific potential problems.
Surgery and the elderly
Common misconceptions
  • Elderly patients benefit just as much from potentially curative cancer surgery as younger patients. Cancers demonstrate the same range of behaviours in all ages and are neither more benign nor less responsive to treatment in the elderly.
  • Minimally invasive procedures in the elderly can offer all the benefits available to younger patients.
  • Palliative procedures for benign disease (e.g. cholecystectomy, joint surgery, eye surgery) are just as important in the elderly as they may allow preservation of independence and offer just as much improvement in quality of life as in the young.
Common problems in the elderly
  • Multiple comorbidities and polypharmacy increase the scope for potential complications and drug interactions.
  • Comorbidities are often silent, either due to atypical presentation or underreporting of symptoms (e.g. angina may not be manifest due to reduced mobility).
  • Social, family, nursing, and medical support structures are often complex and easily lost during a hospital admission.
  • Reduced or acutely impaired mental faculties may make history taking and consent taking difficult.
  • Reduced or abnormal immune responses may reduce or impair some physical signs (e.g. clinically detectable peritonism may be absent).
  • The elderly are particularly prone to mild or moderate chronic malnutrition increasing general complication rates and the risk of pressure sores, etc.
Strategies for the management of the elderly
  • Involve all the necessary specialities as soon as possible (prior to admission for elective surgery), e.g. elderly care, anaesthetists, physicians.
  • Consider pre-optimization in critical care (HDU) especially in urgent or emergency surgery.
  • Start to plan for discharge on the day of admission and liaise with the GP and family if necessary.
  • Consider nutrition as soon as possible after surgery. Is hyperalimentation necessary?


Category: Surgery

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