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Pre-operative assessment and preparation of elderly patients undergoing major surgery 

Pre-operative assessment and preparation of elderly patients undergoing major surgery
Chapter:
Pre-operative assessment and preparation of elderly patients undergoing major surgery
Author(s):

Chris Dodds

, Chandra M. Kumar

, and Frédérique Servin

DOI:
10.1093/med/9780199234622.003.0004
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date: 17 December 2017

Age as such is not a good predictor of surgical risk.

Physiological age-related changes increase the risks of surgery and anaesthesia.

Co-morbidities increase with age.

Anaesthetic plan for surgery in elderly is a challenge.

Aim of assessment is to identify within the composite elderly patient what integrated responses are critically reduced, or have failed, and then to systematically review individual organ systems for functional reserve.

Incidence of ischaemic heart disease and valve disease increases with age and is associated with increased morbidity and mortality.

Chest disease is common in the elderly, and pulmonary complications are more common in the post-operative period.

Hepatic insufficiency usually results in a poor surgical outcome.

Renal insufficiency associated with uraemia increases risk.

Presence of interval delirium or confusion indicates a very high risk of post-operative cognitive impairment and general anaesthetic or sedation should be avoided.

Before emergency surgery, there may not be time for complete evaluation and correction of risk factors.

Life saving treatment can proceed without consent.

Advance directives before surgery should be documented, and the name of the patient’s surrogate should be recorded.

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