Preoperative Evaluation of the Elderly Surgical Patient

Abstract

The elderly population uses a significant portion of health care resources in the United States and poses an increasing challenge to perioperative care. Many reports point to both increasing age and frailty as important risk factors for short-term mortality; cardiovascular, pulmonary, and renal complications; and increased length of stay and hospital costs following operation. To provide the best care for the aging US population, it is important for the clinician to be familiar with the appropriate presurgical workup specific to the comorbidities prevalent to the elderly population. This review discusses the postoperative complications facing elderly surgical patients and the physiologic complications of aging, with a particular emphasis on the concept of frailty as a predictor of major morbidity and mortality. With age and comorbidities in mind, this review discusses the relevant preoperative cardiovascular, respiratory, and renal workup and includes important guidelines for appropriate risk assessment and reduction in the elderly surgical patient. This review contains 1 figure, 5 tables, and 86 references. Key words: aging, anesthesia, elderly, frailty, outcomes, preoperative workup, risk assessment