Estrogen replacement therapy and the surgeon

Area of Science:

• Geriatric Medicine
• Surgical Oncology
• Pharmacology

Background:

• The population aged over 65 is growing, increasing surgical demand by 50%.
• Postmenopausal women frequently use estrogen replacement therapy (ERT) for symptom relief and disease prevention.
• Women constitute the majority of the elderly population undergoing surgery.

Purpose of the Study:

• To review the impact of ERT on wound healing and fracture repair.
• To assess ERT's effect on perioperative cardiac morbidity and thrombosis.
• To provide evidence-based recommendations for ERT management in surgical patients.

Main Methods:

• A comprehensive literature review was conducted using the Medline database.
• Studies examining estrogen therapy and surgical outcomes were systematically analyzed.
• Evidence regarding wound healing, bone repair, cardiovascular events, and thrombosis was synthesized.

Main Results:

• Limited data exists on the direct impact of ERT on surgical wound healing and fracture repair.
• Current evidence does not strongly support or refute a significant increase in perioperative cardiac morbidity or thrombosis with ERT.
• The review highlights a lack of conclusive studies on ERT's role in surgical contexts.

Conclusions:

• There is insufficient evidence to warrant the routine discontinuation of ERT upon hospital admission for surgery.
• Postmenopausal women not on ERT should be considered for therapy initiation upon regaining ambulatory status.
• Further research is needed to clarify the risks and benefits of ERT in surgical patients.