Preoperative evaluation and risk assessment for elderly thoracic surgery patients

Assessment for thoracic surgery in elderly patients should proceed on the basis of physiologic rather than chronologic age. Thoracic surgery has been shown to be safe in selected elderly patients, and age should not be a contraindication to a therapy that offers the best chance of cure for early stage cancer patients. A targeted preoperative assessment can help individualize the morbidity and mortality risk of surgery for each patient and provide the surgeon and patient with the information needed for operative decision making. Operative interventions in the elderly require coordinated attention to the specific requirements of the aged. Specialized multidisciplinary care provided by primary care physicians, geriatric specialists, cardiologists, oncologists, surgeons, anesthesia personnel, nurses, physical therapists, and nutritionists will optimize care for the elderly thoracic surgery patient. Careful selection of patients for surgery has contributed to the improvement in operative mortality over time, and refinements in preoperative testing should continue this trend in the future.