Preoperative considerations in the geriatric patient

Because of the "graying" of the population, the increasing availability of surgeons, and the improvement of surgical techniques and intensive care, more and more surgery will be done on geriatric patients. Sometimes, however, surgery will not be considered in a geriatric patient because of mistaken underestimation of life expectancy. The medical consultant is charged with confirming that surgery represents the consequence of the patient's informed decision, a task that is usually time consuming and often difficult. The medical consultant next identifies patient-related and procedure-related factors that affect surgical morbidity and mortality. General physiologic declines in all organ systems are characteristic of aging, but the most important ones affecting surgical risk are those of cardiovascular, pulmonary, immunologic, and central nervous systems. These systems must be assessed by an orderly preoperative evaluation that aims to optimize the patient's status and anticipate and minimize postoperative complication.