When your patient needs surgery: weighing risks versus benefits

The likelihood of being a candidate for elective or emergency surgery increases with age. The higher rates of perioperative morbidity and mortality seen in older patients result in part from co-existing medical illnesses. Age alone should not be a contraindication for surgery, however, and the long-term benefits of procedures such as coronary artery bypass grafting appear similar for young and old. Emergency operations account for 39 to 75% of all surgery after age 70 and carry a 20-fold increase in mortality compared with elective procedures. Appropriate surgical interventions, therefore, should not be deferred simply because the patient is elderly. Age-associated changes in body composition and organ physiology contribute to the risk of perioperative complications.