[Changes in surgical cases]

The shift of age distribution within the population of industrialized societies has led to an increased need of treating diseases in elderly patients and at the same time bearing an increased operative risk. Today, the development of surgical techniques and intensive care treatment enables us to carry out numerous procedures in geriatric patients. Innovative surgical techniques like minimal invasive surgery with minor trauma due to the surgical approach changed patient's categories, also. Taken together with other procedures causing less operative stress indications for patients who were not operable previously have changed. New developments such as organ transplantation and immunosuppression also generated totally new groups of patients with very distinct conditions for the operative procedure. Vanishing indications or selection of patients as in peptic ulcer disease changed the surgical approach completely: Negative selection has shifted elective operative interventions in ulcer disease to emergency procedures. Contrasting experiences made in most other countries and especially in the third world, in Germany economic restrictions have not been encountered as of yet. Economical conditions, an increase in surgical procedures in elderly patients and advances in medical science will continue to change the surgical patient's characteristics profoundly. From the physicians viewpoint we have actively participate in this development by personal interaction with the patient, by interdisciplinary cooperation and prompt social and political action.