Aging Pearls: General Surgery Answer Guide
Carol L. Howe, MD, MLS, College of Medicine, University of Arizona
1. In providing informed consent for an 82 year old patient about to undergo an elective cholecystectomy, it is important to have her understand that because she is older and has more co-morbid diseases it is important for the surgeon to do an open cholecystecomy and “really get in there to see what is going on” than to take the risk of a laparoscopic procedure. True or False? Please discuss.
False “To summarize the findings of recent research: ▪Cholecystectomy is one of the most frequently performed operations in older patients. ▪Elderly patients present with a greater proportion of complicated biliary disease. ▪The morbidity and mortality rates for cholecystectomy are higher in elderly than in younger patients. ▪In elderly patients laparoscopic cholecystectomy has a lower mortality rate than does open cholecystectomy.”[1](p.98)
2. The survival rates of elderly patients undergoing elective general surgery operations are similar to those of age-matched groups. True or False? Please discuss. True
“The survival rates of elderly patients undergoing elective general surgery operations are similar to those of age-matched groups.”1(p.86)
3. Age is a more important predictor of postoperative complications (including death) than how severe a disease is. So, a 95 year old with moderate diverticulitis is more at risk from surgery than a 63 year old with severe diverticulitis. True or False? Please discuss. False
“A 2-year study of 8899 patients aged 65 years and older undergoing surgery found that severity of illness is a better predictor than age of morbidity, mortality, and length of stay. Outcomes for a given disease severity were found to be stable in patients from age 65 to 85 years and older.
To summarize the findings of recent research: ▪Emergency operations, especially on the gastrointestinal system, account for a significant fraction of the general surgery procedures performed on older people. ▪The survival rates of elderly patients undergoing elective general surgery operations are similar to those of age-matched groups. ▪Costs associated with surgical care are significantly higher in older people. ▪Severity of illness, rather than chronologic age, predicts postoperative morbidity, mortality, and length of stay.”1(p.86)
Last updated 04/13/2011
[1] Pofahl WE. Geriatric General Surgery. In:Solomon DH, LoCiceroJ, Rosenthal RA, American Geriatrics Society, JohnA.Hartford Foundation. New Frontiers in Geriatrics Research : An Agenda for Surgical and Related Medical Specialties. New York: American Geriatrics Society; 2004: 85-109.