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37 - Surgery in the elderly

Published online by Cambridge University Press:  12 January 2010

By
Michael F. Lubin
Edited by
Michael F. Lubin ,
Robert B. Smith ,
Thomas F. Dodson ,
Nathan O. Spell  and
H. Kenneth Walker
Michael F. Lubin
Affiliation:
Emory University, School of Medicine, Atlanta, GA
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Robert B. Smith
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Nathan O. Spell
Affiliation:
Emory University, Atlanta
H. Kenneth Walker
Affiliation:
Emory University, Atlanta
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Summary

Introduction

Surgical and anesthetic care have improved markedly in the last half century. It is likely that the greatest benefit of this improvement has been for the elderly population. Older patients can benefit from surgery that would not have been contemplated in the past; thus, patients are living longer and with a better quality of life than ever before.

The literature in surgical care of the elderly patient is extensive, growing rapidly and indicates that, with careful planning and care, the elderly can undergo surgery safely and with approximately the same risk as many younger patients. This section discusses the following topics as they pertain to the elderly population: (a) physiologic decrements of aging, (b) risks of surgery, (c) preoperative evaluation, (d) anesthesia, (e) common surgical procedures and (f) postoperative care.

Physiologic decrements of aging

Although physicians see many elderly patients who appear old and sick with many underlying health problems, a large percentage of the elderly population is quite well. These people can function entirely normally and have no limitations to their activities. Despite this degree of functional normality, however, all older people experience various decrements in physiologic function that are of importance in planning their care, particularly when they are under stresses such as surgery. These decrements make even healthy older patients more fragile and more likely to suffer postoperative complications and death than their younger counterparts. Physicians must take them into account in their evaluations.

The cardiovascular system has been studied and reviewed extensively.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
 , pp. 445 - 464
Publisher: Cambridge University Press
Print publication year: 2006

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References

Boss, G. R. & Seegmiller, J. E.Age-related physiological changes and their clinical significance. West. J. Med. 1981; 135: 434–440.Google ScholarPubMed
Abrass, I. B.The biology and physiology of aging. West. J. Med. 1990; 153: 641–645.Google ScholarPubMed
Evers, B. M., Townsend, C. M., & Thompson, J. C.Organ physiology of aging. Surg. Clin. North Am. 1994; 74: 23–39.CrossRefGoogle ScholarPubMed
Gerstenblith, G., Lakatta, E. G., & Weisfeldt, M. L.Age changes in myocardial function and exercise response. Prog. Cardiovasc. Dis. l976; 19: 1–21.CrossRefGoogle Scholar
Weisfeldt, M. L.Aging of the cardiovascular system. N. Engl. J. Med. 1980; 303: 1172–1173.CrossRefGoogle ScholarPubMed
Port, S., Cobb, F. R., Coleman, R. E., & Jones, R H.Effect of age on the response of the left ventricular ejection fraction to exercise. N. Engl. J. Med. 1980; 303: 1133–1137.CrossRefGoogle Scholar
Strahlman, E. R., ed. Clinical conferences at the Johns Hopkins Hospital: Presbycardia. Johns Hopkins Med. J. 1981; 149: 203–208.Google Scholar
Kent, S.The aging lung. Part 1. Loss of elasticity. Geriatrics 1978; 33(2): 124–130.Google ScholarPubMed
Sorbini, C. A., Grassi, V., Solinas, E., & Muiesan, G.Arterial oxygen tension in relation to age in healthy subjects. Respiration 1968; 25: 3–13.CrossRefGoogle ScholarPubMed
Muiesan, G., Sorbini, C. A., & Grassi, V.Respiratory function in the aged. Bull. Physio.-Pathol. Respir. 1971; 7: 973–1007.Google ScholarPubMed
McLachlan, M. S. F.The aging kidney. Lancet 1978; 2: 143–146.CrossRefGoogle Scholar
Friedman, S. A., Raizner, A. E., Rosen, H., Solomon, N. A., & Sy, W.Functional defects in the aging kidney. Ann. Intern. Med. 1972; 76: 41–45.CrossRefGoogle ScholarPubMed
Cockcroft, D. W. & Gault, M. H.Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16: 31–41.CrossRefGoogle ScholarPubMed
Hollenberg, N. K., Adams, D. F., Solomon, H. S.et al. Senescence and the renal vasculature in normal man. Circ. Res. 1974; 34: 309–316.CrossRefGoogle ScholarPubMed
Creditor, M.Hazards of hospitalization of the elderly. Ann. Intern. Med. 1993; 118: 219–223.CrossRefGoogle ScholarPubMed
Ochsner, A.Is risk of indicated operation too great in the elderly?Geriatrics 1967; 22: 121–130.Google ScholarPubMed
Gilbert, T., Orr, W., & Banning, A. P.Surgery for aortic stenosis in severely symptomatic patients older than 80 years: experience in a single UK centre. Heart 1999; 82: 138–142.CrossRefGoogle Scholar
Rosengart, T. K., Finnin, E. B., Kim, D. Y.et al. Open heart surgery in the elderly: results from a consecutive series of 100 patients aged 85 or older. Am. J. Med. 2002; 112: 143–147.CrossRefGoogle ScholarPubMed
Pofahl, W. E. & Pories, W. J.Current status and future directions of geriatric general surgery. J. Am. Geriatr. Soc. 2003; 51: S351–S354.CrossRefGoogle ScholarPubMed
Liu, L. L. & Leung, J. M.Predicting adverse postoperative outcomes in patients aged 80 years or older. J. Am. Geriatr. Soc. 2000; 48: 405–412.CrossRefGoogle ScholarPubMed
Leung, J. M. & Dzanic, S.J. Am. Geriatr. Soc. 2001; 49: 1080–1085.CrossRef
Polanczyk, C. A., Marcantonio, E., Goldman, L.et al. Impact of age on perioperative complications and length of stay in patients undergoing noncardiac sugery. Ann. Intern. Med. 2001; 134: 637–643.CrossRefGoogle Scholar
Michel, S. L., Stevens, L., Amodeo, P., & Morgenstern, L.Surgical procedures in nonagenarians. West. J. Med. 1984; 141: 61–63.Google ScholarPubMed
Keating, H. J. III.Major surgery in nursing home patients: procedures, morbidity and mortality in the frailest of the frail elderly. J. Am. Geriatr. Soc. 1992; 40: 8–11.CrossRefGoogle ScholarPubMed
Katlic, M.Surgery in centenarians. J. Am. Med. Assoc. 1985; 253: 3139–3141.CrossRefGoogle ScholarPubMed
Cogbill, T. H., Strutt, P. J., & Landercasper, J.Surgical procedures in centenarians. Wisc. Med. J. 1992; 91: 527–529.Google ScholarPubMed
Linn, B. S. & Linn, M. W.Evaluation of results of surgical procedures in the elderly. Ann. Surg. 1982; 195: 90–96.CrossRefGoogle ScholarPubMed
Goldman, L., Caldera, D. L., Nussbaum, S. R.et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N. Engl. J. Med. 1977; 297: 845–850.CrossRefGoogle ScholarPubMed
Sikes, E. D. & Detmer, D. E.Aging and surgical risk in older citizens of Wisconsin. Wisc. Med. J. 1979; 78: 27–30.Google ScholarPubMed
Turnbull, A. D., Gundy, E., Howland, W. S., & Beattie, E. J.Surgical mortality among the elderly. An analysis of 4050 operations (1970–1974). Clin. Bull. 1978; 8: 139–142.Google Scholar
Adkins, R. B. & Scott, H. W.Surgical procedures in patients aged 90 years and older. South. Med. J. 1984; 77: 1357–1364.CrossRefGoogle ScholarPubMed
Seymour, D. G. & Pringle, R.A new method of auditing surgical mortality rates: application to a group of elderly general surgical patients. Br. Med. J. 1982; 284: 1539–1542.CrossRefGoogle ScholarPubMed
Alexander, K. P., Anstrom, K. J., Muhlbaier, L. H.et al. Outcomes of cardiac surgery in patients greater than or equal to 80 years: results from the National Cardiovascular Network. J. Am. Coll. Cardiol. 2000; 35: 731–738.CrossRefGoogle Scholar
Craver, J. M., Puskas, J. D., Wintraub, W. W.et al. 601 octogenarians undergoing cardiac surgery: outcome and comparison with younger age groups. Ann. Thorac. Surg. 2000; 69: 317–318.Google Scholar
Alonso-Perez, M., Segura, R., Pita, S.et al. Operative results and death predictors for nonruptured abdominal aortic aneurysms in the elderly. Ann. Vasc. Surg. 2001; 15: 306–311.CrossRefGoogle ScholarPubMed
Huynh, T. T., Miller, C. C., Estrera, A. L.et al. Thoracoabdominal and descending thoracic aortic aneurysm surgery in patients aged 79 years or older. J. Vasc. Surg. 2002; 36: 469–475.CrossRefGoogle ScholarPubMed
Conti, B., Brega Massone, P. P., Lequaglie, C.et al. Major surgery in lung cancer in elderly patients? Risk factors analysis and long term results. Minerva Chir. 2002; 57: 317–321.Google ScholarPubMed
Hanagiri, T., Muranaka, H., Hashimoto, M.et al. Results of surgical treatment of lung cancer in octogenarians. Lung Cancer 1999; 23: 129–133.CrossRefGoogle ScholarPubMed
Reiss, R., Deutsch, A. A., & Nudelman, I.Abdominal surgery in elderly patients: statistical analysis of clinical factors prognostic of mortality in 1,000 cases. Mt. Sinai J. Med. 1987; 54: 135–140.Google ScholarPubMed
Sandler, R. S., Maule, W. F., Baltus, M. E.et al. Biliary tract surgery in the elderly. J. Gen. Intern. Med. 1987; 2: 149–154.CrossRefGoogle ScholarPubMed
Pigott, J. P. & Williams, G. B.Cholecystectomy in the elderly. Am. J. Surg. 1988; 155: 408–410.CrossRefGoogle ScholarPubMed
Rørbæk-Madsen, M.Herniorrhaphy in patients aged 80 years or more: a prospective analysis of morbidity and mortality. Eur. J. Surg. 1992; 158: 591–594.Google ScholarPubMed
Terai, T., Henmi, T., Kanematsu, Y.et al. Clinical evaluation of aged patients who underwent surgery for femoral neck fractures – comparative study of clinical results according to age. J. Orthop. Surg. 2002; 10: 23–28.CrossRefGoogle Scholar
Susini, T., Scambia, G., Margariti, P. A.et al. Gynecologic oncologic surgery in the elderly: a retrospective analysis of 213 patients. Gynecol. Oncol. 1999; 75: 437–443.CrossRefGoogle ScholarPubMed
Dunlop, W. E., Rosenblood, L., Lawrason, L.et al. Effects of age and severity of illness on outcome and length of stay in geriatric surgical patients. Am. J. Surg. 1993; 165: 577–580.CrossRefGoogle ScholarPubMed
Andersen, B. & Ostberg, J.Long term prognosis in geriatric surgery: 2–17 year follow-up of 7922 patients. J. Am. Geriatr. Soc. 1972; 20: 255–258.CrossRefGoogle ScholarPubMed
Hosking, M. P., Warner, M. A., Lobdell, C. M.et al. Outcomes of surgery in patients 90 years of age and older. J. Am. Med. Assoc. 1989; 261: 1909–1915.CrossRefGoogle ScholarPubMed
Salem, R., Devitt, P., Johnson, J., & Firmin, R.Emergency geriatric surgical admissions. Br. Med. J. 1978; 2: 416–417.CrossRefGoogle ScholarPubMed
Seymour, D. G. & Pringle, R.Surgical emergencies in the elderly: can they be prevented?Health Bull. 1981; 41: 112–131.Google Scholar
Keller, S. M., Markovitz, L. J., Wilder, J. R.et al. Emergency and elective surgery in patients over the age 70. Am. Surg. 1987; 53: 636–640.Google ScholarPubMed
Schöön, I. M. & Arvidsson, S.Surgery in patients aged 80 years and over. Eur. J. Surg. 1991; 157: 251–255.Google ScholarPubMed
Pomorski, M. E.Surgical care for the aged patient: the decision-making process. Nurs. Clin. North Am. 1983; 18: 365–372.Google ScholarPubMed
Neugent, M. C.Social and emotional needs of geriatric surgery patients. Soc. Work Health Care l981; 6: 69–75.CrossRefGoogle Scholar
Reiss, R.Moral and ethical issues in geriatric surgery. J. Med. Ethics 1980; 6: 71–77.CrossRefGoogle ScholarPubMed
Palmberg, S. & Hirsjarvi, E.Mortality in geriatric surgery. Gerontology 1979; 25: 103–112.CrossRefGoogle ScholarPubMed
Wilder, R. J. & Fishbein, R. H.The widening surgical frontier. Postgrad. Med. 1961; 29: 548–551.Google ScholarPubMed
Samiy, A. H.Clinical manifestations of disease in the elderly. Med. Clin. North Am. 1983; 67: 333–344.CrossRefGoogle ScholarPubMed
Hodkinson, H. M.Mental impairment in the elderly. J. Roy. Coll. Phys. Lond. 1973; 7: 305–317.Google ScholarPubMed
Heijmeriks, J. A., Dassen, W., Prenger, K.et al. The incidence and consequences of mental disturbances in elderly patients post cardiac surgery – a comparison with younger patients. Clin. Cardiol. 2000; 23: 540–546.CrossRefGoogle ScholarPubMed
Corish, C. A.Pre-operative nutritional assessment in the elderly. J. Nutr. Health Aging 2001; 5: 49–59.Google ScholarPubMed
Mullen, J. L., Buzby, G. P., Matthews, D. C.et al. Reduction of operative morbidity and mortality by combined preoperative and postoperative nutritional support. Ann. Surg. 1980; 192: 604–613.CrossRefGoogle ScholarPubMed
Master, A. M. & Lasser, R. P.Tables of average weight and height of Americans aged 65 to 94 years. J. Am. Med. Assoc. 1960; 172: 658–662.CrossRefGoogle ScholarPubMed
Kaminski, M. V., Nasr, N. J., Freed, B. A., & Sriram, K.The efficacy of nutritional support in the elderly. J. Am. Coll. Nutr. 1982; 1: 35–40.CrossRefGoogle ScholarPubMed
Berens, E. S., Kouchoukos, N. T., Murphy, S. F.et al. Preoperative carotid artery screening in elderly patients undergoing cardiac surgery. J. Vasc. Surg. 1992; 15: 313–323.CrossRefGoogle ScholarPubMed
Wickstrom, I., Holmberg, I., & Stefansson, T.Survival of female geriatric patients after hip fracture surgery: a comparison of 5 anesthetic methods. Acta Anaesth. Scand. 1982; 26: 607–614.CrossRefGoogle ScholarPubMed
Del Guercio, L. R. M. & Cohn, J. D.Monitoring operative risk in the elderly. J. Am. Med. Assoc. 1980; 243: 1350–1355.CrossRefGoogle ScholarPubMed
Dzanic, S., Pastor, D., Gonzalez, C.et al. The prevalence and predictive value of abnormal preoperative laboratory tests in elderly surgical patients. Anesth. Analg. 2001; 93: 301–308.Google Scholar
Seymour, D. G., Pringle, R., & MacLennan, W. J.The role of the pre-operative electrocardiogram in the elderly surgical patient. Age Aging 1983; 12: 97–104.CrossRefGoogle ScholarPubMed
Liu, L. L., Dzanic, S., & Leung, J. M.Preoperative electrocardiogram abnormalities do not predict postoperative cardiac complications in geriatric surgical patients. J. Am. Geriatr. Soc. 2002; 50: 1186–1191.CrossRefGoogle Scholar
Tornebrandt, K. & Fletcher, R.Pre-operative chest X-rays in elderly patients. Anaesthesia 1982; 37: 901–902.CrossRefGoogle ScholarPubMed
Campbell, J. C.Detecting and correcting pulmonary risk factors before operation. Geriatrics 1977; 32: 54–57.Google ScholarPubMed
Tisi, G. M.Preoperative evaluation of pulmonary function. Am. Rev. Resp. Dis. 1979; 119: 293–310.Google ScholarPubMed
Schrader, L. L., McMillen, M. A., Watson, C. B.et al. Is routine preoperative hemodynamic evaluation of nonagenarians necessary?J. Am. Geriatr. Soc. 1991; 39: 1–5.CrossRefGoogle ScholarPubMed
Hole, A., Terjesen, T., & Breivik, H.Epidural versus general anesthesia for total hip arthroplasty in elderly patients. Acta Anaesth. Scand. 1980; 24: 279–287.CrossRefGoogle ScholarPubMed
Guillen, J. & Aldrete, J. A.Anesthetic factors influencing morbidity and mortality of elderly patients undergoing inguinal herniorrhaphy. Am. J. Surg. 1970; 120: 760–763.CrossRefGoogle ScholarPubMed
Miller, R., Marlar, K., & Silvay, G.Anesthesia for patients aged over ninety years. NY State J. Med. 1977; August: 1421–1425.Google ScholarPubMed
Davis, F. M., Woolner, D. F., Frampton, C.et al. Prospective, multi-centre trial of mortality following general or spinal anaesthesia for hip fracture surgery in the elderly. Br. J. Anaesth. 1987; 59: 1080–1088.CrossRefGoogle ScholarPubMed
Asbjørn, J., Jakobsen, B. W., Pilegaard, K.et al. Mental function in elderly men after surgery during epidural analgesia. Acta Anaesthesiol. Scand. 1989; 33: 369–373.CrossRefGoogle ScholarPubMed
Parker, M. J., Urwin, S. C., Handoll, H. H. G.et al. Regional versus general anesthesia for hip surgery in older patients: does the choice affect patient outcome?J. Am. Geriatr. Soc. 2002; 50: 191–194.CrossRefGoogle Scholar
Detsky, A., Abrams, H., McLaughlin, J.et al. Predicting cardiac complications in patients undergoing non-cardiac surgery. J. Gen. Intern. Med. 1986; 1: 211–219.CrossRefGoogle ScholarPubMed
Gerson, M. C., Hurst, J. M., Hertzberg, V. S.et al. Cardiac prognosis in noncardiac geriatric surgery. Ann. Intern. Med. 1985; 103: 832–837.CrossRefGoogle ScholarPubMed
Gerson, M. C., Hurst, J. M., Hertzberg, V. S.et al. Prediction of cardiac and pulmonary complications related to elective abdominal and noncardiac thoracic surgery in geriatric patients. Am. J. Med. 1990; 88: 101–107.CrossRefGoogle ScholarPubMed
Eagle, K. A., Berger, P. B., Calkins, H. et al. ACC/AHA guideline update for perioperative cardiovascular evaluation for non cardiac surgery: a report of the American College of Cardiology/American Heart Association task force on practice guidelines 2002 American College of Cardiology website http://www.acc.org/clinical/guidelines/perio/dirIndex.htm.
Mannion, J. D., Armenti, F. R., & Edie, R. N.Cardiac surgery in the elderly patient. Cardiovasc. Clin. 1992; 22: 189–207.Google ScholarPubMed
Kolh, P., Kerzmann, A., Lahaue, L.et al. Cardiac surgery in octogenarians: peri-operative outcome and long-term results. Eur. Heart J. 2001; 22: 1235–1243.CrossRefGoogle ScholarPubMed
Mittermair, R. P. & Muller, L. C.Quality of life after cardiac surgery in the elderly. J. Cardiovasc. Surg. 2002; 43: 43–47.Google ScholarPubMed
Ko, W., Gold, J. P., Lazzaro, R.et al. Survival analysis of octogenarian patients with coronary artery disease managed by elective coronary artery bypass surgery versus conventional medical treatment. Circulation 1992; 86(suppl): II191–197.Google ScholarPubMed
Glower, D. D., Christopher, T. D., Milano, C. A.et al. Performance status and outcome after coronary artery bypass grafting in persons aged 80 to 93 years. Am. J. Cardiol. 1992; 70: 567–571.CrossRefGoogle ScholarPubMed
Hoff, S. J., Ball, S. K., Coltharp, W. H.et al. Coronary artery bypass in patients 80 years and over: is off-pump the operation of choice?Ann. Thorac. Surg. 2002; 74: S1340–S1343.CrossRefGoogle Scholar
Al-Ruzzeh, S., George, S., Yacoub, M.et al. The clinical outcome of off-pump coronary artery bypass surgery in the elderly patient. Eur. J. Cardio-Thorac. Surg. 2001; 20: 1152–1156.CrossRefGoogle Scholar
Demaria, R. G., Carrier, M., Fortier, S.et al. Reduced mortality and strokes with off-pump coronary artery bypass grafting surgery in octogenarians. Circulation 2002; 106(12 Suppl 1): I5–I10.Google ScholarPubMed
Olsson, M., Granstrom, L., Lindblom, D.et al. Aortic valve replacement in octogenarians with aortic stenosis: a case-control study. J. Am. Coll. Cardiol. 1992; 20: 1512–1516.CrossRefGoogle ScholarPubMed
Pasic, M., Carrel, T., Laske, A.et al. Valve replacement in octogenarians: increased early mortality but good long-term result. Eur. Heart J. 1992; 13: 508–510.CrossRefGoogle ScholarPubMed
Davis, E. A., Gardner, T. J., Gillinov, M.et al. Valvular disease in the elderly: influence on surgical results. Ann. Thorac. Surg. 1993; 55: 333–338.CrossRefGoogle Scholar
Nair, C. K., Biddle, W. P., Kaneshige, A.et al. Ten-year experience with mitral valve replacement in the elderly. Am. Heart J. 1992; 124: 154–159.CrossRefGoogle ScholarPubMed
Bouma, B. J., Brink, R. B., Meulen, J. H.et al. To operate or not on elderly patients with aortic stenosis: the decision and its consequences. Heart 1999; 82: 143–148.CrossRefGoogle ScholarPubMed
Goldsmith, K., Lip, G. Y., Kaukuntla, H.et al. Hospital morbidity and mortality and changes in quality of life following mitral valve surgery in the elderly. J. Heart Valve Dis. 1999; 8: 702–707.Google ScholarPubMed
Tabayashi, K., Ohmi, M., Syohji, Y.et al. Thoracic aortic operations in patients aged 70 years or older. Ann. Thorac. Surg. 1992; 54: 279–282.CrossRefGoogle ScholarPubMed
Dean, R. H., Woody, B. A., Carn, E.et al. Operative treatment of abdominal aortic aneurysms in octogenarians: when is it too much too late?Ann. Surg. 1993; 217: 721–728.CrossRefGoogle ScholarPubMed
Ommer, A., Pillny, M., Grabitz, K.et al. Reconstruction surgery for carotid artery occlusive disease in the elderly – a high risk operation?Cardiovasc. Surg. 2001; 9: 552–558.CrossRefGoogle ScholarPubMed
Ekelund, A., Rydell, N., & Nilsson, O. S.Total hip arthroplasty in patients 80 years of age and older. Clin. Orthop. 1992; 281: 101–106.Google Scholar
Phillips, T. W., Grainger, R. W., Cameron, H. S.et al. Risks and benefits of elective hip replacement in the octogenarian. CMAJ 1987; 137: 497–500.Google ScholarPubMed
Harness, J. K., Strodel, W. E., & Talsma, S. E.Symptomatic biliary tract disease in the elderly patient. Am. Surg. 1986; 52: 442–445.Google ScholarPubMed
Margiotta, S. J., Horwitz, J. R., Willis, I. H.et al. Cholecystectomy in the elderlyAm. J. Surg. 1988; 156: 509–512.CrossRefGoogle ScholarPubMed
Pessaux, P., Tuech, J. J., Derouet, N.et al. Laparoscopic cholecystectomy in the elderly: a prospective study. Surg. Endosc. 2000; 14: 1067–1069.Google ScholarPubMed
Mayol, J., Martinez-Sarmiento, K., Tamayo, F. J.et al. Complications of laparoscopic cholecystectomy in the ageing patient. Age Ageing 1997: 26: 77–81.CrossRefGoogle ScholarPubMed
Brunt, L. M., Quasebarth, M. A., Dunnegan, D. L.et al. Outcomes analysis of laparoscopic cholecystectomy in the extremely elderly. Surg. Endosc. 2001; 15: 700–705.CrossRefGoogle ScholarPubMed
Smithy, W. B., Wexmer, S. D., & Dailey, T. H.The diagnosis and treatment of acute appendicitis in the aged. Dis. Colon Rectum 1986; 29: 170–173.CrossRefGoogle ScholarPubMed
McCallion, J., Canning, G. P., Knight, P. V.et al. Acute appendicitis in the elderly: a 5-year retrospective study. Age Aging 1987; 16: 256–260.CrossRefGoogle ScholarPubMed
Hui, T. T., Major, K. M., Avital, I.et al. Outcome of elderly patients with appendicitis: effect of computed tomography and laparoscopy. Arch. Surg. 2002; 137: 995–1000.CrossRefGoogle ScholarPubMed
Cohen, H., Willis, I., & Wallack, M.Surgical experience of colon resection in the extreme elderly. Am. Surg. 1986; 52: 214–217.Google Scholar
Stewart, B. T., Stitz, R. W., & Lumley, J. W.Laparoscopically assisted colorectal surgery in the elderly. Br. J. Surg. 1999; 86: 938–941.CrossRefGoogle ScholarPubMed
Schneider, J. & Benito, R.Extensive gynecologic surgical procedures upon patients more than 75 years of age. Surg. Gynecol. Obstet. 1988; 167: 497–500.Google ScholarPubMed
Lichtinger, M., Averette, H., Penalver, M.et al. Major surgical procedures for gynecologic malignancy in elderly women. South. Med. J. 1986; 79: 1506–1510.CrossRefGoogle ScholarPubMed
Roxburgh, J. C., Thompson, J., & Goldstraw, P.Hospital mortality and long-term survival after pulmonary resection in the elderly. Ann. Thorac. Surg. 1991; 51: 800–803.CrossRefGoogle ScholarPubMed
Thomas, P., Sielezneff, I., Ragni, J.et al. Is lung cancer resection justified in patients aged over 70 years?Eur. J. Cardio-Thorac. Surg. 1993; 7: 246–251.CrossRefGoogle ScholarPubMed
Sioris, T., Salo, J., Perhoniemi, V.et al. Surgery for lung cancer in the elderly. Scand. Cardiovasc. J. 1999; 33: 222–227.Google ScholarPubMed
Whittle, J., Steinberg, E. P., Anderson, G. F.et al. Results of colectomy in elderly patients with colon cancer, based on Medicare claims data. Am. J. Surg. 1992; 163: 572–576.CrossRefGoogle ScholarPubMed
Fitzgerald, S. D., Longo, W. E., Daniel, G. L.et al. Advanced colorectal neoplasia in the high-risk elderly patient: is surgical resection justified?Dis. Colon Rectum 1993; 36: 161–166.CrossRefGoogle ScholarPubMed
Colorectal Cancer Collaborative Group. Outcomes in older people undergoing operative intervention for colorectal cancer. Lancet 2000; 356: 968–974.
Vara-Thorbeck, C., Garcia-Caballero, M., Salvi, M.et al. Indications and advantages of laparoscopy-assisted colon resection for carcinoma in elderly patients. Surg. Laparosc. Endosc. 1994; 4: 110–118.Google ScholarPubMed
Sugimachi, K., Inokuchi, K., Ueo, H.et al. Surgical treatment for carcinoma of the esophagus in the elderly patient. Surg. Gyn. Obstet. 1985; 160: 317–319.Google ScholarPubMed
Xijiang, Z., Xizeng, Z., Xishan, H.et al. Surgical treatment for carcinoma of the esophagus in the elderly patient. Ann. Thorac. Cardiovasc. Surg. 1999; 5: 182–186.Google ScholarPubMed
Coluccia, C., Ricci, E. B., Marzola, G. G.et al. Gastric cancer in the elderly: results of surgical treatment. Int. Surg. 1987; 72: 4–10.Google ScholarPubMed
Matsushita, I., Hanai, H., Kajumura, M.et al. Should gastric cancer patients more than 80 years of age undergo surgery? Comparison with patients not treated surgically concerning prognosis and quality of life. J. Clin. Gastroenterol. 2002; 35: 29–34.CrossRefGoogle Scholar
Amsterdam, E., Birkenfeld, S., Gilad, A.et al. Surgery for carcinoma of the breast in women over 70 years of age. J. Surg. Oncol. 1987; 35: 180–183.CrossRefGoogle ScholarPubMed
Grube, B. J., Hansen, N. M., Ye, W.et al. Surgical management of breast cancer in the elderly patient. Am. J. Surg. 2001; 182: 359–364.CrossRefGoogle ScholarPubMed
Vaughn, M. S., Vaughn, R. W. & Cork, R. C.Postoperative hypothermia in adults: relationship of age, anesthesia, and shivering to rewarming. Anesth. Anal. 1981; 60: 746–751.Google Scholar
Heymann, A. D.The effect of incidental hypothermia on elderly surgical patients. J. Gerontol. 1977; 32: 46–48.CrossRefGoogle ScholarPubMed
Lipowski, Z. J.Transient cognitive disorders (delirium, acute confusional states) in the elderly. Am. J. Psychiatry 1983; 140: 1426–1436.Google Scholar
Bedford, P. D.General medical aspects of confusional states in elderly people. Br. Med. J. 1959; 2: 185–188.CrossRefGoogle ScholarPubMed
Blundell, E.A psychological study of the effects of surgery on eighty-six elderly patients. Br. J. Soc. Clin. Psychol. 1967; 6: 297–303.CrossRefGoogle ScholarPubMed
Marcantonio, E. R., Flacker, J. M., Wright, R. J.et al. Reducing delirium after hip fracture: a randomized trial. J. Am. Geriatr. Soc. 2001; 49: 516–522.CrossRefGoogle ScholarPubMed
Pathy, M. S.Clinical presentation of myocardial infarction in the elderly. Br. Heart J. 1967; 29: 190–199.CrossRefGoogle ScholarPubMed

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