Surgical Considerations in the Elderly

Question 1

Physiologic aging or senescence, is defined as decreased fucntional reserve of critical organ system. It is generally believed to occur at what age

Answer 1

70

Question 2

Frailty is a major risk factor for postoperative complications. It is associated with what measures contributing to failty

Answer 2

Impaired cognition, One or more falls in past 6 months, Hematocrit <35%

Question 3

What is the most common indication for surgical intervention in the elderly?

Answer 3

Biliary tract disease

Question 4

What is the leading cause of postoperative morbidity and ortality in the elderly?

Answer 4

Congestive heart failure

• Impaired cardiac reserve means that elderly patients cannot increase their ejection fraction as demand increases
• Dependent on ventricular filling and increased stroke volume to meet the need for increased output
• Fluid overload is poorly tolerated can result in congestive heart failure

Question 5

Elderly patients with acute peritonitis may not present with typical symptoms of acute abdominal pain, fever, or leukocytosis due to an impaired immune response. A high index of suspicion is needed as the intial clinical diagnosis in elderly patients with acute appendicitis is correct in what percent of cases

Answer 5

less than 50%

Question 6

Determination of an elderly patient’s nutritional status and reversal of malnutrition is important to prevent these complications

Answer 6

Poor wound healing, Increased nosocomial infections, Delayed functional recovery

• 9 to 15% of aptients older than 65 years are malnoursihed in the outpatient setting, and this icnreases to 12 to 50% in the acute hospital setting
• The incidence of postoperative complications is increased in patients with an albumin level <3.5 g/L

Question 7

In elderly patients undergoing heart valve replacement, bioprosthetic valves are preferred over synthetic valves because ________

Answer 7

There is less need for anticoagulation which is hazardous in the elderly

Question 8

Cancer treatment in elderly patients is _______

Answer 8

Complicated by the fact that clinical trials usually do not include elderly patients

• Survival after surgery is nearly equivalent for same stage malignancy as in younger patients

Question 9

Avoidance of srugical resection of breast cancer in an elderly patient is unacceptable because

Answer 9

Mortality rates of breast surgey are very low in the elderly

• less than 1%

Question 10

What is the likelihood that an asymptomatic, 2 cm, solitary pulmonary nodule seen in chest xray in a 70 year old smoker in a malignancy

Answer 10

70%

• Peak incidence is between 75 to 79 years
• non small cell lung cancer accounts for roughly 80% of all cases
• In cases of resectable primary lung cancer, resection remains the treatment of choice, with an expected survival of almost 3 years

Question 11

In elderly trauma patients, injuries from falls accounts for about 20% of etiologies. The management of these is complicated by__________

Answer 11

• concurrent medication use including anticoagulants
• Coexisting dementia and cerebrovascular disease
• Underlying cardiac arrythmias

Question 12

Minimally invasive approaches to surgical treatment have been shown to be associated with reduced morbidity and mortality in elderly patients for ____________

Answer 12

• Repair of abdominal aortic aneurysm
• Removal of gallbladder
• Colon resection

Question 13

Goals of palliative surgery

Answer 13

Relief of symptoms, preservation of quality of life, Prevention of complications of disease

Question 14

The goals of ethical decision making in the elderly patient includes _______________

Answer 14

• Acknowledgement of medical futility
• Clarify and follow patients’ wishes regarding like-sustaining therapy
• Respect patient’s autonomy to decide he course of therapy

The primacy of the patient and his/her decisions regarding their own care is of greatest importance in the ethical care of the elderly surgical patient

Question 15

The combined recommendations of the American college of surgeons National Surgical Quality Improvement Program and the American Geriatrics Society have provide best practice guidelines for the preoperative evaluation of elderly surgical patients, These recommendations are required standards for training programs in which of the following specialties?

Answer 15

General surgery residency training

Cardiothoracic surgical residency training

Vascualr surgical residency training