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Chapter 47: Surgical Considerations in the Elderly

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Physiologic aging, or “senescence,” is defined as decreased functional reserve of critical organ systems. It is generally believed to occur at what age?

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A. 55 years

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B. 70 years

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C. 90 years

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D. No defined age

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Answer: B

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The cut off for the definition of senescence has increased from 55 years in the late 1960s to 70 years currently. This is a general definition as each patient should be assessed for their own capacity to respond to the stress of surgery. (See Schwartz 10th ed., p. 1923.)

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Frailty is a major risk factor for postoperative complications. Which of the following measures does NOT contribute to frailty?

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A. Impaired cognition

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B. One or more falls in past 6 months

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C. Osteoporosis

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D. Hematocrit <35%

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Answer: C

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Frailty, disability (inability to perform more than one activity of daily living), and comorbidities such as anemia and hypoalbuminemia are the primary conditions which impact on the outcome of surgical procedures in the elderly. Each condition should be assessed preoperatively. (See Schwartz 10th ed., p. 1926.)

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

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A. Coronary disease

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B. Appendiceal disease

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C. Long bone fracture

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D. Biliary tract disease

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Answer: D

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Biliary tract disease due to pigmented or cholesterol stone formation and acute cholecystitis are common problems in the elderly and most likely to lead to surgical intervention. The mortality risk of emergency cholecystectomy is four times that of elective cholecystectomy in the elderly. (See Schwartz 10th ed., p. 1924.)

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

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A. Congestive heart failure

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B. Cerebrovascular accident

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C. Pneumonia

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D. Renal failure

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Answer: A

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Impaired cardiac reserve means that elderly patients cannot increase their ejection fraction as demand increases, but are dependent on ventricular filling and increased stroke volume to meet the need for increased output. Intravascular volume is therefore critically important, but ...

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