E. Lee Strohl

Abdominal surgery in the aged patient.

The objective of the American Geriatrics Society is the clinical study of geriatrics in the broadest sense. This includes the study of the causes, the prevention and treatment of diseases of advancing years, the rehabilitation of patients, and the dissemination of this knowledge (1). Despite the advances in the field of surgery, there lingers a traditional reluctance on the part of physicians to refer old patients for surgery. Is it possible that our surgical failures of thirty years ago influence the thinking of physicians more than our surgical successes of today? When one is confronted with the problem of surgery in the elderly patient, a few basic concepts should be borne in mind (2). 1. In 1850, the half million old people could be told they were too old for surgery, but the 12% million old people of the 1950’s refuse to be considered so carelessly. This group of people is increasing in size, and will approach 23 million in 1970. 2. The chronologic age does not parallel the physiologic age. On many occasions, the patriarch of 80 can undergo surgery more satisfactorily than the ne’er-do-well in his 30’s. 3. Tissue healing occurs equally well a t all ages. The elderly patient has the same ability to lay down fibrous tissue as has the young adult (3). 4. In old patients, the complications in the preoperative and postoperative periods are higher. These complications, however, are not related necessarily to the problem at hand. 5. Taking the foregoing factors into consideration, the criteria for surgery in the elderly patient are: A. Is surgery essential to save the patient’s life? B. Will operation remove the physical disability, and rehabilitate the patient