Surgery in the Elderly — Outcome and Complication Pattern

  • L. S. Rasmussen
Conference paper


An increasing number of elderly patients is undergoing surgery. In addition, even elderly patients with significant concurrent disease are now frequently considered eligible for major surgical procedures. Generally, postoperative complications occur more frequently with increasing age. Age, however, is not in it self a very strong risk factor but the presence of chronic, age-related diseases increase with age and in addition, a predictable decrease in physiologic organ reserve is seen in the elderly. The elderly patient is therefore less able to compensate for any disturbance in organ function and clinical postoperative complications may result. Postoperative complications can be classified into cardiac, respiratory, infectious, and cerebral complications.


Cardiac Complication Postoperative Delirium Noncardiac Surgery Postoperative Pulmonary Complication Elective Cardiac Operation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Mangano DT (1990) Perioperative cardiac morbidity. Anesthesiology. 72: 153–84.PubMedCrossRefGoogle Scholar
  2. 2.
    Dirksen A, Kjoller E (1998) Cardiac predictors of death after non-cardiac surgery evaluated by intention to treat. BMJ 297: 1011–1013CrossRefGoogle Scholar
  3. 3.
    Zaugg M, Tagliente T, Lucchinetti E et al (1999) Beneficial effects from beta-adrenergic blockade in elderly patients undergoing noncardiac surgery. Anesthesiology 91: 1674–1686PubMedCrossRefGoogle Scholar
  4. 4.
    Mangano DT, Layug EL, Wallace A et al (1996). Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group. N Engl J Med 335: 1713–1720PubMedCrossRefGoogle Scholar
  5. 5.
    Pedersen T, Eliasen K, Henriksen E (1990) A prospective study of risk factors and cardiopulmonary complications associated with anaesthesia and surgery: risk indicators of cardiopulmonary morbidity. Acta Anaesthesiol Scand 34: 144–155PubMedCrossRefGoogle Scholar
  6. 6.
    Nimmo AF, Drummond GB (1996) Respiratory mechanics after abdominal surgery measured with continuous analysis of pressure, flow and volume signals. Br J Anaesth 1996 77: 317–326PubMedCrossRefGoogle Scholar
  7. 7.
    Rothen HU, Sporre B, Engberg G et al(1993) Re-expansion of atelectasis during general anaesthesia: a computed tomography study. Br J Anaesth 71: 788–795PubMedCrossRefGoogle Scholar
  8. 8.
    Viby-Mogensen J (2000) Postoperative residual curarization and evidence-based anaesthesia BrJ Anaesth 84: 301–303CrossRefGoogle Scholar
  9. 9.
    Eriksson LI, Sato M, Severinghaus JW (1993) Effect of a vecuronium-induced partial neuromuscular block on hypoxic ventilatory response. Anesthesiology 78: 693–699PubMedCrossRefGoogle Scholar
  10. 10.
    Berg H, Roed J, Viby-Mogensen J et al (1997) Residual neuromuscular block is a risk factor for postoperative pulmonary complications. A prospective, randomized, and blinded study of postoperative pulmonary complications after atracurium, vecuronium and pancuronium Acta Anaesthesiol Scand 41: 1095–1103Google Scholar
  11. 11.
    Moller JT, Cluitmans P, Rasmussen LS et al (1998) Long-term postoperative cognitive dysfunction in the elderly: ISPOCD1 study. Lancet 351: 857–861PubMedCrossRefGoogle Scholar
  12. 12.
    Rosenberg J, Ullstad T, Rasmussen J et al (1994) Time course of postoperative hypoxaemia. Eur J Surg 160: 137–143PubMedGoogle Scholar
  13. 13.
    Lewer BMF, Larsen PD, Torrance JM et al (1998) Artefactual episodic hypoxaemia during postoperative respiratory monitoring. Can J Anaesth 45: 182–185PubMedCrossRefGoogle Scholar
  14. 14.
    Jayr C, Thomas H, Rey A et al (1993) Postoperative pulmonary complications. Epidural analgesia using bupivacaine and opioids versus parenteral opioids. Anesthesiology 78: 666–676PubMedCrossRefGoogle Scholar
  15. 15.
    Wetterslev J, Hansen EG, Roikjaer O et al (2001) Optimizing perioperative compliance with PEEP during upper abdominal surgery: effects on perioperative oxygenation and complications in patients without preoperative cardiopulmonary dysfunction. Eur J Anaesthesiol 18: 358–365PubMedGoogle Scholar
  16. 16.
    Wallace WC, Cinat ME, Nastanski F et al (2000) New epidemiology for postoperative nosocomial infections. Am Surg 66: 874–878PubMedGoogle Scholar
  17. 17.
    Wacha H, Hau T, Dittmer R et al (1999) Risk factors associated with intraabdominal infections: a prospective multicenter study. Langenbecks Arch Surg 384: 24–32PubMedCrossRefGoogle Scholar
  18. 18.
    Jensen LS, Kissmeyer-Nielsen P, Wolff B et al (1996) Randomized comparison of leucocytedepleted versus buffy-coat-poor blood transfusion and complications after colorectal surgery. Lancet 348: 841–845PubMedCrossRefGoogle Scholar
  19. 19.
    Kurz A, Sessler DI, Lenhardt R (1996) Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med 334: 1209–1215PubMedCrossRefGoogle Scholar
  20. 20.
    Kam PCA, Calcroft RM.(1997) Peri-operative stroke in general surgical patients. Anaesthesia 52: 879–883PubMedCrossRefGoogle Scholar
  21. 21.
    Nosan DK, Gomez CR, Maves MD (1993) Perioperative stroke in patients undergoing head and neck surgery Ann Otol Rhin Laryng 102: 717–723Google Scholar
  22. 22.
    O’Keefe ST, Chonchubhair AN (1994) Postoperative delirium in the elderly. Br J Anaesth 73: 673–687CrossRefGoogle Scholar
  23. 23.
    Gustafson Y, Brännström B, Berggren D et al (1991) A geriatric-anesthesiologic program to reduce acute confusional states in elderly patients treated for femoral neck fractures. J Am Geriat Soc 39: 655–662PubMedGoogle Scholar
  24. 24.
    Rasmussen LS, Larsen K, Houx P et al (2001) The assessment of postoperative cognitive function. Acta Anaesthesiol Scand 45: 275–289PubMedCrossRefGoogle Scholar
  25. 25.
    Savageau JA, Stanton B, Jenkins CD et al (1982) Neuropsychological dysfunction following elective cardiac operation. Early assessment. J Thorac Cardiovasc Surg 84: 585–594PubMedGoogle Scholar
  26. 26.
    Shaw PJ, Bates D, Cartridge NEF et al (1987) Long-term intellectual dysfunction following coronary artery bypass graft surgery: a six month follow-up study. QJ Med 62: 259–268Google Scholar
  27. 27.
    Savageau JA, Stanton B, Jenkins CD et al (1982) Neuropsychological dysfunction following elective cardiac operation. II. A six-month reassessment. J Thorac Cardiovasc Surg 84: 595–600PubMedGoogle Scholar
  28. 28.
    Shaw PJ, Bates D, Cartridge NEF et al (1986) Early intellectual dysfunction following coronary bypass surgery. QJ Med 58: 59–68Google Scholar
  29. 29.
    Malheiros SMF, Brucki SMD, Gabbai AA et al (1995) Neurological outcome in coronary artery surgery with and without cardiopulmonary bypass. Acta Neurol Scand 92: 256–260PubMedCrossRefGoogle Scholar
  30. 30.
    Bedford PD (1955). Adverse cerebral effects of anaesthesia on old people. Lancet ii: 259–263CrossRefGoogle Scholar
  31. 31.
    Ghoneim MM, Hinrichs JV, O’Hara MW et al (1988) Comparison of psychologic and cognitive functions after general or regional anesthesia. Anesthesiology 69: 507–515PubMedCrossRefGoogle Scholar
  32. 32.
    Nielson WR, Gelb AW, Casey JE et al (1990) Long-term cognitive and social sequelae of general versus regional anesthesia during arthroplasty in the elderly. Anesthesiology 73: 1103–1109PubMedCrossRefGoogle Scholar
  33. 33.
    Jones MJT, Piggot SE, Vaughan RS et al (1990) Cognitive and functional competence after anaesthesia in patients aged over 60: controlled trial of general and regional anaesthesia for elective hip or knee replacement. Br Med J 300: 1683–1687CrossRefGoogle Scholar
  34. 34.
    Williams-Russo P, Sharrock NE, Mattis S et al (1995) Cognitive effects after epidural vs general anesthesia in older adults. JAMA 274: 44–50PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2002

Authors and Affiliations

  • L. S. Rasmussen
    • 1
  1. 1.Department of AnaesthesiaCopenhagen University HospitalRigshospitaletDenmark

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