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Book and Media Reviews
May 9, 2012

Principles and Practice of Geriatric Surgery

Author Affiliations

Author Affiliations: Metropolitan Surgical Associates and Department of Surgery, Mercy Hospital, Chicago, Illinois (djk1956@msn.com).

JAMA. 2012;307(18):1981. doi:10.1001/jama.2012.4472

Two premises underlie geriatric surgery textbooks: elderly patients respond differently to the stresses of surgery, and by understanding these differences, surgeons can enhance care and improve outcomes. A central theme of the first edition of Principles and Practice of Geriatric Surgery suggested that, when controlling for comorbid illness and emergency surgery, chronologic age is not a contraindication to surgery. A decade has passed since the first edition, and most, if not all, surgeons now accept that an individual's physiology trumps chronological age as a reliable determinant of operative risk. As such, the clinician's conundrum becomes how to objectively determine an individual's physiologic reserve. For instance, many surgeons operate on elderly patients who recover quite uneventfully despite expectations to the contrary. More disconcerting, however, are the patients expected to tolerate surgery but who lack so-called reserve and instead follow a downward postoperative course.