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Jan 2012

Geriatric Surgery: Past, Present, and Future

Author Affiliations

Author Affiliation: Department of Surgery/Suburban Hospital, Johns Hopkins Medicine, Bethesda, Maryland.

Arch Surg. 2012;147(1):10. doi:10.1001/archsurg.2011.1040

In February 2007, I wrote an editorial titled “Surgery in the Geriatric Patient: Aging, the Heart, Emergencies, and Us.”1 I expanded on the premise that comorbid illnesses, specifically cardiac disease and emergency status, were the most powerful predictors of outcomes for elderly patients.

Well, that was the past. My position was based on the observation that for most surgical interventions, such as abdominal, cardiac, or vascular surgery, the increase in mortality with age was not based on the actual chronologic number. When concomitant medical diseases were controlled (eg, cardiac, pulmonary and respiratory systems, and emergency situations), the age-related mortality rates increased only slightly. For example, middle-aged persons with 3 comorbidities have similar mortality rates as septuagenarians with the same number of comorbidities. In only a few surgical illnesses such as trauma and burns were mortality rates dependent on chronologic age and independent of comorbidities. The postulate was that if we controlled for these factors, surgery in elderly patients is safe. The Charlson Comorbidity Index is the standard measurement for the concomitant disease.