Medical considerations in older surgical patients
Medical considerations in older surgical patients
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DOI：
10.1016/j.jamcollsurg.2006.08.006
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发表时间：
2006-11-01
影响因子：
5.2
通讯作者：
Burton, John R.
中科院分区：
文献类型：
--
作者：
Christmas, Colleen;Makary, Martin A.;Burton, John R.
在过去的二十年里，医疗保健、手术技术和麻醉方法的进步使手术越来越安全。与此同时，新的预防战略、治疗方法、技术和公共卫生方面的进步使预期寿命显著延长。恶性肿瘤和血管疾病等疾病的主要治疗方式往往包括手术，这些疾病在老年人，特别是80岁以上的老年人中非常常见。目前，大约有一半的手术是在65岁以上的患者中进行的，但基于越来越有利的风险-收益比，预期寿命的延长以及手术指征的增长，计算得出，到2020年，平均手术工作量将增加14%至47%。1决定高龄患者的手术需要很强的临床判断，包括对每个个体独特的手术风险-收益比的具体因素的认识。急诊手术几乎没有绝对的禁忌症，而且越来越多的择期手术也是如此。许多经验丰富的外科医生和外科教科书都指出，年纪很大的病人可以在一次大手术中存活下来，但往往无法应对相关的术后并发症。因此，临床医生在为老年患者提供任何手术的独特风险和益处因素建议时，必须仔细进行术前评估。决定赞成或反对手术的独特性源于一种称为衰老异质性的复杂现象。
Over the past 2 decades, advances in medical care, surgical techniques, and anesthetic approaches have made surgery increasingly safe. At the same time, new preventive strategies, treatments, technologies, and advances in public health have resulted in a remarkably increased life expectancy. Conditions such as malignancy and vascular disease, in which the primary mode of treatment often involves surgery, are very common in the elderly, especially those who are older than 80 years of age. Currently, approximately half of all operations are performed in patients over the age of 65 years, but based on the increasingly favorable risk-to-benefit ratio, increasing life expectancy, and a growth of surgical indications, it is calculated that the average surgical workload will increase by 14% to 47% by 2020. 1 Deciding about surgery in very elderly patients requires great clinical judgment involving the recognition of factors specific to the unique surgical risk-to-benefit ratio in each individual. There is almost no absolute contraindication to emergency surgery, and, increasingly, this is also the case for elective operation. Many experienced surgeons and surgical textbooks 2 state that very elderly patients can survive one major operation, but often not the related postoperative complications. So the clinician advising an elderly patient about the unique risk and benefit factors for any given operation must carefully perform a preoperative evaluation. The uniqueness of the decision for or against surgery derives from the complex phenomena called the heterogeneity of aging.