Skip to main content

Frailty and Surgery in the Elderly

  • Chapter
  • First Online:
Principles and Practice of Geriatric Surgery

Abstract

Conventional surgical wisdom has long held that the elderly do not tolerate surgery as well as their younger counterparts. Numerous case series comparing outcomes such as morbidity and length of stay often corroborate that viewpoint. However, the older surgical population displays great heterogeneity, and that heterogeneity is not always obvious from preoperative morbidities and preoperative testing criteria. In fact, we have on numerous occasions been surprised by the elderly patient who beats the odds following surgery, and the patient who, ostensibly, should recover well, but does not.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Makary MA, Winter JM, Cameron JL, Campbell KA, Chang D, Cunningham SC et al (2006) Pancreaticoduodenectomy in the very elderly. J Gastrointest Surg 10(3):347–356

    Article  PubMed  Google Scholar 

  2. Filsoufi F, Rahmanian PB, Castillo JG, Chikwe J, Silvay G, Adams DH (2008) Excellent early and late outcomes of aortic valve replacement in people aged 80 and older. J Am Geriatr Soc 56(2):255–261

    Article  PubMed  Google Scholar 

  3. Boyd JB, Bradford B Jr, Watne AL (1980) Operative risk factors of colon resection in the elderly. Ann Surg 192:743–746

    Article  PubMed  CAS  Google Scholar 

  4. Hamel MB, Henderson WG, Khuri SF, Daley J (2005) Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc 53(93):424–429

    Article  PubMed  Google Scholar 

  5. Fried LP, Walston J (1993) Frailty and failure to thrive. In: Principles of geriatric medicine and gerontology, 3rd edn. McGraw-Hill, New York, pp 241–248

    Google Scholar 

  6. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146–M156

    Article  PubMed  CAS  Google Scholar 

  7. Taylor HL, Jacobs DR Jr, Schuker B, Knudsen J, Leon AS, Debacker G (1978) A questionnaire for the assessment of leisure-time physical activities. J Chronic Dis 31:745–755

    Article  Google Scholar 

  8. Orme J, Reis J, Herz E (1986) Factorial and discriminate validity of the Center for Epidemiologic Studies depression (CES-D) scale. J Clin Psychol 42:28–33

    Article  PubMed  CAS  Google Scholar 

  9. Rothman RD, Leo-Summers L, Gill TM (2008) Prognostic significance of potential frailty criteria. J Am Geriatr Soc 56(12):2211–2216

    Article  PubMed  Google Scholar 

  10. Walston J, Hadley EC, Ferrucci L, Guralnik JM, Newman AB, Studenski SA et al (2006) Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the AGS/NIA on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc 54(6):991–1001

    Article  PubMed  Google Scholar 

  11. Walston J, McBurnie MA, Newman A, Tracy RP, Kop WJ, Hirsch CH et al (2002) Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study. Arch Intern Med 162:2333–2341

    Article  PubMed  Google Scholar 

  12. Harris TB, Ferrucci L, Tracy RP, Corti MC, Wacholder S, Ettinger WH Jr et al (1999) Associations of elevated IL-6 and C-reactive protein levels with mortality in the elderly. Am J Med 106:506–512

    Article  PubMed  CAS  Google Scholar 

  13. Ershler WB, Keller ET (2000) Age-associated increased interleukin-6 gene expression, late-life diseases, and frailty. Annu Rev Med 51:245–270

    Article  PubMed  CAS  Google Scholar 

  14. Stookey JD, Purser JL, Pieper CF, Cohen HJ (2004) Plasma hypertonicity: another marker of frailty? J Am Geriatr Soc 52:1313–1320

    Article  PubMed  Google Scholar 

  15. Kamath PS, Wiesner RH, Malinchoc M et al (2001) A model to predict survival in patients with end-stage liver disease. Hepatology 33(2):464–470

    Article  PubMed  CAS  Google Scholar 

  16. Makary MA, Segev DL, Fried LP, Syin D, Bandeen-Roche K, Patel P et al (2006) Frailty as a predictor of surgical outcomes in older patients. Paper presented at first annual academic surgical congress, San Diego, CA, 7–10 February 2006

    Google Scholar 

  17. Saklad M (1941) Grading of patients for surgical procedures. Anesthesiology 2:281–284

    Article  Google Scholar 

  18. Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF et al (1999) Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 100(10):1043–1049

    Article  PubMed  CAS  Google Scholar 

  19. Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE et al (2007) ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: executive summary a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Circulation 116:1971–1996

    Article  PubMed  Google Scholar 

  20. O’Connell JB, Maggard MA, Ko CY (2004) Cancer-directed surgery for localized disease: decreased use in the elderly. Ann Surg Oncol 11(11):962–969

    Article  PubMed  Google Scholar 

  21. Ryynanen OP, Myllykangas M, Kinnunen J, Takala J (1997) Doctors’ willingness to refer elderly patients for elective surgery. Fam Pract 14(3):216–219

    Article  PubMed  CAS  Google Scholar 

  22. Bouma BJ, van der Meulen JH, van den Brink RB, Arnold AE, Smidts A, Teunter LH et al (2001) Variability in treatment advice for elderly patients with aortic stenosis: a nationwide survey in The Netherlands. Heart 85(2):196–201

    Article  PubMed  CAS  Google Scholar 

  23. Studenski S, Hayes RP, Leibowitz RQ, Bode R, Lavery L, Walston J, Duncan P, Perera S (2004) Clinical global impression of change in physical frailty: development of a measure based on clinical judgment. J Am Geriatr Soc 52:1560–1566

    Article  PubMed  Google Scholar 

  24. Lawrence VA, Hazuda HP, Cornell JE, Pederson T, Bradshaw PT, Mulrow CD, Page CP (2004) Functional independence after major abdominal surgery in the elderly. J Am Coll Surg 199(5): 762–772

    Article  PubMed  Google Scholar 

  25. Milne AC, Potter J, Avenell A (2002) Oral protein and energy supplements reduce all-cause mortality in elderly persons. Cochrane Database Syst Rev (3):CD003288

    Google Scholar 

  26. Leung JM, Dzankic S (2001) Relative importance of preoperative health status versus intraoperative factors in predicting postoperative adverse outcomes in geriatric surgical patients. J Am Geriatr Soc 49:1080–1085

    Article  PubMed  CAS  Google Scholar 

  27. Hutchings LF, Unger JM, Crowley JJ, Coltman CA JR, Albain KS (1999) Underrepresentation of patients 65 years of age or older in cancer-treatment trials. New Engl J Med 34:2061–2067

    Article  Google Scholar 

  28. Benson AB III, Pregler JP, Bean JA, Rademaker AW, Eshler B, Anderson K (1991) Oncologists’ reluctance to accrue patients onto clinical trials: an Illinois Cancer Center study. J Clin Oncol 9:2067–2075

    PubMed  Google Scholar 

  29. Leng S, Chaves P, Koenig K, Walston J. Serum interleukin-6 and hemoglobin as physiological correlates in the geriatric syndrome of frailty: a pilot study. J Am Geriatr Soc 50(7):1268–1271

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Orandi, B.J., Winter, J.M., Segev, D.L., Makary, M.A. (2011). Frailty and Surgery in the Elderly. In: Rosenthal, R., Zenilman, M., Katlic, M. (eds) Principles and Practice of Geriatric Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-6999-6_9

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-6999-6_9

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-6998-9

  • Online ISBN: 978-1-4419-6999-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics