8.1OBJECTIVES OF SURGERY IN OLD PATIENTS 8.1 OBJECTIVES OF SURGERY IN OLD PATIENTS

The objective of performing surgery in geriatric patients is to prolong active, enjoyable life and procedures that offer no benefits to the patient should be avoided. However, a policy of avoiding all 'high risk' surgery would deny some patients with responsive conditions the benefits of surgical treatment.

The decision to perform elective surgery on old patients has to be a clinical judgement following full discussion with the owner. Owners should be made aware that older patients generally need preoperative screening, take longer to recover, require more post-surgical nursing, and may need careful (sometimes expensive) monitoring.

Ageing changes affecting the liver, kidneys, and the cardiovascular and respiratory systems are of major importance in anaesthesia. To maximise the benefits of any surgical procedure the physiological, pharmacological and pathological changes commonly seen in older animals need to be understood by both the surgeon and the anaesthetist.

A substantial proportion of surgery is performed in older animals, for example for the removal of tumours, and advancing age is not in itself a contraindication to major surgery or to the administration of a general anaesthetic. However, it is important to assess the elderly patient fully before surgery because they frequently have multiple organ system disease necessitating modifications in technique. Postoperative support is also very important, and mortality and morbidity may be higher if pre- and post-surgical risk factors are not managed properly.