Perioperative responsibilities of the surgeon.

Surgery is as effective in the elderly as in any age group and should not be denied on the basis of age. The elderly need and deserve more courtesy and respect. Meticulous attention to preoperative preparation is critical. Anticipation of problems such as hypokalemia and dependency on tranquilizers and prompt preemptive action go a long way toward the prevention of complications. Preoperative invasive monitoring in the ICU using a Swan-Ganz catheter and appropriate volume preloading will reduce operative mortality in high-risk patients. Suitable candidates are best recognized by lung function studies and blood gases in addition to a global assessment. The operation itself must be kept simple, and the surgeon needs to work swiftly but gently. The elderly require particular attention to the prevention of specific complications. Urinary catheters, nasogastric tubes, and prolonged parenteral nutrition should be avoided whenever possible. Immobility for any length of time is to be condemned. Heparin prophylaxis against thromboembolism and antibiotic prophylaxis are liberally employed. Finally, should the elderly patient develop a major complication, this complex situation must be handled with both skill and compassion. The surgeon must not lose sight of the fact that the goal is most often palliation and that quality of life is paramount.