Surgery for the Aged

Even more startling than recent overall advances in surgery is the improved outlook for aged patients who need operations. Surgeons used to dread such cases; all too often the patient went into shock on the operating table, or died soon after of pneumonia. How radically things have changed is pointed out by Surgeon Sidney E. Ziffren of the State University of Iowa. "Successful surgery is now constantly performed in the aged," he notes. "Surgery should not be withheld because of a patient's age."

Only in the last eight years has this become possible, says Dr. Ziffren, because of many new insights gained by surgeons. Among them:

P: Many older patients neglect their diets, but where such deficiency used to be treated by suddenly feeding them a rich diet--which often upset their metabolism --doctors have now learned to enrich the diet gradually, add vitamins liberally.

P: With their lowered metabolism, old people have a reduced blood volume, and surgeons now know how to raise the volume by transfusion during operation.

P: However, the aged actually need a smaller fluid volume than younger persons, so in trying to guard against a deficit, doctors now take care not to boost the patient's fluid volume too high--otherwise, there is a risk of pneumonia.

P: The aged need less salt than the young; doctors no longer give it intravenously during surgery unless a definite salt deficit is proved.

P: Anesthesia is kept to a minimum, so that the patient is already "coming out" at the end of the operation, thereby reducing strain on the heart and further reducing the pneumonia risk.

The value of these unspectacular but important lessons is shown in the increased frequency of surgery in Iowa's institutions for the aged: a 50% increase in operations on patients over 60 since 1952, and a 64% increase (from 369 to 606) on those over 80, with proportionately fewer deaths than ever before.

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