Der Orthopäde
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The percentage of elderly people in our population is increasing, and anaesthesiologists and surgeons need to find ways of decreasing perioperative complications in these patients. The chronological age is of lesser importance than biological age as far as the risks of perioperative complications are concerned. Indicators for biological age are the number and type of previous diseases, nutritional status and the doctor's clinical impression of the patient. ⋯ The most frequent perioperative complications are alterations to the cardiopulmonary system and postoperative bleeding. Even minor perioperative complications can have a predictive value for later fatal events. Thus, careful preoperative preparation, a suitable anaesthetic procedure and a fast and atraumatic mode of operation will help to decrease perioperative complications in elderly patients.
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The altered physiology of the older patient in combination with the increased number of disease processes increases the potential risk of perioperative complications. The usual diagnostic procedures often fail to uncover the multiple problems these patients have. ⋯ Special considerations include an evaluation of the nutritional status, the functional capabilities and an assessment of the patients' cognitive and emotional status. This type of comprehensive assessment helps the physician to minimize the perioperative risks for older patients and is an excellent tool for improving the postoperative care and rehabilitation procedures.