Book Review

The Ageing Surgical Patient: Anaesthetic, Operative and Medical Management

N Engl J Med 1993; 329:69July 1, 1993

Article

The Ageing Surgical Patient: Anaesthetic, Operative and Medical Management
Edited by D.L. Crosby, G.A.D. Rees, and D.G. Seymour. 457 pp., illustrated. New York, John Wiley, 1992. $149.95. ISBN: 0-471-92847-X

There is an ever-growing number of elderly patients in the United States and the United Kingdom. It is estimated that by the year 2025, 16 percent of the U.S. population will be over the age of 65. As the population ages, the elderly represent a larger proportion of our adult population. Thus, The Ageing Surgical Patient, edited by Crosby, Rees, and Seymour, is particularly timely and important. This book thoroughly addresses the potential weaknesses that can occur in the evaluation of the elderly patient.

This concise book is written with British flair and has excellent, current references. In the first chapter, which is particularly well written, the authors present a superb overview of the physiology and pathophysiology of aging and its relation to surgical risk. This chapter not only deals with theoretical considerations but also provides practical guidelines with regard to gas exchange and fluid, electrolyte, and nutritional management. The Goldman Index of cardiac risk, a currently used evaluation tool, is also discussed. The remaining chapters focus on the specialized relations between anesthetic and surgical techniques in elderly patients. There is some variability in the quality and degree of depth of these chapters. In general, each succeeds in thoroughly addressing specific management issues. For example, in the chapter on urology, there is an excellent discussion of the problems associated with temperature decreases, fluid and electrolyte issues, and homeostatic complications.

Readers should be cautioned about differences in practice patterns between the United Kingdom and the United States. For example, in the chapter on breast cancer, a wedge mastectomy for operable tumors in fit patients is described. There are also superficial differences in management style resulting from economic limitations (for example, the approach to a second valve replacement and coronary bypass surgery in the elderly), but principles rather than practice patterns remain the primary focus of each chapter.

In summary, this is a well-written book dealing with issues related to surgical and anesthetic care of the elderly patient. It is well referenced, up to date, thorough, and practical. It allows for subtle differences in practice between the United Kingdom and the United States. The chapters deal primarily with management issues and often provide practical solutions. Although this book would not be appropriate for beginning medical students, it would make an excellent reference for practicing surgeons.

Timothy J. Eberlein, M.D.
Brigham and Women's Hospital, Boston, MA 02115