We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editorial |

Geriatric Surgery Past, Present, and Future

Michael Zenilman, MD
Arch Surg. 2012;147(1):10. doi:10.1001/archsurg.2011.1040.
Text Size: A A A
Published online


In February 2007, I wrote an editorial titled “Surgery in the Geriatric Patient: Aging, the Heart, Emergencies, and Us.”1 I expanded on the premise that comorbid illnesses, specifically cardiac disease and emergency status, were the most powerful predictors of outcomes for elderly patients.

Well, that was the past. My position was based on the observation that for most surgical interventions, such as abdominal, cardiac, or vascular surgery, the increase in mortality with age was not based on the actual chronologic number. When concomitant medical diseases were controlled (eg, cardiac, pulmonary and respiratory systems, and emergency situations), the age-related mortality rates increased only slightly. For example, middle-aged persons with 3 comorbidities have similar mortality rates as septuagenarians with the same number of comorbidities. In only a few surgical illnesses such as trauma and burns were mortality rates dependent on chronologic age and independent of comorbidities. The postulate was that if we controlled for these factors, surgery in elderly patients is safe. The Charlson Comorbidity Index is the standard measurement for the concomitant disease.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

7 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles