دانلود کتاب Principles and Practice of Geriatric Surgery

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Preface to the Third Edition Preface to the Second Edition Preface to the First Edition Contents About the Editors List of Section Editors Contributors Part I: Principles 1 Principles of Geriatric Surgery Introduction Principle I: Clinical Presentation Principle II: Lack of Reserve Principle III: Preoperative Preparation Principle IV: Emergency Surgery Principle V: Attention to Detail Principle VI: Age is a Scientific Fact Conclusion References 2 Defining Quality of Care Impact of the Aging Population Quality of Care in Surgery Quality of Care Definitions Cognitive Impairment Functional Status Frailty Medication Management Patient Goals and Preferences The Coalition for Quality in Geriatric Surgery (CQGS) Conclusion References 3 Biology of Aging Geroscience and the Surgical Patient Immunosenescence and Inflammaging Hemostasis Delirium Cardiovascular Gastrointestinal Metabolic and Endocrine Renal Summary References 4 Surgery in Centenarians Introduction History Case Studies Case 1 Case 2 Case 3 Discussion Physiologic Changes in Centenarians Pathology in Centenarians Determinants of Extreme Longevity Selective Survival Hypothesis Supercentenarians Conclusions References 5 Geriatric Syndromes Introduction Assessment of the Geriatric Surgical Patient Common Geriatric Syndromes in the Setting of Surgical Care Frailty Delirium Dementia Depression Falls Hearing Impairment Visual Impairment Urinary Incontinence Sleep Disorders Conclusion References Part II: Preoperative Assessment 6 Patient-Centered Surgical Decision Making Introduction Clinical Vignette What is Patient-Centered Decision Making? Barriers to Patient-Centered Decision Making Approach to Patient-Centered Decision Making in Geriatric Surgery Setting the Stage: Conveying Overall Prognosis and the Problem of Uncertainty Identify More than One Treatment Option and the Need to Work Together to Make a Decision Describe the Treatment Options Elicit Patient Values and Goals Make a Recommendation Conclusion References 7 Frailty Introduction What Is Frailty? Limitations of Age (Superiority of Frailty Measurements) Pathophysiology Sarcopenia: Two Sides of the Same Coin Clinical Implementation of Frailty Frailty Index Frailty Score FI Versus FS Frailty and Kinesiology Preoperative Assessment Postoperative Outcomes Complications Length of Stay Discharge Disposition Hospital Resources Failure to Rescue Conclusion References 8 Function and Prehabilitation Preoperative Assessment for Prehabilitation Exercise Tolerance Sarcopenia and Frailty Cognitive Assessment Nutritional Assessment Summary Prehabilitation to Enhance Postoperative Outcome Prehabilitation to Attenuate Deconditioning Literature on Surgical Prehabilitation Prehabilitation for the Frail Elderly Patient Duration of Prehabilitation Preoperative Exercise Activity to Enhance Functional Capacity Optimizing Prehabilitation with Nutrition Monitoring Prehabilitation Conclusions References 9 Preoperative Cognitive Assessment in Older Adults Introduction The Aging Brain Cognitive Impairment and Dementia Preoperative Cognitive Screening Mini Mental State Examination (MMSE) Montreal Cognitive Assessment (MoCA) Mini-Cog General Practitioner Assessment of Cognition (GPCOG) Verbal Fluency Test Optimizing Patients with Cognitive Impairment Conclusion References 10 Nutrition in the Geriatric Surgical Patient Clinical Vignette Introduction Factors Contributing to Geriatric Malnutrition Physiologic Psychologic Socioeconomic Nutritional Assessment of Geriatric Patients History and Physical Exam Subjective Global Assessment Biochemical Markers Albumin Transthyretin (Prealbumin) and C-Reactive Protein Other Biochemical Markers Body Composition and Anthropometric Measures Ultrasonography Anthropometry Sarcopenia and Frailty Functional Assessment Nutritional Assessment Scoring Systems Mini Nutritional Assessment GNRI MUST NRS 2002 Impact of Nutrition on Outcomes Nutrition Optimization Energy Requirements in the Elderly Perioperative Nutrition Management Oral supplementation Enteral Nutrition Parenteral Nutrition Refeeding Syndrome ``Prehabilitation´´ Comprehensive Geriatric Assessment Conclusion References 11 Medication-Related Problems in Surgical Patients Biology of Aging Drug Absorption Distribution Metabolism Pharmacogenomics and the Cytochrome P450 Enzymes Renal Elimination Medication-Related Problems in the Elderly Polypharmacy, Potentially Inappropriate Medications, and the Surgeon Preoperative Medication Therapy Management Medication Selection in Older Adults Medication Review and Reconciliation De-prescribing Specific Prescribing Issues Delirium Antipsychotics Antidepressants Anxiolytics Sedative/Hypnotics Pain Management Antihistamines Antibiotics Summary References 12 Cancer in Older Adults Introduction Preoperative Considerations Life Expectancy Decision-Making Capacity Goals of Care Comprehensive Geriatric Assessment Treatment Approaches Planning and Sequencing of Care Surgical Therapy Radiation Therapy Systemic Therapy Specific Chemotherapy-Related Challenges Targeted Therapy and Immunotherapy Evaluation Prior to Systemic Therapy Disease-Specific Treatment Recommendations in Elderly Cancer Patients Breast Cancer Lung Cancer Colorectal Cancer Liver Cancer Prostate Cancer Bladder Cancer Ovarian Cancer Melanoma Conclusion References 13 Diabetes in Older Adults Introduction Epidemiology, Pathophysiology, and Diagnosis of Diabetes Acute and Chronic Complications Acute Complications Chronic Complications Goals of Treatment in Older Adults Tools of Glucose Management Management of Glucose in the Hospital Conclusion References 14 Cardiac Disease in Older Adults Introduction Afterload Preload Contractility Diastolic Function Cardiovascular Response to Exercise Age-Related Changes in Cardiovascular Function Treatment of Congestive Heart Failure Abnormal Left Ventricular Ejection Fraction Normal Left Ventricular Ejection Fraction Other Cardiovascular Disorders Aortic Valvular Disease Mitral Valvular Disease Conduction Defects Conclusions References 15 Pulmonary Disease in the Older Adult Airways and Lung Parenchyma Lung Shape Conducting Airways Lung Parenchyma Mechanical Properties of the Lungs Changes in Lung Recoil Due to Surface Forces Changes in Structural Macromolecules Chest Wall Muscles of Respiration Control of Breathing Diminished Ventilatory Response to Hypercapnia Diminished Ventilatory Response to Hypoxia Diminished Occlusion Pressure Responses Respiratory Load Compensation and Dyspnea Pulmonary Circulation Pulmonary Function Tests Lung Volumes Airflow Gas Exchange Summary and Implications for Geriatric Surgery References 16 Renal Disease in Older Adults Assessing Renal Function in the Older Surgical Patient Specific Concerns for the Older Patient with Kidney Disease Undergoing Surgery Volume Management Hypertension Hyperkalemia Metabolic Acidosis Preventive Strategies for Acute Kidney Injury in the Perioperative Period Ischemic Kidney Injury Avoiding Nephrotoxins Surgery in the Older Adult Patient with End-Stage Renal Disease on Dialysis Timing of Dialysis Prior to Surgery Protecting Vascular Access in Hemodialysis Patients References 17 Traumatic Injury in Older Adults Introduction: Epidemiology of Injury in the Elderly The Impact of Altered Physiology and Comorbid Disease Changes in Physiology by Organ System Central Nervous System Cardiovascular Pulmonary Renal Disease Musculoskeletal Gastrointestinal Metabolic/Endocrine Immunology Common Injury Patterns in the Elderly Falls Motor Vehicle Collision Pedestrian-Motor Vehicle Collision Depression, Substance Abuse, and Suicide Burns Elder Abuse Management of the Elderly Injured Patient Triage Initial Management and Resuscitation Considerations for Specific Injuries in the Elderly Head Injuries Spinal Injuries Thoracic Injuries Abdomen/Pelvis Injuries Fractures Rehabilitation and Disposition Long-Term Outcome Injury Prevention Decision-Making Capability End of Life/Withdrawal of Treatment Conclusion Case Study Physical Exam Lab Work Radiographs Things to Consider Hospital Course References 18 Ethical Issues in Older Adults Introduction Truth-Telling Informed Consent Assessment of Decisional Capacity Decision-Making for Incapacitated Patients (Table 6) DNR Orders in the Operating Room Confidentiality Limits to Autonomy and Choice (Futility) Prognostication Decisions Near the End of Life Conclusion References 19 Legal Issues in Older Adults Introduction Medical Malpractice Duty/Standard of Care Breach of Duty Damage or Injury Causation Informed Consent Elements Voluntariness Knowledge or Information Decisional Capacity Exceptions to the Consent Requirement Documentation of Consent Advance Medical Planning Surrogate/Proxy Decision Making Advance Planning Guardianship Default Authority Statutes ``Unbefriended´´ Patients Nonbeneficial Surgery Research Context Confidentiality Patient Safety and Risk Management Safety Checklists Hospital Credentialing Documentation Error Disclosure and Apology Conclusion References 20 Physiologic Responses to Anesthesia in the Elderly Introduction A Patient Cardiovascular Implications of Anesthesia in the Elderly Cardiovascular Changes with Aging that Affect Anesthetic Physiology Left Ventricle Structure and Function Conduction Abnormalities Autonomic Responses Cardiac Disease The Interplay of the Aging Cardiovascular System and the Effects of Anesthesia Individual Anesthetic Drugs General Interactions of Cardiovascular Aging with Anesthetic Management Regional Anesthesia: Spinal and Epidural Pulmonary Implications of Anesthesia in the Elderly Pulmonary Changes with Aging that Affect Anesthetic Physiology The Interplay of the Aging Pulmonary System and the Effects of Anesthesia Regional Anesthesia and Pulmonary Implications Physiologic Response to Anesthesia in the Aging Nervous System Altered Pharmacodynamics Increased Susceptibility to Postoperative Delirium and Cognitive Dysfunction Renal Implications of Anesthesia in the Elderly Hepatic Implications of Anesthesia in the Elderly Endocrine Implications of Anesthesia in the Elderly Thermoregulation Anesthetic Drugs in Older Adults Pharmacokinetic Considerations Specific Anesthetic Drugs Anxiolytics Induction Agents Opioids Neuromuscular Blocking Agents Inhalational Agents Other Conclusion References Part III: Perioperative Care 21 Management of Acute Postoperative Pain in the Geriatric Patient Introduction Nociception Is Not Pain Pharmacodynamics/Pharmacokinetics, Organ Function, and Aging Perioperative Cognitive Impairment and Pain Perioperative Pain Management Planning Education, Counseling, and Forming a Plan Methods of Post-Op Pain Assessment Multimodal Therapy Systemic Pharmacologic Therapy Opioids Weak Opioids Strong Opioids Principles of Dosing and Delivery Methods Systemic Nonopioid Adjuvants Acetaminophen NSAIDs Gabapentinoids Ketamine Glucocorticoids α2-Agonists Antidepressants Regional Analgesic Techniques Neuraxial Analgesia Peripheral Perineural Analgesia Nonpharmacologic Therapies Transitioning to Outpatient Care Special Considerations The Elderly Chronic Pain Patient Addiction, Dependence, Tolerance, Pseudoaddiction Conclusion References Further Reading 22 Postoperative Delirium Introduction Risk Factors for Postoperative Delirium Preoperative Factors Intraoperative Factors Postoperative Factors Features, Etiology, and Diagnosis of PD Features Etiology Diagnosis Treatment of PD Conclusion References 23 Models of Care Introduction Complications of Older Hospitalized Patients Geriatric Care Model Objectives Educate Health Care Providers in Core Geriatric Principles Target Risk Factors for Complications Incorporate Patient (Family) Choices and Treatment Goals Employ Evidence-Based Interventions Promote Interdisciplinary Communication Emphasize Discharge Planning (or Transitional Care) Geriatric Models Geriatric Consultation Service The Community Aging in Place: Advancing Better Living for Elders (CAPABLE) Acute Care for the Elders (ACE) Units Nurses Improving the Care of Health System Elders (NICHE) The Hospital Elder Life Program (HELP) Transitional Care Models Surgical Specialty Models Orthogeriatric Models Surgical Onco-Geriatrics Other Surgical Specialties Conclusion References 24 Nursing Issues in Older Adult Surgery Patients Complications of Older Hospitalized Patients Functional Decline Fall-Related Injury Undernutrition/Malnutrition Pressure Ulcers Urinary Tract Infection Delirium Geriatric Care Model Objectives Educate Health-Care Providers in Core Geriatric Principles Target Risk Factors for Complications Incorporate Patient (Family) Choices and Treatment Goals Employ Evidence-Based Interventions Promote Interdisciplinary Communication Emphasize Discharge Planning (or Transitional Care) Geriatric Models Geriatric Consultation Service Acute Care for the Elderly Units Nurses Improving the Care of Health System Elders The Hospital Elder Life Program Transitional Care Models New Specialty Models Conclusion References 25 Intensive Care in Older Adult Surgery Patients Introduction Outcomes Delirium Evaluation Prevention Treatment Respiratory Failure Changes in Pulmonary Function Associated with Aging Management Shock Changes in the Cardiovascular System Associated with Aging Evaluation Management Acute Kidney Injury Changes in the Renal System Associated with Aging Evaluation Clinical Management Outcomes: Renal Replacement Therapy Nutrition Caring for Dying Patients Conclusion References 26 Age, Frailty, and Impaired Wound Healing Introduction Pathophysiology of Chronic Wounds in the Aging and the Frail Management of Chronic Wounds in Frail Older Adults Risk Factors and Red Flags Functional and Cognitive Status Determination and Frailty Assessment Prognostication: Does This Wound Have the Potential to Heal in a Normal Time Frame? Promoting a Healing Environment Nutritional Support Risk Factor Modification Physical Rehabilitation Medication Debridement A Different Focus on the Wound That Will Not Heal Pain Management Discharge and Exudate Management Odor Control Hemostasis Financing Wound Care Clinical Vignette Conclusion: Putting It All Together References Part IV: Outcomes and Transitions of Care 27 Transitioning Care at Discharge Introduction Patients at Risk for Poor Care Transitions Following Surgery Multimorbidity Frailty Functional Deficits Low Health Literacy Inadequate Social Support Cognitive Impairment Interventions to Improve Care Transitions Before Hospital Discharge Assessment of Readmission Risk and Readiness for Discharge Education and Engagement of Patients and Their Caregivers Enhanced Discharge Planning Medication Management and Reconciliation Interventions to Improve Care Transitions Following Hospital Discharge Scheduled Early Follow-Up Visits with Healthcare Providers Home Visits Follow-Up Telephone Communication Home Telemonitoring Interventions to Improve Care Transitions Across Episode of Care Maintaining Continuity of Provider Care Care Transitions Navigators Bundled Care Models for Transitional Care Transitional Care Model Care Transitions Intervention Project RED Project BOOST Conclusion References 28 Postoperative Recovery and Rehabilitation Introduction Functional Status Symptoms Status General Health Perception Quality of Life Risk Factors for Protracted Recovery Strategies for Optimizing Recovery Preoperative Care Comprehensive Geriatric Assessment Pre-habilitation Hospitalization Enhanced Recovery Pathways Multidisciplinary Intervention Team Hospital Elder Life Program (HELP) Proactive Care of Older People Undergoing Surgery (POPS) Acute Care for Elders (ACE) Geriatric Surgery Service (GSS) Post Hospital Care Rehabilitation Conclusion References 29 Available Government and Community Resources for the Care of Older Adults Introduction Government Resources: Medicare and Medicaid Community Resources Conclusion References 30 Outcomes of Surgery in Older Adults Introduction Surgical Outcomes in the Elderly Population Optimizing Surgical Outcomes for Elderly Patients: Best Practice Guidelines Special Considerations Assessment of Frailty Prehabilitation Postoperative Cognitive Decline Preexisting Do Not Resuscitate (DNR) and Failure to Rescue Specific Patient Populations The Nursing Home Patient Elderly Patients with Dementia Postoperative Care The Use of Enhanced Recovery Pathways in the Elderly Prevention of Postoperative Complications in the Elderly Conclusion References 31 Surgery in the Frail Elderly: Nursing Home Patients Introduction Focusing Surgical Care on the Frail Elderly: Development of a Dedicated Consult Service for Nursing Home Patients Analysis of Data from the Geriatric Surgery Consult Service: Role of Dementia, Age, and Coronary Artery Disease in the Nursing... Case Examples Case 1 Case 2 Case 3 Comment Development of a Second Geriatric Surgery Consult Service: Decubitus Care A Dedicated Surgical Service for Community Nursing Home: The Einstein College of Medicine Experience Population-Based Outcomes After Major Surgery in Nursing Home Residents Conclusions References Part V: Specific Specialties 32 Neurosurgery-Intracranial Introduction Traumatic Brain Injury Extra-Axial Hematomas Intracerebral/Subarachnoid Hemorrhage Fractures Penetrating Trauma Nontraumatic Vascular Lesions Aneurysms Vascular Malformations Stroke Amyloid Angiopathy Adverse Drug Reactions Sinus Thrombosis Infection Peripheral Nerve Injury Tumors Conclusions References 33 Anatomic and Physiologic Changes in the Ears, Nose, and Throat Introduction The Aging Ear Auditory Anatomy and Physiology External Ear Middle Ear Cochlea Auditory Nerve Central Auditory Processing Auditory Function Clinical Implications Vestibular Anatomy and Physiology Vestibular Function Clinical Implications The Aging Nose Anatomy and Physiology Olfactory Function Clinical Implications The Aging Throat Anatomy and Physiology Aging Changes in Voice Function and Swallowing Voice Function Oropharyngeal Function Clinical Implications Conclusion References 34 Cardiac Surgery in the Older Adult Introduction Characteristics of the Older Adult Undergoing Cardiac Surgery Pharmacokinetics and Pharmacodynamics in the Older Adult Undergoing Cardiac Surgery Age-Related Changes in Pharmacokinetics and Pharmacodynamics Cardiac Medications and Aging Preoperative Assessment of the Older Adult Undergoing Cardiac Surgery Frailty in the Cardiac Surgery Patient Strategies to Decrease Operative Risk Pre-habilitation Predictors of Perioperative Morbidity and Mortality Quality of Life Considerations Postoperative Complications General Postoperative Complications Major Bleeding, Transfusion, and Anemia Complications Germane to the Older Adult Undergoing Cardiac Surgery Postoperative Atrial Fibrillation Stroke Delirium Deep Sternal Wound Infection Nonsurgical Alternatives Transplantation and Mechanical Circulatory Support Strategies for Postoperative Follow-Up Conclusions References 35 Vascular Surgery Introduction Perioperative Risk Factors and Anesthesia Peripheral Arterial Disease Noninvasive Imaging Invasive Imaging Decision for Intervention Endovascular Versus Open Surgical Revascularization Amputation Acute Limb Ischemia Extracranial Carotid Disease Management of the Symptomatic Patient Management of Asymptomatic Patient Endarterectomy Versus Stenting Aneurysm Disease Epidemiology and Clinical Presentation Decision to Intervene Open Versus Endovascular Repair Frailty Conclusion References 36 Pulmonary Surgery for Malignant Disease in Older Adults Case Study Introduction Physiologic Changes of Age Preoperative Evaluation Cardiac Risk Assessment Pulmonary Risk Assessment Cognitive Assessment Geriatric Assessments Postoperative Care Non-small Cell Lung Cancer Stage at Presentation Histology Extent of Resection Pulmonary Carcinoid Surgical Resection for Pulmonary Metastases Treatment Patterns of Elderly Cancer Patients Case Reveal Conclusion References 37 Benign and Malignant Diseases of the Prostate General Anatomical Considerations Benign Prostatic Hyperplasia Epidemiology Pathophysiology Diagnosis and Evaluation of Prostate Disease Treatment of Benign Prostatic Hyperplasia Alpha Blockers 5-Alpha Reductase Inhibitors (5ARIs) Surgical Management of BPH Simple Prostatectomy Transurethral Incision of the Prostate (TUIP) Prostatic Urethral Lift (UroLift) Prostate Cancer Epidemiology Pathophysiology Diagnosis and Evaluation Prostate MRI Active Surveillance Treatment of Prostate Cancer Radical Prostatectomy Radiation Therapy Ablative Therapy for the Treatment of Localized Prostate Cancer Cryoablation High-Intensity Focused Ultrasound (HIFU) Prostate Summary Kidney Cancer Kidney Cancer Epidemiology and Etiology Natural History Management Radiologic Evaluation Treatment of Kidney Cancer Radical Nephrectomy Partial Nephrectomy Thermal Ablative Therapies Adjuvant Therapies for Localized RCC Management of Advanced RCC Bladder Cancer Diagnosis Natural History Non-muscle Invasive Bladder Cancer Muscle Invasive Bladder Cancer Radiologic Evaluation Treatment: Non-muscle Invasive Disease Intravesical Therapy Treatment: Muscle-Invasive Bladder Cancer Surgical Therapy Multimodality Therapy for Muscle Invasive Bladder Cancer Metastatic Bladder Cancer Conclusions References 38 Gynecologic Disorders in the Older Woman Benign Gynecologic Conditions Introduction Menopause Lower Genital Tract Vulva Lichen Sclerosus Lichen Simplex Chronicus Lichen Planus Bartholin´s Cysts and Abscesses Vulvodynia Cervix Urogenital Atrophy and Vaginitis Genitourinary Syndrome of Menopause (GSM) Upper Genital Tract Uterus Endometrial Atrophy Endometrial Polyps Leiomyomas (Fibroids) Endometrial Hyperplasia and Cancer Ovary Urogynecologic Conditions Introduction Urethra Urethral Prolapse Urethral Caruncles Urethral Diverticulum Pelvic Floor Disorders Introduction Pelvic Organ Prolapse and Urinary Incontinence Treatment of POP and UI Nonsurgical Treatment of POP and UI Surgical Treatment of POP Surgical Treatment of Urinary Incontinence Fecal Incontinence Gynecologic Malignancies in the Older Woman Introduction Uterine Cancer Endometrial Adenocarcinomas Uterine Sarcomas Ovarian, Primary Peritoneal, and Fallopian Tube Cancers Cervical Cancer Vulvar Cancer Other Vulvar Malignancies Vaginal Cancer Research Involving Older Woman Conclusion References 39 Anesthetic Management Introduction Preoperative Evaluation Intraoperative Management Anesthetic Goals Central Nervous System Management Cardiovascular System Management Respiratory System Management Temperature Management Stress Response to Surgery Controversies in Geriatric Anesthesia Postoperative Care of the Surgical Geriatric Patient Anesthesia Considerations for Postoperative Care in the Elderly Patient Organ Anatomy and Physiology Postoperative Pain Management In Patients with Renal Dysfunction In Patients with Hepatic Dysfunction Postoperative Complications in the Elderly Patient Long-Term Outcome in the Elderly Patient Putting All Together: The Geriatric Perioperative Surgical Home Conclusions References 40 Skin Lesions and Pressure Ulcers Common Benign and Malignant Skin Lesions Basic Skin Anatomy Dermis Epidermal Appendages Skin Function Changes in the Skin Associated with Aging Epidermis Dermis Benign Epidermal Lesions Seborrheic Keratoses Epidermal Appendages Solar Lentigo (Senile Lentigo, Actinic Lentigo) Melanocytic Nevi (Moles) Benign Dermal Lesions Acrochordons (Skin Tags) Xanthelasma Palpebrarum (Eyelid Xanthomas) Sebaceous Hyperplasia Chondrodermatitis Nodularis Helicis Cherry Hemangioma (Campbell de Morgan Spots) Venous Lakes Premalignant Lesions Actinic Keratoses (Solar Keratoses) Actinic Cheilitis Leukoplakia Cutaneous Horn Bowen´s Disease (Squamous Cell Carcinoma In Situ) Lentigo Maligna (Hutchinson´s Freckle) Melanoma In Situ Malignant Lesions Squamous Cell Carcinoma Keratoacanthoma Basal Cell Carcinoma Melanoma Atypical Fibroxanthoma Merkel Cell Carcinoma Conclusions Discussion Pressure Sores in the Elderly Pathophysiology Evaluation Management Reduction of Pressure and Deleterious Extrinsic Factors Restoration of Nutrition and Other Wound-Promoting Intrinsic Factors Wound Care (Active Debridement and Regular Maintenance) Principles of Surgical Treatment Sacral Pressure Sores Ischial Pressure Sores Greater Trochanter Pressure Sores Foot Pressure Sores Postoperative Care Conclusions References 41 Abdominal Wall Hernias in the Elderly Case Studies Case Study #1 Background Management Case Study #2 Background Management Introduction Special Considerations Groin Hernias Etiology and Distribution Diagnosis Emergency Repair Watchful Waiting Versus Elective Repair Anesthesia Surgical Treatment Suture Repair Synthetic Repair Laparoscopic Repair Bilateral Hernias Recurrence Inguinodynia Incisional Hernias Umbilical Hernias Richter´s Hernia Obturator Hernias Spigelian Hernias Conclusion References 42 Benign Esophageal Diseases in the Elderly Gastroesophageal Reflux Disease Pathophysiology Clinical Presentation Diagnosis Treatment Nonsurgical Treatment Surgical Treatment Endoscopic Treatment Paraesophageal Hernia Case Study: Part 1 Pathophysiology Clinical Presentation Diagnosis Treatment Case Study: Part 2 Salient Points Esophageal Motility Disorders Achalasia Pathophysiology Clinical Presentation Diagnosis Treatment Nonsurgical Treatment Surgical Treatment Diffuse Esophageal Spasm Diagnosis Treatment Other Esophageal Motility Disorders Benign Tumors of the Esophagus Leiomyomas Fibrovascular Polyps Esophageal (Zenker´s) Diverticula Clinical Presentation and Diagnosis Treatment of Zenker´s Diverticula Surgical Treatment Endoscopic Treatment References 43 Elderly Transplant Recipients Introduction The Elderly: Is It Age or Frailty or Both? What Can Be Done to Address Frailty? Transplantation in Elderly Patients: Criteria for Selection Justification of Transplant in Elderly End-Stage Renal Disease Patients Access to Transplantation for Seniors: The UNOS New Allocation Policy Selecting the Right Candidate: Evaluation Issues in the Elderly Organ Selection for the Elderly Transplant Candidate Liver Transplantation Kidney Transplantation The Older Living Donor: Should There Be an Upper Age Limit? Liver Transplantation Kidney Transplantation Immunosuppressive Strategies in Older Recipients Immunosenescence and Immunological Characteristics of the Elderly Recipient Risk and Challenges for Immunosuppression Considerations General Considerations for an Optimal Immunosuppressive Regimen Outcomes Conclusion References 44 Benign and Malignant Tumors of the Liver Introduction Case Study Background Management Epidemiology of Liver Neoplasms Liver Surgery in the Elderly The Aging Liver Pre-op Evaluation and Prehabilitation Benign Liver Tumors Malignant Liver Tumors Hepatocellular Carcinoma Intrahepatic Cholangiocarcinoma Colorectal Cancer Metastasis Neuroendocrine Metastasis Conclusion References 45 Benign and Malignant Neoplasms of the Exocrine Pancreas Introduction Epidemiology Risk Factors Percent of New Cases by Age Group Pathology Solid Tumors Cystic Tumors Precancerous Lesions Clinical Presentation History and Physical Laboratory Studies Management of Malignant Neoplasms Diagnosis and Staging Preparation for Operation Resection of Lesions of the Pancreatic Head Resection of Lesions of the Body and Tail Palliation Postop Care and Complications Chemotherapy/Radiation Therapy Long-Term Outcomes and Quality of Life Treatment Disparities in the Elderly Management of Benign and Premalignant Neoplasms Diagnosis Estimating the Malignant Potential Indications for Resection Resection Outcomes Conclusions References 46 Colorectal Cancer in Elderly Patients: Considerations in Treatment and Management Introduction Case Study #1 Case Study #2 Epidemiology Incidence in Geriatric Patients Survival in Geriatric Patients Screening in Elderly Patients Clinical Presentation and General Treatment Considerations in Elderly Patients Emergency Surgery Metastatic Colorectal Cancer Concerns for Elective Colorectal Cancer Treatment in Geriatric Patients Geriatric Surgical Risk Assessment Enhanced Recovery Pathways Minimally Invasive Surgery The Volume-Outcome Relationship Sphincter Sparing Surgery for Rectal Cancer Colorectal Cancer and Inflammatory Bowel Disease Neoadjuvant and Adjuvant Therapy in the Elderly Neoadjuvant Chemoradiation Therapy for Rectal Cancer and Geriatric Patients Adjuvant Chemotherapy and Geriatric Patients Posttreatment Surveillance Conclusions References 47 Gastric Cancer in the Elderly Introduction Epidemiology Risk Factors Anatomic Classification Histologic Classification Molecular Classification Presentation and Diagnosis Workup Geriatric Assessment Surgery Lymphadenectomy Minimally Invasive Surgery Staging Outcomes in the Elderly Perioperative Locoregional and Systemic Therapy Preoperative Chemoradiation Therapy Adjuvant Chemoradiation Therapy Perioperative Therapy Adjuvant Systemic Therapy Clinical Trials in the Elderly Advanced Disease Targeted Therapies Palliative Surgery Future Directions Conclusion Clinical Vignette 1 Clinical Vignette 2 References 48 Esophageal Cancer in the Elderly Case Studies Patient 1 Patient 2 Introduction Treatment Options for Esophageal Cancer Conclusion References 49 Breast Cancer in Elderly Women Introduction Epidemiology Screening Local Therapy of Breast Cancer Mastectomy Breast-Conserving Surgery in the Elderly Sentinel Lymph Node Biopsy Primary Endocrine Therapy as an Alternative Local Therapy Systemic Therapy Breast Cancer Survival and Patterns of Care in the Elderly Healthy Versus Frail Elderly Patients Conclusion Case Study Background Management References 50 Small Bowel Obstruction in the Elderly Case Study 1 Background Management Case Study 2 Background Management Introduction Epidemiology Etiology-Specific Considerations in the Elderly Adhesions Malignancy Hernia Pathophysiology of SBO and Evaluation Clinical Features of SBO in the Elderly Diagnostic Considerations for the Elderly Initial Treatment Surgical Treatment: General Principles Laparoscopic Treatment of SBO Nonoperative Management Outcomes of Treatment of SBO Biological Barriers Conclusion References 51 Ischemic Disorders of Small and Large Intestine Mesenteric Ischemia Vignettes Case Study: SMV Thrombosis Management Case Study: Mesenteric Ischemia Management Case Study: Mesenteric Ischemia Management Epidemiology Anatomy Imaging/Diagnosis Arterial Mesenteric Ischemia Acute Pathology Chronic Pathology Ischemic Colitis Venous Mesenteric Ischemia Nonocclusive Mesenteric Ischemia Treatment Preoperative Planning Open Surgery Embolectomy Bypass Endarterectomy Endovascular Conclusion References 52 Benign Disease of Stomach and Duodenum Case #1 Background Management Case #2 Background Management Anatomy and Physiology of the Stomach and Duodenum Effect of Age on Physiology Perioperative Considerations in the Elderly Patient Peptic Ulcer Disease Epidemiology Pathophysiology Classification of Gastric Ulcers Etiology Helicobacter pylori Nonsteroidal Anti-inflammatory Drugs Zollinger-Ellison Syndrome Smoking Clinical Manifestations of Uncomplicated Peptic Ulcer Disease Medical Treatment for Uncomplicated Peptic Ulcer Disease Clinical Manifestations of Complicated Peptic Ulcer Disease Perforation Primary Closure Reinforced with Omental Patch Bleeding Surgical Treatment of Bleeding Gastric Ulcers Surgical Treatment of Bleeding Duodenal Ulcers Gastric Volvulus Gastric Outlet Obstruction Gastric Polyps Hyperplastic Polyps Fundic Gland Polyps Adenomatous Polyps Dieulafoy Lesion/Malformation Gastroparesis Etiology Clinical Manifestation Treatment Duodenal Diverticula Complications After Gastric Surgery Dumping Syndrome Postvagotomy Diarrhea Gastroparesis or Delayed Gastric Emptying Afferent Loop Syndrome Efferent Syndrome Duodenal Stump Leak Alkaline Gastritis Conclusion References 53 Benign Disease of the Gallbladder and Pancreas in the Elderly Introduction Gallbladder Cholelithiasis Choledocholithiasis Gallstone Ileus Acute Cholecystitis Pancreas Pancreatitis Acute Chronic Conclusions Conclusion References 54 Elderly Donors in Transplantation Cases for Contemplation Introduction Demographics Renal Transplantation Age-Dependent Changes in Kidney Function Deceased Donor Living Donor Choice of Older Donors for LDKT Encouraging Older Patients to Become Donors Summary Liver Transplantation Age-Dependent Changes in Liver Function Deceased Donor Liver Transplantation Living Donor Liver Transplantation Prognostic Scoring of Donor Organs Summary Improving Utilization of Organs from Older Donors Current Organ Allocation Policies Conclusion References 55 Malignant Diseases of the Gallbladder and Bile Ducts Introduction Case Study Gallbladder Adenocarcinoma Background Management Case Study Perihilar Cholangiocarcinoma Background Management Gallbladder Malignancy Incidence Etiology Pathology and Staging Presentation and Diagnosis Clinical Presentation Radiological Evaluation Treatment Incidental Discovery Single Polyp Resection of T2 + Disease Outcomes Adjuvant Therapy Palliation Cholangiocarcinoma Incidence Etiology Pathology and Staging Klatskin and Distal Extrahepatic Cholangiocarcinoma Intrahepatic Cholangiocarcinoma Presentation and Diagnosis Klatskin and Distal Extrahepatic Cholangiocarcinoma Intrahepatic Cholangiocarcinoma Treatment Surgical Resection of Klatskin Tumor Surgical Resection of Distal Extrahepatic Cholangiocarcinoma Surgical Resection of Intrahepatic Cholangiocarcinoma Transplantation Chemoradiation Therapy Outcomes Unresectable Disease/Palliation Conclusion References 56 Benign Colorectal Disease in the Elderly Case Study Background Management Introduction Constipation and Pelvic Floor Dysfunction Rectal Prolapse Colonic Pseudo-obstruction Stercoral Ulceration and Perforation Clostridium difficile Infection Volvulus Fecal Incontinence Conclusion References 57 Diverticulitis and Appendicitis in the Elderly Introduction Diverticular Disease Case Study Background Etiology Epidemiology Pathogenesis Symptoms Diagnosis Management Prevention of Symptoms Uncomplicated Diverticulitis Surgical Technique for Elective Sigmoid Resection Robotic Surgery for Diverticulitis Emergent Surgery for Uncomplicated Diverticulitis Complicated Diverticular Disease Laparoscopic Lavage Right-Sided Diverticulitis Appendicitis Case Study Background Etiology Epidemiology Symptoms and Diagnosis Management Complicated Appendicitis: Differences Between Young and Old Patients Conclusion References 58 Lower Gastrointestinal Bleeding in the Elderly Introduction Causes of Lower Gastrointestinal Bleeding in the Elderly Diverticulosis Colonic Angioectasias Colorectal Malignancy Colitis Anorectal Disease Assessment of Lower Gastrointestinal Bleeding in the Elderly Management of Lower Gastrointestinal Bleeding in the Elderly Conclusion References 59 Hip Fracture Introduction Preoperative Care Surgical Treatment Postoperative Care System Improvements Clinical Vignettes Femoral Neck Fracture Intertrochanteric Fracture Atypical Hip Fracture Failed Screw Fixation Conclusion References 60 Total Joint Replacement Introduction Total Hip Replacement History Indications Surgical Technique Implant Design Outcomes Complications Total Knee Replacement History Indications Surgical Technique Implant Design Outcomes Complications Minimally Invasive Surgery, Bundled Payments, and Changes in Joint Replacement Clinical Vignettes Vignette 1: Routine Total Hip Replacement Vignette 2: Complex Total Hip Replacement Vignette 3: Loose Total Hip Replacement Vignette 4: Primary Total Knee Replacement Vignette 5: Infected Total Knee Replacement Conclusion References 61 Burns in the Older Adult Introduction Epidemiology Prognosis Frailty Acute Phase Response Inflamm-Aging/Immunosenescence Infection and Sepsis Infections Sepsis Long-Term Outcomes Conclusion References Index