Aging, pathophysiological changes, and their impact on anesthesia and surgery

This chapter describes the pathophysiological changes related to aging, considered from the perspective of incoming surgical procedures. These changes can highly impact anesthesiologic and surgical outcomes in older patients requiring surgery. Aging can negatively influence homeostasis at a cellular level and in organ systems. Pathophysiological changes in older patients, partially linked to the onset of associated conditions and partially increased by cellular aging, can contribute to an exaggerated surgical stress response. Combined with preoperative frailty and comorbidities, an exaggerated surgical stress response can significantly increase postoperative morbidity and mortality. Understanding the pathophysiological changes associated with aging can contribute to preoperative screening methods, decision-making, preoperative risk reduction, and improve perioperative care.