Pulmonary assessment and optimization for older surgical patients.

Advances in surgical and anesthetic techniques coupled with increased life expectancy have led to an increasing proportion of older adults receiving surgical care. Commonly, these patients are medically complex, conferring increased risk for postsurgical complications. Postoperative pulmonary complications (PPCs), including respiratory failure, pneumonia, and exacerbation of chronic lung disease, are common in older surgical patients, occurring in ~6% of major abdominal procedures. Although older adults are at a significantly increased risk for cardiovascular disease, PPCs may account for a larger proportion of surgical complications than cardiac events and be associated with greater morbidity and mortality than cardiovascular complications. The older adult population is especially prone to these complications, as evidenced by the correlation between PPCs and advanced age, cognitive impairment, and functional dependence. Appropriately assessing and managing the risk of PPCs in older adults can help encourage age-friendly health system practices in the perioperative setting.