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Issues in Geriatric Orthopedic Anesthesia

Surgery of the musculoskeletal system is very common in persons over 65 years of age, and approximately 2.2 million of these surgeries are performed annually in the United States. Total joint arthroplasty (TJA) is particularly common and also costly in the elderly population. In 2010 alone, there were a total of 332,000 total hip arthroplasty (THA), 719,000 total knee arthroplasty (TKA), and 53,000 shoulder arthroplasty procedures performed. Half of these procedures were performed on patients over 65 years of age. In 2006, at $5 billion, these surgeries accounted for more Medicare expenditure than any other inpatient procedure. There is no doubt that in the coming years surgery and anesthesia workforces and facilities will be stressed by needs of the elderly population, and it is imperative that we develop safe, effective, and efficient methods to care for these patients. The focus of this chapter is to address various issues associated with ambulatory orthopedic surgical procedures and TJA in the geriatric population.