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In the elderly, there is a unique situation where factors resulting from the ageing process and the cumulative effect of accompanying diseases interact with severe stress associated with surgery. Currently, there is no effective way to phar­macologically influence the course of pro- and anti-inflammatory responses. Therefore, surgeons should attempt to limit potential risks during procedures by conducting scheduled surgery, positioning the patient in the safe way, using minimally invasive surgical techniques, limiting intraoperative blood loss – even at the expense of prolonged surgical time, avoiding hypothermia and working in an experienced surgical and anaesthetic team. Such elements are of paramount importance for older patients undergoing surgery, particularly with frailty syndrome.