The Elderly Spine Surgery Patient: Pre- and Intraoperative Management of Drug Therapy

Spine surgery is one of the most common surgeries for adults greater than 65 years of age. Optimizing and caring for the elderly patient presenting for spine surgery requires planning and multidisciplinary input from surgeons, primary care physicians, and anesthesiologists. Controversies exist surrounding appropriate perioperative management of complicated chronic medication regimens and the ideal selection of intraoperative therapy for these patients. In this article we present an overview of the controversies anesthesiologists face as they work with the elderly patient's primary doctor and surgical team to achieve a safe perioperative course. Specifically, we discuss the interaction of geriatric physiology and pathophysiology with medications used in the perioperative period. While care of the geriatric spine surgery patient is nuanced, the anesthesiologist can work together with medical personnel, surgeons, and pharmacy to provide safe and effective care.