TY - CHAP
T1 - Postoperative stress, metabolism, and catabolism
AU - Calvani, Riccardo
AU - Picca, Anna
AU - Coelho-Júnior, Hélio José
AU - Tosato, Matteo
AU - Marzetti, Emanuele
PY - 2025
Y1 - 2025
N2 - The number of older people undergoing major surgery has significantly grown over the last decades. In older adults, surgical procedures elicit a perturbed stress response, which may combine with preexisting conditions to increase the risk for perioperative complications and negative outcomes, including delirium, infections, functional decline, and mortality. Surgical stress in aging is characterized by altered peak response, which may be either exaggerated or blunted, followed by a slow (and often incomplete) return to baseline. Multiple age-related alterations in hypothalamic-pituitary axis and in inflammatory response have been described in older adults undergoing surgery and may be associated with abnormal surgical stress. Muscle atrophy frequently occurs after surgery due to prolonged bed rest and impaired anabolism/catabolism balance associated with anesthesia and surgical procedures. Muscle wasting may further hamper recovery and promote the development of adverse events. Postoperative stress response overstimulates the core biological processes of aging, the so-called “hallmarks of aging,” thereby inducing an accelerated aging phenotype. Currently, multimodal interventions, including nutrition and exercise, are the most effective strategies to contrast impaired perioperative stress response and preserve muscle in older adults. In the present chapter, the impact of aging on stress response to surgery will be summarized, with a specific focus on muscle anabolism/catabolism. Finally, current therapeutic options and novel intervention strategies, including the use of geroprotectors (i.e., molecules targeting biological pillars of aging), will be briefly introduced.
AB - The number of older people undergoing major surgery has significantly grown over the last decades. In older adults, surgical procedures elicit a perturbed stress response, which may combine with preexisting conditions to increase the risk for perioperative complications and negative outcomes, including delirium, infections, functional decline, and mortality. Surgical stress in aging is characterized by altered peak response, which may be either exaggerated or blunted, followed by a slow (and often incomplete) return to baseline. Multiple age-related alterations in hypothalamic-pituitary axis and in inflammatory response have been described in older adults undergoing surgery and may be associated with abnormal surgical stress. Muscle atrophy frequently occurs after surgery due to prolonged bed rest and impaired anabolism/catabolism balance associated with anesthesia and surgical procedures. Muscle wasting may further hamper recovery and promote the development of adverse events. Postoperative stress response overstimulates the core biological processes of aging, the so-called “hallmarks of aging,” thereby inducing an accelerated aging phenotype. Currently, multimodal interventions, including nutrition and exercise, are the most effective strategies to contrast impaired perioperative stress response and preserve muscle in older adults. In the present chapter, the impact of aging on stress response to surgery will be summarized, with a specific focus on muscle anabolism/catabolism. Finally, current therapeutic options and novel intervention strategies, including the use of geroprotectors (i.e., molecules targeting biological pillars of aging), will be briefly introduced.
KW - Postoperative
KW - Hallmarks of aging
KW - Inflammation
KW - Sarcopenia
KW - Postoperative
KW - Hallmarks of aging
KW - Inflammation
KW - Sarcopenia
UR - http://hdl.handle.net/10807/306517
U2 - 10.1007/978-3-031-77707-3_21
DO - 10.1007/978-3-031-77707-3_21
M3 - Chapter
SN - 9783031777066
T3 - PRACTICAL ISSUES IN GERIATRICS
SP - 287
EP - 308
BT - The frail surgical patient: A geriatric approach beyond age
A2 - Virginia Boccardi, Luigi Marano
ER -