Ask the doctors: Surgical comorbidities increase with age | Various

Dear Doctor, Can you please talk about the risks for elderly patients with co-morbidities when going for surgery? My sister, who was older and sick, had a joint replacement. It was done by a very good surgeon and in a good hospital, but she did not survive to walk again.

Dear Reader, First of all, we are terribly sorry to hear of the passing of your sister. Thank you for raising an important topic. About 17% of adults in the United States are 65 or older, and data shows they account for about 40% of inpatient surgeries. Add outpatient procedures, and that number is closer to 50%.

There are several reasons for this, not the least of which are the physiological stresses associated with aging. In many cases, surgery offers an older person the best chance to manage an existing medical problem. However, as you point out, not everyone is a good candidate for surgery. This is because many are living with additional medical conditions, known as co-morbidities, that are unrelated to the problem the surgery is supposed to solve. These include high blood pressure; impaired heart function; Diabetes; kidney disease; obesity; lung conditions such as asthma, COPD or emphysema; digestive disorders; depression; and decreased cognition, to name a few.

Data shows that surgical patients 65 years and older have an increased risk of postoperative complications, longer hospital stays, and slower recovery. Another factor in the surgical equation is frailty. It is a clinical term that refers to the loss of muscle mass, strength, endurance, endurance and general physical fitness that occurs in old age, which leaves a person in a weak and physically weak state. vulnerable. Frailty is often accompanied by two or more of the co-morbidities just discussed. The incidence of frailty increases with age and is somewhat more common in women. It is estimated that a quarter of those 85 and over are frail.

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