Surgical comorbidities increase with age | Ask the doctors |
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 sorry to hear of your sister’s passing. 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 hospital-based 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 diminished cognition, to name a few.
Data shows that surgical patients 65 and older are at 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 it is somewhat more common in women. It is estimated that a quarter of those 85 and over are frail.
All of this makes a thorough preoperative assessment for the elderly a necessity. It begins with establishing the patient’s goals for the surgery and weighing the risks of the procedure against the potential benefits. When it comes to risk, there is a wide range of factors to consider. These include the rigors of the surgery itself, the length of the post-operative hospital stay, and what the post-surgical rehabilitation will entail. The patient should have a clear understanding of the costs of surgery, from preoperative appointments to the entire recovery period.
In addition to co-morbidities, patients should be assessed for cognitive function, nutritional status, their ability to understand new information and make decisions, and risk for falls. Problems in these areas have been linked to an increased risk of complications after surgery, functional decline, the need for home care or institutionalization.
When it comes to recovery, patients need both a realistic timeline and a detailed plan. Those with a strong social support network have been shown to perform better. And, while it seems grim to contemplate the worst-case scenarios, it is crucial for any surgical patient, regardless of age, to be clear about their wishes regarding life-saving measures and procedures. It is best to do this with a legal document that deals with future medical care.