August 26, 2010

USA: Is Surgery Safe for People Who are Elderly?

Kristie Leong MD writes on HEALTHMAD, on August 26, 2010

Some doctors are reluctant to recommend surgery for elderly patients because of their age. Should surgery in the elderly be denied solely on the basis of age?

Doctors sometimes fail to recommend surgery for an elderly person, because they fear a higher risk of complications. Their fears may be unfounded. Some older people are healthy and hardy enough to undergo the stress of surgery – without significant risk of complications

Surgery in the Elderly: Is It Too Risky?

According to Dr. Mark Katic M.D, director of the thoracic surgery department at Geisinger Wyoming Valley Medical Center in Pennsylvania, a doctor should look at a patient’s physiologic age rather than their chronological age when deciding whether surgery is safe.

Some elderly people are still healthy and active – and function physiologically at the level of a person fifteen to twenty years younger. Using age criteria to decide whether they are “fit” for surgery would exclude a lot of seniors who are still at low risk for complications – despite being older.

Unfortunately, there are no standard tests to help a doctor determine whether surgery in an elderly person is safe or not, and many doctors fail to recommend surgery to older patients solely based on their age.

Dr. Katic is quick to emphasize that surgery is not only safe in healthy, elderly patients, but for some conditions it reduces overall medical costs by treating a problem that could lead to hospitalization later, if left untreated.

Surgery in the Elderly More Common than Ever

Surgery in elderly people is on the rise, particularly for higher risk procedures such as bypass surgery for heart disease. What’s driving this trend? People anticipate living longer lives and want to be as free of disease as possible. Plus, there’s a growing consensus that age shouldn’t be factor when determining whether to do surgery in elderly patients – a person’s overall health and whether or not they have serious medical problems that would decrease their chance of surviving surgery are most important.

Does Surgery in the Elderly Lead to Mental Decline?

There is one area of concern about surgery in the elderly. One study showed that elderly patients who undergo surgery were more likely to experience a mental decline, involving memory loss and a general mental slow-down, during their recovery period.

Many of these patients initially improved in the first three months after surgery, but then declined again – and still had cognitive and memory problems years later. There may be ways to reduce this risk during surgery by using regional rather than general anesthesia – and using different anesthesia drugs.

Surgery in the Elderly: Is It Safe?

Whether surgery in the elderly is safe depends upon an older person’s general physical and mental condition – and age shouldn’t determine whether or not a person’s a good surgical candidate. The pros, cons, and risks need to be discussed with a surgeon and anesthesiologist – and don’t hesitate to get a second opinion.

Medical News Today. “Surgeon, Age Is Relative When Considering Surgical Intervention”
Med Clin North Am. 1993 Mar;77(2):327-33.
WebMd. “Elderly Patients Face Post-Surgery Mental Decline”