Weighing the risks of a major surgery: 7 questions older Americans should ask their surgeons
Larry McMahon, turning 80 in December, is considering whether to undergo major surgery. Over the past five years, his back pain has become increasingly severe. Physical therapy, muscle relaxants, and injections do not help with pain.
“It was such a pain that I could barely do anything,” he said.
Should McMahon, a retired Virginia State trooper who now lives in Southport, North Carolina, try spinal fusion surgery, a procedure that can take up to six hours? (Eight years ago, he had a cut off the beltanother arduous back surgery.)
“Will I recover in six months — or in a few years? Is it safe for a man my age with various health problems to go to bed for a long time?” McMahon asked, passing some of his concerns to me during a phone conversation.
Older adults planning major surgery are often unsure whether to proceed. In many cases, surgery can save or improve the quality of life of the elderly. But advanced age puts people at greater risk of unwanted consequences, including difficulty with daily activities, prolonged hospital stays, mobility problems, and loss of independence.
I written in November about a new study that sheds light on some of the risks older adults face when having invasive procedures. But readers want to know more. How to determine if the potential benefits from major surgery are worth the risks? And what questions should elders ask as they try to figure this out? I asked several experts for their recommendations. Here are some of what they recommend.
What is the goal of this surgery? Ask your surgeon, “How will this surgery make things better for me?” speak Margaret “Gretchen” Schwarze, an associate professor of surgery at the University of Wisconsin School of Medicine and Public Health. Will it prolong your life by removing a fast-growing tumor? Would your quality of life be improved by making commuting easier? Will it prevent you from becoming disabled, such as a hip replacement?
If your surgeon says, “We need to remove this tumor or remove this tumor,” ask what impact that will have on your daily life. Just because an abnormality like a hernia has been discovered doesn’t mean it has to be addressed, especially if you don’t have uncomfortable symptoms and the procedure comes with complications, Dr. Robert Becher and Thomas Gill of Yale University, authors of a recent paper on major surgery in older adults.
If all goes well, what can I expect? Schwarze, a vascular surgeon, often cares for patients with abdominal aortic aneurysms, a large, enlarged blood vessel that can be life-threatening if it ruptures.
Here’s how she describes a “best-case” surgery scenario for that condition: “The surgery will take about four to five hours. When it’s over, you’ll be in the ICU with a breathing tube overnight for a day or two. You will then be in the hospital for about a week. You will probably have to go to rehab after that to get your strength back, but I think you can go home in 3 to 4 weeks and it will probably take you 2 to 3 months to feel like you did before the surgery. “
Among other things, people can ask their surgeon, according to a patient documents Schwarze’s team created: What will my daily life be like right after surgery? Three months later? One year later? Do I need help, and for how long? Will pipes or drains be inserted?
If things don’t go well, what can I expect? According to Schwarze, a “worst-case scenario” might look like this: “You have surgery, and you go to the ICU, and you have serious complications. You have a heart attack. Three weeks after surgery, you are still in the ICU with a breathing tube, and you have lost most of your strength, and have no chance to return home. Or, the surgery doesn’t work, and you still have to go through all of this.”
“People often think I’ll die on the operating table if things don’t go my way,” he said. Dr. Emily Finlayson, director of the UCSF Center for Aging Surgery in San Francisco. “But we are very good at saving lives, and we can help you live a long life. The reality is, there can be a lot of pain, suffering and interventions like feeding tubes and ventilators if things don’t go the way we hope.”
Given my health, age and function, what is the most likely outcome? Once your surgeon has guided you through the different situations, ask, “In your opinion, do I really need to do this surgery?” and “What do you think is the most likely outcome for me?” Finlayson advises. Research shows that older people who are frail, cognitively impaired, or have other serious conditions like heart disease have worse experiences with major surgery. In addition, seniors in their 80s and 90s are at a higher risk of hiccups.
“It’s important to have family or friends in the room to talk to high-risk patients,” says Finlayson. Many seniors have some degree of cognitive difficulty and may need help navigating complex decisions.
What are the alternatives? Finlayson says: “Make sure your doctor tells you what the non-surgical options are. For example, older men with prostate cancer may want to consider “watchful waiting,” continuous monitoring of their symptoms, rather than risky invasive surgery. Women in their 80s with small breast cancer may choose to leave it alone if its removal poses risks, due to other health factors.
Due to Larry McMahon’s age and potential medical problems (knee replacement surgery in 2021, arthritis, high blood pressure), his neurosurgeon suggested he explore options. other interventions, including injections and physical therapy, prior to surgery. “He told me, ‘I make money from surgery, but it’s a last resort,'” McMahon said.
What can I do to prepare myself? “Preparing for surgery is really important for older adults: If patients do some of the things their doctors recommend — stop smoking, lose weight, walk more, eat more regularly — then they can reduce the likelihood of complications and the number of days in the hospital. ” speak Dr. Sandhya Lagoo-Deenadayalana leader in the Duke University Medical Center’s Perioperative Optimization for Aging Health program.
When older patients are offered POSH, they receive a comprehensive assessment of medication, nutritional status, mobility, availability, ability to perform daily activities, and home support. They leave with a “to do” list of suggested actionusually begins a few weeks before surgery.
If your hospital doesn’t have a program of this type, ask your doctor, “How can I get my body and mind ready” before surgery, says Finlayson. Also, ask: “How can I prep my home in anticipation of what I will need during recovery?”
What will recovery be like? There are three levels to consider: What will recovery in the hospital entail? Will you be transferred to a rehabilitation facility? And what will it be like to recover at home?
Ask how long you can stay in the hospital. Will you experience pain, or consequences of the anesthesia? Maintaining cognitive ability is a concern and you may want to ask your anesthesiologist what you can do to maintain cognitive function after surgery. If you go to a rehabilitation center, you’ll want to know what kind of treatment you’ll need and if you can expect to return to your normal level of activity.
During the covid-19 pandemic, “a lot of older people have chosen to go home rather than go to rehab, and it is really important to make sure they get the right support,” said. Dr. Rachelle Bernackidirector of transition care and postoperative services at the Center for Geriatric Surgery at Brigham and Women’s Hospital in Boston.
For some older people, the loss of independence after surgery can be permanent. Be sure to ask your options if that happens.
We’d love to hear from our readers on the questions you’d like answered, the problems you’re facing with your health care, and the advice you need to deal with the care system. health. Visit khn.org/columnists to send your inquiry or advice.