While surgeons operate often on the elderly, studies are just starting to detail the risks

surgtools-150x150Seniors and their loved ones should take note of new and increasing data that researchers are developing about the risks undertaken by elderly patients who choose to undergo significant surgeries — procedures that make up a little less than half of costly operations performed in this country.

The numbers about invasive medical work can be mind-changing, especially for those with age-associated conditions, the independent, nonpartisan Kaiser Health News Service reported. As KHN’s “navigating aging” columnist Judith Graham wrote:

“Nearly 1 in 7 older adults die within a year of undergoing major surgery, according to an important new study that sheds much-needed light on the risks seniors face when having invasive procedures. Especially vulnerable are older patients with probable dementia (33% die within a year) and frailty (28%), as well as those having emergency surgeries (22%). Advanced age also amplifies risk: Patients who were 90 or older were six times as likely to die than those ages 65 to 69. The study in JAMA Surgery, published by researchers at Yale School of Medicine, addresses a notable gap in research: Though patients 65 and older undergo nearly 40% of all surgeries in the U.S., detailed national data about the outcomes of these procedures has been largely missing.”

Graham reported that researchers looked over time at records on more than 5,000 study participants 65 and older, more than 1,000 of whom had major operations, defining them, thusly:

“Invasive procedures that take place in operating rooms with patients under general anesthesia were counted as major surgeries. Examples include procedures to replace broken hips, improve blood flow in the heart, excise cancer from the colon, remove gallbladders, fix leaky heart valves, and repair hernias, among many more.

The researchers, Graham reported, were eager to understand “how many seniors die, develop disabilities, can no longer live independently, or have a significantly worsened quality of life after major surgery.” As one expert explained, older patients, as with all individuals, want to know what their lives will be like after a big operation, and the reported quoted Dr. Thomas Gill, the lead author of the new study done with Yale colleagues:

“Older adults tend to experience more problems after surgery if they have chronic conditions such as heart or kidney disease; if they are already weak or have difficulty moving around; if their ability to care for themselves is compromised; and if they have cognitive problems, noted Gill, a professor of medicine, epidemiology, and investigative medicine at Yale. Two years ago, Gill’s team conducted research that showed 1 in 3 older adults had not returned to their baseline level of functioning six months after major surgery. Most likely to recover were seniors who had elective surgeries for which they could prepare in advance. In another study, published last year in the Annals of Surgery, his team found that about 1 million major surgeries occur in individuals 65 and older each year, including a significant number near the end of life.”

Graham also reported this, writing in decidedly understated fashion:

“Remarkably, data documenting the extent of surgery in the older population has been lacking until now.”

She quoted another expert who makes key points about operations on the aged:

“’This opens up all kinds of questions: Were these surgeries done for a good reason? How is appropriate surgery defined? Were the decisions to perform surgery made after eliciting the patient’s priorities and determining whether surgery would achieve them?’ said Dr. Clifford Ko, a professor of surgery at UCLA School of Medicine and director of the Division of Research and Optimal Patient Care at the American College of Surgeons.”

In my practice, I see the harms that patients suffer while seeking medical services, including the devastating problems due to botched surgeries and post-operative complications. All medical procedures carry risks, and surgeries should never be undertaken without extensive discussion, preparation, investigation, and care.

Patients have a precious, vital, and fundamental right to informed consent. This means they are told clearly and fully all the vital facts they need to make an intelligent decision about what treatments to have, where to get them, and from whom. It is true that various advancements have led more of us to live longer, and, in many cases healthier than ever.

But in our increasingly graying society, we need far more hard evidence about the risks and benefits of treatments for older patients, especially painful, costly, and invasive operations, as Graham reported:

“The choices older Americans make about undergoing major surgery will have broad societal implications. As the 65-plus population expands, ‘covering surgery is going to be fiscally challenging for Medicare,’ noted Dr. Robert Becher, an assistant professor of surgery at Yale and a research collaborator with Gill. Just over half of Medicare spending is devoted to inpatient and outpatient surgical care, according to a 2020 analysis. What’s more, ‘nearly every surgical subspecialty is going to experience workforce shortages in the coming years,’ Becher said, noting that in 2033, there will be nearly 30,000 fewer surgeons than needed to meet expected demand. These trends make efforts to improve surgical outcomes for older adults even more critical. Yet progress has been slow. The American College of Surgeons launched a major quality improvement program in July 2019, eight months before the covid-19 pandemic hit. It requires hospitals to meet 30 standards to achieve recognized expertise in geriatric surgery. So far, fewer than 100 of the thousands of hospitals eligible are participating.”

We have much work to do to better safeguard all patients, especially vulnerable elders, and to ensure they and their loved ones fully know what they can expect if they undergo major medical treatments.

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