Larry McMahon, who turned 80 in December, is contemplating whether to undergo major surgery.
Over the past five years, his back pain has become more severe. Physical therapy, muscle relaxants, and injections do not relieve symptoms.
“I can hardly do anything,” he said.
Should McMahon, a retired Virginia state trooper now living in Southport, North Carolina, try spinal fusion, a procedure that takes up to six hours? underwent a painful back surgery.)
he has a question:
“Will I recover in six months or a few years? Is it safe for a man my age with various health problems to be put to sleep for long periods of time?”
Older people who are considering major surgery are often uncertain whether to proceed.
Surgery can often save the lives of older people and improve their quality of life. However, as people get older, they are at greater risk of undesirable consequences, such as difficulties in daily living, longer hospital stays, mobility problems, and loss of independence.
In November, I wrote about new research that sheds light on some of the risks older people face when undergoing invasive procedures.
How do we determine if the potential benefits of major surgery are worth the risks? And what questions should older people ask as they try to make sense of this? It is suggested by several experts.
What is the purpose of this surgery?
Margaret “Gretchen” Schwartz, associate professor of surgery at the University of Wisconsin School of Medicine and Public Health, said people should ask their surgeons how a particular procedure would improve them.
Can removing a rapidly growing tumor prolong life? Does walking better improve quality of life? Will it prevent me from being disabled like a hip replacement?
If your surgeon says, “We need to remove this tumor or remove this blockage,” ask how that will affect your daily life. does not mean that you need to take action. Robert Becher and Thomas Gill of Yale University are the authors of a recent paper on major surgery in the elderly.
Hopefully what can you expect?
Vascular surgeon Schwarze often treats patients with abdominal aortic aneurysms, enlargements of large blood vessels that can be life-threatening if they rupture.
She describes a “best case” surgical scenario for the condition:
“The operation takes four to five hours. After the treatment, you will be hospitalized (intensive care unit) with a breathing tube for a day or two. After that, you will be hospitalized for about a week.
“I’ll probably have to go to rehab to get my strength back,” she added. She did it before surgery. ”
Among other things, people might ask surgeons: What will my daily routine look like right after surgery? Three months later? A year later? Do you need help and for how long? Will tubes and drains be inserted?
What can you expect if it doesn’t work?
According to Schwarze, the “worst case” scenario would be:
“You’ve had surgery, you’ve been to the ICU, and you’ve had serious complications. You’ve had a heart attack. Three weeks after your surgery, you’re still in the ICU with a breathing tube. You’ve lost most of your strength and can’t go home again, or you’ve been through all this despite having surgery that didn’t go your way.”
Many people think that once a procedure is performed, they will be on the operating table, but the reality is that surgical teams know how to rescue people and keep them alive, says the University of California, San Francisco Center. Director Emily Finlayson, Ph.D. Surgery for the elderly. But it comes at a cost.
“If things don’t go the way we want them to, it can lead to a lot of pain and suffering and the need for interventions like feeding tubes and ventilators,” Finlayson said.
What is the most likely outcome?
After the surgeon described various scenarios, Finlayson advised asking two questions:
“In your opinion, do I really need to have this surgery?”
“What outcome do you think is most likely for me?”
Research suggests that older people who are frail, who have cognitive impairment, or who have other serious conditions such as heart disease have a worse experience with major surgery. Older people in their 90s are at a higher risk of things getting worse.
“It’s important to have family and friends in the room for these conversations with high-risk patients,” Finlayson said.
Many older people have some degree of cognitive impairment and may need assistance in making complex decisions.
What are the alternatives?
Be sure to tell your doctor what your non-surgical options are, says Finlayson.
For example, an older man with prostate cancer may want to consider ‘wait and see’ continuous monitoring of symptoms rather than risk invasive surgery. A woman in her 80s who develops a small breast cancer may choose to leave it alone if removing it poses a risk, given other health factors.
Due to McMahon’s age and underlying medical problems (unhealed from a 2021 knee replacement, arthritis, high blood pressure), his neurosurgeon recommended other options, such as injections and additional physical therapy, before surgery. suggested that intervention be considered.
“He told me, ‘I make money from surgery, but it’s a last resort,'” McMahon said.
What can you do to prepare yourself?
“Surgery preparation is very important for older adults,” said Sandhya Lagoo-Deenadayalan, PhD, leader of the Perioperative Geriatric Health Program at Duke University Medical Center. “If patients do some of the things doctors recommend, such as quitting smoking, losing weight, walking more, and eating better, they can reduce the chance of complications and length of stay in hospital. ”
When older patients are referred to POSH, they receive a comprehensive assessment of medications, nutritional status, mobility, pre-existing conditions, ability to perform daily activities, and support at home. They usually start out weeks before surgery with a “to do” list of recommended actions.
If your hospital doesn’t have this kind of program, ask your doctor “How can I prepare my body and mind?” before undergoing surgery. How can I prepare the house in advance?”
What will recovery look like?
There are three levels to consider. What do I need for hospital recovery? Will you be transferred to a rehab facility? And what will the recovery at home look like?
Ask how long you might be hospitalized. Are there any pain or side effects of anesthesia?
Preserving cognitive function is a concern, so ask your anesthesiologist what you can do to preserve cognitive function after surgery. If you go to a rehab center, you’ll want to know what kind of treatment you’ll need and if you can expect to return to baseline levels of functioning.
During the coronavirus pandemic, “many older people are choosing to go home rather than rehab, and it’s very important that they have the right support,” says Care Transformation Center and Director of Postoperative Services, Rachelle Bernacki, Ph.D. For Geriatric Surgery at Brigham and Women’s Hospital in Boston.
In some older people, loss of independence after surgery may be permanent. Check your options if that happens.
Kaiser Health News is eager to hear from our readers about the questions they’d like answered, the issues they’re having in their care, and the advice they need in dealing with the health care system. To submit requests and tips, visit khn.org/columnists.
KHN is a national newsroom that produces in-depth journalism on health issues. KHN is one of his three major operating programs for the Kaiser Family Foundation, along with policy analysis and polls. KFF is a donated non-profit organization that provides information on health issues to the public.
