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Should older seniors risk major surgery? New research offers guidance.

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.

Nearly 1 in 7 older adults dies within a year of undergoing major surgery, according to a 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, 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 United States, detailed national data about the outcomes of these procedures have been largely missing.  "As a field, we’ve been really remiss in not understanding long-term surgical outcomes for older adults,” said Zara Cooper, a professor of surgery at Harvard Medical School and the director of the Center for Geriatric Surgery at Brigham and Women’s Hospital in Boston.  Of particular importance is information about how many seniors die, develop disabilities, can no longer live independently, or have a significantly worsened quality of life after major surgery.  "What older patients want to know is, ‘What’s my life going to look like?’” Cooper said. "But we haven’t been able to answer with data of this quality before.”

In the new study, Thomas Gill and Yale colleagues examined claims data from traditional Medicare and survey data from the National Health and Aging Trends study spanning 2011 to 2017. (Data from private Medicare Advantage plans were not available at that time but will be included in future studies.)  Invasive procedures that are done 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.  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. Remarkably, data documenting the extent of surgery in the older population have been lacking until now.  "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 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.

As an example of this kind of decision-making, Ko described a patient who, at 93, learned he had early-stage colon cancer on top of preexisting liver, heart, and lung disease. After an in-depth discussion and being told that the risk of poor results was high, the patient decided against invasive treatment.  "He decided he would rather take the risk of a slow-growing cancer than deal with a major operation and the risk of complications,” Ko said.  Still, most patients choose surgery. Marcia Russell, a staff surgeon at the Veterans Affairs Greater Los Angeles Healthcare System, described a 90-year-old patient who recently learned he had colon cancer during a prolonged hospital stay for pneumonia. "We talked with him about surgery, and his goals are to live as long as possible,” said Russell. To help prepare the patient, now recovering at home, for future surgery, she recommended he undertake physical therapy and eat more high-protein foods, measures that should help him get stronger.  "He may need six to eight weeks to get ready for surgery, but he’s motivated to improve,” Russell said.

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 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.

One of the most advanced systems in the country, the Center for Geriatric Surgery at Brigham and Women’s Hospital, illustrates what’s possible. There, older adults who are candidates for surgery are screened for frailty. Those judged to be frail consult with a geriatrician, undergo a thorough geriatric assessment, and meet with a nurse who will help coordinate care after discharge.  Also initiated are "geriatric-friendly” orders for postsurgery hospital care. This includes assessing older patients three times a day for delirium (an acute change in mental status that often afflicts older hospital patients), getting patients moving as soon as possible, and using non-narcotic pain relievers.  "The goal is to minimize the harms of hospitalization,” said Cooper, who directs the effort.  Cooper described a recent patient as a "social woman in her early 80s who was still wearing skinny jeans and going to cocktail parties.” This woman came to the emergency room with acute diverticulitis and delirium; a geriatrician was called in before surgery to help manage her medications and sleep-wake cycle, and recommend non-pharmaceutical interventions.  With the help of family members who visited this patient in the hospital and have remained involved in her care, "she’s doing great,” Cooper said. "It’s the kind of outcome we work very hard to achieve.”

Kaiser Health News is a national newsroom that produces journalism about health issues.

 

I don't know why we insist on starting the number at 65. Right from the article it says " Patients who were 90 or older were six times as likely to die than those ages 65 to 69". Start the discussion there then.

29 minutes ago, Paul852 said:

I don't know why we insist on starting the number at 65. Right from the article it says " Patients who were 90 or older were six times as likely to die than those ages 65 to 69". Start the discussion there then.

Because that's when the government starts paying. We need to raise the age for Medicare

Sanctuary.

11 minutes ago, vikas83 said:

Because that's when the government starts paying. We need to raise the age for Medicare

Good luck convincing people to work until they're 90

23 minutes ago, Paul852 said:

Good luck convincing people to work until they're 90

you can't go right to 90.

tell them they need to work until 69 (nice). that'll take the edge off. 

there really needs to be a schedule. my generation (gen x) shouldn't be eligible until at last 70. frankly it ought to be higher. for ALL benefits - SSN, medicare, etc. 

grade it out based on life expectancy. 

Just now, JohnSnowsHair said:

you can't go right to 90.

tell them they need to work until 69 (nice). that'll take the edge off. 

there really needs to be a schedule. my generation (gen x) shouldn't be eligible until at last 70. frankly it ought to be higher. for ALL benefits - SSN, medicare, etc. 

grade it out based on life expectancy. 

I don't disagree at all. And frankly, if they want to retire sooner then save for it. Problem is, these are the people who vote and that will be driving such decisions.

1 hour ago, JohnSnowsHair said:

you can't go right to 90.

tell them they need to work until 69 (nice). that'll take the edge off. 

there really needs to be a schedule. my generation (gen x) shouldn't be eligible until at last 70. frankly it ought to be higher. for ALL benefits - SSN, medicare, etc. 

grade it out based on life expectancy. 

Raise it gradually over time from 65 to low 70s at a minimum.

1 hour ago, vikas83 said:

Raise it gradually over time from 65 to low 70s at a minimum.

Or maybe Congress should just stop stealing the money from from the SS Trust Fund?

Why would you replace the hips on a person that is 100 lbs overweight?  First, what have we tried that is not invasive.  Diet.  Exercise.  Then try what is invasive.  

But then people will call this fascist.  They will ask "why is the government stopping me from having surgery? This is a death panel!"  

I like the Vibrator thread better.

One star.

2 hours ago, JohnSnowsHair said:

you can't go right to 90.

tell them they need to work until 69 (nice). that'll take the edge off. 

there really needs to be a schedule. my generation (gen x) shouldn't be eligible until at last 70. frankly it ought to be higher. for ALL benefits - SSN, medicare, etc. 

grade it out based on life expectancy. 

The majority of Gen X’ers and younger, who are primarily relying on a 401k for retirement, will probably have to continue working into their 70’s anyway… if they have a plan at all.

11 minutes ago, MidMoFo said:

The majority of Gen X’ers and younger, who are primarily relying on a 401k for retirement, will probably have to continue working into their 70’s anyway… if they have a plan at all.

Anyone my age counting on Social Security or Medicare to still exist in 20 years is delusional. They'll start by raising the retirement age, move to means testing, and then they will both finally collapse.

4 minutes ago, vikas83 said:

Anyone my age counting on Social Security or Medicare to still exist in 20 years is delusional. They'll start by raising the retirement age, move to means testing, and then they will both finally collapse.

I don’t expect to see anything from Social Security.

Medicare I expect will be expanded into Universal Healthcare in the next 20 years. Pricing for healthcare and insurance is out of control.

I’m trying to make it to full retirement which is 67 for me, 9 more years. Arthritis is doing its best to keep me from getting there. I will mostly likely need 4 artificial joints by then. Left knee already done, both shoulders scheduled for next Feb and hoping to get another year or two in before right knee needs done.  

7 minutes ago, Tnt4philly said:

I’m trying to make it to full retirement which is 67 for me, 9 more years. Arthritis is doing its best to keep me from getting there. I will mostly likely need 4 artificial joints by then. Left knee already done, both shoulders scheduled for next Feb and hoping to get another year or two in before right knee needs done.  

 

1 hour ago, Arthur Jackson said:

I like the Vibrator thread better.

One star.

Go eat some spotted deek you poncey little git.

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A Florida woman who shot and killed her terminally ill husband inside a Daytona Beach hospital made her first court appearance Sunday and was denied bond.  Online Volusia County jail records show Ellen Gilland, 76, of New Smyrna faces one count of first-degree premeditated murder and three aggravated assault with a deadly weapon charges.  No family or friends showed up on her behalf at the court appearance, FOX 35 Orlando reports.  Gilland apparently did not say much during the appearance. She answered the judge's questions as she was read her charges and then was escorted out of the courtroom.

Daytona Beach police officers were called to the hospital around 11:35 a.m. Saturday and found Gilland had allegedly fired a single shot that killed her husband, 77-year-old Jerry GIlland.  She then confined herself to his room on the 11th floor, which led to a lockdown at the hospital as hostage negotiators tried to get her to come out. The incident happened on Saturday at AdventHealth Daytona Beach, Florida, according to police, who said officers saw that the woman shot her husband and stayed in the room, according to FOX 35.  "After nearly four hours of negotiating, police used a flash bang and a taser to get Gilland to drop the gun. They say she was never a threat to anyone else and no staff or patients were injured," FOX 35 states. 

Police say the shooting was orchestrated.  Apparently because he was terminally ill, they had a conversation about it, and they actually planned this approximately three weeks ago that if he continued to take a turn for the worst that he wanted her to end this," Daytona Beach police Chief Jakari Young said at a news conference, according to WESH 2 News. "Obviously, we're unsure how she brought that gun into the hospital, but this was planned."

 

On 12/12/2022 at 4:18 PM, Tnt4philly said:

I’m trying to make it to full retirement which is 67 for me, 9 more years. Arthritis is doing its best to keep me from getting there. I will mostly likely need 4 artificial joints by then. Left knee already done, both shoulders scheduled for next Feb and hoping to get another year or two in before right knee needs done.  

I didn’t realize you were as old as Dr. Philly