(CNN) — Larry McMahon is considering major surgery. Over the past five years, your back pain has intensified. Physiotherapy, muscle relaxants and injections offer no relief.
“It’s a pain that barely lets me do things,” he says.
Should McMahon, an 80-year-old retired Virginia state trooper who now lives in Southport, North Carolina, have spinal fusion surgery, a procedure that can take up to six hours? (Eight years ago he underwent a lumbar laminectomy, another arduous back operation.)
“¿Me recuperaré en seis meses o en un par de años? ¿Es seguro para un hombre de mi edad, con diversos problems de salud, estar dormido pendante un largo periodo?”, told me McMahon, transmitiéndome algunas de sus preocupaciones en una phone call.
Older people who are considering major surgery are often unsure whether or not to proceed. In many cases, surgery can save the patient’s life or improve their quality of life. But advancing age puts people at increased risk for adverse outcomes, such as difficulty with activities of daily living, prolonged hospital stays, mobility issues and loss of independence.
In November, I wrote about a new study that shed light on some of the risks older adults face when undergoing invasive procedures. But readers wanted to know more. How do you determine if the potential benefits of major surgery outweigh the risks? And what questions should older people ask themselves to try to find out? I asked several experts for recommendations. Here are some of their suggestions.
What is the purpose of this surgery?
Ask your surgeon, “How will this surgery make things better for me?” says Margaret “Gretchen” Schwarze, MD, associate professor of surgery at the University of Wisconsin. Will removing a fast-growing tumor prolong your life? Will it improve your quality of life by making it easier for you to walk? Will it prevent you from becoming disabled, like with a hip replacement?
If your surgeon tells you, “We need to remove this tumor or remove this obstruction,” ask yourself what impact this will have on your daily life. Just because an abnormality, such as a hernia, is detected doesn’t mean it needs to be treated, especially if you don’t have bothersome symptoms and the procedure involves complications, say Dr. Robert Becher and the Dr. Thomas Gill of Yale University. , authors of this recent article on major surgery in the elderly.
If all goes well, what can I expect?
Schwarze, a vascular surgeon, often treats patients with abdominal aortic aneurysms, a bulge in a major blood vessel that can be fatal if ruptured.
Here’s how he describes a “best case” surgical scenario for this condition: “The operation will take approximately four to five hours. Once complete, the elderly person will be in the intensive care unit with a breathing tube for one to two hours.. days. After that he will be in the hospital for about a week. After that he will probably have to go to rehab to get his strength back, but I think he will be able to go home in three or four weeks, and it will probably take two or three months for him to feel good again, like before the operation.
Among other things, people might ask their surgeon, according to a patient brochure Schwarze’s team created: What will my daily life be like right after surgery? Three months later? One year later? Will I need help and for how long? Will I have tubes or drains placed?
If things are not going well, what can I expect?
According to Schwarze, the “worst case scenario” could be this: “You have surgery, you go to the intensive care unit (ICU) and you have serious complications. You have a heart attack. Three weeks after the operation, you’re still in intensive care with a breathing tube, you’ve lost most of your strength and have no chance of getting home. Or the operation didn’t work, and you’re still going through it all .
“People often think they’re going to die on the operating table if things go wrong,” says Dr. Emily Finlayson, director of the UCSF Senior Surgery Center in San Francisco. “But we’re very good at saving people, and we can keep people alive for a long time. The reality is there can be a lot of pain and suffering and interventions like feeding tubes and ventilators if things are not going our way.”
Given my health, age and functional status, what is the most likely outcome?
After the surgeon has explained different scenarios to you, ask him: “Do you think I really need surgery?” and “Which outcomes do you think are most likely for me?” advises Finlayson. Research suggests that frail older people with cognitive impairment or other serious conditions, such as heart disease, have worse experiences with major surgeries. Also, people in their 80s and 90s are at a higher risk of things going wrong.
“It’s important to have family or friends in the room for those conversations with high-risk patients,” Finlayson said. Many seniors have some degree of cognitive difficulty and may need help making complex decisions.
What are the alternatives ?
Make sure your doctor explains the nonsurgical options to you, Finlayson says. Older men with prostate cancer, for example, might consider “watchful waiting” — ongoing monitoring of their symptoms — rather than risk invasive surgery. Women in their 80s who develop small breast cancer may choose to leave it alone if removing it poses a risk, taking into consideration other health factors.
Due to McMahon’s age and underlying medical issues (a 2021 knee replacement that didn’t heal, arthritis, high blood pressure), his neurosurgeon suggested he explore other options. other interventions, including more injections and physiotherapy, before surgery. “He said to me, ‘I’m making money from the surgery, but it’s a last resort,'” McMahon said.
What can I do to prepare?
“Preparing for surgery is really vital for older people. If patients do some of the things doctors recommend – quitting smoking, losing weight, walking more, eating better – they can reduce the risk of complications and the number days of hospitalization,” says Dr. Sandhya Lagoo-Deenadayalan, co-director of the Perioperative Health Optimization for Older Adults (POSH) program at Duke University Medical Center.
When elderly patients are referred to POSH, they receive a comprehensive assessment of their medications, nutritional status, mobility, pre-existing conditions, ability to perform activities of daily living, and home support. Patients leave with a list of recommended actions, usually starting several weeks before surgery.
If your hospital doesn’t have such a program, ask your doctor, “How can I prepare my body and mind?” before undergoing surgery, Finlayson says. Also ask, “How can I prepare my home in advance to anticipate what I will need during recovery?”
How will the recovery be?
There are three levels to consider: What will hospital recovery involve? Will they transfer you to a rehabilitation center? And how will the recovery be at home?
Ask how long you could stay in the hospital. Will you have pain or sequelae of anesthesia? Preservation of cognition is a concern and you may want to ask your anesthesiologist what you can do to maintain cognitive function after the operation. If you are going to a rehabilitation center, you will want to know what type of therapy you will need and whether you can expect to return to your original level of functioning.
During the covid-19 pandemic, “many older people have chosen to return home rather than go to rehab, and it’s really important to make sure they have the right support,” says Dr Rachelle Bernacki, director of transformation at Postoperative Care and Services in Brigham and the Center for Geriatric Surgery at Boston Women’s Hospital.
For some older people, the loss of independence after the operation may be permanent. Be sure to ask what your options are if this happens.
Author Judith Graham is part of KHN (Kaiser Health News), which is an American national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of the three main operational programs of the KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides information on health issues to the nation.