Larry McMahon is considering having major surgery. His back pain has increased significantly over the past five years. There is no relief from physical therapy, muscle relaxants, or injections.
He stated, “It’s a pain that leaves me hardly able to do anything.”
Should McMahon, an 80-year-old former state trooper from Virginia who now lives in Southport, North Carolina, attempt spinal fusion surgery, which can take up to six hours? He had another difficult back surgery, a lumbar laminectomy, eight years ago.)
“Will I be able to get better in six months, or in a few years? Is it safe to put a man my age with a number of health issues to sleep for a long time?” In a telephone conversation, McMahon inquired, expressing some of his concerns to me.
Older adults contemplating major surgery often aren’t sure whether to proceed. In many cases, surgery can be lifesaving or improve a senior’s quality of life. But advanced age puts people at greater risk of unwanted outcomes, including difficulty with daily activities, extended hospitalizations, problems moving around, and the loss of independence.
I wrote in November about a new study that shed light on some risks seniors face when having invasive procedures. But readers wanted to know more. How does one determine if potential benefits from major surgery are worth the risks? And what questions should older adults ask as they try to figure this out? I asked several experts for their recommendations. Here’s some of what they suggested.
What is the purpose of this operation?
Ask your surgeon, “How will this surgery improve my situation?” said Dr. Margaret “Gretchen” Schwarze, an associate professor of surgery at the School of Medicine and Public Health of the University of Wisconsin. Will it expand your life by eliminating a quickly developing cancer? Will making walking easier improve your quality of life? Like a hip replacement, will it prevent you from becoming disabled?
If your surgeon says, “We need to remove this growth or clear this blockage,” ask how that will affect your day-to-day activities. According to Drs., just because an abnormality like a hernia has been discovered doesn’t mean it needs to be fixed. This is especially true if you don’t have any unpleasant symptoms and the procedure is complicated. The most recent paper on major surgery in older adults was written by Yale University professors Robert Becher and Thomas Gill.
What can I anticipate if everything goes well?
As a vascular surgeon, Schwarze frequently treats abdominal aortic aneurysms, which are enlargements of major blood vessels that can cause death if they rupture.
This is the way she portrays a “best case” careful situation for that condition: ” The procedure will take four to five hours. At the point when it’s finished, you’ll be in the ICU with a breathing cylinder short-term for a little while. After that, you’ll spend another week or so in the hospital. You will probably need to go to rehab afterward to regain your strength; however, I believe you will be able to return home within three to four weeks, and it will probably take you two to three months to feel the same way you did before the surgery.
According to a patient brochure created by Schwarze’s team, other questions that patients might ask their surgeon include: What will my immediate post-surgery life be like? After three months? After a year? How long will I require assistance? Will any drains or tubes be inserted?
What can I anticipate if things don’t go as planned?
Schwarze says the following about a “worst-case” scenario: After surgery, you go to the intensive care unit and experience serious complications. A heart attack strikes. You are still in the intensive care unit with a breathing tube three weeks after surgery, have lost most of your strength, and there is no way you will ever return home. Or, the surgery didn’t work, but you still went through everything.The director of the UCSF Center for Surgery in Older Adults in San Francisco, Dr. Emily Finlayson, stated, “People often think I’ll just die on the operating table if things go wrong.” However, we are skilled at rescues and can keep you alive for a long time. If things don’t go as planned, there can be a lot of pain, suffering, and interventions like feeding tubes and ventilators.”
What is the most likely outcome in light of my age, health, and functional status?
Ask your surgeon, “Do I really need to have this surgery, in your opinion,” after he or she has shown you various scenarios. and “What do you think are the most likely outcomes for me?” Finlayson gave advice. Major surgery may be more difficult for elderly people who are frail, have cognitive impairment, or suffer from serious conditions like heart disease, according to research. Additionally, seniors in their 80s and 90s are more vulnerable to mishaps.
Finlayson said, “It’s important to have these conversations with high-risk patients with family or friends in the room.” Numerous seniors have some degree of mental hardships and may require help dealing with complex choices.
What other choices do you have?
Finlayson advised that you ensure that your physician informs you of your nonsurgical options. For example, older men who have prostate cancer might want to think about “watchful waiting,” which is continuous monitoring of their symptoms, rather than taking the chance of having invasive surgery. Given other health factors, women in their 80s who develop a small breast cancer may decide not to remove it. His neurosurgeon advised McMahon to investigate additional interventions, such as additional injections and physical therapy, prior to surgery because of McMahon’s age and underlying medical conditions (arthritis, a knee replacement in 2021 that has not healed, high blood pressure). McMahon stated, “He told me, “I make my money from surgery, but that’s a last resort.””
What can I do to get myself ready?
“For older adults, preparing for surgery is extremely important: According to Dr. Sandhya Lagoo-Deenadayalan, a codirector in the Perioperative Optimization of Senior Health (POSH) program at Duke University Medical Center, “they can reduce the likelihood of complications and the number of days spent in the hospital if patients do a few things that doctors recommend — stop smoking, lose weight, walk more, and eat better.”
A comprehensive assessment of their medications, nutritional status, mobility, preexisting conditions, ability to perform daily activities, and support at home are provided to elderly patients who are recommended to POSH. They get a “to-do” list of things to do, usually starting a few weeks before their surgery. Finlayson advised asking your doctor, “How can I get my body and mind ready?” prior to surgery if your hospital does not have such a program. Also inquire: How can I anticipate what I’ll need during recovery and prepare my home in advance?
How will recovery appear?
There are three consideration levels: How will you recover in the hospital? Will you be moved to a rehabilitation facility? And how will home recovery be like?
Inquire about the likelihood of your hospital stay. Will the anesthetic make you feel any pain or have any side effects? Preserving cognitive function after surgery is a concern, so you might want to inquire from your anesthesiologist about your options. If you go to a rehabilitation center, you will want to know what kind of therapy you will need and if you can expect to get back to where you were before.
Dr. Rachelle Bernacki, director of care transformation and postoperative services at the Center for Geriatric Surgery at Brigham and Women’s Hospital in Boston, stated that during the Covid-19 pandemic, “a lot of older adults have opted to go home instead of to rehab, and it’s really important to make sure they have appropriate support.”
After surgery, some elderly people may lose their independence for life. Make certain to ask what your choices are should that happen.