More elderly people are now opting for surgery: Study

Frailty particularly correlates with increased mortality and complications

People over 65 represent roughly 16 per cent of the American population, but account for 40 per cent of patients undergoing surgery in hospitals — and probably more than half of all surgical procedures.

Those proportions are likely to increase as the population ages and more seniors consider surgery, including procedures once deemed too dangerous for them.

Clifford Ko, a colorectal surgeon at the University of California, Los Angeles, recently performed major surgery on an 86-year-old with rectal cancer, for instance.

“Ten years ago, I’d think, ‘My god, can this person even survive the operating room?’” Ko said. “Now, it’s increasingly common to see octogenarians for these types of operations.”

He and Ronnie Rosenthal, a surgeon and geriatrician at the Yale University School of Medicine, lead the American College of Surgeons’s Coalition for Quality in Geriatric Surgery.

As older people undergo more operations, the coalition has focused on the results. Perhaps unsurprisingly, older surgical patients often fare worse than younger ones.

One study reviewing major, nonemergency surgery in 165,600 adults over 65 found that mortality and complications increased with age; hospital stays often lengthened.

Patients in their 80s undergoing major surgery for lung, esophageal and pancreatic cancer have substantially higher mortality rates than those aged 65 to 69, another study found; they’re also more likely to go to nursing homes afterward.

Why? Older patients often have chronic health problems, aside from whatever the surgery is supposed to fix, and take long lists of drugs. The hospital itself, where they risk acquiring infections or losing mobility after days in bed, can endanger them.

Frailty, an age-related physiological decline, particularly correlates with increased mortality and complications. “How we talk to them, how we care for them, their outcomes — there’s a lot of opportunity to do better” for older surgical patients, said Ko.

Hence, the college’s new geriatric surgery verification program, to be unveiled next month at a conference in Washington, D C, after four years of planning and research. It sets 30 standards that hospitals should 

meet to improve results for older patients.

In October, hospitals will begin applying for verification, an assurance to patients and families that the best possible surgical care will be provided. The college previously devised similar quality programs for trauma, cancer and pediatric surgery.

“People understand that children are different from adults,” Rosenthal said. “It’s taken a surprisingly long time to come around to the realisation that older adults are also different.”

A team will visit each applying hospital. “We’ll look at charts, we’ll interview people,” she said. 

© 2019 The New York Times News Service