Avoiding Surgery in the Elderly
The New York Times reports in its "The New Old Age - Caring and Coping Blog" on the high-risk of performing surgery in older adults, even for otherwised routine operations.
Even operations considered fairly routine in younger patients, like appendectomies, become high-risk for nursing home residents. “Something about undergoing anesthesia, the surgery’s physiological assault on the body, impacts older people much more than we think,” said Dr. Emily Finlayson, an Associate Professor of Surgery at University of California, San Francisco, and lead author of a recent study published in The Annals of Surgery.
In fact, the study, which compared mortality risks and subsequent interventions for four types of major abdominal surgery, found that even compared with adults of similar age who had the same number of chronic illnesses — but who weren’t in institutions — nursing home residents fared sharply worse.
Bluntly put, surgery is much more likely to kill them.
Dr. Finlayson and her colleagues used national Medicare claims and nursing home surveys to identify nearly 71,000 nursing home residents who had surgery from 1999 through 2006. They compared them with more than a million elders who underwent the same four procedures but did not live in a nursing home. The researchers chose operations frequently performed on older adults: removal of an infected appendix (appendectomy), removal of an infected gallbladder (cholecystectomy), surgery for a bleeding ulcer in the upper part of the intestine, or surgery for noncancerous colon diseases like diverticulitis or colitis. These are painful conditions requiring immediate decisions, as opposed to diagnoses like breast or prostate cancer, in which a patient and his or her family can take a few days to figure out the best course........