Should Older Seniors Undergo Major Surgery?
Men and women are living longer. The trend towards an ever-growing larger cohort of “older seniors” is expected to continue indefinitely. For example, the number of people reaching the century mark in the United States is expected to double over the next 20 years. With more and more Americans living longer, a question that must frankly be considered is, should older seniors undergo major surgery?
In this article, we take a close look at research study data and other information in working towards an answer to the challenging question of whether or not an older senior should submit to major surgery. For the purposes of this discussion, we are classifying “older seniors” as those who are 80 and older (unless otherwise noted).
Trending to the Century Mark
Before digging deeper into the discussion of older seniors submitting to major surgery, we take a moment to look closely at the trend. Let us look towards the century mark to consider how the number of people in the United States over age 100 will increase during the coming 40 years. We also include data on the population of centenarians in the United States since 2016.
The breakdown of the number of people in the U.S.A. 100 years of age or older from 2016 to 2060 helps illustrate how the overall number of older seniors who will face decisions regarding major surgery will expand during the coming four decades.
- 2016 – 82,000 people 100 or older
- 2020 – 92,000 people 100 or older
- 2025 – 120,000 people 100 or older
- 2030 – 140,000 people 100 or older
- 2040 – 196,000 people 100 or older
- 2045 – 270,000 people 100 or older
- 2050 – 386,000 people 100 or older
- 2055 – 486,000 people 100 or older
- 2060 – 589,000 people 100 or older
Yale School of Medicine Study Data on Older Senior Mortality Rates Following Major Surgery
A new research study undertaken by the Yale School of Medicine reveals that approximately one in seven older adults dies within a year of undergoing major surgery. This study has shed much-needed light on older Americans’ risks when undergoing invasive medical procedures.
The Yale School of Medicine study was reported in JAMA Surgery. A critical data from the study is that although patients 65 and older undergo nearly 40 percent of all surgeries in the United States, detailed national data about the outcomes of these invasive procedures have been largely missing.
“As a field, we’ve been really remiss in not understanding long-term surgical outcomes for older adults,” said Dr. 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.
There are three categories of seniors who are particularly vulnerable to a higher risk of mortality when undergoing major surgery:
- Patients with dementia (or suspected dementia) – 33 percent die within a year from surgery
- Patients defined as medically frail – 27 percent die within a year from surgery
- Patients having to undergo emergency surgery – 22 percent die within a year from surgery
It is also important to note that patients over the age of 90 are six times as likely to die within a year from surgery than those between the ages of 65 and 69.
In the new study, Dr. 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.
Major surgeries are defined in the Yale study as invasive procedures that take place in operating rooms with patients under general anesthesia. Examples include procedures to:
- Replace broken hips
- Improve blood flow in the heart
- Excise cancer from the colon
- Remove gallbladders
- Fix leaky heart valves
- Repair hernias
According to the results from the Yale study, older adults tend to experience more problems after surgery if:
- They have chronic conditions such as heart or kidney disease
- They are already weak or have difficulty moving around
- Their ability to care for themselves is compromised
- They have cognitive problems
The Yale research team concluded that one in three older adults had not returned to their baseline level of functioning six months after major surgery. Those seniors who were most likely to recover were those individuals who had elective surgeries for which they could prepare in advance.
Research Data on Rate of Major Surgery Among Seniors Generally
In another research study published in 2021, the Annals of Surgery, researchers found that approximately 1 million major surgeries occur annually in individuals 65 and older each year. This includes a significant number of major surgeries that occur near the end of life. Data about these patients was also largely lacking until this research study.
“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 Dr. 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.
An example of the kind of decision-making needed when an older person faces the major jury is that of a patient who was 93. At that age, the man 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 slow-growing cancer than deal with a major operation and the risk of complications,” Ko said.
Majority of Seniors Choose Major Surgery
Despite the high probability of a negative outcome, most senior patients choose surgery. Dr. 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.
In order to prepare for surgery, the patient undertook physical therapy and ate more high-protein foods. This was designed to make the man stronger for the planned major surgery. “He may need six to eight weeks to get ready for surgery, but he’s motivated to improve,” Russell said.
Steps to Improve Surgical Outcomes for Geriatric Patients
Finally, as the number of people in the older population increases, improved surgical outcomes for seniors are even more critical. The American College of Surgeons launched what it describes as a major quality improvement program in 2019. The program requires hospitals to meet 30 standards to become recognized as having expertise in geriatric surgery. So far, fewer than 100 of the thousands of eligible hospitals in the United States are participating in this geriatric surgery program.