Surgery on older people can be riskier than other generations. But it can be safely done if doctors take certain precautions. Dr. Mark Katlic, chief of surgery at Sinai Hospital of Baltimore and an expert on surgical care of patients 80 and older, talks about the risks involved.
Is a patient ever too old for surgery?
There is no age in years that makes a patient ineligible for needed surgery. Early in the last century, many surgeons held the view that age 50 was old! Now we are doing complex operations, even heart surgery, in patients in their 80s, 90s and into their 100s. Each patient's individual medical condition is the most important factor, regardless of age.
How do you balance the risk of surgery versus improved quality of life?
Numerous studies have documented that most elderly people prefer better quality of life over prolonged length of life. They'd rather have a few good years than have more years. It is vital to engage older patients and their family and/or caregivers in a discussion on ways surgery might affect their day-to-day life. Sometimes a smaller operation may have 95 percent of the results of a bigger operation with less risk for affecting quality of life. It is important to follow the "Goldilocks" or "just right" philosophy of treatment — not too much, not too little.
A specialized battery of pre-operative testing including, cognition, frailty, functional status and nutrition helps us make a more informed treatment decision for each older patient we serve.
What special considerations do elderly surgical patients require compared to younger patients?
It is important to be aware that elderly patients have less physical reserve — less in the tank, if you will. They can handle physical stress, but only to a certain point, and may not survive a complication during surgery. There needs to be an excessive attention to detail in and out of the operating room around the time of surgery. Elderly patients will not tolerate excessive blood loss, so surgeons need to be especially careful to prevent blood loss during and after the surgery. While we try to limit the amount of anesthesia required for a procedure, it is more important to do an operation perfectly to prevent complications and having to worry about how long the patient is under anesthesia.
Getting patients up and walking soon after surgery holds great benefit and respiratory care is especially important to prevent pneumonia.
What effect will aging baby boomers and their increased desire for surgery have on our nation's health care system?
What many refer to as the Silver Tsunami, the dramatic aging of the American population, will be the greatest factor affecting health care in our lifetime. The entire health care system in general is not taking this coming challenge seriously enough. We need more geriatricians and surgeons to give older patients the specialized care they need.
We plan to conduct numerous studies that will contribute to the knowledge base in this area nationally and even internationally.
Most elderly people rely on a caregiver. How does the caregiver factor into the course of treatment?
Most of our patients come to the center with caregivers, usually daughters or granddaughters or, in some cases, a hired caregiver. We know there is a burden on the caregiver, and we are diligently surveying those caregivers in order to assess that burden. It has a strong bearing on our treatment decisions. We try to involve the caregiver as much as possible in the entire process, from pre-operative testing to the day of surgery to the care administered immediately following surgery in the hospital. If the caregiver's services need to be supplemented, we offer social services and other resources to provide more care in the home or may even recommend temporary rehab facilities or long-term acute care after surgery to reduce the direct burden on the caregiver.