Major surgery for elderly patients: Is it worth it?

By Salma Mahmoud | Fact-checked by Barbara Bekiesz
Published February 10, 2023

Key Takeaways

  • Major surgery leaves many older patients with numerous complications and diminished quality of life.

  • Discussing possible outcomes with patients helps them make informed decisions on their treatment plans.

  • There are alternatives available for certain procedures that may reduce the risk for senior patients.

The publication of a study discussing the risks that older seniors face when undergoing major surgery has prompted a conversation among clinicians on whether such risks outweigh the potential benefits.

While such choices will be unique for each patient based on their current health status, physicians can help guide them in deciding for or against surgery by discussing its possible outcomes and presenting alternative, less-risky treatments as an option.

Troubling statistics

According to a research article published by JAMA Surgery, nearly 1 in 7 older adults die within a year of undergoing major surgery.[] The older the patients were, the higher the risks they faced, with patients over the age of 90 being six times more likely to die than those between the ages of 65 to 69.

This study also showed that 1 in 3 older adults did not return to their baseline level of functioning at 6 months after major surgery.

In addition, major surgeries tend to greatly affect older patients who already have other health complications. For example, 33% of patients who suffer from dementia die within a year of having major surgery.

Twenty-eight percent of patients with frailty die within a year after major surgery. And about 22% of older patients who undergo emergency surgery die within a year.

This research is especially pertinent since surgeries on patients who are older than 65 make up 40% of the surgeries done in the US.[]

What are the risks?

There are many risks associated with major surgery, especially for older seniors. These include (but are not limited to) developing disability from the surgery, worsened quality of life, the inability to live independently, and extended hospitalizations, as well as death, according to a Kaiser Health News article published by CNN.[]

Two additional risks to surgery—especially in older patients who are undergoing anesthesia—are postoperative delirium and postoperative cognitive dysfunction (POCD).

Postoperative delirium is particularly common in older patients. It tends to start a few days after surgery, but it will only affect patients for a short time post-surgery.

However, this is an important consideration when discussing surgery with patients, as a person with postoperative delirium will require attentive care after surgery, either from healthcare professionals (HCPs) or loved ones, according to information from the American Society of Anesthesiologists.[]

POCD is a more serious condition that can cause memory loss as well as difficulty in thinking and learning, exacerbating such problems if they already exist. Older patients who have conditions such as heart, lung, Alzheimer, or Parkinson’s disease, or who have had a stroke, are at a higher risk of developing POCD.

Related: Health-related quality of life in elderly patients with heart failure

Alternatives to surgery

For certain older patients, depending on their health status before surgery and their desired outcome for the procedure, there may be less risky alternatives such as medications, injections, or continued monitoring of symptoms. These can be tried before determining that surgery is needed, per another Kaiser Health News article published by CNN.[]

Weighing the risks associated with the surgery and if it's worth being performed could save some patients from future complications—and perhaps even save their life.

Facilitating the talk

In the conversations between HCPs and patients about whether or not to have surgery, providing the answers to these questions can be useful:

  • What is the goal of this surgery?

  • If things go well, what can the patient expect?

  • If things don’t go well, what can they expect?

  • Given the patient’s health, age, and functional status, what’s the most likely outcome?

  • What are the alternatives?

  • What can the patient do to prepare themselves?

  • What will recovery look like?

Discussing these topics with the patient and their family members in a clear, concise, and empathetic manner may help them understand the potential risks and benefits of undergoing surgery and make a sensible decision based on what’s best for them and their future.

What this means for you

In order for older patients to achieve the best possible outcomes from surgery, it’s important for HCPs to go over the risks involved. Discuss what the patient hopes to achieve post-surgery and consider whether that can be achieved through a different course of treatment besides surgery. Having these discussions with the patient's family or loved ones is worthwhile, as postoperative care for older patients can be just as important as the surgery itself.

Read Next: Health concerns of the super-elderly to watch out for
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