{"id":7267,"date":"2023-04-25T07:08:05","date_gmt":"2023-04-25T11:08:05","guid":{"rendered":"https:\/\/www.silvercentury.org\/?p=7267"},"modified":"2023-04-26T06:47:21","modified_gmt":"2023-04-26T10:47:21","slug":"questions-to-ask-before-major-surgery","status":"publish","type":"post","link":"http:\/\/78.142.243.82\/~silvercentury\/2023\/04\/questions-to-ask-before-major-surgery\/","title":{"rendered":"Questions to Ask before Major Surgery"},"content":{"rendered":"

Back in November, <\/span><\/i>Kaiser Health News<\/span><\/a> columnist Judith Graham wrote about what older adults risk when they have a major operation. Readers wanted to know more, so she consulted experts and zeroed in on seven questions to ask a surgeon before surgery. Graham\u2019s article was posted on the <\/span><\/i>KHN<\/span> website on January 3, 2023, and also ran on <\/span><\/i>CNN<\/span><\/i><\/a>. <\/span>Funding from the Silver Century Foundation helps <\/span><\/i>KHN<\/span> develop articles (like this one) on longevity and related health and social issues.<\/span><\/i> <\/span><\/p>\n

L<\/span>arry McMahon, who turned 80 in December, is weighing whether to undergo a major surgery. Over the past five years, his back pain has intensified. Physical therapy, muscle relaxants and injections aren\u2019t offering relief.<\/span><\/p>\n

\u201cIt\u2019s a pain that leaves me hardly able to do anything,\u201d he said.<\/span><\/p>\n

Should McMahon, a retired Virginia state trooper who now lives in Southport, NC, try spinal fusion surgery, a procedure that can take up to six hours? (Eight years ago, he had a <\/span>lumbar laminectomy<\/a>,<\/span> another arduous back surgery.)<\/span><\/p>\n

\u201cWill I recover in six months\u2014or in a couple of years? Is it safe for a man of my age with various health issues to be put to sleep for a long period of time?\u201d McMahon asked, relaying some of his concerns to me in a phone conversation.<\/span><\/p>\n

Older adults contemplating major surgery often aren\u2019t sure whether to proceed. In many cases, surgery can be lifesaving or improve a senior\u2019s quality of life. But advanced age puts people at greater risk of unwanted outcomes, including difficulty with daily activities, extended hospitalizations, problems moving around and the <\/span>loss of independence<\/a>. <\/span> <\/span><\/p>\n

I <\/span>wrote in November<\/span><\/a> about a new study that shed light on some risks seniors face when having invasive procedures. But readers wanted to know more. How does one determine if potential benefits from major surgery are worth the risks? And what questions should older adults ask as they try to figure this out? I asked several experts for their recommendations. Here\u2019s some of what they suggested.<\/span><\/p>\n

What\u2019s the goal of this surgery? <\/b>Ask your surgeon, \u201cHow is this surgery going to make things better for me?\u201d said <\/span>Margaret \u201cGretchen\u201d Schwarze, MD<\/a>,<\/span> an associate professor of surgery at the University of Wisconsin School of Medicine and Public Health. Will it extend your life by removing a fast-growing tumor? Will your quality of life improve by making it easier to walk? Will it prevent you from becoming disabled, akin to a hip replacement?<\/span><\/p>\n

If your surgeon says, \u201cWe need to remove this growth or clear this blockage,\u201d ask what impact that will have on your daily life. Just because an abnormality such as a hernia has been found doesn\u2019t mean it has to be addressed, especially if you don\u2019t have bothersome symptoms and the procedure comes with complications, said Robert Becher, MD, and Thomas Gill, MD, of Yale University, authors of that recent paper on major surgery in older adults.<\/span><\/p>\n

If things go well, what can I expect? <\/b>Schwarze, a vascular surgeon, often cares for patients with abdominal aortic aneurysms, an enlargement in a major blood vessel that can be life-threatening if it bursts.<\/span><\/p>\n

Here\u2019s how she describes a \u201cbest case\u201d surgical scenario for that condition: \u201cSurgery will be about four to five hours. When it\u2019s over, you\u2019ll be in the ICU with a breathing tube overnight for a day or two. Then, you\u2019ll be in the hospital for another week or so. Afterwards, you\u2019ll probably have to go to rehab to get your strength back, but I think you can get back home in three to four weeks, and it\u2019ll probably take you two to three months to feel like you did before surgery.\u201d<\/span><\/p>\n

Among other things people might ask their surgeon, according to a patient brochure<\/a> Schwarze\u2019s team has created: What will my daily life look like right after surgery? Three months later? One year later? Will I need help, and for how long? Will tubes or drains be inserted?<\/span><\/p>\n

If things don\u2019t go well, what can I expect? <\/b>A \u201cworst case\u201d scenario might look like this, according to Schwarze: \u201cYou have surgery, and you go to the ICU, and you have serious complications. You have a heart attack. Three weeks after surgery, you\u2019re still in the ICU with a breathing tube, and you\u2019ve lost most of your strength, and there\u2019s no chance of ever getting home again. Or, the surgery didn\u2019t work, and still you\u2019ve gone through all this.\u201d<\/span><\/p>\n

\u201cPeople often think I\u2019ll just die on the operating table if things go wrong,\u201d said <\/span>Emily Finlayson, MD<\/span><\/a>, director of the UCSF Center for Surgery in Older Adults in San Francisco. \u201cBut we\u2019re very good at rescuing people, and we can keep you alive for a long time. The reality is, there can be a lot of pain and suffering and interventions like feeding tubes and ventilators if things don\u2019t go the way we hope.\u201d<\/span><\/p>\n

Given my health, age and functional status, what\u2019s the most likely outcome? <\/b>Once your surgeon has walked you through various scenarios, ask, \u201cDo I really need to have this surgery, in your opinion?\u201d and \u201cWhat outcomes do you think are most likely for me?\u201d Finlayson advised. Research suggests that older adults who are frail, have cognitive impairment or other serious conditions such as heart disease have worse experiences with major surgery. Also, seniors in their 80s and 90s are at higher risk of things going wrong.<\/span><\/p>\n

\u201cIt\u2019s important to have family or friends in the room for these conversations with high-risk patients,\u201d Finlayson said. Many seniors have some level of cognitive difficulties and may need assistance working through complex decisions.<\/span><\/p>\n

What are the alternatives? <\/b>Make sure your physician tells you what the nonsurgical options are, Finlayson said. Older men with prostate cancer, for instance, might want to consider <\/span>\u201cwatchful waiting,\u201d<\/span><\/a> ongoing monitoring of their symptoms, rather than risk invasive surgery. Women in their 80s who develop a small breast cancer may opt to leave it alone if removing it poses a risk, given other health factors.<\/span><\/p>\n

Because of Larry McMahon\u2019s age and underlying medical issues (a 2021 knee replacement that hasn\u2019t healed, arthritis, high blood pressure), his neurosurgeon suggested he explore other interventions, including more injections and physical therapy, before surgery. \u201cHe told me, \u2018I make my money from surgery, but that\u2019s a last resort,\u2019\u201d McMahon said.<\/span><\/p>\n

What can I do to prepare myself? <\/b>\u201cPreparing for surgery is really vital for older adults: if patients do a few things that doctors recommend\u2014stop smoking, lose weight, walk more, eat better\u2014they can decrease the likelihood of complications and the number of days spent in the hospital,\u201d said <\/span>Sandhya Lagoo-Deenadayalan, MD<\/a>,<\/span>  a leader in Duke University Medical Center\u2019s Perioperative Optimization of Senior Health program [POSH].<\/span><\/p>\n

When older patients are recommended to POSH, they receive a comprehensive evaluation of their medications, nutritional status, mobility, preexisting conditions, ability to perform daily activities and support at home. They leave with a \u201cto-do\u201d list of <\/span>recommended actions<\/a>,<\/span> usually starting several weeks before surgery.<\/span><\/p>\n

If your hospital doesn\u2019t have a program of this kind, ask your physician, \u201cHow can I get my body and mind ready\u201d before having surgery, Finlayson said. Also ask: \u201cHow can I prepare my home in advance to anticipate what I\u2019ll need during recovery?\u201d<\/span><\/p>\n

What will recovery look like? <\/b>There are three levels to consider: What will recovery in the hospital entail? Will you be transferred to a facility for rehabilitation? And what will recovery be like at home?<\/span><\/p>\n

Ask how long you\u2019re likely to stay in the hospital. Will you have pain, or aftereffects from the anesthesia? Preserving cognition is a concern, and you might want to ask your anesthesiologist what you can do to maintain cognitive functioning following surgery. If you go to a rehab center, you\u2019ll want to know what kind of therapy you\u2019ll need and whether you can expect to return to your baseline level of functioning.<\/span><\/p>\n

During the COVID-19 pandemic, \u201ca lot of older adults have opted to go home instead of to rehab, and it\u2019s really important to make sure they have appropriate support,\u201d said <\/span>Rachelle Bernacki, MD<\/a>,<\/span> director of care transformation and postoperative services at the Center for Geriatric Surgery at Brigham and Women\u2019s Hospital in Boston.<\/span><\/p>\n

For some older adults, a loss of independence after surgery may be permanent. Be sure to inquire what your options are should that occur.<\/span><\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

L<\/span>arry McMahon, who turned 80 in December, is weighing whether to undergo a major surgery. Over the past five years, his back pain has intensified. Physical therapy, muscle relaxants and injections aren\u2019t offering relief.<\/span><\/p>\n

Read more Questions to Ask before Major Surgery<\/span> ›<\/span><\/a><\/div>\n

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