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Is Surgery a Death Sentence?
A study shows that adults over the age of 65 have a much higher chance of dying after a surgical procedure than was previously thought.
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"The doctor tore a hole the size of a quarter in his colon and he had to have a double re-section -major surgery to repair the damage. Don't be the last one in line on a Friday as he was. "
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• Surgical Risk Assessment
• Helping The High Risk Surgical Patient
Are you are looking at the possibility of having a surgical procedure in either the near or distant future? While you may be healthy now, the incidence of needing surgery for cancer treatment, joint repair or replacement, or surgery to repair a damaged heart increases as you age. But will that surgery help you or harm you? That is one of the questions that researchers from Dartmouth Medical School/VA Medical Center were trying to answer in a study that looked at survival rates of older people following surgery. The study reviewed surgical procedures for over a million patients ages 65 to 99. This research found that morality risk increase greatly with age and operative deaths for patients over the age of 80 was more than twice that of patients ages 65 through 69. Researchers hope that their findings will help both patients and their physicians make better-informed decisions about surgery.

Researchers John Birkmeyer, MD, associate professor of surgery at Dartmouth Medical School, and Emily Finlayson, MD, research fellow at White River Junction VA Medical Center lead the study. They found that operative mortality for major surgery not only varies by procedure and patient age, but is considerably higher than that typically reported in individual case studies and trials. Operative mortality is defined as death within 30 days of the operation or death before discharge from hospital.

"When reviewing surgical risks with patients, surgeons often rely on one-size-fits all-estimates, which tend to be unrealistically low," said Birkmeyer. He added, "Both surgeons and patients need to be aware that operative mortality depends strongly on patient factors--particularly age. Elderly patients often have operative risks that are two- to four-fold higher than younger patients. Mortality risks also depend on where the surgery is performed. Unfortunately, some hospitals have much higher mortality rates than others."

If you are considering any type of elective surgical procedure this study can be the starting point for discussing the risks associated with surgery. This study showed that some procedures hold a higher risk than do others. Carotid endarterectomy to unblock the carotid artery had the lowest overall operative mortality at 1.3%. The highest mortality was observed for those procedures involving the removal of all or part of the stomach (gastrectomy), the esophagus (esphagectomy) and lung (pneumonectomy) and major resection of a part of the pancreas. These surgical procedures had mortality rates of 8.6% to 13.7% overall.

Discuss in depth any elective surgery with the surgeon who will do the procedure. Ask him (or her) how many times they have performed the procedure and question how those patients did in the post-operative period. Ask about the hospital and their mortality rate for all surgical procedures. Undergoing major invasive surgery will increase the length of time you will need to be hospitalized and therefore increase your chances of getting a hospital-acquired infection. Any infection in the postoperative period increases the mortality risk. Ask your doctor what you can do prior to surgery to decrease the risks. If you smoke, quit! If you are overweight, try to put off the surgery until you have lost weight by diet and exercise. If blood loss is anticipated donate your own blood prior to surgery to reduce any chance of blood product reactions. And finally ask if there is any alternative to surgery especially if you are over the age of 80, be sure that the possible benefits outweigh the risks.

If you have any questions or comments on senior health nutrition, fitness, etc., go to the Senior Health Forum where we are talking about the following:

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