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Even simple surgeries carry serious risks for frail older people

Written by Diane Archer

Gina Kolata reports for the New York Times on new findings reported in JAMA surgery showing that frail older people can be at serious risk even when receiving simple surgeries. Frail older patients are far more likely to die prematurely from procedures deemed to be “low-risk” than younger patients in better health.

In a nutshell, surgery on a frail older patient is never low-risk. Frail patients tend to be physically and mentally weak; they are often underweight with multiple health conditions. Most of the time, they struggle to get their strength and independence back post-surgery.

Surgical procedures for people who are frail have high risks. Surgeries increase frail older people’s likelihood of death within 30 days after surgery by one and a half percent or more. And, for the most frail people, there’s a 10 percent increase in likelihood of death. In sharp contrast, high-risk procedures for people who are not frail increase their likelihood of death by as little as one percent.

Doctors may not be aware of the high risks of surgery for frail older patients. Even something as simple as a gall bladder removal has a five percent higher risk of death for frail older patients in the 30 days after surgery and a 19 percent higher risk if they are very frail. In the 90 days after surgery, the risk of death is still higher. And, it’s higher still in the six months after surgery.

To be clear, when frail older patients die in the weeks and months after surgery, it is not necessarily because they underwent surgery. The researchers cannot know what precisely causes death in frail older patients. There are a multitude of possible causes. And, sometimes, surgeries can increase quality of life for frail older patients.

Still, given the known risks of surgery for frail older adults, talk to your doctor before opting for surgery. Ask your doctor about choices for treating your condition. And, learn about the possible outcomes of these choices. You want to know the best and worst case scenarios and  what is most likely to happen from a given choice.

If you are frail and opt for surgery, you may want to take some time pre-surgery to “pre-habilitate” or improve your strength and ability to withstand the traumas of surgery.

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