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  • Cameron Oglesby

The biggest worry about major surgery isn’t the surgery itself.

It’s what happens during and after the recovery.

Of all US surgeries, almost 40% are performed on patients 65 or older, almost one in seven of whom die within a year after the invasive procedure. This includes a third of older patients with probable dementia, 28% of those with frailty, and 22% of those undergoing emergency surgery. The older the patient, the higher the risk; patients in their 90s were six times as likely to die as 65-to-69-year-olds.

So when your doctor or a specialist recommends major surgery, does this mean you should automatically say no? Of course not! Major operations can restore your ability to walk, fix leaky heart valves, remove tumors and gallbladders, repair hernias, and more.

But you shouldn’t automatically say yes, either – particularly if you have chronic heart or kidney disease, are already weak, have cognitive problems, or have difficulty caring for yourself.

What you should do is ask your surgeon some specific questions, then think over the answers:

· How will this surgery affect my daily life? Will removing a fast-growing tumor let me live longer? Will surgery improve my quality of life by making walking easier? Will it keep me from becoming disabled? And don’t take “We need to remove this abnormality” for an answer. Just because there’s an abnormality (a hernia, for example), it doesn’t necessarily need to be fixed right away – especially if you’re not bothered by pain or other symptoms and the procedure comes with complications.

· If things go well, what happens next? What will my daily life look like right after surgery? Three months later? A year later? Will I need help? For how long? How long will I be in surgery? In the ICU, and under what conditions? In the hospital? In a rehab facility? What will recovery at home be like, and how long until I’m my old self again? Our thorough three-part assessment of your physical, emotional, cognitive, and psychosocial needs can help you and your family clarify your priorities, values, preferences, and which if any trade-offs you’re willing to make. After surgery, it can help us create a custom-designed holistic coordinated senior care management plan to help speed your way to recovery. This plan will identify the specific types of care you need and avoid wasting your time and money on care you don’t. And our monthly registered nurse visits include mini-needs assessments, so we can adjust your care as you recover your health and regain your independence.

· If things don’t go well, what happens? One thing that’s very, very unlikely to happen is dying on the operating table. “We’re very good at rescuing people,” says Dr. Emily Finlayson, director of the UCSF Center for Surgery in Older Adults, “and we can keep you alive for a long time.” But “there can be a lot of pain and suffering and interventions like feeding tubes and ventilators.”

· Do I really need this surgery? That depends on the likeliest outcomes for someone of your age and in your physical condition. Are there nonsurgical options? If you’re an older man with prostate cancer or a woman in her 80s with a small breast tumor, you may want to just monitor its slow growth rather than risk invasive surgery.

· How can I prepare myself? Particularly for older patients, cutting out smoking, losing weight, walking more, and eating better can shorten your recovery time in the hospital and lower the risk of complications.

Once you’ve thought through the answers to these questions, there are some that only you can answer:

· What’s most important to me in my life?

· How important is avoiding pain and suffering?

· Would I rather live as long as possible, with more pain, or live fewer years without prolonged suffering or disability?

· Would I rather be at home, in a hospice, or in a hospital for the last days or weeks of my life?

We sincerely hope you never need pre- or post-surgical care, but if you ever do, please contact us.

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