Risks Surgeons Don’t Tell Older Patients About

Elderly surgical patients are not aware of the true risks, and surgeons aren’t telling them, new research suggests.

Dec. 13, 2019

The New York Times – The patient, a man in his 70s, had abdominal pain serious enough to send him to a VA Pittsburgh Healthcare hospital. Doctors there found the culprit: a gallstone had inflamed his pancreas.

Dr. Daniel Hall, a surgeon who met with the patient, explained that pancreatitis can be fairly mild, as in this case, or severe enough to cause death.

Recovery usually requires five to seven days, some of them in a hospital, during which the stone passes or a doctor uses a flexible scope to remove the blockage.

But “because it can be life-threatening, after patients recover, we usually take out the gall bladder to prevent its happening again,” Dr. Hall said.

A cholecystectomy, as that operation is known, isn’t high-risk surgery. When done with a laparoscope to avoid large incisions, it’s usually an outpatient procedure.

But Dr. Hall advocates screening all older patients for frailty, and this patient met the criteria. He had coronary artery disease and liver disease, had lost weight and took multiple medications.

“He was sunken behind the eyes, skinny, unsteady on his feet,” Dr. Hall recalled.

Dr. Hall’s research, recently published in JAMA Surgery, has found that frail, older adults are more likely than other patients to die after even supposedly minor procedures — and even when the surgery goes well, without complications.

Frail, older patients frequently undergo such operations, which surgeons tend to see as routine, simple fixes — but may not be. “Our data indicate that there are no low-risk procedures among patients who are frail,” Dr. Hall and his co-authors concluded in their study.

So he had a lot to talk over with this patient and his son, who joined the discussion by phone … Read more.