A new study has identified surgical procedures and risk factors for elderly people that could change the way doctors make decisions and inform patients.
The study examined high-risk and low-risk procedures among patients over the age of 65 and categorized the patients as either non-frail, frail, or extremely frail, according to reporting by U.S. News & World Report.
Frailty involves several physical factors resulting from physiological decline. The factors include weakness, slow walking speed, low physical activity, self-reported exhaustion, and unintentional weight loss, according to a study published by the National Institute for Health. Frailty is considered an “unstable disability” by healthcare providers.
Low-risk procedures include appendectomies or gallstone removal, while high-risk procedures include colon surgery, surgical removal of part of the small bowel, and the repair of perforated ulcers.
The study looked at the medical records of nearly 57,000 patients over the age of 65, with about 29% classified as non-frail, about 66% considered frail, and 4.3% listed as severely frail. About 25,000 of the procedures were low-risk, while close to 35,500 were high-risk.
Among the frail and severely frail patients, death rates were 11.5% and 25.8%, respectively, for high-risk procedures. They were 1% and 4.1% for low-risk operations. The risk level of the surgery appeared to weigh more heavily on the outcome than the frailty level of the patient, according to the researchers.
The study indicates that patients diagnosed with ailments that will worsen over time should resist the temptation to put off undergoing a procedure. As a person continues to age, frailty risk increases, elevating the risk of death, according to the study.
Often, high-risk surgeries are put off until it becomes an emergency surgery. The researchers behind the study found that when this course of action was taken, patients were at a significantly higher risk of dying during the operation.
“A very significant number of elderly patients are coming to the emergency room for a major operation, urgently,” said study co-author and surgeon-in-chief at Riverside University Health System in Moreno Valley, California, Dr. Raul Coimbra, per U.S. News & World Report. “And the reason is because elderly patients may not seek surgical care early on, and surgeons often shy away from solving the problems selectively.”
“The problem is that diseases don’t disappear. They stay and progress and advance until these patients end up in the emergency department requiring an emergency operation,” he added.
“The message from our study is that elderly patients should undergo surgical treatment when they first present with their disease,” Coimbra said. “It should not be put off until complications develop to the point where an emergency operation is needed. Because that emergency operation is the most significant risk for mortality and complications.”
