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AMONG OLDER PATIENTS, frailty and cognitive impairment before surgery are associated with developing complications after surgery, but surprisingly, age is not, a new study has found.
In addition to frailty, depressive symptoms and smoking were also associated with developing postoperative complications following elective surgery.
The findings have been published the in BMC Medical journal.
The researchers found a patient’s American Society of Anesthesiologists (ASA) status – which evaluates the physical health of a patient before surgery and is traditionally assessed as a risk factor for postoperative complications – was not associated with complications in older patients.
“The fact that age and ASA status were not risk factors for postoperative complications is somewhat surprising because these are the factors a clinician would typically look at when assessing a patient’s risk of developing complications after surgery,” Dr Jennifer Watt, lead author of the study, said.
The study examined 44 existing studies including more than 12,000 patients 60 years and older and reporting on postoperative outcomes including complications, postoperative mortality, length of hospitalisation, functional decline and whether patients were discharged home or to another hospital or long-term care facility.
The researchers found that across all studies, 25% of older patients experienced some complications following elective surgery.
“Older adults are a diverse group of patients whose risk of postoperative complications is not solely defined by their age, comorbidities or the type of surgical procedure they receive,” Watt said.
“This study highlights how common postoperative complications are among older adults undergoing elective surgery, and the importance of geriatric syndromes, including frailty, in identifying older adults who may be at risk.”
The review didn’t, however, examine why frailty was associated with negative outcomes following surgery, but the authors noted that frailty and not older age was associated with postoperative complications.
This is because frailty represents a patients’ biological age as opposed to their chronological age.
The authors also noted that there are proven interventions for a number of risk factors identified in the study.
Interventions aimed at improving a patient’s nutrition, physical fitness and cognition have been found to improve frailty in older patients.
“With this population, there is potential to intervene to improve outcomes following surgery by identifying and addressing risk factors before surgery, in particular with risk factors like smoking and depressive symptoms,” Watt said.
“These factors could be targeted in the preoperative clinic, potentially leading to better outcomes for older adults undergoing elective surgery.”
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It’s not age that’s the risk, it’s your health status. All else being equal a 40 year old that has a pre-existing cardiac problem is a higher anaesthetic risk that a 80 year old with a healthy heart. It’s just that more 80 year olds will have a heart problem that 40 year olds. That’s a simplistic way of putting it as there are many factors to be considered for each individual other than just heart function but still the same, all else being equal, whilst it’s always down to the individual risk assessment for the individual that is to undergo the procedure, the anaesthetic risk is higher for the 80 year old population that for the 40 year old population.
Who said there was a risk? Never heard there was a risk before it depends on other factors besides age.
@Gillian Scully: A lot of surgeons have historically had an ageist approach, assuming that age was a risk factor for morbidity and mortality in surgery, whereas nowadays it’s all about co-morbidity and ‘performance status’. Basically, “what existing ailments do they already have that might affect their ability to survive and recover?”
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