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Title

Making the cut

What you should know as you consider surgery

Created date

November 23rd, 2010

If you are going to have surgery, the first two questions you should ask are: Do the benefits of this procedure outweigh the risks? Am I likely to return to my normal, or an even better, level of functioning after the procedure? says Frederick Sieber, M.D., chairman and director of clinical research at Johns Hopkins Bayview Medical Center s department of anesthesiology. Government data shows approximately 16 million surgical procedures are performed each year on adults age 65 and over. Most of these are elective surgeries. An elective surgery is a planned, nonemergency procedure. It may be medically required (a joint replacement) or optional (a facelift).

Preparation is key

Older adults often take longer to recover than younger adults, Sieber says. Preparing as much as possible beforehand is essential. Your primary doctor is a valuable resource. Along with a preoperative evaluation, which includes managing your health conditions and medications so that you are in the best health possible for surgery, I make sure my patients understand the risks, benefits, and alternatives to any procedure, says Barbara Morris, M.D. I also consider what someone will need after surgery, whether it s home health care, equipment, or other support. If a rehab facility is needed, I can help someone choose which one is best for them, Morris adds. Plan for someone to be with you in the hospital. You need an advocate, Morris says. With shorter hospital stays and staffing changes, someone needs to make sure you are getting your medications and everything else you need, right after your surgery. You need to thoroughly understand the procedure, Sieber says. This means you must give informed consent by signing a document after the risks and benefits of the surgery have been completely explained to you. If someone having surgery cannot understand the informed consent, we must determine who is able to do so, for example, the spouse or family decisionmaker, he adds. If you have them, take along your advance directive (living will or do not resuscitate order). Sometimes, living wills are put on hold for the duration of the operation and recovery room period; it depends on the facility s policy, Sieber says. If your living will states that you don t want cardiopulmonary resuscitation [CPR] in case of cardiac arrest, then you need to clarify with both your surgeon and anesthesiologist whether that order is to remain in place while you re in surgery.

Anesthesia

Ask what kind of anesthesia to expect for your procedure and what the risks and side effects are. You may not necessarily need general anesthesia for a particular procedure, Sieber says. Ask your surgeon and anesthesiologist if you have options like local anesthesia [numbing the immediate surgical area], twilight anesthesia [intravenous sedation], or a nerve block [like spinal blocks or epidural anesthesia]. Seniors may have better outcomes and fewer side effects with nerve blocks. The trend for surgeries is toward less invasive procedures [done with tools like laparoscopes surgical instruments that require a small incision], especially for older adults. Studies have shown that recovery time is quicker, pain is less, and complications are fewer. Ask your surgeon if a less invasive method is appropriate for you, Sieber says.

Other considerations

Sieber continues, It s important to know who s going to take care of you not only during your recovery period but who s taking care of you during your operation. Look into the surgeon and hospital s track record. Check the facility s accreditations and a doctor s board certifications. The number of older adults having surgery is increasing dramatically with better techniques and better outcomes, Sieber adds. No one should be denied surgery based solely on age. Make the decision with the help of your primary doctor, surgeon, and family.

What you should know as you consider surgery

  • Why do I need surgery?
  • What surgery is recommended?
  • Can another treatment be tried instead of surgery?
  • What happens if I don t have the surgery?
  • How will the surgery affect my health and lifestyle?
  • Am I in optimal medical condition for this operation, or is there anything else that needs to be done before having it?
  • Are there any activities I won t be able to do after the surgery either short- or long-term?
  • How long will it take to recover?

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