Risks of Surgery and Anesthesia in Seniors

What to Know to Prepare for Surgery

We’ve put together the most helpful information and some pointers on the topic. It will help you better understand what’s involved in having anesthesia and surgery and what happens before, during and after.

Does It Help to Get in Shape Before Surgery?

Before you have a surgical procedure, you can benefit greatly by improving your physical condition and stamina through prehab. It can reduce the time you remain in the hospital, and affect whether you experience complications and your need to go to a rehab facility after surgery.

Focus on the following:

• Eat nutritiously.
• Get enough restorative sleep.
• Stave off stress and anxiety.
• Stop smoking.
• Maximize your lung power with a spirometer or by doing breathwork (pneumonia is a common and dangerous complication after surgery in older adults).
• Exercise regularly.

Walking and exercising greatly contribute to a positive recovery. Hiroko Kunitake, the surgical director of the Perioperative Optimization of Senior Health Clinic at Mass General Brigham (formerly Massachusetts General Hospital and Brigham and Women’s Hospital), says older adults have better outcomes when they prioritize movement and develop their strength, balance and mobility.3

What Happens Before Surgery?

Certain surgical procedures, including for cataracts, carpal tunnel repairs, knee arthroscopies and hernia repairs, are usually performed on an outpatient basis. Other procedures are done in the hospital or even a private medical center.

If the patient has a complicated medical history or needs assistance after surgery, a surgeon is more likely to schedule the procedure on an in-patient basis in a hospital setting.

Presurgery

Discuss your surgery with your family, surgeon and primary-care physician so you’re reassured about everything. Patients should feel that the surgery is safe, and determine ahead of time if they’ll need follow-up home health care. The better you feel about the surgery, the more likely you will fare well.

The medical office will instruct you about your medication schedule for the days before and the morning of the procedure. In addition to not being allowed to eat or drink after midnight on the day of surgery, you’ll likely be told to stop smoking and possibly abstain from certain foods and drinks.

Your surgeon and anesthesiologist will review your medications. They may adjust or modify what you take for your safety during and after the procedure. Don’t stop taking any medications unless your medical team directed you to do so as part of your preoperative plan. By adhering to the instructions, you can avoid having to reschedule surgery and decrease the risk of complications.

Preoperative Testing

The surgeon may request preoperative tests. Testing can help surgeons establish a baseline, screen for common diseases and assess your ability to process the anesthesia during and after the procedure.

Before major surgeries in older adults, such as hip or knee joint replacement, heart valve replacement, coronary artery bypass grafting (CABG), and major abdominal surgeries, some common tests are ordered. They include an electrocardiogram (an assessment of the heart’s ability to function properly), a basic metabolic panel (a blood test establishing how well your body is processing energy and waste), and a complete blood count (CBC), which measures components of your blood cells.

What Happens Regarding Anesthesia?

To relieve pain and the sensation of feeling, you will probably need anesthesia for the surgery. It may be local, regional or general. Age is not necessarily a reason to be disqualified from having anesthesia, but it affects how patients react to anesthetic medicines during and after a procedure.

According to Johns Hopkins Medicine, those providing anesthesia watch intently for even the slightest changes in bodily functions.5 They’ll monitor your temperature, heart rate and rhythm, blood pressure, breathing, blood, and fluids.

The American Society of Anesthesiologists highlights the extreme importance of preoperative assessments for older patients. The assessments help anesthesiologists tailor the anesthesia levels and surgical plans for the older patient’s individual needs.6

Anesthesia Step by Step

Below is more of the nitty-gritty regarding general anesthesia and surgery.

• Preoperative assessment: Depending on the surgery and the facility’s procedures, you may have a preoperative visit or phone call. Staff will review your medical records and medications, and hear about any previous experiences you had with anesthesia. The team will discuss the anesthesia and address your concerns.
• Day of surgery: You’ll meet your anesthesiologist, who will take a detailed medical history, including allergies, current medications and previous surgeries. They’ll review relevant test results and discuss your overall health.
• Airway exam: The anesthesiologist will examine your airway to ensure they can safely place breathing tubes to administer anesthesia and help you breathe during surgery. If you have a history of breathing difficulties, they may take extra precautions or order additional tests.
• Informed consent: The anesthesiologist will explain your personalized anesthesia plan and discuss pain-management options. They’ll answer your questions and obtain your informed consent.
• Postsurgery: You’ll be closely monitored in a recovery room. The medical team manages your pain and ensures that your vital signs are stable. If you’ve had general anesthesia, you’ll wake up fairly quickly, but it takes time for anesthesia to completely leave your system. Depending on the surgery and your needs, you may require oxygen therapy. Once you’re stable, you’ll be discharged home or transferred to a hospital room for further recovery.

What You Should Know About Having Anesthesia

About 40 percent of all inpatient operations and 33 percent of outpatient procedures are performed on older adults each year.7 If you’re having anesthesia, here’s what you should know:

• General anesthesia is a medication-induced, sleeplike state during which the brain does not respond to pain or stimulus.
• Your anesthesiologist will deliver accurate dosages of anesthetic medications. They carefully monitor your heart rate, blood pressure and breathing to gauge the level of anesthesia.
• Patients who smoke, abuse opioids or other substances, or have chronic pain may require higher dosages.
• Not all experience going under in the same way. Some have vivid recollections and others have dreamlike memories of the surgery. In very rare cases, patients feel awareness during surgery, but do not feel pain — only slight pressure.
• Some remember events or conversations in the operating room before going to sleep or after awakening from surgery. That doesn’t mean you were awake while under anesthesia.

What Are the Complications of Surgery and Anesthesia in Seniors?

If you’re having cataract surgery or lesion removals from your skin, older adults have fewer risks. Since those procedures are often performed under local anesthesia, you’ll likely have a short recovery time too. That does not include frail older adults though. Frail seniors having major surgery have higher rates of complications, according to JAMA Surgery. Patients who are feeble have more wound infections and delayed healing, for example.

Older patients generally face increased risks from anesthesia during surgery because of their age-related decline in physiological function, which significantly alters their ability to metabolize and respond to the drugs.8

Two serious postsurgical concerns for patients older than 65 merit your attention: delirium and postoperative cognitive dysfunction (POCD).

What Is Post-op Delirium?

Patients sometimes exhibit a temporary state of confusion and disorientation shortly after surgery, and older patients are especially at risk. Delirium may present immediately after waking up from anesthesia or one to three days afterward. The following symptoms indicate a patient may be experiencing delirium:

• Agitation
• Fatigue
• Restlessness
• Aggression
• Confusion
• Slurred speech
• Hallucinations

Older adults with delirium are at a higher risk for physical injury, extended hospitalization or even a transfer to long-term care facilities. Treatment consists of supportive care, removing potential causes and, if appropriate, medication.

To prevent delirium after surgery, especially in a hospital environment, focus on hydration and movement, review medications, engage in cognitive stimulation, prioritize good sleep, and ensure glasses and hearing aids are accessible.

What Is Postoperative Cognitive Dysfunction?

POCD is a decline in brain function after the acute impact of surgery. There’s a wide variation in diagnosing it, but it’s common in older adults and it can last for weeks or even months.

Several factors can increase the risk of POCD, including older age, heavy alcohol use and anticholinergics, which are medications that block a brain chemical crucial for thinking and memory. Longer surgeries — being under anesthesia longer — and having more invasive procedures can also increase the risk for POCD.

You can prevent POCD before surgery by optimizing brain health. Do that by reviewing medications and managing high blood pressure and diabetes. After surgery, focus on hydration, moving and walking, pain control and cognitive stimulation.

By being well informed and proactive, older adults can face surgery with greater confidence. With careful planning and open communication with the surgeon and anesthesiologist, the risks can be minimized and you can be set up for a smoother recovery.