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• Posted April 26, 2024

Which Patients and Surgeries Are 'High Risk' for Seniors?

Most seniors probably view any emergency surgery with a certain level of anxiety.

Now, a new study seeks to sort out who might be at highest risk for a complication from such surgeries -- and which surgeries are more prone to trouble.

Two key factors emerged: How frail any patient over 65 was prior to their emergency procedure, and whether the surgery was deemed to be high- or low-risk.

Too often, seniors and their doctors may put off a needed surgery -- only to find it becoming necessary when a crisis occurs.

“The message from our study is that elderly patients should undergo surgical treatment when they first present with their disease," said study co-author Dr. Raul Coimbra.

"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,” added Coimbra, surgeon-in-chief at Riverside University Health System in Moreno Valley, Calif.

In their study, Coimbra and colleagues looked at data from the American College of Surgeons (ACS).

They focused on the medical records of nearly 57,000 people over the age of 65, classifying them into three groups: Non-frail (about 29% of patients), frail (about 66%) and severely frail (4.3%).

They also divided the procedures into two categories: High- or low-risk.

In the "low-risk" category were surgeries such as appendectomies or gallstone removal; in the "high-risk" category were procedures such as colon surgery, surgical removal of part of the small bowel and the repair of perforated ulcers.

About 25,000 of the procedures were low-risk, while close to 35,500 were high-risk.

How risky a procedure was appeared to be more important to the risk of complications and death, compared to how frail the patient was, the research team found.

For example, non-frail patients undergoing high-risk emergency surgeries had a 7.1% death rate, while the death rate for low-risk procedures was 0.2%, Coimbra's group reported.

Similarly, among the frail and severely frail, death rates were 11.5% and 25.8%, respectively, with a high-risk procedure, and 1.0% and 4.1% with low-risk operations.

Overall, the rate of surgical complications quadrupled for any high-risk procedure compared to a low-risk one, regardless of the level of patient frailty, the researchers said.

The study was published April 25 in the Journal of the American College of Surgeons.

Far too many patients are waiting too long to get surgeries, Coimbra believes. Many put the procedures off until emergency strikes and they might be in greater danger.

"A very significant number of elderly patients are coming to the emergency room for a major operation, urgently," he said in an ACS news release. "And the reason is because elderly patients may not seek surgical care early on, and surgeons often shy away from solving the problems electively."

“The problem is that diseases don’t disappear," Coimbra added. "They stay and progress and advance until these patients end up in the emergency department requiring an emergency operation.”  

More information

Find out more about preparing for a surgery at Stanford Medicine.

SOURCE: American College of Surgeons, news release, April 25, 2024