Larry McMahon, who turned 80 in December, is weighing whether to undergo a major surgery. Over the past five years, his back pain has intensified. Physical therapy, muscle relaxants, and injections aren鈥檛 offering relief.
鈥淚t鈥檚 a pain that leaves me hardly able to do anything,鈥� he said.
Should McMahon, a retired Virginia state trooper who now lives in Southport, North Carolina, try spinal fusion surgery, a procedure that can take up to six hours? (Eight years ago, he had a , another arduous back surgery.)
鈥淲ill I recover in six months 鈥� or in a couple of years? Is it safe for a man of my age with various health issues to be put to sleep for a long period of time?鈥� McMahon asked, relaying some of his concerns to me in a phone conversation.
Older adults contemplating major surgery often aren鈥檛 sure whether to proceed. In many cases, surgery can be lifesaving or improve a senior鈥檚 quality of life. But advanced age puts people at greater risk of unwanted outcomes, including difficulty with daily activities, extended hospitalizations, problems moving around, and the .
I wrote in November about a new study that shed light on some risks seniors face when having invasive procedures. But readers wanted to know more. How does one determine if potential benefits from major surgery are worth the risks? And what questions should older adults ask as they try to figure this out? I asked several experts for their recommendations. Here鈥檚 some of what they suggested.
What鈥檚 the goal of this surgery? Ask your surgeon, 鈥淗ow is this surgery going to make things better for me?鈥� said , an associate professor of surgery at the University of Wisconsin School of Medicine and Public Health. Will it extend your life by removing a fast-growing tumor? Will your quality of life improve by making it easier to walk? Will it prevent you from becoming disabled, akin to a hip replacement?
If your surgeon says, 鈥淲e need to remove this growth or clear this blockage,鈥� ask what impact that will have on your daily life. Just because an abnormality such as a hernia has been found doesn鈥檛 mean it has to be addressed, especially if you don鈥檛 have bothersome symptoms and the procedure comes with complications, said Drs. Robert Becher and Thomas Gill of Yale University, authors of that recent paper on major surgery in older adults.
If things go well, what can I expect? Schwarze, a vascular surgeon, often cares for patients with abdominal aortic aneurysms, an enlargement in a major blood vessel that can be life-threatening if it bursts.
Here鈥檚 how she describes a 鈥渂est case鈥� surgical scenario for that condition: 鈥淪urgery will be about four to five hours. When it鈥檚 over, you鈥檒l be in the ICU with a breathing tube overnight for a day or two. Then, you鈥檒l be in the hospital for another week or so. Afterwards, you鈥檒l probably have to go to rehab to get your strength back, but I think you can get back home in three to four weeks, and it鈥檒l probably take you two to three months to feel like you did before surgery.鈥�
Among other things people might ask their surgeon, according to a Schwarze鈥檚 team has created: What will my daily life look like right after surgery? Three months later? One year later? Will I need help, and for how long? Will tubes or drains be inserted?
If things don鈥檛 go well, what can I expect? A 鈥渨orst case鈥� scenario might look like this, according to Schwarze: 鈥淵ou have surgery, and you go to the ICU, and you have serious complications. You have a heart attack. Three weeks after surgery, you鈥檙e still in the ICU with a breathing tube, and you鈥檝e lost most of your strength, and there鈥檚 no chance of ever getting home again. Or, the surgery didn鈥檛 work, and still you鈥檝e gone through all this.鈥�
鈥淧eople often think I鈥檒l just die on the operating table if things go wrong,鈥� said , director of the UCSF Center for Surgery in Older Adults in San Francisco. 鈥淏ut we鈥檙e very good at rescuing people, and we can keep you alive for a long time. The reality is, there can be a lot of pain and suffering and interventions like feeding tubes and ventilators if things don鈥檛 go the way we hope.鈥�
Given my health, age, and functional status, what鈥檚 the most likely outcome? Once your surgeon has walked you through various scenarios, ask, 鈥淒o I really need to have this surgery, in your opinion?鈥� and 鈥淲hat outcomes do you think are most likely for me?鈥� Finlayson advised. Research suggests that older adults who are frail, have cognitive impairment, or other serious conditions such as heart disease have worse experiences with major surgery. Also, seniors in their 80s and 90s are at higher risk of things going wrong.
鈥淚t鈥檚 important to have family or friends in the room for these conversations with high-risk patients,鈥� Finlayson said. Many seniors have some level of cognitive difficulties and may need assistance working through complex decisions.
What are the alternatives? Make sure your physician tells you what the nonsurgical options are, Finlayson said. Older men with prostate cancer, for instance, might want to consider ongoing monitoring of their symptoms, rather than risk invasive surgery. Women in their 80s who develop a small breast cancer may opt to leave it alone if removing it poses a risk, given other health factors.
Because of Larry McMahon鈥檚 age and underlying medical issues (a 2021 knee replacement that hasn鈥檛 healed, arthritis, high blood pressure), his neurosurgeon suggested he explore other interventions, including more injections and physical therapy, before surgery. 鈥淗e told me, 鈥業 make my money from surgery, but that鈥檚 a last resort,鈥� McMahon said.
What can I do to prepare myself? 鈥淧reparing for surgery is really vital for older adults: If patients do a few things that doctors recommend 鈥� stop smoking, lose weight, walk more, eat better 鈥� they can decrease the likelihood of complications and the number of days spent in the hospital,鈥� said , a leader in Duke University Medical Center鈥檚 Perioperative Optimization of Senior Health program.
When older patients are recommended to POSH, they receive a comprehensive evaluation of their medications, nutritional status, mobility, preexisting conditions, ability to perform daily activities, and support at home. They leave with a 鈥渢o-do鈥� list of recommended actions, usually starting several weeks before surgery.
If your hospital doesn鈥檛 have a program of this kind, ask your physician, 鈥淗ow can I get my body and mind ready鈥� before having surgery, Finlayson said. Also ask: 鈥淗ow can I prepare my home in advance to anticipate what I鈥檒l need during recovery?鈥�
What will recovery look like? There are three levels to consider: What will recovery in the hospital entail? Will you be transferred to a facility for rehabilitation? And what will recovery be like at home?
Ask how long you鈥檙e likely to stay in the hospital. Will you have pain, or aftereffects from the anesthesia? Preserving cognition is a concern, and you might want to ask your anesthesiologist what you can do to maintain cognitive functioning following surgery. If you go to a rehab center, you鈥檒l want to know what kind of therapy you鈥檒l need and whether you can expect to return to your baseline level of functioning.
During the covid-19 pandemic, 鈥渁 lot of older adults have opted to go home instead of to rehab, and it鈥檚 really important to make sure they have appropriate support,鈥� said , director of care transformation and postoperative services at the Center for Geriatric Surgery at Brigham and Women鈥檚 Hospital in Boston.
For some older adults, a loss of independence after surgery may be permanent. Be sure to inquire what your options are should that occur.
We鈥檙e eager to hear from readers about questions you鈥檇 like answered, problems you鈥檝e been having with your care, and advice you need in dealing with the health care system. Visit聽聽to submit your requests or tips.