Risk Factors After Major Surgeries in Older Adults - An Overview

Introduction:

Older adults usually have many underlying disease conditions that must be addressed. In many cases, as the disease may have crossed the primary stages, it cannot be dealt with minimal treatment protocols using medications. Surgeries have been advised in older patients considering the risks associated with them. The patient's medical history and clinical examination play an important role in deciding whether the patient is an ideal candidate for surgery. Benefits over risks are evaluated and advised. In the end, the patient has the right to agree or disagree with surgery and also live with the outcome of the surgery. And hence, the various risk factors associated with major surgeries should be understood properly.

Why Are Elderly People More Affected Than Younger Individuals After Major Surgery?

The ability of the body to recover and bear the outcome of the surgery decreases with age. The effect in older adults is higher because the body cells take time to carry out the necessary process for recovery.

What Are the Risk Factors Affecting Surgeries in Older Adults?

Factors that increase the possibility of causing disease are called risk factors. Risk factors after surgery hamper the estimated outcome of the surgery. The physician identifies all the possible risks before the surgery, and required precautions are taken to prevent them. Following are some of the risk factors:

• Age - It is said that age is a number, but when one undergoes surgery, an older adult takes longer to recover than someone younger. Many factors disrupt the healing process, which includes age-related diseases like diabetes (uncontrolled sugar), as well as the healing process, which is slowed down as the body cells age too.

• Malnutrition - Results in ongoing energy deficiencies as the patient might be restricted in the diet when they undergo surgery related to the digestive tract. An individual's body weight is considered to evaluate the tolerance to the surgical process, medications, and recovery.

• Smoking - Chances of impaired heart and lung function can be experienced after surgery in older patients with a smoking habit. Smoking reduces blood flow which in turn reduces the healing process, leading to infection at the surgical site.

• Obesity - Esophageal (food pipe) cancer surgery, gastric (stomach) cancer surgery, liver surgery, and surgeries of the digestive tract lead to adverse effects due to obesity by prolonging the operative time.

• Frailty - Loss of weight, loss of grip strength, exhaustion, decreased physical activity, and decreased walking speed denotes frailty in an older adult, which worsens after major surgeries.

• Underlying Diseased Conditions - Diabetes (uncontrolled sugar levels in the blood), hypertension (blood pressure), viral infections, and genetic disorders also affect the surgical process.

• Effect of COVID - The SARS-CoV-2 virus might have already shown its effects on the body, like myalgia and muscle damage. Factors like these harm recovery after surgery. Covid related lung damage decreases the body's immunity, which places older patients at significant risk from surgeries.

• People have already been under medication for years.

• Intolerance To Treatments - Allergies to certain medications, reactions between drugs.

• General Anesthesia - Cardiac complications occur as a result of longer anesthetic time. The type of anesthesia also determines the outcome of the surgery. Although rare, allergies due to anesthesia can also occur.

• Excessive loss of blood during the surgery.

What Are the Risks After Major Surgeries in Older Adults?

• Sleep Disturbance - Many older patients can experience immediate sleep disturbance after surgery. This includes sleep deprivation, sleep fragmentation, or loss of sleep, which will recover back after a certain time after surgery. Older adults find it difficult to adjust to sleep changes. The elderly are associated with a higher apnea-hypopnea (decreased sleep) index and lower sleep insufficiency after surgery and are hence prone to sleep disturbances than younger patients.

• Change In Blood Pressure - Blood pressure can change after surgery, causing hypotension (low blood pressure) or hypertension (high blood pressure) for many reasons. Sudden withdrawal of medications, lowered oxygen level, anesthesia (drugs used to sedate during the surgery).

• Dyspnoea - Difficulty in breathing.

• Infections - Bacteria entering the surgical site can cause infection, which can delay healing. The spreading of infections from one site to another can occur through the bloodstream.

• Shock - Severe decrease in blood pressure causes reduced blood flow.

• Hemorrhage - Uncontrolled bleeding from the surgical site.

• Delirium - Disturbance in the mental ability of the older patient leads to mental confusion. Postoperative delirium is a frequent risk among elderly patients and increases adverse events like lengthy hospital stays and mortality (death); hence, delirium prevention is essential.

• Postoperative Cognitive Dysfunction - Impairment in recollecting things or thinking processes after surgery.

• Long recovery time.

• Death.

How to Prevent Risk Factors After Major Surgeries in Older Adults?

The physician informs every patient of the risks involved during and after the surgery. Physicians usually do not suggest surgery when the risks involved are riskier or can be fatal than an expected positive surgical outcome. The decision is left to the patient and their family. Most of the patients opt for surgery based on the information provided. Below are how risk factors can be prevented:

• Identifying the risk factors

• Make the right decision based on the physician's advice.

• Early identification of the risk factor for its complete management.

• Anesthesia-related risks can be prevented by following a proper anesthetic care plan.

• Reviewing medical records for underlying diseased conditions, the complexity of the surgery, type of anesthesia, and estimated blood loss.

• Decreasing the effects of long-term hospitalization.

How Can Risks After Major Surgeries in Older Adults Be Treated?

Risks such as shock, change in blood pressure, and wound infections can be treated in the following ways.

1) Shock Can Be Treated By:

• Preventing any blood loss.

• Providing continuous IV (intravenous) fluids.

• Providing required oxygen.

2) Change in Blood Pressure Can Be Treated By:

• Prescribing medications to raise or decrease blood pressure, respectively.

• Having a proper medical history and Administering medications through IV (intravenously).

3) Wound Infections Can Be Treated By:

• Administering antibiotics.

• Debridement (cleaning) of the infection site.

Conclusion:

All the associated risk factors owing to major surgeries are explained, and the patient is monitored to keep a check on the patient's reactions. The treatment is designed after taking risks under consideration, and the recovery of the patient is managed accordingly. It is very important for the physician to explain all the risk factors to the patient and for the patient to understand them.