Old age not necessarily a risk factor for surgical complications

Older adults may not necessarily be at risk for surgery complications just because of their age, but their risk for serious complications may be at least doubled if they are frail or suffering from dementia, a research review suggests. 

The study team examined data from 44 studies of postoperative complications among almost 13,000 patients and found that, overall, about one in four elderly people experienced complications after surgery. 

Even though surgeons often consider age when assessing elderly patients’ odds of postoperative complications, age did not appear to influence the risk, the study found. But factors like frailty, dementia, depression and smoking were all tied to a higher risk of complications for older surgical patients. 

“Frailty and cognitive impairment are geriatric syndromes, whereas age is merely a reflection of how long someone has been alive,” said lead study author Dr Jennifer Watt, a geriatrician at the University of Toronto and the Li Ka Shing Knowledge Institute of St Michael’s Hospital. 

“Many people have had the experience of knowing two older adults of similar age, but recognising that one of those older adults is very robust, spending their typical day exercising at the gym, visiting with friends, and completing a challenging Sudoku puzzle on their iPad; while the other is more frail, spending their typical day at home, needing help to cook meals because they get short of breath from heart failure, and struggling to remember medical appointments,” Watt said by e-mail. 

Geriatric syndromes like frailty and cognitive impairment were associated with higher odds of complications like pneumonia, infections and blood clots, the researchers report in BMC Medicine. 

Frailty in particular was also associated with longer hospital stays, especially among frail patients who also experienced postoperative complications. 

In addition, frailty was linked to a greater chance that patients would be moved to another hospital or to a nursing home or another type of institutional setting and not discharged to their own home. 

One limitation of the analysis is that many of the smaller studies used varied methods to look at the relationship between age and complications after surgery, making it difficult for researchers to calculate meaningful differences in outcomes based on specific risk factors. 

Even so, the findings highlight a need for surgeons to assess elderly patients’ risk of complications using a more nuanced approach that considers how well they function in daily life, said Dr Carolyn Dacey Seib of the UCSF Medical Centre in San Francisco. 

“The most likely reason that age was not an independent predictor of complications is that other geriatric syndromes, such as frailty, cognitive impairment and functional decline, are more representative of a patient’s surgical risk than chronological age,” Seib, who wasn’t involved in the study, said by e-mail. 

“This doesn’t mean that frail or cognitively impaired patients should not ever undergo surgery,” Seib added. “It means they or their decision-makers should be informed of their risk and should be able to make an individualised decision about whether the potential benefit is worth the risk given what is most important to them.”