Is surgery safe for older patients?

Today I saw a patient for the first time. Because of a condition, she will require bilateral hip replacements. Cardiology cleared her for surgery and ortho believes it will significantly help the patient. The surgery, however, requires 2-4 weeks of bed rest afterwards for optimal healing. And orthopedics wants to do one hip at a time. In a frail elderly patient who is bed-bound (due to her hip problem), the issue is not the surgery itself, but the recovery. This is something often missed by nongeriatricians. One number that I always remember is that an elderly person who is on bed rest for four weeks will lose 50% of their muscle mass and 75% of their strength. Joint contractures (permanent stiffness of the joints) can occur in as little as a week in an elderly patient and sometimes as little as 24 hours. Bed rest can cause a loss of calcium, and nitrogen that may never recover and new onset diabetes after 8 weeks of bed rest. In someone who is already cognitively impaired, pyschosis is not uncommon or infections such as pneumonia and urinary tract infections.

I have not met with the family yet, but a surgery requiring prolonged bed rest may still be very risky even if the surgery itself is not terribly risky. One thing to remember though is that not all people who are 85 are the same. The best predictor of outcome after a surgery is how functional a person was before the surgery. But a frail cognitively impaired older adult is going to have a very though rehabilitation course after a prolonged period of bed rest.

In other news, I may not be able to continue this blog after all. I have to clear this with the legal folks of the University of Pennsylvania. We'll see what they have to say!