Operations: The biological constitution is more important than the year

Up to what age should you lie under the knife?

The surgical methods are constantly improving and with it the burden on the patient. Surgery is a higher risk of complications in older patients. But when is a patient too old to have an operation? Should an 85 year old still go under the knife or better not? Scientists from St. Michael’s Hospital in Toronto addressed this question in a meta-analysis. The aim of the study was to identify the prognostic factors associated with the development of postoperative complications in the elderly.

When analyzing more than 12,000 patients from 44 studies, the researchers found that the age of a patient is no reason to refrain from surgery. Doctors should be guided more by a patient's biological age than by their actual age. The scientists were able to identify prognostic factors that can help decide whether surgery makes sense or is too dangerous. These factors include, for example, the patient's frailty and depressive symptoms. Whether someone is a smoker or not also matters. The results of the analysis were published in the specialist magazine "BMC Medicine".

Common complications from surgery in old age

According to the studies, postoperative complications occur in every fourth case, which lead to an extended hospital stay. Approximately 10 percent of the elderly cannot return to their former surroundings after the operation. An average of one in twenty patients died within 30 days of the operation. However, the researchers discovered that age is not solely to blame for these effects. Rather, the general condition of those affected was decisive.

The old methods are inaccurate

The researchers were able to determine that the conventional methods that have so far been used for the evaluation cannot give reliable predictions about the occurrence of complications. So far, only the age of the patient and the risk classification of the "American Society of Anesthesiologists" used in anesthesia have been taken into account. According to the scientists, these methods turned out to be unreliable.

Which factors actually determine a risk of complications?

According to the study results, poor general condition increases the risk of postoperative complications by two and a half times. Smokers also had an increased risk potential. In addition, the state of frailty influences the risk of complications. But not only physical factors play a role. Patients with depression or cognitive impairment were also at increased risk of complications.

The biological age counts

The results of the meta-analysis are clear: the numerical age of the patients does not determine whether complications arise after the operation or not. Even elderly patients do not have to do without surgery if they are in good general condition. The study also points to measures that can reduce the risk of postoperative complications. This includes a healthy diet before the operation, physical fitness, a cessation of smoking or therapy in the event of depression. Doctors are advised to look more closely at biological age and to include factors such as general condition, frailty and cognitive status. (vb)

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