Phil Moeller: 5 questions to ask when considering surgery

I turned 80 in March and am a few months into recovery from major spinal surgery. My odds of a lengthy but successful recovery are good, and I’ve been able to enjoy multiple celebrations with family and friends.

But many older folks are no longer candidates for surgery — there’s a lot more to consider besides whether or not you want to do it. Knowing the reasons why and learning how you might become a viable candidate for surgery should you wish, may give you more years to enjoy it.

Before getting into details, I recommend that patients and their families first establish that surgery is appropriate. Choosing Wisely, a program started by the American Board of Internal Medicine, has helpful questions and guides to help people avoid surgeries that are either not helpful or produce limited benefits not worth the risk.

Here are five questions the organization recommends asking:

1. Do you really need this test or procedure? What medical tests can help you and your doctor, or another healthcare provider, decide how to address your medical problem? What are the medical procedures to treat it?
2. What are the risks? Will there be side effects? What are the chances of getting test results that aren’t accurate? Could that lead to more testing or another procedure?
3. Are there simpler, safer options? Sometimes all you need to do is make lifestyle changes, such as eating healthier food or exercising more.
4. What happens if you do nothing? Ask if your condition might get worse or better if you don’t have the test or procedure right away.
5. How much does it cost? Ask if there are less expensive tests, treatments or procedures, what your insurance may cover, and whether there are generic drugs to treat the condition instead of brand name drugs.

If surgery makes sense, geriatric patients (that’s us!) need to carefully review surgical risks. Your physician and surgeon should conduct what’s called a “comprehensive geriatric assessment” that includes gaining insights from you and any family members or caregivers about your physical and mental condition.

A 2024 study published in the Journal of the American Medical Association said hospital readmissions were higher with frail patients and patients showing signs of dementia.¹ The findings revealed that nearly 1 in 8 community-living older adult (more than 1 million people) had a hospital readmission within 30 days of a major surgery. More than 1 in 4 were readmitted to the hospital after 180 days.

Anesthesia can also be a heightened risk for older surgery patients, according to a 2024 article from the American Society of Anesthesiologists.²

The article states things like increased blood pressure, clogged arteries or heart and lung disease may increase the chance of side effects or complications, either during or after surgery.

Reviewing your heart and lung health prior to surgery is advised. Talk with your doctor about appropriate pre-surgical improvement efforts that make sense.

Older brains have their own risk factors in their response to sedation, the Society article noted, including post-surgical delirium and cognitive dysfunction that can lead to permanent memory loss.

In the end, as with all medical care, remember that you and your family have the final say on whether to receive medical treatment.

And if a surgeon says you’re not a candidate for surgery, ask for a second or even third opinion to make sure you’re comfortable with the decision.

Doing your presurgical homework is essential.