Ask the Doctors

Dear Doctor: I'm 75 years old and am scheduled to have minor surgery next month. My doctor has been pushing me to walk every day and to perform core exercises -- not to mention eating right -- ahead of my operation. Does this really matter?

Dear Reader: Indeed, it does. Recent studies show that elderly patients are at increased risk for a range of complications during surgery and during the recovery process as well. But it's not just about age. By comparing pre-operative assessment data to how patients fare during surgery and recovery, researchers have been able to establish a definitive link between frailty and poor surgical outcomes. These range from complications during the procedure, slow or incomplete recovery afterward, and a net decline in health and cognition in the weeks and months after the surgery.

And younger readers, take note. This correlation turns out to hold true for patients of any age. In fact, the new thinking is that frailty is a more important indicator than chronological age when evaluating patients for elective surgery.

However, frailty, which is basically a reduction of the physical and mental reserves that help us bounce back from setbacks due to illness or injury, is far more common in older adults. Additional factors also make surgery more of a challenge for older adults. These include ongoing conditions or illnesses that place added stress on the body. Problems with vision, hearing or mobility have an effect on both surgery and recovery. A range of prescription medications can increase the risk of certain complications. And issues related to cognitive function, mood and social circumstances play a role in overall well-being.

The good news is that this new research has prompted the American College of Surgeons to launch a nationwide effort for hospitals, health care providers and patients to become aware of the unique challenges that elderly adults face when undergoing surgery and recovery, as well as the steps they can take to mitigate those risks. Supporting data comes from Duke University's Perioperative Optimization of Senior Health (POSH) program, an interdisciplinary team approach to helping older adults prepare for and recover from surgery. This program includes the very behaviors your physician is urging you to adopt.

In an assessment of elderly patients undergoing elective abdominal surgery, those from the POSH program had shorter hospital stays (four days for the POSH group versus six days for the control group) and lower readmission rates (7.8 percent vs. 18.3 percent) over the course of the month following surgery. They also experienced fewer complications and were more likely to be discharged to go home with self-care than were the patients in the control group, who had not taken part in the POSH program.

We hope that you'll take your physician's advice to heart and follow the recommended program. Not only can these behaviors increase the chances for a good outcome following your surgery, but continuing the fitness regimen of daily walks, core exercises and deep breathing after your recovery will improve your quality of life.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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