Surgery is the most invasive and riskiest of all therapies. And it takes a toll on the body–especially as you get older. In fact, in a new study published in the medical journal JAMA Surgery, researchers looked at common surgeries performed on older patients. They found 227 of these surgeries are so risky, with such higher mortality rates among older patients, they recommended seriously considering the alternatives.
For the new study, U.S. researchers reviewed hospital admissions data for patients 65 years or older between 2001 and 2007. They found high-risk surgeries for older patients often involve cardiac, gastrointestinal, neurological, thoracic, urological, and vascular procedures.
The top-10 riskiest procedures are (in alphabetic order):
-Abdominal vein resection or replacement
-Adrenal gland removal
-Arm blood vessel replacement
-Bile duct excision
-Carotid artery endarterectomy (removal of atherosclerotic plaque)
-Gastric bypass (upper)
-Proctopexy (suturing of rectum)
-Ureter repair (connects kidney to bladder)
-Varicose vein removal
In addition, other high-risk procedures for older patients included:
-coronary artery bypass grafts (open heart surgery for coronary artery disease)
-heart valve operations (also involving open heart surgery)
-surgical resection (removal of a portion) of the small intestine
-surgical resection of the lung
Of course, some of these procedures–such as gastric bypass and varicose vein removal–aren’t even medically necessary. Especially when you consider the many safe, effective and non-surgical alternatives.
Not surprisingly, the highest-risk procedures are also among the most costly as well. In fact, the average costs per hospital stay were $53,400 for heart valve procedures, $38,700 for coronary artery bypass grafts, $34,500 for small bowel resection, and $23,000 for surgical removal of the lung.
No doubt, some of these risky, high-cost procedures are highly effective and lifesaving. For example, there is no alternative to open heart surgery for replacing a defective heart valve in someone dying of heart failure.
Although new research suggests one day it will be possible to grow new heart valves in patients. I will never forget “scrubbing-in” on open-heart surgeries in the mid-1970s for young adults dying of rheumatic heart disease. They received new heart valves during open-heart surgeries. In the mid-20th century, it was a medical miracle.
But by the 1980s, for every younger person who had a life-saving heart valve replacement, there were 10 or 20 older people getting risky open-heart surgeries for coronary artery bypass grafts. This costly and risky procedure continues to keep cardiac surgery centers busy at hospitals around the country, despite any real evidence that it works better than the right non-surgical approaches.
Indeed, high risk often goes hand and hand with high cost in modern medicine. But a rational healthcare system should insist doctors and patients try the least-costly, least-invasive alternative first. If that alternative fails, only then should a doctor proceed up the ladder to a more costly, dangerous treatment, like surgery.
Of course, I always recommend trying all the alternatives before you ever consider surgery. And you should only ever consider it as a last resort, after you’ve exhausted the wide spectrum of lower-cost, non-invasive options. Many of these alternative approaches have been around since the dawn of history, but mainstream medicine is just beginning to recognize them.
As a nation, we are literally dying for this kind of “healthcare reform.”
Instead, we got the partisan Affordable Care Act–commonly called Obamacare. But it just rearranged the deck chairs on the Titanic. And this time, everyone has to buy a ticket. Fortunately, this new JAMA Surgery study can serve as a useful warning about which parts of this sinking ship you should avoid.
- “Development of a List of High-Risk Operations for Patients 65 Years and Older,” JAMA Surg. 2015;150(4):325-331