How to decide whether surgery is the best option

How do you assess whether the potential benefits outweigh the risks?

The keys to deciding on surgery

“He’s not having surgery – too old. The doctors decided it’s not worthwhile.” How often do we hear such statements? And how do the various parties arrive at this conclusion?

We’re living longer, and more of us are living healthier lifestyles, so how do we assess when surgery is considered beneficial and when it becomes too great a risk?

The key concerns are frailty and the stress of anaesthesia.

Dr Juliana Kok, an anaesthetist and lecturer at the University of Melbourne, says stresses on the body during and after surgery mobilise our defences. “Surgery results in an increased secretion of hormones that promote the breakdown of carbohydrates, fats and proteins in the body to provide extra energy during and after surgery,” she wrote in The Conversation.

These hormonal changes also have an effect on the sympathetic nervous system, which causes a rise in heart rate and blood pressure.

“The changes in the heart rate and blood pressure during surgery and anaesthesia create a state where the heart requires more oxygen, while the surgical stress response and anaesthesia often impede the oxygen supply to the vital organs such as the heart and the brain,” she says.

But frailty is the big issue, according to Dr Kok.

Frailty relates to a decline in body function which means we are less able to cope with acute and everyday stress.

“In a frail person, there is an accumulation of defects in different organ systems of the body, causing them to function close to the threshold of failure,” she says. “The organ systems near the threshold of failure are then unable to ‘bounce back’ from an external or internal stressor.”

Dr Kok explains that the Clinical Frailty Scale evaluates a person’s level of frailty on a scale of one to nine, with one being very fit. She says studies have shown frailty is associated with a higher risk of surgical complications, a greater chance of requiring discharge to a residential care facility and a lower rate of survival. And the more frail the patient, the higher the risk.

Couple the Frailty Scale with a study comparing surgery with sham or placebo surgery and the decision-making gets more complicated.

This review found certain surgeries were no better than placebo in just over half of the studies. And in studies where surgery was better than placebo, the difference was generally small.

Study authors Professors Ian Harris and Paul Myles wrote: “As an example, two studies compared placebo surgery to keyhole surgery (arthroscopy) of the knee in patients with degenerative conditions (arthritis, meniscus tears and catching and clicking). Both studies showed no important difference in surgery outcomes between the two groups.

“We don’t always need to compare surgery with a sham. Sometimes comparing surgery with non-surgical treatment (like physiotherapy or medications) is more appropriate.

“One study looked at all orthopaedic surgical procedures performed on more than 9000 patients in three hospitals over three years. Only half the procedures were compared with non-operative treatment. And of that half, about half were no better than not operating.”

The professors concluded in an article in The Conversation that there were two problems in surgery – an evidence gap (in which there’s a lack of high quality evidence) and an evidence-practice gap (where there’s high quality evidence that a procedure doesn’t work, yet is still performed).

They warned that doctors should not perform surgical procedures and taxpayers should not have to cover their cost until there was high quality evidence they worked.

The moral of the story? Do your own research and gather informed opinion.

Have you had surgery that resulted in more problems post-procedure? How did you go about making the decision to proceed with surgery?

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    Disclaimer: This article contains general information about health issues and is not advice. For health advice, consult your medical practitioner.





    COMMENTS

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    MICK
    9th Aug 2018
    11:33am
    Some older folk live in the doctor's rooms and in hospitals. Personally I'd rather travel and get something other than medical procedures out of life. Sure I might prolong life a bit longer if I put all our assets into medicine but what is it worth being prodded, poked and needles stuck into me if the quality of life is marginal at best.
    Western society can learn a lot from eastern cultures and we are our own worst enemy and bring many illnesses and conditions on ourselves, but there's line in the sand where enough is enough as well.
    HarrysOpinion
    9th Aug 2018
    11:48am
    As an aged senior person I sometimes wonder too, whether an extra 5-10 years of living is worth the high expense of a surgery or not...and reality is that I don't believe it is.unless you are really having a wow of a good time....like wine, women and song....well, maybe not the women at such an old age...
    JJ
    9th Aug 2018
    2:48pm
    In many cases you wouldn't get even that much time even throwing buckets of money at the problem! Best to be reasonably comfortable for a short time rather than miserable for the gain of a few months of life. Quality over quantity every time for me.
    HarrysOpinion
    9th Aug 2018
    4:35pm
    Yep, better to live it out ... but pain killers will be essential...Recently I went through an episode that before seeing my doctor...thoughts of crossed the mind....can I live on one kidney...what if its the colon....maybe kidney stones....cancer...maybe gallstones...it can't be heart attack it's on my right side... do I really want to go through surgery.....It turned out to be an excruciating painful case of lumbago....Pain killer tablets and muscle relaxing tablets done the trick.
    Charlie
    9th Aug 2018
    9:36pm
    Did somebody say there was some chance of wine women and song in old age.

    I cant take alcohol with my medication.

    I cant play in bands anymore because of the noise, lifting speaker boxes, staying out late, and driving to venues.

    I can't have women anymore because I've forgotten why I wanted to be around them to begin with. There's no big turn on anymore? When I was young it turned on and now its turned off, so I am left thinking "Was that really me? What was I doing"?
    musicveg
    9th Aug 2018
    3:43pm
    There are many other options to consider before surgery. I am currently using Trigger Point therapy to relieve frozen shoulder, and it is working well. I just read up on it and followed the instructions, doesn't cost a cent when you borrow a book from the library.
    MD
    9th Aug 2018
    7:59pm
    Steady on, if it weren't for the relentless visits to doctors, specialists, district nurse and chemist, what sort of a social life would old farts, those fully expecting to live forever, otherwise have ? "I've gotta lotta livin to do" - heard it countless times, but my take on their idea of 'livin' probably only means just outa spite they're hangin out for the next pension payment.
    jonboy
    9th Aug 2018
    8:15pm
    I believe the Medical profession has no idea of how anaesthesia works and any damages it causes. I won't risk it at my age.
    Also I knew an older male who got an erection during surgery, possibley because of the above stimuli, and became brain dead.
    Charlie
    9th Aug 2018
    9:15pm
    It says "were living longer and people are living healthier lifestyles"

    I haven't seen any convincing study that shows the majority are living healthier lifestyles.

    Longer life can be achieved by better nursing care so that doesn't prove anything.
    musicveg
    9th Aug 2018
    9:23pm
    I agree Charlie, I think it is just that fact that we have more people on the planet, and an excuse for the Government to complain about pension costs. When 60% of the population take some sort of medication does not sound healthy to me, they might live longer but suffer longer too.


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