Guidelines help protect senior patients during surgery
Q: I’m 87 and having a knee replacement. I’m healthy and active, but concerned. How can someone my age make sure to get the best treatment during and after surgery? — Bev G., Ketchum, Idaho
A: You sound like a wonderful example of the new wave of super-seniors! About 2 million folks in North America are 90 or older, and they’re proving that you can stay healthy and happy even if you need an operation to replace a worn-out knee.
So to protect older surgery patients, the American College of Surgeons and the American Geriatrics Society have issued guidelines to help assure the best possible outcomes. They’re worth knowing, so you can talk to your doctors about them before you head in for your operation.
Before the operation your docs should determine how to manage all your current and future medications and make sure they’re all taken correctly, including an appropriate schedule for preoperative fasting. A couple of hours before the operation, you should be given antibiotics to curb incision-site infection, and steps to prevent blood clots should be taken.
During the operation the anesthesia must suit your respiratory and circulatory health (regional as opposed to general may be a better option). Use of opioid-sparing pain relief should be discussed. Forced air warmers and/or warmed IV fluids should be used whenever an older person is undergoing a procedure longer than 30 minutes.
Post-op your docs will have a plan to prevent and deal with delirium, if it occurs; pulmonary complications (keeping fluid out of your lungs); nutrition; prevention of falls, urinary tract infections and pressure ulcers in the legs. To prevent blood clots they will get you up as soon as possible.
We’d add: Programs like Dr. Mike’s Cleveland Clinic Shared Medical Appointments for future joint recipients also improve outcomes. They can help you get optimal pain therapy, reduce stress and get in good nutritional and physical shape before surgery (insurance is covering this!). See what your local hospitals provide.
Your question implies you’re proactive, and that makes it more likely you’ll fly through this surgery and enjoy increased mobility. Good luck!