What you need to know about anaesthetics, age and surgery risks 

‍As we get older, the risks of surgery and anaesthesia become higher. That means we should all understand our need for surgery and anaesthetics as early as possible - and do our best to look after ourselves.

By Paula Goodyer

Been for a walk today and maybe polished off a breakfast of oats, berries and yoghurt? Or perhaps you’re off to the gym for a HIIT class or strength training? 

Staying fit makes sense for so many reasons but here’s one you probably hadn’t thought of:  it lowers the risk of complications if you need surgery at an older age. And couldn’t that be any of us?

As the Australian population ages, more older people are now having surgery.

Until recently, a hip replacement seemed pretty routine. Then last year, the deaths of 2 high profile Australians – 81-year-old Cardinal George Pell and 69- year-old singer Renee Geyer – dropped a bomb. 

Both died within days of each other from complications from hip surgery. 

It shone a light on what we all need to know: that although joint replacement surgery is generally safe, being older and having underlying health problems (as both Pell and Geyer did), can increase complications in any kind of surgery.

How age affects the risk of complications in surgery

“For a rough idea, If you’re a healthy 55-year-old having major surgery such as a hip replacement, the risk of dying within 30 days of surgery is 3 in 1000, but if you’re 83 and have significant heart disease, the risk increases to about 30 in 1000,” explains Professor David Story who heads the Department of Critical Care at the University of Melbourne and is Vice-President of the Australian and New Zealand College of Anaesthetists. 

“Ageing itself makes every organ in the body less resilient, so roughly every ten years the risk of complications with surgery doubles.”

Becoming frail – meaning someone has difficulty walking without help or managing everyday tasks or is dependent on others for their care, for example – also increases the risk of complications and mortality. 

But the risk of death isn’t the only issue. There’s also the possibility of complications that can reduce someone’s quality of life, Professor Story says

“If you’re left with a complication from surgery such as a cardiac event or kidney problem it can affect your ability to do the things you enjoy.”

What you can do to reduce the risk of complications

“Be as fit and strong, and as well-nourished as you can. Ask your doctor what you can do to optimise your health,” says Professor Story. 

“If you’re having surgery for cancer, it’s also important to know that exercise is now part of the treatment for cancer, and is recommended before during and after treatment. It can improve how you respond to treatment for some cancers and reduce complications from surgery and time spent in hospital. “

Download the Citro checklist for health checks to do in your 50s.

Why good mental health matters 

“Looking after mental health is important too. If you have problems with depression, try to tackle it before you have surgery, because if there are complications, depression might make it harder to deal with them,” he adds.

“If the surgery is for cancer, do what you can to be as healthy as possible physically and mentally.  If you have anxiety, talk about it to a health professional and those around you – verbalising how you feel makes it easier for others to provide support.”

The Cancer Mind Care website has good information on managing your mind and wellbeing.

Can anaesthesia trigger cognitive decline or dementia?

“We don’t think anaesthesia causes dementia or cognitive decline,” says Professor Story. 

“It’s more likely that anaesthesia and surgery can unmask an existing problem rather than cause it. One reason for that is that the body becomes slightly inflamed during surgery.  Sometimes people look back after surgery and can see that the early signs of a problem were already there. But if there is some cognitive decline after surgery, it’s also possible that the person may eventually return to how they were before surgery.”

Read more about eating well and how to prevent dementia.

A new approach to getting fit for surgery

Some hospitals now offer prehabilitation programs in the weeks before surgery to help get patients into better shape before their procedure.

“It’s still an evolving area but one large study has found that prehabilitation can halve the risk of mortality from surgery,” says Professor Story. 

Other benefits can include fewer complications, less time in hospital after treatment and improved fitness, according to Melbourne’s Peter McCallum Cancer Centre which offers its own program. 

So what does a prehabilitation program offer? It can vary according to the program and a patient’s needs but is likely to include an exercise program designed to improve cardio fitness and strength, advice on healthy eating, breathing exercises, quitting smoking if necessary, and stress management.

Making the decision to have surgery at age 80 or above

At this age, decisions about surgery should be guided by what you can reasonably expect to get out of the surgery, says Professor Story. 

“While age is a factor in increasing the risk, the number and severity of other diseases, and frailty are more important. The biggest question is around quality of life after surgery. If someone’s quality of life is at risk, options including other less invasive surgery, other non-surgical therapy, or comfort therapy may be options.”

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