Hi, I’m Dr. McClintock at the Orthopedic Specialty Center of Northern California. I’m an orthopedic surgeon who specializes in shoulder and elbow surgery. I wanted to talk to you a little bit today about one of the common questions that I get from patients–specifically elderly patients who are considering undergoing surgery. They often ask, is orthopedic surgery safe for seniors like me?
To answer the question, I want to start with a little bit of data regarding surgery in the United States and how it might pertain to seniors who are considering surgery. Approximately 50% or more of the procedures that are performed in the United States every year are performed on patients over the age of 65.
It’s important to take into account multiple factors including things like other medical condition such as diabetes, heart disease, or history of stroke for example. We use that information to make a informed decisions. Has a surgeon really explained to you the risks and the benefits associated with the surgical procedure, given your current situation?
In medicine when we talk about whether or not someone is healthy enough to undergo surgery, we are referring to this idea of what we call frailty. Frailty is a term that’s used to describe people who are weak or tired, malnourished, or having other medical problems, and their body may not able to tolerate the stress of a surgical procedure or general anesthesia.
The first step in determining a patient’s risk is to get the facts. You need to understand from your medical providers such as your surgeon or primary care physician, those things that are going to be pertinent or important to you as you decide whether or not surgery is something that you want and can pursue. You want to know what the risks of the procedure are. You will want to ask questions like:
- Are there complications associated with the procedure?
- How long does it take to recover?
- Do you have any medical conditions that would put you at an increased risk of having a negative or bad outcome or a complication?
- How are you going to care for yourself after the surgery?
The other thing to think about is, what are my treatment options if I choose not to undergo surgery? If I choose to just live with this condition, how will that impact my life?
Making a Difference with Pre-Habilitation
One of the first things that can be helpful for patients is this idea of pre-habilitation. Oftentimes we talk about rehabilitation, which takes place after surgery to get the shoulder, hip, or knee back to good functioning status after surgery. Pre-habilitation is the same idea, but it takes place before surgery. It’s important to understand that your body as a whole is a really complex system and that other things that you can do to help ensure that you would have a good outcome can be undertaken prior to the procedure.
Some actions you can take during this pre-habilitation include staying active, being fit, working on core strengthening exercises, working on discontinuing medications that can predispose you to a negative outcome or side effect associated with anesthesia. You will also want to make sure that you’re eating a high protein diet. Protein is essential for our healing ability, and you can really help your own recovery by making sure that your protein levels and your nutrition is up to par before you undergo the surgery. Hydration is also important–making sure that you have enough fluids on board so that you don’t have any complications associated with dehydration postoperatively.
Preparing for Recovery at Home
One of the really important steps to prepare for surgery is to survey the situation that you have at home. What does your living arrangement look like? Who’s there to help you? Do you have family members close, a spouse, someone else, a neighbor who can help take care of you–help you organize your medications, help you get to and from physical therapy?
In our office, we’re trying hard to work on helping to bring some of those services into your home. The thing that’s really nice about that is it allows us to survey your home environment beforehand, make specific recommendations regarding potential hazards that may be there, and how you can set everything up before you have surgery. So that once you returned home from surgery, you don’t have to worry about anything. Everything’s already taken care of. Then those therapists will be in the home regularly to check on you, to help you work through the rehabilitation process, and have really good direct feedback with us and our office staff–to ensure that we stay on top of any potential complications that may arise. This helps us ensure that you’re progressing and hitting the milestones that we want you to hit during the recovery window.
Have a Detailed Plan
Some of the things that you can do before surgery include:
- installing a shower chair or a handrail in the bathroom or shower
- removing anything that might be a tripping hazard, like a rug or a small footstool, or something that you just might lose visual sight of as you’re trying to navigate after you had surgery.
- putting things that you’re going to need on a regular basis in easy to access positions. These might include:
- coffee cup
- a water glass
- the TV remote
- a telephone
- a charger for your phone
- things that you might not necessarily think of, but that you would use on a regular basis
You are just trying to avoid having to rummage around trying to navigate or find something, and then you fall or find yourself in a bad situation.
Another thing that’s really important is planning how you’re going to take care of yourself for simple things, such as eating, preparing meals, and grocery shopping. One option is to go ahead and prepare those meals beforehand for a certain set amount of time and then freezing those meals. You can also sign up for a food delivery service, Meals on Wheels, DoorDash. Ask a neighbor, or a friend who’s offered to come and help. Consider anything that you can do to minimize the things that you have to do on your own and make your life after surgery more convenient.
Nutrition and Hydration are Key
Finally, a nutritional program is critical to your recovery process. We talked about protein building before surgery. You’re going to want to continue that after surgery. Will will also want to esure you continue to stay hydrated. Ensure you’re getting all of the essential proteins, vitamins, minerals that your body needs for healing. Healing is a very complex process within your body. It has many moving parts, but you need to feed it and you need to make sure that it’s working efficiently.
Feel Free to Rely On Others
It’s also important to identify caregivers. Who’s going to be that person or those people who are going to help take care of you in this postoperative period? It’s a family member, a neighbor, a spouse. They’re going to be not just taking care of you and helping you with meals and showers, hygiene, and activities, but also offering you encouragement. Rehab can be challenging sometimes; it can be painful. There will be ups and downs so it’s always good to have people around who can provide a support system. Having somebody who can give you encouragement and cheer you on through the process–celebrating your progress that you’re going to have as you recover through your rehab–is very important.
Most patients who identify themselves as being too old or too elderly for surgery are actually not. There’s a lot of things that we can do by working with a primary care physician to optimize your medical status–making sure that your chronic medical conditions are under control. We ensure that you’re in the best physical and nutritional shape possible leading up to the surgery. Having that really well-balanced support system for you at home will help you have a successful recovery after surgery.
Family members and friends are really critical part of the recovery process and your support system after surgery. It’s not uncommon that I will encourage patients to bring their family members, bring their friends, bring those people who are going to be helping them during that pre and post-operative window to come into the office for that visit, so that we can talk together and we can listen to one another’s concerns and standpoints. That lets us all work as a collaborative team to build a plan that’s going to be the most beneficial for you.
I think that when we do that and we bring in the primary care physician and the therapists, and we have this really robust network of support that patients and family members both feel a lot better. They’re more at ease, and they feel confident that the plan that we put together is going to lead to a good outcome and allow them to improve their function, their lifestyle, and get rid of the pain that’s been troubling them.
Go ahead and setup an appointment with us if you think you would like to consider surgery. We will walk with you every step of the way.