Age-Related Risks After Surgery May Lead to Increased Mortality and Health Care Costs

A UCLA study, published online in the Journal of Clinical Oncology, found that age-related issues following cancer surgery may lead to longer hospital stays, increased health care costs, and greater risk of death for older adults (doi: 10.1200/JCO.2015.63.4592).

Age-related events were defined as falling down, breaking bones, dehydration, bed sores, failure to thrive, and delirium. These problems in addition to post-surgery complications can make recovering from surgery much more challenging for older adults.

Researchers used nationwide data on hospital admissions for major cancer surgery in people aged 65 years and older; they also studied a younger group of people, aged 55 to 64 years. Both groups of patients underwent operations between 2009 and 2011. The research team searched for the specific age-related events and estimated their prevalence in relation to age, other health problems, and the location of the cancer.

Within the total sample of 939,150 patients, the researchers identified at least one age-related event in 9.2% of cases, with much higher rates in patients aged 75 years and older and those undergoing surgery for bladder, ovarian, colorectal, pancreatic, or stomach cancer. The study also found that those patients experiencing age-related health issues had a greater risk of concurrent complications and of being discharged to rehabilitation facilities rather than their own homes.

This study brings to light issues related to frailty and reduced functionality, conditions among older adults that tend to be overshadowed by more common focuses of study, such as survival rates and chemotherapy toxicity. The results could lead to better care planning and, the researchers hope, better outcomes for patients whose age puts them at higher risk, said Hung-Jui Tan, MD, the study’s first author and a fellow in urologic oncology at UCLA.

Researchers claim that these events may add to operative morbidity and resource utilization, straining both patients and the cancer care delivery system. Efforts aimed at addressing older age-related health concerns and reducing associated morbidity will be essential as the number of older adults with cancer continues to grow.

“The findings highlight the importance for older patients to discuss these potential events with their doctors as they prepare for surgery,” Dr Tan explained. “Now that the prevalence of such events is known, treatment approaches that keep these age-related health concerns in mind may be better applied in the future to better assist these patients.”—Amanda Del Signore