Six post-surgery, lifesaving interventions often linked to poor outcomes for older adults

Surgery on older patients is common, but in rare cases it can lead to complications so serious that intensive, highly invasive interventions are required. While intended to be last-resort, lifesaving efforts, these interventions carry significant risk.

A new study shows that when post-surgery complications lead to six particular interventions, patient outcomes are often especially poor. These include CPR, intubation/mechanical ventilation for 96 hours or longer, feeding tubes, tracheostomy, new dialysis and ECMO. Samir Shah, MD, MPH, of the University of Florida, is the study’s lead author, and Joel Weissman, PhD, of Mass General Brigham, is the senior author.

The research team explored how often Medicare beneficiaries aged 66 or older underwent these unexpected, burdensome interventions after ten of the most common inpatient surgeries. They also examined which patients were at the highest risk and the downstream consequences.

While these unplanned interventions were only necessary for about 2% of the cohort, these individuals had markedly worse outcomes: ~25% died during their hospital stay, compared to just 0.5% inpatient mortality among other surgical patients. About 44% of patients undergoing intensive interventions died within a year and only ~34% were discharged home. Of the patients who required an intensive intervention, about 17% needed more than one and had even poorer outcomes. The study also found that older age, male sex, frailty, more comorbidities and urgent or emergency surgery were associated with a higher risk of needing these interventions.

Overall, not having these intensive postoperative interventions when they’re called for will almost certainly result in death, but having them is no guarantee of a good outcome. While results varied across individual interventions, the takeaway was clear: experiencing any of these procedures was a strong sign of “severe physiologic deterioration.” The authors suggest these findings could help better assess surgical risk and inform post-surgery care decisions.