Understanding the Risks of Surgery in Older Adults

Yi Wang, PhD, a postdoctoral associate (geriatrics) at Yale School of Medicine, researches health disparities after major surgery in disadvantaged older persons. As the lead author of a recent study, Wang worked alongside co-senior authors, Thomas Gill, MD, Humana Foundation Professor of Medicine (Geriatrics), and Robert Becher, MD, associate professor of surgery, to estimate the rates of hospital readmissions within 30 and 180 days after major surgery for older adults.

In a Q&A, Wang discusses the inspiration behind his research, the importance of recognizing frailty and dementia in older persons before surgery, and his goal of helping older adults maintain health and independence.

We know that many older Americans undergo surgery. In our previous research, we found an increased risk of mortality within one year after major surgery for persons aged 65 years or older.

Until now, there has been little information on hospital readmission after major surgery in older persons, especially concerning longer-term readmission. This is concerning because hospital readmission is an important metric in evaluating hospital performance. The National Institutes of Health and the American College of Surgeons have argued that evaluating longer-term outcomes following surgery is critical to assessing surgical quality and safety.

In this study, we found that nearly one in eight community-living older U.S. residents were readmitted to the hospital within 30 days after having a major operation, and more than one in four were readmitted within 180 days. The likelihood of hospital readmissions within 180 days after a major surgery was higher among older persons who were frail or had probable dementia.

Surprisingly, our findings suggested that readmissions after major surgery are expected not only in the short term but also in the longer term.

Another surprising discovery we made is that nonelective surgery is associated with an increased risk of hospital readmission within 30 days but not within 180 days, suggesting that these patients’ comparative vulnerability doesn’t escalate over time. These findings indicate that older patients undergoing nonelective surgery represent a distinct group compared with those undergoing elective surgery.

This new information highlights the frequency of hospital readmissions among older adults after undergoing major surgery and the potentially negative downstream consequences of these readmissions, such as functional limitations.

Our findings also stress the importance of preoperatively identifying frailty and dementia in older persons to inform decision-making and set realistic expectations for recovery. Discussions with patients and their families before major surgery are critical to anticipating short- and long-term needs.

We hope that more research and interventions, such as frailty screening and social support, will be dedicated to the postoperative care of these patients to reduce readmission rates and, ultimately, help older adults maintain health and independence after major surgery.

Yale School of Medicine’s Department of Internal Medicine Section of Geriatrics strives to improve the health of older adults by providing exceptional patient care, training future leaders and innovators in aging, and engaging in cutting-edge research. To learn more about their mission, visit Geriatrics.