Some time ago, I took care of an 80 year old man who underwent surgery for an expanding abdominal aortic aneurysm.  This is a ballooning of the major abdominal blood vessel that carries blood to the abdomen and lower extremities.  At a certain size, the risk for rupture is high, and consequences are grave.  Surgical repair is indicated.

John was a cognitively normal octogenarian prior to the surgery.  His procedure went well technically, but postoperatively he became confused and combative.  In short, he was delirious–he recognized neither his wife nor me.  

This was “postoperative neurocognitive decline,” a condition that, according to a study in the British Journal of Anesthesiology in 2019, afflicts 65% of patients 65 or older after major non-cardiac surgery.  The same study found that 10% of these patients developed long-term cognitive decline.

Research designed to improve outcomes (Journal of the American Medical Association, Internal Medicine, 2020) points to strategies that may improve this important syndrome.  In this study, a family-involved combination of cognitive stimulation and mobilization significantly reduced delirium in both the short and long term.

If you need surgery, you need surgery.  Life threatening conditions such John’s aneurysm certainly justified the risk of surgery.  

The major take home, though, is that an elderly patient (or any patient) should carefully consider therapies besides surgery in an elective situation.  If a hip or knee has gone bad, for instance, perhaps physical therapy, or more intense physical therapy, may provide an acceptable alternative to a prosthetic joint.

John recovered from his delirium after a few days, and his surgery was a success.  But his wife said that he never was quite like his old self. 

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