Rajesh was in a dilemma when his 91-year-old grandmother, who had fallen in the bathroom, was suggested a hip replacement surgery.
At this age? he wondered. Like Rajesh, there are hundreds of families who wonder if an octogenarian, nonagenarian, or centenarian loved one should undergo hip surgery at that age.
Director and Chief of Orthopaedics at Bengaluru’s Hosmat Hospital, Dr Thomas Chandy, told South First that there are more centenarians and nonagenarians than believed who are undergoing ortho-surgeries to walk freely again.
In the past 13 years, Chandy has performed hip surgeries on 101 patients who are above 90 years old.
101 and counting
Chandy told South First that out of the 101 patients, 96 were above 90 years old and five were above 100 years of age. “My oldest patient was 104 years old,” he said.
“Of the 101 patients who had undergone surgeries at Hosmat, one died in the operation theatre and four died during their stay in the hospital due to other comorbid conditions. This kind of survival rate is very unusual, but shows that the mortality rate is about 1 percent,” explained Dr Chandy.
The number of super-senior citizens coming in with hip fractures due to severe osteoporosis has risen, noted the doctor. He said that these fractures could lead to an increase in mortality and deterioration in the quality of life.
“Many of them were unable to move and are in severe pain; some with bed sores, too. The mean survival time there is hardly four months for people in such conditions,” Chandy said.
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‘Don’t dodge surgeries’
Chandy argued that several people postpone surgery or dodge it, but that was like trying to escape the inevitable.
Many postpone surgeries fearing the risk of death, and feel it may be unnecessary to put the patient through it at that age of life.
Then there are the expenses of surgery for someone at that age, he added.
However, it is important to consider the potential consequences of postponing the surgery, Dr Chandy added. He said that these patients are in much pain that they can’t even move an inch. And the bed sores are so huge — almost one foot wide.
They survive only for about four months or so.
Also, as there is no movement, the chances of getting pneumonia is very high. This can also lead to clots in their legs and body, increasing their chances of death in just three months.
Weighing the risks
Chandy said that, for families, it can be difficult to weigh the pros and cons of surgery. Delaying the surgery is what a majority of families consider.
However, he advised, the most important thing families can do is weigh the risks of going through surgery and the risk of not going through the surgery.
Dr Chandy explained, “Several studies in the US and India have shown that delaying or not going through surgeries has more risk attached to it than the risk of the procedure itself.”
Outlining some issues himself, Chandy said that with dependency on relatives, these patients will need 24×7 care without surgery. This includes expenses of nursing care and then there is the chance of them dying in pain within months or even coming back as an emergency.
Another important consequence of not doing the surgery is increased emotional anxiety, he noted.
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Possible risks and complications
Talking us through the process, Dr Chandy said that the patients and their families are first explained the risk of surgery as well as not doing the surgery.
He said that while the risk of surgery is often less than no surgery, the risks involved can be dealt with well if the hospital has good anaesthetists, a comprehensive team of doctors including cardiologists, physicians, pulmonologists, critical care specialists, a good ICU, good post-operative care, and physiotherapists.
It is also important to have protocols in place, like beginning physiotherapy the day after surgery to help mobilise them and reduce the mortality risk.
“This can also boost their morale. Their will to live may have gone down but when they see that they are able to sit and stand without pain, they feel confident. This really works wonders. Their will to live increases. Many of them have survived much longer after this surgery with us,” he said.
Complications in the surgery include problems with the age-related functioning of the heart, lungs, brain, and kidneys, as well as comorbidities like high blood pressure, diabetes, and cardiac failure during surgery.
“It is key to ensure that the surgery is done very quickly — within an hour’s time. Those with known heart and kidney history are those who are at high risk, but the surgery can be done after explaining the risk factors to the family,” Chandy advised.
The hospital authorities at Hosmat Hospital explained that all these patients are monitored closely for a few days and will be made to walk with a walker.
Chandy added that those patients who were walking before their fall would be made to walk 24-48 hours post-surgery.
They are first made to turn on the sides, then sit on the bed and then, the wheelchair. This itself gives them a lot of confidence, said Chandy.
With medical and rehabilitative care with physiotherapy and family counselling, these patients can leave the hospital as quickly as one week.