Colorectal Surgery for the Elderly
With Singapore’s high life expectancy comes a corresponding high number of elderly with colorectal diseases. This means that the number of colorectal surgeries that need to be performed on a geriatric population has also increased. While it is generally safe and possible to do so, there are special considerations that doctors have to factor in when determining when and how to go about doing this.
Medical Characteristics of Elderly Patients
Elderly patients tend to have more complex medical needs as compared to younger patients. These have to be factored into the doctor’s consideration and include:
- Elderly patients often have multiple comorbidities, such as heart disease, diabetes, or kidney disease, which can complicate surgical procedures and postoperative care for older patients.
- Age-related factors such as frailty and a weakened immune system can also impact surgical outcomes. For instance, older patients may take longer to recover from surgery, and they are at a higher risk of complications such as infections, blood clots, and cognitive decline following surgery.
- Furthermore, the stress of surgery can sometimes exacerbate chronic conditions, leading to poorer overall outcomes.
Choice of Surgical Techniques
When it comes to the choice of surgical techniques, this largely depends on the patient's overall health, the severity of their condition, and the surgeon's expertise:
- Traditional open surgery involves making a single large incision in order to access the diseased part to operate on. While this method is effective, it often involves greater post-operative pain, higher surgical risks and a longer recovery period, which can be harder for elderly patients to manage.
- Minimally invasive surgery, on the other hand, involves the use of small incisions and specialised surgical tools. This includes laparoscopic surgery and robot-assisted surgery. This typically results in less post-operative pain, shorter hospital stays, and quicker recovery. This can be very beneficial to eligible elderly patients.
Pre-operative Evaluation For Elderly Patients
Before undergoing colorectal surgery, elderly patients should undergo a thorough evaluation to assess their overall health and potential risks versus benefits associated with the procedure. This evaluation will include a detailed medical history, physical exam, and laboratory tests to assess vital organ function and identify any underlying conditions to manage. Overall, this is to ensure that the patient is indeed fit for surgery.
Recovering from Colorectal Surgery for Elderly Patients
The recovery period following colorectal surgery in elderly patients can vary significantly depending on their overall health, type of surgery performed, and adherence to rehabilitation. This can range from several days to several weeks.
Palliative Care and End-of-Life Considerations
When surgery is no longer an option, palliative care becomes extremely important. Palliative care aims to improve the quality of life for patients facing serious illness, with a focus on easing physical symptoms, and fulfilling emotional and spiritual needs. This can involve pain management, psychological support, and help with decision-making about treatment options.
End-of-life care choices and decisions are deeply personal and should be made in consultation with the patient, their family, and their medical team. These can include decisions about resuscitation, use of a ventilator, as well as preferences for where the patient would like to spend their final days.
