How old is too old?

Every now and then I think it is important for us to reflect on how we are spending our healthcare dollars. When I was a young surgeon, I remember a lot of discussion about how ridiculous is was to operate on patients with advanced age. Their complication rate and mortality was significantly higher than their younger counter parts. So, what to do?

Chance Fracture

Chance Fracture

A 97-year-old female presents to the ER after a fall. She has a Chance fracture of T12. A Chance fracture is basically when a bone splits in half. None of these fractures heal on their own. They are highly unstable. For reasons that are unclear, the patient was sent home only to have more and more back pain. Ten days after the fall, she presented with increasing back pain. She was awake and alert with no major medical problems. After long discussions with the family and the patient she underwent an extensive back stabilization procedure. The patient does remarkably well and is discharged to rehab after seven days in the hospital.

A 92-year-old male with a long history of inguinal hernia presents now with sudden pain in his groin. The patient lives by himself. He is awake and alert. “Doctors told me if it isn’t bothering me, don’t worry about it.” The patient’s hernia is clearly stuck. The patient undergoes a standard repair. He does well and is discharged home.

So, the question is how old is too old? When do you say that we can’t or shouldn’t operate?