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Call for frank discussions about risks for older patients

October 12, 2017

Anaesthetists call for frank discussions about the risks as well as benefits of operating on older patients

Older patients, their families and carers should not be afraid to have frank and open discussions with their medical specialists about the possible risks as well as the benefits of proposed surgery, including when it may become futile, according to anaesthetists.

“The reality is we have an ageing population and that means more high-risk procedures are being undertaken on elderly and sometimes frail patients,” according to Dr Dick Ongley, a Fellow of the Australian and New Zealand College of Anaesthetists (ANZCA).

Ageing and anaesthesia is the theme of this year’s ANZCA National Anaesthesia Day on Monday October 16, which is the anniversary of the first public demonstration of ether anaesthetic given 171 years ago in 1846, in Boston, Massachusetts.

While people aged 65 years or older make up 15 per cent of the population, they account for 30 per cent of hospital admissions in New Zealand. Statistics also show that up to 20 per cent will have an operation in their last year of life.

Dr Ongley says anaesthesia today has an excellent safety profile, especially here and in Australia, because of the advances in technology, robust research and, most importantly, the safety culture. However elderly patients can be frail, on multiple medications and be suffering from pre-existing conditions.

“This may mean surgery might not be the best option and these conversations need to be had with the patient and family,” Dr Ongley says.

“Conversations should include consideration of advanced care directives and end-of-life care plans, and aim to reduce the risk of inappropriate and potentially low benefit intervention.’’

ANZCA is one of Australasia’s largest specialist medical colleges with 6400 (700 in New Zealand) specialist anaesthetists (Fellows) and 1500 anaesthetists in training (trainees – 250 in New Zealand). It is responsible for the training, examination and specialist accreditation of anaesthetists and pain medicine specialists, and for setting the high standards of clinical practice in New Zealand and Australia.

The College warns that many patients aged over 70 years are at high risk for problems after surgery, with 20 per cent experiencing complications within five days, 10 per cent needing to be admitted to critical care and five per cent dying within 30 days.

ANZCA recommends that doctors weigh the benefits of giving anaesthesia to patients with limited life expectancy, or patients at high risk of death or severely impaired recovery, and to first discuss these risks with the patient concerned.

Other questions older patients might wish to discuss include:
• How could my medical conditions and medications affect my anaesthesia?
• Will my memory and thinking be affected by anaesthesia?
• Is an operation the best option? What are the risks and benefits of an operation and anaesthesia compared with alternative treatment options?
• How can I prepare for my operation?

On Monday, October 16, hospitals around New Zealand will display information about ageing and anaesthesia with a number also having interactive displays at which the public can talk to anaesthetists about these and other issues such as advance care plans.

Hospitals holding staffed displays are Whangarei, North Shore, Auckland, Middlemore, Manukau Super Clinic, Palmerston North, Wellington, Christchurch and Dunedin. Other public and private hospitals will display posters and patient information fact sheets.

More information about ANZCA National Anaesthesia Day 2017, including images for download, can be found here.

Television quality video footage of an older patient and his grandson talking to anaesthetist Dr Phillipa Hore about his upcoming operation is available here.

Dr Dick Ongley is a specialist anaesthetist at Christchurch Hospital. He is helping develop perioperative medicine in New Zealand and Australia and helped develop ANZCA’s recommendations for the Choosing Wisely campaign (designed to minimise patient harm and encourage greater communication between doctors and patients when considering surgery). Dr Ongley has recently been appointed to New Zealand’s Perioperative Mortality Review Committee.

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