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Reasons for failure of surgical procedures for the elderly

Discuss about the College of Surgeons National Surgical Quality.

In the current day Australia, the elderly individuals encounter health-threatening conditions that require urgent surgical procedures (Clarke, Soneji, Ko, Yun, & Wijeysundera, 2014). However, the success rates of the methods are not something to report home about. A majority of surgical operation cases flop because of many reasons. There are numerous reasons why the surgical processes fail. A significant number of advanced aged persons discover about the conditions that require surgery a little too late. The elderly have a frail body structure making operation to be a hard medical task.  Surgical procedures are likely to fail when the diagnosis of a disorder takes place later than usual.

Cases of polypharmacy and comorbidity also lead to the failure of most surgical procedures (Clarke, Courtwright, Karlage, Gawande, & Block, 2014). This critical review looks at the various surgical procedures aimed at caring for the elderly. Furthermore, it describes the difficulties that health practitioners undergo when handling elderly patients. The paper looks at seventeen research projects by various Australian health facilities. The information in the write-ups looks into examples of surgical procedures in the old and the challenges. In a study carried out in 2013 of the success rates of surgical procedures, at least 1000 elderly patients responded to the research (Coulter, Locock, Ziebland, & Calabrese, 2014). The study took place at four health facilities in Melbourne, Australia. Of the one thousand patients assessed, 250 patients, 70 patients succumbed after surgery (Coulter et al., 2014).

The massive death rates arise due to the high costs of treatment and the elevated amount of time that the elderly spend at the hospitals (Dabholkar, 2015). In Australia, surgery is carried out public facilities while a majority of operational processes pre-occupy private health facilities (Dabholkar, 2015). Proper End-of-life care can help to reduce the number of deaths after surgery. Both elderly and their relatives can devise appropriate communication strategies to reduce the mortality rates.

An elaborate communication strategy leads to proper decision making (Arnold, & Boggs, 2015). The primary objective of such communication is to consider the candid opinion of the person to undergo surgery. If an elder declines such an opportunity, autonomy should take the course. However, if they consent, their wishes deserve respect. The paper also looks at the risks of elderly surgical operations. Additionally, the communication strategies that can boost decision making in end-of-life care also takes center stage.

Challenges faced by health practitioners while handling elderly patients

The objective of this critical review is to carry out systematic research for literary information. The information is on critical issues revolving around surgery of the older adults. Additionally, the survey looks at the potential risks of carrying on surgery on the elderly. Moreover, the paper looks at the communication methods that facilitate clear decision making during end-of-life care. The results of this review can assist the elderly persons about the potential dangers of surgery. Furthermore, the medical world can look at the statistics on the death rates from surgical operations. Additionally, clinicians can use the paper to train patients on the practical communication skills in end-of-life care.

The team of experts carried out an organized search for literature sources. Some of the literary sources used include British Medical journals, the annals of surgery, BMC, JAMA medical records, the American Journal of surgery among others. Those are just but a few sources. The full list of the sources exists in the reference list, at the end of this critical review paper. After a thorough consultation with the University supervisor and the current chief librarian, the above terms exist in the sources: (Proper communication skills in nursing) AND (Cohort based on numbers, communicational pitfalls, autonomy, beneficence, justice, surgical procedures, surgery, and surgical processes). (Risk factors in surgery, end-of-life care, principles of communication, and elderly surgical procedures are also inclusive). Other keywords include: (health facility, legislation, Australian Nurses and Midwifery Association). The sources date from 2014-2018. A few sources have a link that traces them back to their origins. However, more information exists in Google scholar and

The number of sources retrieved was 167 in total. However, only 60 sources attained a close look by the team of researchers. After many deliberations, the group disqualified a further 28 references. The excluded sources were not scholarly. Only 32 sources qualified to be used and included in this review.

Once the team settled on 32 sources, they closed looked at numerous parameters. Firstly is the year of publication. Literature published before 2014 did not cut; since a proper review depends on conventional sources. Furthermore, the sources on general surgery did not make a list. The literature on communication skills did not qualify. Additionally, any information on risks of operation is essential to the elderly. The experts used sources on surgery on the old; challenges doctors face on the surgery of the senior population, and the healthcare communication skills.

Communication strategies for end-of-life care

The information on the literature provided a majority of topics and subtopics. The first topic is on the emergency surgery of the elderly. Under the subject, there is an overview, challenges and possible suggestions. Another problem is on challenges of the surgical operation on the old. The last topic is on the active communication that can enhance decision making on the end-of-life care. The first topic is from sources such as (Merani, Payne, Padwal, Hudson, Widder, & Khadaroo, 2014) and (Du, Karvellas, Baracos, Williams, & Khadaroo, 2014) and many others.

In most developed nations such as Australia, the stage of elderliness set in at 65 and above.  However, those above that age can be classified further. There are those who are more susceptible to diseases than others; thus, the frail-elderly, less frail and non-frail elderly (Austin, Mohottige, Sudore, Smith, & Hanson, 2015). Those who are highly vulnerable to diseases require sufficient care. In Australia, 15% of the population consists of people from the age of 67 and above (Devereaux, & Sessler, 2015). The frail elderly population faces numerous disease conditions.  An emergency surgical chamber exists in almost all hospitals in Australia. In the past ten years, the number of older patients reporting at the special treatment chamber has nearly doubled (Du et al., 2014). Most elderly patients are seeking urgent surgical attention to curb old age diseases.

The doctors attending to elderly patients have admitted that operating the elderly is a challenging task. The old people have a weakened skin and require keen attention. Moreover, the procedures require substantial financial investment and highly skilled medical staff (Eneanya et al., 2015). Most individuals succumb after the operation. The few that survive the surgery suffer from additional complications (Epstein et al., 2017). Elderly individuals require a comprehensive feeding program that only exists at their homes. Additionally, they miss the warm care that home provides.

Clinicians say that the elderly rejects the best operational methods tendered towards them. The young generation responds to change more than the old generation. Recent research states that, as someone advances in age, their level of selectivity increases (Gleason et al., 2015). However, not all the elderly resist modern surgical procedures. Others accept any method, provided that they are safe.

Recent research has indicated that emergency surgery is not always successful (Joseph et al., 2016). A few elders die after the procedures. The elderly overstay at the health facilities; while the rest develop other complications due to the proceedings. Efforts to solve the issues are underway in Australia (Merani et al., 2014). Research centers across Australia are finding out the best methods to use on the elderly. Media campaigns have reached top gear (Miilunpohja et al., 2018). Health associations are educating the old on the essence of the new surgical procedures.

Research methodology and sources

The mental capacity of mostly senior men rejects anesthesia. The chemical is used to minimize pain during surgery. Any individual who is not responsive to anesthesia is difficult to operate (Moir, Roberts, Martz, Perry, & Tivis, 2015). Some issues arise when doctors decide to use anesthesia to work. Firstly, the patient gets a confusion state. Furthermore, the elderly lose focus and cannot gauge where they are at the moment of surgery (Olufajo et al., 2017).            Afterward, the elder suffers from memory loss. However, they regain their memory back after a month. Others can lose consciousness forever (Ostherr, Killoran, Shegog, & Bruera, 2016). Before surgery, an examination is necessary for the patient. Individuals having numerous health complications should skip the procedure.

The effect of an anesthetic drug is severe in a disease-laden elder than that feeling well.  The drug can cause a permanent state of confusion for elders who have suffered from critical infections in the past (Peters, van Dijk, Roodenburg, van der Laan, & Halmos, 2014). To prevent the diverse effects of anesthesia, the doctor should use other means before surgery. If the patient is not responding to the operation, other methods of treatment become mandatory (Qiao et al., 2015). The elder should request the physician to run a test to ascertain whether they are positively responsive to anesthesia. Moreover, after the surgery, the doctor should stay put check on the progress of the patient (Raats, Van Eijsden, Crolla, Steyerberg, & van der Laan, 2015). The elder should avoid using drugs that can negatively affect them after surgery.

The elder should request for any walking aids that they were using before the surgery. The older citizens with a delicate body faces provide doctors with new nightmares (Ramos et al., 2016). A frail person has a worn out body system. The organs cannot accommodate more stressing factors such as surgery (Scholz, Oldroyd, McCarthy, Quinn, & Hewitt, 2016). Frail elders should use alternative means of treatment and avoid surgery at all costs.

The category of elders has a significantly reduced weight. Additionally, they have weak and exhausted bones (Shoair et al., 2015). Their borne marrows and spleen are no longer making new structures. Frail elders walk slowly and rarely engage in economic activities (Sinuff et al., 2015). The chances of such elders not surviving a successful operation are high. When a hospital finds out that a patient is frail, they should widely consult the patients and the family members on the surgeon.

Emergency surgery of the elderly

Surgery is a process that takes a long time. The younger generation does not have issues by sleeping for extended hours in health facilities. However, the elders are significantly affected by more extended hospital stays (Song et al., 2015). The patient can suffer from mental disorientation. Moreover, the elder can experience slow motion in their movement. Furthermore, prolonged hospital stays prevent individuals from resuming their chores conclusively. The elderly are likely to experience a sharp decline in the weight of their muscles (Søreide et al., 2015).  Their blood pressure increases after surgery. Additional surgical effects include dehydration, disorientation, and stress (Stewart et al., 2014). Furthermore, the society can alienate the patient after surgery. Survivors of the process at times feel anxious (Suskind et al., 2016). Less-supportive society can harm the progress of the elder after surgery.

A majority of patients experience a fracture in their hips during the surgery. The most patient also undergoes mental disturbance after surgery. However, there are different ways of solving the harmful effects of surgery on the elderly (Tan, Saliba, Kwan, Moore, & Litwin, 2016). The health facility should examine whether a patient is frail or not. A weak patient should seek alternatives to surgical procedures. Alternatively, the physicians should refer them to anesthetic specialists.

Elderly who are physically healthy can undergo surgery. The fit individuals escape death and other diverse effects such as memory loss. The elderly population should regularly visit the hospitals. The physicians, therefore, get the opportunity to test the levels of their frailty.

The clinician and the family of the elder should respect their Autonomy.  When an elder decides that surgery is the way out, the relatives should obey that. Those that reject operation should consider alternative modes of treatment.

Any surgery should get a nod from a health specialist. A proper process should have sufficient financial backing. Additionally, the family members should support the elder before, during and after the procedure (Torrance, Powell, & Griffiths, 2015). Moreover, the physician carrying out the process should be highly qualified. After the operation, the specialist should keenly monitor the patient and address any arising matters. The Australian administration should expand educational outreach on operational processes.

Emergency surgery can be defined in several ways. However, the best explanation lies with different health care providers. The operation is a procedure that is essential, and the patient in need can die when not treated in that manner (Velmahos et al., 2015). The surgery aims to protect the well-being of individuals. Additionally, the operation can save a given cell or organ system from destruction. Rapture in the cells disorientates an individual. The elderly individuals are vulnerable to infections due to their advanced ages. They can contact these life-threatening diseases: fractured bones, chest pains, and complications of the abdomen. Additional complications include: tearing of tendons and mental disorders.

Risks of surgical operation on the elderly

In most scenarios, emergency surgery leads to some health-threatening conditions. The tibia and femur can mainly tear during those operations. Australian health practitioners define surgery as an essential procedure which is necessary. An emergency operation should follow a set of principles. The health practitioner has the sole responsibility to gauge whether a condition requires surgery or otherwise. When the specialist feels that the operation is dangerous to the patient, it should receive no attention (Wilson, 2017). The patient should assess the various surgical procedures. The elderly patient should choose the method that suits them.

The hospital should carry out any surgery within the working periods during the day. A procedure done at night is likely to be unsuccessful. Physicians who are fresh from their homes should do the process. Otherwise, an exhausted doctor can make fatal mistakes that may strain the excellent reputation of the health facility (Tan et al., 2016). Furthermore, series of unsuccessful procedures can end the careers of promising doctors. The patient should not force the doctor into carrying out any process. The patient must do a thorough consultation with family, friends, and practitioners before any procedure. A rash decision by the patient, doctor or relative may lead to surgical mistakes.

For a surgical procedure to be a success, the physician should consider all the health policies. Furthermore, the doctor should consult widely. Patients who are not responsive to anesthesia should avoid surgery (Tan et al., 2016). Any health facility should have a counseling department. In that category, the specialists should advise the patients on surgical procedures. Before the beginning of any process, the patient should have the adequate information to make an informed consent.

A health facility should have an elaborate way of communicating with patients. Consequently, the family members should give their say before a surgical procedure. An effective communication strategy is vital in the caregiving as a whole. Additionally, end-of-life care thrives on good conversations. The doctors should consider the opinion of the elder before any surgical procedure. Before that, the clinician should educate the elderly on the dangers and benefits of an emergency surgical process. A patient chooses the mode of treatment that suits their beliefs and tastes (Ostherr et al., 2016). The physician should record the preference of the patient. So that, when the patient returns, the physician uses the previous procedure hence creating a continuity culture.

Health stakeholders should boost the end-of-life communication relationships between the elderly patient, the physician and the relatives. A majority of older patients cannot make informed decisions on issues relating to the surgeon. Thus, the family members should team up with practitioners to help the person in making critical treatment decisions (Ostherr et al., 2016). Therefore, patients should state their medical attention preferences when they still can reason correctly. Patients who record their tastes earlier give the clinicians an easy time in the surgical tables. Adequately defined care is advantageous to the patient and the doctor alike. Both parties get immense satisfaction in the kind of treatment that they offer and receive respectively.

Challenges of surgical operations on the elderly

Additionally, proper communication between the patient and the physician increases the life expectancy. Furthermore, the improved conversation lowers the cost of treatment. An adequate communication comfort family members who lost loved ones after surgery. An elder who is informed about surgical procedures is confident to undergo the operation process (Ostherr et al., 2016). Additionally, the techniques lower the rate of deaths after surgery. Any individual should visit a nearby hospital and record their treatment preferences. The physician should strictly follow the wishes of the patient before conducting any forms of medical attention. Therefore, the procedure makes the treatment to be a simple venture.

The literature used in the paper is quite expansive and conclusive. However, the information on the modes of communication towards effective end-of-life care is not enough. Additionally, the literature does not adequately cover the outcomes of the efficient care for the elderly. The documentation on the emergency surgery is not complete. The findings are only dominant on the threats, challenges, and solutions to the eventualities arising from the operations.

Due to few limitations on the sources of literature gathered, a few adjustments are necessary. The scientists should explain the importance of emergency surgery; since they have demonstrated the threats and the solutions to those threats.  Furthermore, they should provide more information on the challenges and the answers to the surgical procedures on the elderly. Researchers should add more knowledge on the communication strategies which can aid in informed decision making within the healthcare departments. Moreover, more research is necessary to explain the importance of emergency surgery.

When conclusive research takes center stage concerning all the controversial issues, a majority of benefits slowly accrue. Patients and the general world get the full information about emergency surgical processes in the elderly individuals. Furthermore, the older get to know the advantages of considering an emergency surgery. Additionally, the senior citizen gets to know the challenges and possible solutions of an unsuccessful procedure. Moreover, the patients get to understand the essence of effective communication in healthcare. A complete study makes patients to make informed treatment decisions.


Emergency surgery is a standard procedure among the elderly. Due to their advanced age, senior citizens at times require an urgent operation to correct disorders such as broken bones. However, doctors face significant challenges when dealing with elderly patients. A majority of frail elders do not respond positively to anesthesia. The injection disrupts their normal orientations. The effects of anesthesia are so diverse that they can lead to memory loss among other effects. A procedure carried out hurriedly may lead to fatal errors. Health practitioners should ensure that communication strategies between them and the patients are efficient. Practical communication skills lead to informed decision making by the patient.

Efforts to solve the challenges


Arnold, E. C., & Boggs, K. U. (2015). Interpersonal Relationships-E-Book: Professional Communication Skills for Nurses. Elsevier Health Sciences.

Austin, C. A., Mohottige, D., Sudore, R. L., Smith, A. K., & Hanson, L. C. (2015). Tools to promote shared decision making in serious illness: a systematic review. JAMA internal medicine, 175(7), 1213-1221.

Clarke, H., Soneji, N., Ko, D. T., Yun, L., & Wijeysundera, D. N. (2014). Rates and risk factors for prolonged opioid use after major surgery: population based cohort study. Bmj, 348, g1251.

Clarke, Z., Courtwright, A., Karlage, A., Gawande, A., & Block, S. (2014). Pitfalls in communication that lead to nonbeneficial emergency surgery in elderly patients with serious illness: description of the problem and elements of a solution. Annals of surgery, 260(6), 949-957.

Coulter, A., Locock, L., Ziebland, S., & Calabrese, J. (2014). Collecting data on patient experience is not enough: they must be used to improve care. BMJ: British Medical Journal, 348.

Dabholkar, P. A. (2015). How to improve perceived service quality by increasing customer participation. In Proceedings of the 1990 academy of marketing science (AMS) annual conference (pp. 483-487). Springer, Cham.

Devereaux, P. J., & Sessler, D. I. (2015). Cardiac complications in patients undergoing major noncardiac surgery. New England Journal of Medicine, 373(23), 2258-2269.

Du, Y., Karvellas, C. J., Baracos, V., Williams, D. C., & Khadaroo, R. G. (2014). Sarcopenia is a predictor of outcomes in very elderly patients undergoing emergency surgery. Surgery, 156(3), 521-527.

Eneanya, N. D., Goff, S. L., Martinez, T., Gutierrez, N., Klingensmith, J., Griffith, J. L., ... & Berzoff, J. (2015). Shared decision-making in end-stage renal disease: a protocol for a multi-center study of a communication intervention to improve end-of-life care for dialysis patients. BMC palliative care, 14(1), 30.

Epstein, R. M., Duberstein, P. R., Fenton, J. J., Fiscella, K., Hoerger, M., Tancredi, D. J., ... & Kaesberg, P. (2017). Effect of a patient-centered communication intervention on oncologist-patient communication, quality of life, and health care utilization in advanced cancer: the VOICE randomized clinical trial. JAMA oncology, 3(1), 92-100.

Gleason, L. J., Schmitt, E. M., Kosar, C. M., Tabloski, P., Saczynski, J. S., Robinson, T., ... & Inouye, S. K. (2015). Effect of delirium and other major complications on outcomes after elective surgery in older adults. JAMA surgery, 150(12), 1134-1140.

Joseph, B., Zangbar, B., Pandit, V., Fain, M., Mohler, M. J., Kulvatunyou, N., ... & Rhee, P. (2016). Emergency general surgery in the elderly: too old or too frail?. Journal of the American College of Surgeons, 222(5), 805-813.

Role of anesthesia in surgery for the elderly

Merani, S., Payne, J., Padwal, R. S., Hudson, D., Widder, S. L., & Khadaroo, R. G. (2014). Predictors of in-hospital mortality and complications in very elderly patients undergoing emergency surgery. World Journal of Emergency Surgery, 9(1), 43.

Miilunpohja, S., Kärkkäinen, J., Hartikainen, J., Jyrkkä, J., Rantanen, T., & Paajanen, H. (2018). Need of Emergency Surgery in Elderly Patients with Upper Gastrointestinal Bleeding: Survival Analysis during 2009–2015. Digestive surgery.

Moir, C., Roberts, R., Martz, K., Perry, J., & Tivis, L. (2015). Communicating with patients and their families about palliative and end-of-life care: comfort and educational needs of nurses. International journal of palliative nursing, 21(3), 109-112.

Olufajo, O. A., Reznor, G., Lipsitz, S. R., Cooper, Z. R., Haider, A. H., Salim, A., & Rangel, E. L. (2017). Preoperative assessment of surgical risk: creation of a scoring tool to estimate 1-year mortality after emergency abdominal surgery in the elderly patient. The American Journal of Surgery, 213(4), 771-777.

Ostherr, K., Killoran, P., Shegog, R., & Bruera, E. (2016). Death in the digital age: A systematic review of information and communication technologies in end-of-life care. Journal of palliative medicine, 19(4), 408-420.

Peters, T. T., van Dijk, B. A., Roodenburg, J. L., van der Laan, B. F., & Halmos, G. B. (2014). Relation between age, comorbidity, and complications in patients undergoing major surgery for head and neck cancer. Annals of surgical oncology, 21(3), 963-970.

Qiao, Y., Feng, H., Zhao, T., Yan, H., Zhang, H., & Zhao, X. (2015). Postoperative cognitive dysfunction after inhalational anesthesia in elderly patients undergoing major surgery: the influence of anesthetic technique, cerebral injury and systemic inflammation. BMC anesthesiology, 15(1), 154.

Raats, J. W., Van Eijsden, W. A., Crolla, R. M., Steyerberg, E. W., & van der Laan, L. (2015). Risk factors and outcomes for postoperative delirium after major surgery in elderly patients. PLoS One, 10(8), e0136071.

Ramos, K. J., Downey, L., Nielsen, E. L., Treece, P. D., Shannon, S. E., Curtis, J. R., & Engelberg, R. A. (2016). Using nurse ratings of physician communication in the ICU to identify potential targets for interventions to improve end-of-life care. Journal of palliative medicine, 19(3), 292-299.

Scholz, A. F. M., Oldroyd, C., McCarthy, K., Quinn, T. J., & Hewitt, J. (2016). Systematic review and meta?analysis of risk factors for postoperative delirium among older patients undergoing gastrointestinal surgery. British Journal of Surgery, 103(2).

Shoair, O. A., Grasso II, M. P., Lahaye, L. A., Daniel, R., Biddle, C. J., & Slattum, P. W. (2015). Incidence and risk factors for postoperative cognitive dysfunction in older adults undergoing major noncardiac surgery: a prospective study. Journal of anaesthesiology, clinical pharmacology, 31(1), 30.

Sinuff, T., Dodek, P., You, J. J., Barwich, D., Tayler, C., Downar, J., ... & Heyland, D. K. (2015). Improving end-of-life communication and decision making: the development of a conceptual framework and quality indicators. Journal of pain and symptom management, 49(6), 1070-1080.

Song, M. K., Ward, S. E., Fine, J. P., Hanson, L. C., Lin, F. C., Hladik, G. A., ... & Bridgman, J. C. (2015). Advance care planning and end-of-life decision making in dialysis: a randomized controlled trial targeting patients and their surrogates. American Journal of Kidney Diseases, 66(5), 813-822.

Søreide, K., & Desserud, K. F. (2015). Emergency surgery in the elderly: the balance between function, frailty, fatality and futility. Scandinavian journal of trauma, resuscitation and emergency medicine, 23(1), 10.

Stewart, B., Khanduri, P., McCord, C., Ohene?Yeboah, M., Uranues, S., Vega Rivera, F., & Mock, C. (2014). Global disease burden of conditions requiring emergency surgery. British Journal of Surgery, 101(1).

Suskind, A. M., Walter, L. C., Jin, C., Boscardin, J., Sen, S., Cooperberg, M. R., & Finlayson, E. (2016). Impact of frailty on complications in patients undergoing common urological procedures: a study from the American College of Surgeons National Surgical Quality Improvement database. BJU international, 117(5), 836-842.

Tan, H. J., Saliba, D., Kwan, L., Moore, A. A., & Litwin, M. S. (2016). Burden of geriatric events among older adults undergoing major cancer surgery. Journal of Clinical Oncology, 34(11), 1231.

Torrance, A. D., Powell, S. L., & Griffiths, E. A. (2015). Emergency surgery in the elderly: challenges and solutions. Open access emergency medicine: OAEM, 7, 55.

Velmahos, G., Soderstrom, C. A., Rhee, P., Timberlake, G. A., Utter, G., & Rangel, E. L. (2015). Mortality after emergency surgery continues to rise after discharge in the elderly: Predictors of 1-year mortality DISCUSSION.

Wilson, T. (2017). Improving healthcare provider communication in end of life decision making. Journal of Intensive and Critical Care, 3(3).

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