Before an Operation

Before surgery, the surgeon explains the operation and its possible complications. The person is then asked to sign an informed consent agreement. If the person is mentally incapacitated and cannot understand the benefits and risks of the proposed operation, any advance directives (for example, a living will or durable power of attorney for health care agreement) are reviewed. If there is no advance directive or if available advance directives do not address the person's wishes regarding surgery, the surgeon must involve an appropriate alternative person (a surrogate) in the decision making.

The doctor obtains a thorough medical history before surgery. During this process, other disorders and past problems are reviewed. A careful accounting of drug use, including prescription and nonprescription drugs, and use of nutritional supplements and vitamins are part of the history as well. The doctor also performs a physical examination to determine whether the person is physically ready to undergo surgery.

Laboratory tests and imaging tests such as x-rays are sometimes necessary. More specialized tests, such as a measurement of breathing (for example, pulmonary function testing) or heart function (for example, an echocardiogram), may be needed if the person has known diseases that might affect lung or heart function.

Assessment of surgical risk may involve consultation with other health care practitioners. Sometimes these consultations are coordinated by doctors who specialize in addressing the health needs of older people (geriatricians). Surgery may be postponed until any potential problems revealed in the assessment are addressed.

Assessment before surgery can help identify needs that an older person might have after surgery. Often a social worker or discharge coordinator helps with this assessment. These needs also exist among people who are undergoing operations that do not involve a hospital stay (ambulatory, or same-day, surgery). Plans for aftercare must be made before the operation. For example, if a person is expected to have difficulty walking after surgery, planning may involve arranging for someone to assist the person, making an appointment with a physical therapist, and obtaining an assistive device, such as a cane or walker.