These 10 surgeries are considered “uniquely high risk” for older adults

A study named 227 risky surgeries for older adults. But these 10 procedures can be especially problematic.

Knowing if a surgery is high-risk can help you make an informed decision about the procedure.

That’s why a team of researchers generated a list of 277 risky procedures for older adults, which they hope is useful in preparing for the potential of unwanted outcomes.

The study was published in JAMA Surgery. The list was generated by using admissions data of patients 65 years and older. The scientists found 10 surgeries to be especially problematic for older patients. We discuss these procedures below.

Note: The following article is for informational and educational purposes only and isn’t a substitute for medical advice. It is important to discuss all medical procedures with your doctor.

1. Adrenal gland removal

Adrenal gland removal — or adrenalectomy — is the removal of one or both of the adrenal glands. Though these glands produce hormones that are necessary in carrying out daily bodily functions, sometimes a tumor forms on the glands and causes increased hormone production. When this occurs, the gland(s) needs to be removed.

According to the Cleveland Clinic, the usual recovery time after this surgery is two to six weeks, and the risks can include blood clots, infections and high blood pressure.

2. Removal of plaque buildup from the carotid arteries

Carotid endarterectomy is a procedure that removes plaque buildup from inside a carotid artery in your neck. This surgery is done to restore blood flow to the brain when individuals have symptoms of reduced blood flow. Carotid endarterectomy is typically preventative of a stroke and removes blockages that might trigger one.

According to the National Heart, Lung, and Blood Institute, the risks of this surgery include clotting, stroke or death. However, taking anti-clotting medicines before and after a carotid endarterectomy can reduce these risks.

3. Arm blood-vessel replacement

Also known as peripheral vascular bypass surgery, blood vessel replacement in the arm improves blood flow when one or more of the arteries become narrowed or blocked. In this surgery, a blood vessel from another part of your body or a synthetic blood vessel is used to replace the damaged blood vessel.

According to the Summit Medical Group, the risks of this procedure can include irregular heartbeat, infection, and death.

4. Abdominal vein resection or replacement

When a blood vessel causes tissue injury in the abdomen, part of the tissue might need to be removed or replaced. According to John Hopkins Medicine, complications can include pulmonary embolism, infection and excess bleeding.

5. Varicose vein removal

Varicose veins form in the legs when the valves in the veins aren’t functioning correctly. If you’re experiencing pain, blood clots, or bleeding your doctor might recommend varicose vein removal. This is a surgical procedure with risks that include nerve injury, heavy bleeding and infection.

6. High gastric bypass

Gastric bypass is weight loss surgery that changes how the stomach and small intestine handles the food you eat. There are multiple criteria that must be met to receive this procedure and it can pose major risks and complications. These include malnutrition, perforation of stomach or intestines, and dumping syndrome (aka when food gets “dumped” directly from the stomach pouch into the small intestine without being digested).

7. Proctopexy

When people have trouble with stool leakage, inability to control their bowel movements (fecal incontinence), or obstructed bowel movements they might need a proctopexy. Proctopexy is also known as rectal prolapse surgery: essentially, it helps put the rectum back in place.

According to Mayo Clinic, risks can include damage to nearby nerves and organs, narrowing (stricture) of the anal opening, and development of new or worsened constipation.

8. Bile duct excision

If a tumor is blocking the flow of bile to your bile ducts, you might have surgery to get it removed. Nausea, jaundice, or a temperature  of 101° F (38.3° C) or higher are potential risks of this procedure.

9. A urinary reconstruction technique

Sometimes an individual’s urinary bladder is removed due to cancer, a non-working bladder, or another medical reason. According to the Cleveland Clinic, urinary reconstruction creates a new way for urine to exit the body when a bladder is not present.

A risk of this procedure is urine backing up into the kidneys, causing infections, stone formation, or organ damage over time.

10. Ureter repair

When the ureter is injured (ie. scar tissue forms after an accident or surgery), additional surgery might need to be done to repair it. Chest pain, blood clots, and trouble urinating can be complications that follow this procedure.

See the complete list of all 227 surgeries here (PDF).

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Planning on having surgery? You should see the dentist first

Anthony Kouri, an orthopedic surgeon at the University of Toledo Medical Center in Ohio, says that dental exams should be considered before any surgeries, but are especially important for certain heart surgeries, and surgeries like joint replacements that use implanted devices.

“With both joint replacement and cardiovascular valve replacement surgery, the risk of the bacteria from the mouth traveling systemically to the surgical site is incredibly high,” says Rhonda Kalasho, a dentist who practices in Los Angeles.

She says that in examinations of 36 people with joint replacement failure, DNA evidence pointed to bacteria that traveled from the mouth to the joint 14% of the time.

Kouri explains that during a dental procedure the gum tissue can be broken, and that allows bacteria from the mouth to enter the bloodstream.

“Those bacteria can go to any foreign material in the body and attach themselves to it. They often develop a biofilm, making them very difficult to treat with antibiotics alone, and requiring surgical removal for complete eradication,” he says.

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