Older US adults mull costs, COVID, work when deciding on elective surgery

COVID-19
Influenza, General
Respiratory Syncytial Virus (RSV)
Older couple worried about money

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A survey study of older Americans who considered undergoing elective surgery in the previous 5 years reveals that concerns about out-of-pocket (OOP) costs, COVID-19 exposure, and taking time from work dissuaded some from going ahead with the procedure. A survey 

For the study, published yesterday in JAMA Network Open, a University of Michigan–led team surveyed a nationally representative sample of adults aged 50 to 80 years through the University of Michigan National Poll on Heathy Aging via the National Opinion Research Center AmeriSpeak panel in August 2021. Of 2,110 participants, 53% were women; average age was 63.7 years.

Greater share of older adults still working

A total of 32% of the 2,110 adults said they considered having elective surgery in the past 5 years, with 67% of them following through. The most commonly considered procedures were major joint surgery (eg, hip or knee replacement; 18%), eye surgery (eg, cataract surgery; 12%), abdominal surgery (eg, hernia repair, gall bladder removal, hysterectomy; 10%), cosmetic surgery (9%), and foot or leg surgery (7%).

Of the 676 participants who considered surgery, 64% indicated being very or somewhat concerned about pain or discomfort, and 57% worried about a difficult recovery. They were most commonly very concerned OOP costs (23%), exposure to COVID-19 at the hospital or surgery center (19%), and time needed off work (20%). Multivariable models showed that adults with those three concerns were less likely than others to undergo surgery

When I counsel patients in my clinic who are considering elective surgery, I now also spend a good deal of time discussing the financial and employment implications of surgery with them.

Nicholas Berlin, MD, MPH

The study authors noted that the proportion of employed US adults aged 60 and older doubled from 2000 to 2020.

"These findings highlight opportunities to support older adults who consider elective surgery so that these decisions can be based on clinical benefits, risks, and each patient’s goals and preferences," they wrote. "Future studies should seek to clarify the implications of surgery for employment status and job productivity, in addition to identifying workplace policies that facilitate or limit time off for recovery."

Caregiving concerns a factor for some

In a University of Michigan press release, lead author Nicholas Berlin, MD, MPH, a surgeon, said that he has integrated the results into his interactions with patients.

"When I counsel patients in my clinic who are considering elective surgery, I now also spend a good deal of time discussing the financial and employment implications of surgery with them," he said. "Unfortunately, I have seen a number of insured patients forego needed surgery because they are unable to afford the out-of-pocket costs or take time away from work for recovery."

Senior author Jeffrey Kullgren, MD, MPH, a primary care physician at the Veterans Affairs Ann Arbor Healthcare System and professor at the University of Michigan, called for more research into surgery's effects on caregiving, which some participants had cited as an influential factor in deciding whether to go ahead with a procedure.

"This includes both those who are concerned about surgery temporarily making them unable to care for someone else, and those concerned about having someone to care for them after their operation," he said.

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