Perspectives of Older Adults Undergoing Elective Major Surgery

Objective: Understand challenges faced by older adults who undergo elective major surgery. Background: Preparation for and recovery from elective major surgery is often described from clinician perspectives, limiting insights into older patients’ experiences. Methods: We conducted a qualitative study with adults age 65+ years, 30-90 days post colectomy, using interviews and surveys at a Northeastern U.S. tertiary surgical clinic. Guided by a modified Framework method, we arranged data into domains, themes and subthemes. We categorized patient-identified challenges using the Geriatric 5 Ms framework as deductive themes. Then, we identified additional themes and subthemes inductively. Results: From November 2022 to August 2023, twenty patients completed the study. Themes of personal patient challenges included: the mind (i.e., coping with uncertainty, anxiety/frustration, and underappreciated cognitive challenges), mobility (i.e., physical limitations and challenges completing activities of daily living), medications (i.e., understanding medication frequency and side effects), multi-complexity (i.e., surgical recovery in the context of multi-morbidity), and what matters most (i.e., matters related to self, care-partners, and recovery expectations). Themes of process characteristics included challenges discussing the decision for surgery, understanding expectations for surgical recovery, and obtaining anticipatory guidance. Patients with fecal ostomy described heightened emotional challenges and social support needs. Conclusions: Modifiable challenges older adult patients perceive after elective major surgery often stemmed from perioperative anxiety, uncertainty, inadequate communication and insufficient social support. These findings can guide clinicians in optimizing surgical care and inform future research developing interventions aimed at addressing emotional stressors and enhancing communication between patients and surgical teams.