Poor physical function, dementia and depression all raise seniors’ risk of death after a major operation and should be considered when helping patients make surgical decisions, researchers say.

Investigators analyzed health data from 1,300 seniors who had undergone a major surgical procedure (abdominal aortic aneurysm repair, coronary artery bypass graft or colectomy). Before the surgery, most patients were independent and did not need help with activities of daily living or instrumental activities of daily living. In addition, 6% had dementia, 23% had mild cognitive impairment, and 25% had depression.

Overall, 17% of patients died within the year after surgery. Rates of death were 29% among seniors who needed support for at least two activities of daily living, compared to 13% among those who were independent.

Mortality risk rose as the number of risk factors increased: 10% for no factors, 16% for one factor and nearly 28% for two factors, according to the study, published March 11 in JAMA Surgery.

More older adults are undergoing major surgery despite the greater risk of postoperative mortality, wrote Kenneth E. Covinsky, M.D., University of California, San Francisco, and colleagues. 

“Measures in function, cognition, and psychological well-being need to be incorporated into the preoperative assessment to enhance surgical decision-making and patient counseling,” they concluded.