Candidates for Open Heart Surgery or
Who Is Most Likely To Survive Open Heart Surgery
By Warren Selkow, Successful Patient
The Mad Rush to Open-Heart Surgery
In the headlong dash to get the patient into the operating theater a few very important items are overlooked. If you have just been told you or your loved one needs open-heart surgery and the doctors want to schedule the surgery immediately, if not sooner, do this:
STOP THEM!!!!! Do not sign any consent forms!!!!!
Not everyone that the doctors say need open-heart surgery should just have it. Understand this about the practice of medicine and the principles of insurance compensation: Surgeons are paid to do surgery and not on the outcome of that surgery. If the patient only lives for an agonizing week after the surgery, the surgeon still gets paid. The surgeons emphasis must be on doing the work. This is not always consistent with the patients’ emphasis of surviving and doing well.
Know this fact: Most cardiac patients having open-heart surgery die within two years of the surgery. The exact depressing statistics can be found on the American Heart Association web site. In fact, almost fifty percent of those patients do not survive to a third anniversary date. We will discuss why in another feature on this web site. And while I am thinking about it, you might want to read the companion feature "…The Bad News Is…"
The real issues are:
- Who should have open-heart surgery?
- Who should not have open-heart surgery?
The Successful Cardiac Open-Heart Surgery Candidate
The most successful long time survivors of open-heart surgery will generally fit into a profile that includes the following:
- Is under 70 years of age
- Is in fair to good physical condition
- Will make the lifestyle changes required to live for the long term
- Has a caregiver who takes the disease seriously
- Is less then thirty pounds overweight
- Does not smoke
The above list might appear to be arbitrary and indeed it is but only insofar as nobody has really set out some basic requirements for success. The surgeons only look for the chances the patient will get off the operating table. Even then they will operate on someone not really likely to survive if the patient wants the surgery and on the chance that patient will survive to get out of the hospital and the patient is insured or can cover the expense of the surgery. Outcome statistics are kept right to the front door. If the patient gets out the door the surgery was successful. Read the fine print on the consent forms. The consent forms say nobody is responsible for anything and the surgery is at the patients’ own risk. The forms also say you will pay the bill no matter what the outcome. Encouraging, isn’t it.
The Unsuccessful Candidate for Open-heart Surgery
We all want to live for as long as we can. That being said, there are many folks that should not have open-heart surgery and for damn good reason. Unfortunately, nobody has the bad taste, temerity or honest candor to broach the subject. I will. Doctors and surgeons are not paid for this. I am not paid at all.
Just like the successful candidate for open-heart surgery, the unsuccessful candidates share a general profile. You should not have open-heart surgery if:
- You are over seventy years old and
- You are in generally poor health and/or
- You have multiple chronic diseases like diabetes, COPD etc.
- You will not make all the lifestyle changes required
- You are more than fifty pounds overweight
- You smoke
- You do not have a good support network
- You do not have a full time dedicated caregiver
After reading this feature you may think the author is an unfeeling, uncaring jerk. Quite the contrary is true. I have been witness to many people who have undergone the pain, depression and anxiety of the procedure. Especially older people who had the surgery because they wanted to live and their family badgered them into having it. They were all dead within the first year. Worse, that last time was a horror in pain and grief for all concerned. Friends, believe this: Sometimes it is easier not to go through it all.
For everything you need to know about how to make a decision and what you can expect from open-heart surgery read, The Simplified Handbook for Living With Heart Disease and Other Chronic Diseases.