Question
My 77 year old father has been advised by his GP to have a hip operation. My family are terrified of this because of his age and the possible anaesthetic risks. My father is healthy and is not on any medication except a painkiller for the arthritis. Can a hip operation be performed without a general anaesthetic? Also, my father is a heavy smoker all his life. Would he have to give up smoking before the surgery? I fear that this would be very difficult for him. He is in terrible pain.
Answer
Presumably the hip operation you refer to is a total hip replacement. This can be safely performed under epidural, spinal or general anaesthesia. Usually the anaesthetist decides which type of anaesthetic to use depending on the person’s general state of health. Notwithstanding the fact that your father is a smoker he might be fit for a general anaesthetic. However, irrespective of which type of anaesthetic is used smoking still constitutes a risk particularly with regard to the post-operative risk of DVT (deep venous thrombosis). It would be helpful if your father gave up smoking but I fully acknowledge that it can be very difficult to stop after a lifetime’s habit of smoking. Even if your father could reduce his level of smoking pre-operatively that would be beneficial. As you are aware there are many forms of nicotine substitutes available in gum, patch or inhaler form. These might be of help to your father. Any investment he could make in reducing or eliminating smoking would be worthwhile. Finally, I would not be unduly concerned about your father undergoing surgery at 77 years of age. Age alone should not be an excluding factor to deny him an operation that could transform his quality of life. In other words his age is not a contraindication to surgery.