From Bedridden to Walking again: Elderly Patients and the New Wave of Surgical Breakthroughs
By Arunima Rajan
Elderly patients are often seen as too frail for surgery, but minimally invasive and robotic surgeries are proving that even complex cases can be managed safely.
Imagine a 74-year-old man. He has survived a stroke, lives with chronic kidney disease, and underwent a major surgery to replace part of his aorta years ago. Now, he can barely walk a few steps without gasping for air. Over two weeks, he’s been hospitalised twice for heart failure. The odds don’t seem to be in his favour.
Traditional open-heart surgery is off the table—he’s too old, too frail, and his medical history is far too complicated. So, his doctors opt for Transcatheter Aortic Valve Replacement (TAVR), a much less invasive alternative. But even here, there’s a catch: his kidneys are too weak for the contrast dye typically used in the procedure.
Despite all of these barriers, the doctors move forward. They perform TAVR without the dye, protecting his kidneys while still addressing his heart condition. And in just a matter of weeks, he experiences a dramatic recovery. His heart failure improves, his kidney function stabilizes, and he goes from being bedridden to walking independently again.
This case is not just a medical win—it’s a snapshot of the quiet revolution happening in elder care. India’s healthcare system is evolving, making it possible for older patients to undergo advanced procedures that improve both their survival and their quality of life.
Role of Imaging and Technological Advancements
“Recent advancements in interventional cardiology have significantly enhanced the safety of complex heart procedures for super seniors. Improved imaging methods that provide clearer anatomical features, such as 3D cardiac mapping and enhanced echocardiography, are among the major breakthroughs. Recovery duration and complications are decreased by the advent of minimally invasive procedures like Transcatheter Aortic Valve Replacement (TAVR). Additionally, overall safety throughout the procedure has grown because of improved patient monitoring devices and improved anesthesia techniques. Lastly, an integrated approach to care that includes senior specialists, cardiologists, and surgeons guarantees thorough risk assessment and customized treatment regimens for senior patients,” says Ravinder Singh Rao, Interventional Structural Cardiologist and Chairman at RHL Center Jaipur and Consultant at Lilavati Hospital and Research Centre, Mumbai.
When evaluating elderly patients for interventional cardiology, doctors prioritize key factors like frailty, kidney function, and diabetes, which can heighten procedural risks. They also assess the patient's ability to recover and weigh personal treatment preferences against potential dangers like infection or bleeding. Life expectancy and mental health play a role in determining whether the benefits outweigh the risks, with support systems crucial to recovery.
Common Surgeries Among Elderly Patients
“If we look at the most common surgeries for people over 70 in India, cataract procedures are at the top of the list,” Akash Jaiswal, a geriatrician at Fortis hospital, Gurgaon explains. “They’re followed closely by orthopaedic surgeries, such as total hip and knee replacements, which are often needed due to the prevalence of arthritis in this age group. We also see a number of spinal surgeries, including laminectomy and spinal fusion, though these are less frequent.
Cardiac surgeries are another major category. Coronary artery bypass grafting (CABG), angioplasty, and valve replacements are regularly performed in patients over 70, with nearly half of CABG procedures done on those over 65. Benign prostatic hyperplasia, which affects many older men, often requires surgical intervention when medications are no longer effective. Gastrointestinal surgeries, such as cholecystectomy for gallbladder stones and hernia repairs, are also common. And as the risk of cancer increases with age, surgeries for cancers—particularly of the breast, gastrointestinal system, and prostate—are becoming more routine in this population.”
Advances in surgical techniques and technology have made surgeries safer for older adults. Minimally invasive procedures, like laparoscopic and robotic surgeries, use smaller incisions, reducing trauma, blood loss, and recovery time. Robotic systems enable more precise movements, particularly beneficial for older patients with lower resilience. Similarly, endoscopy in the digestive tract, respiratory system, and joints has minimized the need for large incisions.
Enhanced perioperative care has improved outcomes through better pain management, quicker mobilization, and fewer drains or tubes, resulting in shorter hospital stays and fewer complications. Additionally, improved anaesthesia techniques—such as regional or epidural anaesthesia—along with advanced intraoperative monitoring and imaging (MRI, CT, ultrasound) have increased surgical precision. Multidisciplinary teams, including geriatricians and rehabilitation specialists, ensure comprehensive care tailored to both surgical and age-related needs.
Source for infograph: https://india.unfpa.org/sites/default/files/pub-pdf/20230926_india_ageing_report_2023_web_version_.pdf
Why Multidisciplinary Teams are Key to Elderly Surgery Success?
The involvement of multidisciplinary teams—geriatricians, surgeons, anaesthesiologists, physical therapists, and nutritionists—has significantly improved surgical care for older adults. Elderly patients often face higher risks due to age-related changes and multiple comorbidities. To address this, geriatricians perform comprehensive geriatric assessments (CGA), evaluating cognitive function, nutrition, physical performance, and mental health to guide personalized surgical plans.
Prehabilitation, involving exercise, nutritional support, and mental health care before surgery, helps improve strength and recovery potential. These advancements in assessments, minimally invasive techniques, optimized anaesthesia, and tailored postoperative care have led to better outcomes, reduced risks, and enhanced recovery for elderly patients, ensuring safer surgeries and improved quality of life.
Spine Surgery and Minimally Invasive Techniques
Abhijit Pawar, a consultant specializing in Spine and Scoliosis Surgery at Kokilaben Dhirubhai Ambani Hospital, emphasizes that age plays a critical role in open-back surgeries. Older patients often have conditions like heart disease and diabetes, which increase the risks of complications, infections, or hospital readmissions within 30 days after surgery.
“We counsel families that mobility is key to maintaining quality of life for elderly patients. Untreated conditions can leave them dependent and immobile. For patients at risk from general anaesthesia due to medical conditions, endoscopic spine surgery offers an alternative under local anaesthesia. While age is a factor in most surgeries, it is less so with minimally invasive spine procedures. Techniques like laminotomy, which only partially removes the lamina, help preserve spinal stability and reduce future risks,” he explains.
Minimally invasive techniques are becoming increasingly popular for elderly patients.
“According to the peer-reviewed journal articles, science is on the side of minimally invasive spine surgery, touting it as a safe and effective alternative to open-back surgery for older adults. Many surgeons and medical practices are slowly migrating toward adopting this technique. The endoscopic and minimally invasive technique is a permanent solution for many patients that allow them to preserve mobility and return to their routines and favourite activities. This minimally-invasive procedure is performed through a small tubular device. The surgery is performed under local or general anaesthesia, allowing the patient to leave the hospital the same day. After the disc protrusion is confirmed, a guide wire is inserted to the affected disc under fluoroscope guidance. An obturator tube is passed over the guide wire to push apart the tissue down to the disc and to move the nerve root out of the way. The working sleeve, through which the surgery will be performed, is slid over the dilating tube. The guide wire and dilator are then removed. The surgeon uses instruments to remove degenerative and extruded portions of the disc nucleus. Because only enough of the disc is removed to reduce pressure inside the disc, the spine remains stable. The foramen and nerves are inspected to confirm successful decompression. The instruments and sleeve are removed. Because no muscles or bones are cut during the procedure, recovery is fast and scarring is minimized. The patient may need a day of bed rest after the procedure and physical therapy,” adds Pawar.
Accessibility Challenges
“Robotic spine surgery offers significant benefits over conventional surgery, including smaller incisions, greater precision, less pain, faster recovery, and reduced radiation exposure. With India's aging population, we foresee a shift towards minimally invasive, endoscopic, and robotic-guided surgeries. While we are technologically advanced with tools like 3D navigation and robotic systems, the high cost makes it challenging to make these innovations accessible to all,” concludes Pawar.
Behind every surgery lies a story not just of survival, but of renewed life. The real impact of medical progress isn’t in the precision of the procedure alone—it’s in the way it transforms lives. As India’s healthcare system adapts to the growing needs of an aging population, the focus should be on more than just extending years. It’s about restoring a sense of purpose, mobility, and independence to patients who might otherwise be written off as “too old.” The goal isn’t just to fix what’s broken, but to give super seniors the chance to live fully, on their own terms, in their final chapters.
One such story of transformation comes from *Mukesh Sharma, a 75-year-old who recently underwent spine surgery.
"I underwent spine surgery in February 2023, at the age of 75, and the difference it’s made in my life is remarkable. Post-surgery, I’ve found myself walking longer distances without feeling exhausted—a stark contrast to my previous limitations. Just recently, I climbed over 300 stairs while visiting temples in Uttarakhand, something I couldn’t have imagined before.
The care and support I received throughout the process was exceptional. The attentiveness and expertise of the medical team truly made this a transformative experience. For anyone in need of spine surgery, I can’t recommend the experience highly enough," says Sharma.