LUCKY SEVERSON: Only two decades ago, open-heart surgery on a man as old as Harold Kron would have been quite extraordinary. Eighty-three years and an 80-year-old wife too nervous to be here for the operation. Harold Kron has lived a rich, full life.
What did the doctor say about the -- about the risks? Did he say there were many risks?Mr. HAROLD KRON (Heart Patient): Oh, yes. Of course. That's what they said. There's always risk. But the techniques have been improved in the last few years. And unless you're quite unlucky, you should do fine.
SEVERSON: According to a recent study by the American College of Cardiology, bypass surgery patients who are over 80 face an 8 percent chance of death and a 10 percent chance of stroke, more than twice the risk for younger patients. Harold's doctor is heart surgeon Dr. V. Paul Addonizio.
Dr. V. PAUL ADDONIZIO (Heart Surgeon): His risk for a major heart attack was substantial, far outweighing the risk of the coronary procedure.SEVERSON: One in 10 of Dr. Addonizio's patients is over 80. Bypass surgery on octogenarians nationwide grew by 67 percent from 1987 to 1990; an upward trend that has continued ever since.
Mr. DANIEL CALLAHAN (Medical Ethicist and Founder, Hastings Center): The problem isn't that these aren't good things. The problem is: How in the world are we supposed to finance it?
SEVERSON: Daniel Callahan is a medical ethicist and founder of The Hastings Center, a research institute. He sees the increase in major surgery on elderly patients as the great medical crisis of the future. The U.S. today spends 38 percent of its health care expenditures on people over 65.Dr. CALLAHAN: The question is -- what we're going to see in, say, 20, 30 years from now is the number of young people is going to decline proportionately and the number of older people increase and how into that we throw these very helpful, very valuable, very -- but very expensive operations. So -- it's -- I think it will be a kind of tragic dilemma.
Dr. ADDONIZIO: This device allows me to elevate a portion of the chest wall.
Dr. CALLAHAN: According to a prearranged schedule of charges, Medicare will pay approximately $30,000 for Harold Kron's surgery. If the surgery and recovery become complicated, the charge goes up, and there are complications.
Dr. ADDONIZIO: His heart muscle is less strong than normal. One of his valves is not working properly.SEVERSON: Originally, Dr. Addonizio planned on a triple bypass. Now he decides on a quadruple instead and there are other complications. Cardiologist William Level.
Dr. WILLIAM LEVEL (Cardiologist): Well, we are real concerned about his aorta, and that's one of the things we're going to look at now. This is the arch of the aorta; this is the area the surgeon we'll be working in and there is a fair amount of arteriosclerosis in that area.
Dr. CALLAHAN: The cost, of at least operations for the elderly, is a bit higher because they often can take longer to recuperate and sometimes pose some problems we might not find in younger patients.
SEVERSON: It's true that elderly patients take longer to recover, but doctors said the survival rate is almost as good as younger patients. Elmer Jenkins had open-heart surgery two years ago when he was 88. Now he serves as a crossing guard in the morning and a grocery bagger in the afternoon.
Mr. JENKINS: I'll be 90 in August.
SEVERSON: Dr. Addonizio says it is misguided in today's world of exercise and health foods to think that octogenarians are necessarily in worse condition than much younger patients.
SEVERSON: It is Harold Kron's good fortune that he has always been physically active. But he is 83 and this is quadruple bypass.
Ms. DOROTHY CARLSON (Heart Patient): Oh, yeah. Yeah. Quite a lot. He said, 'You know, you're almost 85 and it's a real big chance to take and, you know, you've had a good life.' And, you know, I gave that a lot of thought.
Dr. ROBERT BINSTOCK (Gerontologist): If we're going to say that people of a described demographic category, in this case, people over a certain age, are unworthy, say, of lifesaving operations, we have to consider what group would be next. It's raising a very scary set of ethical and moral issues for our society.
