Parkinson’s disease (PD) significantly influences mortality after surgery due to its complex effects on multiple body systems, particularly the nervous and respiratory systems. People with Parkinson’s face higher risks of complications that can increase the chance of death following surgical procedures.
Parkinson’s disease is a progressive neurological disorder that primarily impairs movement but also affects many non-motor functions. This includes problems with swallowing, breathing, cognition, and autonomic regulation. These impairments create vulnerabilities during and after surgery.
One major factor is **respiratory complications**. Many individuals with Parkinson’s develop difficulty swallowing (dysphagia), which worsens as the disease progresses. This can lead to aspiration, where food or saliva enters the lungs, causing pneumonia. Pneumonia is the leading cause of death in Parkinson’s patients, responsible for about 70% of deaths in this group. After surgery, the risk of aspiration pneumonia increases due to anesthesia effects, reduced mobility, and weakened cough reflexes. This makes respiratory infections a critical concern for postoperative survival.
Another important issue is **postoperative cognitive dysfunction (POCD)**, which is common in older adults and even more so in those with Parkinson’s. Surgery and anesthesia can worsen cognitive function temporarily or permanently, leading to delirium or dementia-like symptoms. Cognitive decline after surgery is linked to poorer recovery, longer hospital stays, and increased mortality. Since Parkinson’s patients already have a higher baseline risk of dementia and cognitive impairment, surgery can accelerate these problems, further increasing the risk of death.
Parkinson’s also causes **motor impairments** such as rigidity, tremor, and bradykinesia (slowness of movement). These symptoms can complicate postoperative care by limiting mobility, increasing the risk of falls, and delaying rehabilitation. Falls after surgery can cause serious injuries, which in turn raise mortality risk. Reduced mobility also contributes to blood clots and pneumonia, both of which can be fatal.
The autonomic nervous system dysfunction seen in Parkinson’s affects heart rate, blood pressure, and digestion. This can lead to unstable blood pressure during surgery and recovery, increasing the risk of cardiovascular complications such as heart attacks or strokes. These events can be life-threatening, especially in older patients or those with advanced Parkinson’s.
Surgical stress and anesthesia can also interfere with Parkinson’s medications. Interruptions or changes in medication timing can worsen motor symptoms and autonomic instability, complicating postoperative management. Poor control of Parkinson’s symptoms after surgery is associated with worse outcomes and higher mortality.
The severity and subtype of Parkinson’s disease influence postoperative mortality risk. Patients with more advanced disease, cognitive impairment, or diffuse malignant subtypes tend to have shorter survival times and higher complication rates. Younger patients with mild motor symptoms generally have better outcomes but still face elevated risks compared to non-Parkinson’s patients.
Interestingly, some studies suggest that factors like body weight may also impact surgical mortality in older adults, including those with Parkinson’s. For example, being moderately overweight might offer some protective benefit in the short term after surgery, possibly by providing metabolic reserves during recovery. However, this does not negate the overall increased risk Parkinson’s imposes.
In terms of surgical procedures specifically related to Parkinson’s, such as deep brain stimulation (DBS), recent data show that awake versus asleep DBS approaches have similar short-term complication and mortality rates. This indicates that with careful patient selection and perioperative care, some surgeries can be performed safely in Parkinson’s patients.
Overall, Parkinson’s disease affects mortality after surgery through a combination of increased risks of respiratory infections, cognitive decline, motor complications, autonomic instability, and medication management challenges. These factors interact to make postoperative recovery more difficult and increase the likelihood of fatal outcomes. Careful preoperative assessment, meticulous perioperative management, and tailored postoperative care are essential to improve survival chances in people with Parkinson’s undergoing surgery.