Parkinson’s disease (PD) significantly influences mortality risk after surgery, primarily because it affects multiple body systems and complicates both the surgical process and recovery. Parkinson’s is a progressive neurodegenerative disorder characterized by motor symptoms such as tremors, rigidity, bradykinesia (slowness of movement), and postural instability, as well as non-motor symptoms including cognitive impairment, autonomic dysfunction, and swallowing difficulties. These factors collectively increase the vulnerability of patients undergoing surgery.
One major way Parkinson’s disease affects mortality risk after surgery is through its impact on respiratory function. Many patients with PD develop swallowing difficulties (dysphagia), which can lead to aspiration pneumonia—a leading cause of death in Parkinson’s patients. After surgery, especially under general anesthesia or with prolonged immobility, the risk of aspiration and respiratory infections rises sharply. This makes postoperative pneumonia a common and serious complication that increases mortality risk.
Additionally, Parkinson’s patients often have impaired autonomic nervous system function, which controls involuntary bodily functions such as blood pressure and heart rate. This dysfunction can cause unstable blood pressure and heart rate during and after surgery, increasing the risk of cardiovascular complications like stroke or myocardial infarction. These complications can be life-threatening and contribute to higher mortality rates.
The motor symptoms of Parkinson’s also complicate postoperative recovery. Rigidity and bradykinesia can limit mobility, increasing the risk of deep vein thrombosis (blood clots) and pulmonary embolism. Immobility also delays wound healing and rehabilitation, which can prolong hospital stays and increase exposure to hospital-acquired infections.
Cognitive impairment and psychiatric symptoms common in Parkinson’s, such as confusion, hallucinations, or depression, can worsen after surgery due to anesthesia, pain medications, or the stress of hospitalization. This delirium or worsening cognitive state can lead to poor cooperation with care, increased risk of falls, and difficulty managing postoperative care, all of which can indirectly increase mortality risk.
Surgical interventions specifically related to Parkinson’s, such as deep brain stimulation (DBS), carry their own mortality risks. DBS involves implanting electrodes in the brain to regulate abnormal activity and improve motor symptoms. However, mortality rates after DBS can be significant, especially when targeting certain brain regions like the subthalamic nucleus (STN). Postoperative complications, rather than the stimulation itself, are the primary causes of death in these cases. These complications can include infections, hemorrhage, or hardware-related issues. Mortality after DBS has been reported to be higher in patients with advanced disease stages.
When Parkinson’s patients undergo other types of surgery, such as orthopedic procedures like hip replacement, the risk of complications and mortality is also elevated. Neurological impairments increase the risk of dislocation and postoperative complications. Specialized surgical techniques, like dual mobility hip arthroplasty, have been developed to reduce these risks, but the overall vulnerability remains higher than in non-Parkinson’s patients.
The choice of anesthesia and surgical technique can influence outcomes. Some studies comparing awake versus asleep DBS surgeries found no significant difference in short-term complications, suggesting that tailoring the approach to the individual patient’s condition and preferences is important. However, the overall frailty and complexity of Parkinson’s patients mean that any surgery carries a heightened risk of adverse events.
In summary, Parkinson’s disease affects mortality risk after surgery through a combination of respiratory vulnerability, autonomic instability, motor impairment, cognitive challenges, and disease-specific surgical risks. These factors make careful preoperative assessment, meticulous perioperative management, and tailored postoperative care essential to minimize mortality and improve outcomes in Parkinson’s patients undergoing surgery.