Is anyone too old for surgery now? Five facts

At 104, most people would assume major surgery was off the table. Yet Saudi national Taher Ali Alhashim, who had become bedridden because of severe knee problems, underwent replacement of both knees in a single day at the Dr L.H. Hiranandani Hospital in Powai, Mumbai.

Alhashim’s surgeon, Dr Sanjeev Jain, said strong bones and relatively good overall health made him a candidate despite age. He was able to walk again after the procedure.

The case raises a larger question: has medicine changed what doctors consider “too old” for surgery? Increasingly, chronological age alone is not the deciding factor. Doctors look instead at frailty, heart and lung health, cognition, bone quality, nutrition and how independently a patient was functioning before illness.

Five major changes in medicine have helped make major operations possible even at very advanced ages.

DOCTORS ASSESS BIOLOGICAL AGE, NOT JUST BIRTHDAY

Pre-operative assessment has become far more sophisticated. Rather than ruling out an 80-, 90- or even 100-year-old simply because of age, teams assess frailty, existing diseases, medications, mobility and the patient’s physiological reserve. In Alhashim’s case, his good bone strength and overall health were important factors in deciding that surgery was possible.

ANAESTHESIA HAS BECOME SAFER, MORE INDIVIDUALISED

Modern anaesthesia can be tailored closely to an older patient’s cardiovascular and respiratory condition. Regional techniques, nerve blocks and improved monitoring allow anaesthetists to control pain while reducing some of the physiological stress of an operation. Continuous monitoring also means small changes in blood pressure, oxygen levels or heart rhythm can be detected quickly.

SURGERY HAS BECOME MORE PRECISE

Better instruments, computer navigation and robotic-assisted techniques allow surgeons to plan bone cuts and implant positioning with far greater precision. A 2025 analysis of 21 randomised trials, involving 2,692 patients, found robotic-assisted knee replacement produced fewer alignment errors than conventional surgery, although it did not consistently result in better short-term functional outcomes. Greater precision may nevertheless be valuable in complicated cases and in patients where surgeons want to minimise unnecessary tissue disruption.

BLOOD LOSS, PAIN CAN BE CONTROLLED BETTER

Joint replacement once involved substantial blood loss, longer hospital stays and heavy reliance on pain medication. Modern blood-conservation techniques, improved surgical methods and multimodal pain relief have reduced some of that burden. Better pain control is particularly important in older adults because it allows them to start moving sooner. Prolonged bed rest can itself cause rapid loss of muscle strength, mobility and independence.

RECOVERY STARTS MUCH EARLIER

Perhaps the biggest change is what happens after surgery. Older patients are no longer routinely kept in bed for days. Physiotherapists aim to get suitable patients sitting, standing and walking as early as safely possible. Nutrition, clot prevention, breathing exercises and rehabilitation are now planned as part of the surgical journey rather than treated as an afterthought.

None of this means every centenarian—or even every 80-year-old—should undergo major surgery. The remarkable part of Alhashim’s case is not simply that surgeons were willing to operate. It is that modern medicine is increasingly asking a different question: not “How old is this patient?” but “How healthy and resilient is this particular patient?”

Subscribe to India Today Magazine