Older people are still facing age discrimination when doctors decide whether or not to give them life-saving surgery, a new report suggests.
Patients in England face a postcode lottery when it comes to accessing both life saving and life-altering procedures across England, according to the report by the Royal College of Surgeons (RCS) and charity Age UK.
The RCS said it was "crucial" for doctors to decide whether or not to provide surgery based on a patient's needs and not their age.
The review found that there is "significant" regional variation in access to care.
Breast cancer patients aged 65 and over faced the widest regional disparities on whether or not they receive surgery - experts noted a 37-fold difference in the rates of people getting surgery in the best performing areas compared to the worst.
"There is widespread variation in the rates of surgery for the over-65s depending on the area in which people live," the report states.
"These variations are particularly acute for breast excision , hip replacements and knee replacements.
"Patients over the age of 75 living with breast and colorectal cancer, osteoarthritis of the knee and gallstones are less likely to receive surgical treatment for their condition than their over-65 counterparts."
The authors of the report analysed surgery rates across England's 211 local health authorities, or clinical commissioning groups (CCGs), for six common procedures between 2011/12.
"This report raises important questions about how we treat older people on the NHS and whether they have access to the type of surgery they need," said RCS president Professor Norman Williams.
"Every patient must be treated as an individual and, when a decision is made about their treatment, they must be judged according to their physiological age - how healthy they are - rather than their chronological age.
"Many older patients with common health problems such as a very painful hip need costly drugs to alleviate the pain and social care to help them live. Clinical Commissioning Groups could actually save money by commissioning operations which would help a patient to regain their independence and mobility.
"This is why it is crucial that surgeons and GPs refer people for an operation on the basis of their clinical need and not their age."
Caroline Abrahams, charity director at Age UK, added: "Out-dated assumptions about fitness based on age alone have no place in decisions around surgery.
"For local areas to achieve the best possible outcomes they must assess older people's overall state of health, support them to manage any complications resulting from living with a long-term condition and take steps so that they are in the best possible health at the time they undergo surgery.
"We must consign age discrimination to the past."
Martin McShane, national clinical director for long-term conditions, said: "NHS England is committed to ensuring older patients have equal access to treatment which should always be based on what is right for each individual patient, on their informed preferences - not their age.
"As the report highlights, the reasons for variation are complex but can include clinical decisions made by doctors, patients' own preferences, and referral practices in an area."