As POA for my dad, I have a huge decision: Surgery or pain management?

I agree with previous posters. I am so sorry he is going through this and for you too for trying your best. I can't imagine his suffering and confusion.

Please consider hospice and allow him to go gentle into that good night.

Definitely hospice.

Remember that you are not making yourself an instrument in his loss by seeking comfort treatment. That’s just not the way it works.

My LO did very well on hospice for a year, and is now slipping away from me, but she is peaceful and cozy and beautifully cared for. And at this point, although I wish I could do more, this is the best I can do for her.

Be at peace that you have no “good” decisions to make on his behalf, investigate the hospice services he has access to, and make his safety but also his comfort be your guides.

I saw more complications for surgeries on the extremities for circulatory problems than on any other surgeries, and that is no matter the age. It isn't only that you are operating on vessels but it is after surgery, the need and the complications of thinning the blood for some time. Often a clot was the result
Aneurysms have often been with us from birth, may develop at any time, and are often not found for decades. Yes, they may rupture at any time. And they may NEVER rupture. One cannot know. When in his 90s and already admitting he was terribly tired of living and ready for rest, my Dad was diagnosed with a very large abdominal-aortic aneurysm. They let him know but they far from "recommended" surgery. Basically let him know when that puppy ruptured he might not even have time to say ouch. He had no surgery.
I would not for myself choose surgery. You cannot discuss with your father; as you said this falls to you. I would listen to the recommendations of the doctor and of the SURGEON himself; I am hoping they will make very clear to you the risks and complications. Because your father has dementia the hospitalization alone will be tricky and will be terrifying for him.
My answer would be no. It is always hard for people to make these decisions for another. My guess would be that you will have your Dad longer without surgery. Do know that AFib ads another huge complication here due to the irratic nature of the heartbeat and the tendency for clot complications heightened thereby. And the COPD, well, you can guess.
I will be very very surprised if a doctor encourages you toward surgery in this case. VERY surprised. In fact I would want to know if he just lost in Vegas or something and has bills to pay.
I wish you luck. Your Dad counted on you to make these decisions when he has no dementia. I hope you will have talked with him about end of life and quality of life care and know somewhat what HE would want. That's what you are guessing. And I will remind you again, our opinions are only that; this is entirely your decision. And whatever way it goes it is not your responsibility or your guilt to bear as you are doing the best you can with a tough decision. Best to you.

Chergal, Your question was close to home for me. I was POA for my dad who had COPD, AFib, and Dementia. He was the about same age as yours when I took him to the ER with confusion and blood in his urine. He had a UTI but during tests, they found a small spot that could be benign or cancer. A urologist came and sat on the edge of Dad's bed telling him they'd make an appointment in his office for a scope, then if surgery is required and the rest you know. Dad didn't even realize he was in a hospital so I checked that doctor and his bedside manner off my list. I discussed at length with Dad's Primary and we agreed that the testing would cause difficulties for Dad and I would not put him through surgery at that point. My dad lived another year and a half without new health issues, other than the expected UTI on ocassion and progression of Dementia. He died just before he was ready for memory care. I've never regretted the decision I made. Best to you and your dad.

End of life is a tough decision for the caretakers,
Wife and I were in the eighties, both had knees problems
I had hip replaced, found out wife had dementia, we moved into an assisted living place, wife did not like but we had to,
she always wanted to go home but where she grew up as a youngster, she remembered past times but not what she ate that morning, scheduled a knee operation before the move but she cancelled the day before,
On driving before we moved she missed a turn two times, she got home and refused to drive anymore, I mentioned that she should keep up the driving she said if needed she could do,
was in pain and some time she asked if it was ok to wish to die, once I told it was ok, she got more relaxed, after a few months she was under care of hospice care then after we assured that it was ok to wish to die, she stopped eating, hospice people were very caring, did a wonderful job, She passed away in the morning while our daughter was singing Do Not Be Afraid, and I was holding her hand, they said that the sense of hearing is the last thing we loose.
We were married 62 years, she was a good mother to our four children and a very good wife, I do mis her very much,
after I said it was ok to wish to die she got more peacefull, I hope to be able to see her soon.

Some very good insights in these posts. I just wanted to add that I work in cardiac OR and see both reasonable and unreasonable decisions about surgery made frequently. We have more medical modalities available to us all the time. Just because we CAN do something, does it mean that we always SHOULD? Often western medicine is inclined to have us medicate and repair without looking at the patient as a whole. It can become difficult for patients and family to navigate the decision process since there are often doctors wanting to move forward with treatment or surgery.
My 92 yo, demented father had cardiac valvular stenosis. The opportunity to perform a less invasive valve replacement was suggested. We chose not to do the procedure. He ended up declining, due to his dementia, fairly rapidly last year and passed away under hospice care. If he had received surgery, his limited time left would have been consumed by recovery in a rehab facility. Instead, he was able to be at home until the end.
Listen to that little voice in side your head. Mine hasn't lead me wrong.

I believe man’s medicine often gets in the way of God’s plan..

Recovering from a surgery like this may not happen.. and be in worse shape…

I worked years ago at a hospital as a physical therapy aide. We had to get this 90 year old, women up just to stand. She had a pacemaker placed the year before…it made an imprint on my heart , as she cried to just die…

i would get Hospice involved ,

Cherbal, have you ever read a book by Atul Gwande called "On Being Mortal"? When my mother was declining, it clarified for me what was important.

One thing I like to remember about caring for elders in that at some point, there are no "good" choices, only "least bad" ones.

My heart goes out to, needing to weigh these 2 not so great choices.

Chergal, as you know, this operation will not increase function or quality of life. This is strictly about quantity, with not a passing mention to what dads quality of life is now.

You take him out of the nh, that means taking him away from his surroundings and any staff or residents he has bonded to. Should he be in hospital for even a week and a half, he could forget all about them, reintroducing the usually negative period elders have in entering a nh in the first place. That is if the nah doesn’t just make his bed available for the next patient.

So, ok, he is living, but now comes an adjustment period that may be worse as his dementia has progressed. If he has any quality of life where he is, best to keep him where he is.

Dementia is kind of the deal breaker here. I went through similar a year ago. I really wouldn't consign anyone to dementia one second longer than they had to have it. It is a terminal disease and the end stage is as ugly as anything you've seen with any other disease. It is a disease without mercy. If I could do it over again, I'd spare my Mom that procedure and let nature take its course. Now, in retrospect, it was cruel to do that to her. It goes against every instinct you have to not "fix" something with a surgery or procedure but there's a lot to weigh and dementia is a big component in the overall picture.

Peace to you and whatever you decide.