First surgery center for seniors

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Carol Sorgen

Sinai Hospital’s Center for Geriatric Surgery repaired Gloria Levin’s hiatal hernia when other physicians were unwilling to operate on the 83-year-old. The surgery center, the first of its kind in the nation, offers intensive pre- and post-op care to help older adults have more successful operations.
Photo Courtesy of Sinai Hospital

After Gloria Levin had been hospitalized five times earlier this year with a severe hiatal hernia and complications, she was told she was not a candidate for surgery, and there was nothing more that could be done for her. They recommended that hospice care be arranged.

“They gave up on me,” said the 83-yearold Pikesville resident. “They told me to go home and die.”

Fortunately, Levin’s family physician had another idea. He referred her to Dr. Mark Katlic, surgeon-in-chief at Sinai Hospital and director of its groundbreaking Center for Geriatric Surgery. The surgical center is the nation’s first dedicated exclusively to providing specialized surgical pre- and postoperative care for patients age 75 and older.

“By rights, I should be dead,” said Levin. But after an extensive pre-op evaluation, Katlic, a thoracic surgeon, agreed to do the surgery Levin needed, and she’s doing just fine now.

“Every day between 8,000 and 10,000 baby boomers turn 65, and soon they will be the greatest force affecting healthcare in the United States,” said Katlic. “I am passionate about making sure that the quality and length of life for older patients are the best that they can be.”

Katlic, 62, added that he is also dedicated to educating other medical professionals about the unique challenges that geriatric surgery entails.

Levin doesn’t know exactly why the first hospital she visited wouldn’t perform the surgery she needed, but she suspects it was because of her age. That’s not uncommon, according to Katlic, but it’s a mindset he has set out to change in the 30 years that he has been championing the health rights of elderly patients.

Caring for centenarians

While receiving his surgical training at Massachusetts General Hospital, Katlic cared for several 100-year-old patients. He wrote a small paper, “Surgery in Centenarians,” that was published in 1985 in the Journal of the American Medical Association.

“That changed the course of my career,”

said Katlic.

His paper was publicized throughout the world and eventually caught the eye of a publisher who asked him to write the book — literally — on geriatric surgery. Principles and Practice of Geriatric Surgery was published in 1990; since then, four other textbooks and numerous peer-reviewed journal articles have followed.

Katlic joined the staff of Sinai two-and-a-half years ago, having served most recently as director of thoracic surgery at Geisinger Health System, Northeast, in Wilkes-Barre, Pa.

“The idea of a Center for Geriatric Surgery had been percolating in my mind for some time,” said Katlic, who attended medical school at the Johns Hopkins University School of Medicine. “Sinai was interested, and the time was right.”

Specialized pre-op care

While the conditions that often require surgery — cancer, atherosclerosis, degenerative joint disease, cataracts, prostate disease and gallstones — increase in incidence with increasing age, so do the risks of surgery, including complications, lengthier hospital stays and even death.

That doesn’t mean, however, that surgery can’t or shouldn’t be performed, said Katlic. But it does mean that older patients need to be more carefully evaluated and monitored so that they can benefit from surgery to improve the length and quality of their lives.

As part of the center’s clinical program, Katlic and his staff provide a tailored, individualized treatment plan for each patient. This starts with a comprehensive screening and assessment, which will determine a course of action based on the particular patient’s needs.

“There is growing recognition in the medical community that [the traditional] preoperative heart and lung testing in elderly surgical patients may not be sufficient, and that other ‘softer’ tests may be valuable in determining surgical risk,” said Katlic.

The center’s clinical coordinators and full-time nurse practitioner perform an evaluation that includes a routine physical examination and laboratory studies, plus additional testing to evaluate frailty, activities of daily living, delirium risk, cognition, nutritional status, fall risk and current medications.

They also do a specialized evaluation for the primary caregiver to see if he or she is up to the challenge of caring for their recuperating loved one.

According to Katlic, the results of this extensive evaluation are studied to determine what factors are most important in evaluating the risk of surgery to each patient.

“The guiding principle of the Center for Geriatric Surgery is ‘just-right care’ — not too little, not too much, not too limited and not too aggressive,” said Katlic.

Each patient works with a dedicated clinical coordinator to serve as his or her advocate during the inpatient postoperative stay, helping with daily medication review, family communication and discharge planning.

Hundreds of patients seen

Approximately 400 patients have been evaluated since the center opened a little more than a year ago. The oldest patient the center has seen so far was 104 years old, and she suffered from breathing problems.

If a patient’s pre-op evaluation raises red flags, his or her surgeon will be notified. That doesn’t necessarily mean the surgery won’t be performed, Katlic observed, but it gives the surgeon and the pre-op and post-op teams additional information that can help with decision-making and plan of care.

“Our end goal is to optimize treatment,” said Katlic. Furthermore, he added, treatment isn’t always about prolonging life, but often about offering a better quality of life.

In addition to providing comprehensive clinical care for the elderly surgical patient, the center has an academic arm as well. Katlic noted that there is tremendous interest in the topic of geriatric surgery, not just in this country but also worldwide. So he plans to share the knowledge gained at the center with other medical professionals through clinical studies, articles, lectures and symposia, and a fellowship program.

Word about the center is starting to get out: It has received coverage not only in the local media but in the New York Times as well.

Katlic was recently named a 2013 Innovator of the Year by the Daily Record for his pioneering work in caring for older adults. Because of Katlic’s initiatives, hospitals around the country are developing centers similar to Sinai’s. And, as with Gloria Levin, other hospitals are beginning to send their older surgical patients to Sinai.

“We’re geriatric-friendly,” said Katlic

with a smile.

As for Levin, the result of her experience at the Sinai Center for Geriatric Surgery speaks for itself. “I’m alive,” she said. “What else can I ask for?!”

For more information about the Sinai Center for Geriatric Surgery, call (410) 601-WELL (9355) or visit www.lifebridgehealth/geriatricsurgery.