Sinai Hospital of Baltimore, a LifeBridge Health center, is proud to announce the opening of the Sinai Center for Geriatric Surgery, the nation's first surgical center dedicated exclusively to providing specialized surgical and pre and postoperative care for elderly patients.
The center is led by Mark R. Katlic, M.D., who is also chief of Surgery at Sinai Hospital and author of several books and numerous peer-reviewed journal articles on geriatric surgery. With America's aging population as a backdrop, the Sinai Center for Geriatric Surgery's mission is to provide a new level of specialized care for elderly surgical patients and to improve the care of older patients across the country and around the world through research and education.
"The aging population is experiencing explosive growth and will soon be the greatest force affecting health care in the United States," said Katlic. "In addition, the conditions that often require surgery - cancer, atherosclerosis, degenerative joint disease, cataracts, prostate disease and gallstones - increase in incidence with increasing age. Older patients will benefit from surgery to improve the length and quality of their lives. We developed the Center for Geriatric Surgery to meet their specialized needs and to help surgeons and other medical professionals improve treatment methodologies in older patients."
Katlic has had a special interest in caring for older patients for more than three decades. His paper, "Surgery in Centenarians," was published in the Journal of the American Medical Association in 1985, and his first textbook, "Geriatric Surgery," was published in 1990. Katlic has published four additional textbooks on surgery in the elderly.
Clinical Program Offers Unparalleled Resources
As part of the center's clinical program, Katlic and his staff will provide a tailored, individualized treatment plan for each patient, consisting of a comprehensive screening and assessment prior to surgery, which will determine a course of action based on individual patient needs.
There is growing recognition in the medical community that 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. The Sinai Center for Geriatric Surgery's clinical coordinators and a full-time nurse practitioner will perform comprehensive preoperative evaluations of elderly surgical patients in the Sinai Hospital Pre-Anesthesia Screening Service clinic. These evaluations include routine physical examinations and laboratory studies plus additional testing to evaluate:
- frailty
- cognition
- activities of daily living
- nutrition
- delirium risk
- fall risk
- current medications
- specialized evaluation for primary caregiver
The results of this "leave no stone unturned" comprehensive evaluation will also be studied to determine what factors are most important in evaluating the risk of surgery to each individual patient.
The guiding principle of the Sinai Center for Geriatric Surgery is "just-right care" - not too little, not too much, not too limited and not too aggressive. Each patient will work with a dedicated clinical coordinator to serve as his or her advocate during the patient's in-patient postoperative stay, helping with daily medication review, family communication and discharge planning.
Academic Program Enhances Knowledge Base
As the center's clinical program aims to provide optimal, comprehensive care of the elderly surgical patient, the academic program will study what works well and then share that knowledge with other medical professionals on a regional, national and worldwide basis.
A primary focus of the academic program will be research efforts based on a database where all elements of the elderly patient's comprehensive preoperative evaluation will be entered and retrospectively analyzed to help determine which are the greatest surgical risk factors.
Katlic and his team will then develop prospective trials of interventions hypothesized to lessen surgical risk in older patients. Findings will be published in peer-reviewed journals and in case studies to grow the body of knowledge related to geriatric surgery. In addition, the center will offer regular symposiums and lectures for health care professionals on the medical and surgical needs of older patients. A formalized fellowship program is also in the works.
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