How well will a particular patient withstand the stresses of surgery? To make that determination, surgeons typically order cardiovascular tests. Is his heart pumping efficiently? Are her lungs providing enough oxygen? But Dr. Mark Katlic never found that sufficient for older patients.
They undergo lots of operations, because “almost all the conditions that require surgery increase with increasing age,” Dr. Katlic, a thoracic surgeon who has published several textbooks on geriatric surgery, told me. But surgery is also riskier for the elderly, he said: “Longer length of stay. More complications. Higher risk of death.”
For years, Dr. Katlic wanted a more specialized surgical approach for older people. Last fall, he persuaded executives at the nonprofit health organization LifeBridge in Baltimore to take that step. The Sinai Center for Geriatric Surgery, which he directs, is one of the first to focus on elderly surgical patients, and it is already collecting information on what improves their experiences in the operating room and afterward.
Here, every prospective patient over age 75 undergoes a pre-operative screening much more thorough than those normally used in hospitals. At the Sinai Center, for instance, nurse practitioners administer tests of frailty, including assessments of grip strength and walking speed, that have been shown to predict how older patients will withstand surgery. They test for cognitive decline, depression and hearing loss, and review all the medications that patients take — and since nearly all have several chronic illnesses, they typically take a lot of them. Separately, the center gives caregivers a questionnaire to determine how they will handle the stresses of caring for an older person after surgery.