Improving Surgical Outcomes

Interdisciplinary Approach Benefits Patients, Families

An innovative new program at MedStar Good Samaritan Hospital is improving outcomes for older individuals in need of surgery who have multiple medical problems. A partnership between the Center for Successful Aging and the Department of Surgery, this interdisciplinary effort is designed to proactively identify patients who may be at risk for poor outcomes after surgery because of these conditions and engage with them and their families to reduce their risk.

“Some believe that older individuals will not benefit from surgery or have too many risks for certain procedures,” says Jim Parshall, MD, a geriatrician in the Center for Successful Aging. “We follow a patient-centered approach that focuses on helping patients and their families understand the risks and benefits of surgery. The final decision regarding surgery is a shared one that is made by the patient and surgical team. If we decide to proceed with the procedure, we then take the time to fine-tune the patient’s medical conditions prior to scheduling it.”

The Center for Successful Aging has long been dedicated to addressing the unique needs of people experiencing complex medical and social age-related conditions, providing patient-centered care that is comprehensive and coordinated among doctors, nurses, therapists, and other caregivers—all in one location.

“Partnering with surgery is a natural extension of the services we offer,” says Dr. Parshall. “We work with patients and their families as a team to ensure they are as stable as possible prior to a procedure in order to minimize post-surgical complications.”

David Nasrallah, MD, a general surgeon at MedStar Good Samaritan, agrees. “Patients needing surgery tend to be older and many have a number of health issues. Involving the geriatric team in their care from the start helps prevent problems later. Often, post-op complications are not noticed by the care team unless they know the patient well.”

The program targets individuals with characteristics that may include:

• Sensory impairment, low vision, or hearing loss
• Functional challenges, such as a history of falls and the inability to perform activities of daily living
• Frailty, muscle wasting, nutritional deficits, and poor endurance
• Chronic co-morbid conditions, particularly those under poor control
• Dementia or other cognitive issues
• Taking multiple complex medications
• Over 65 years of age

“Individuals meeting these criteria are at higher risk for poor outcomes while in the hospital, which often prolongs the length of their stay,” adds Dr. Nasrallah. “That can exacerbate their problems.”

Yvonne Anderson, 71, is one of the patients who has benefitted from this new partnership. She was referred to the Center for Successful Aging by her primary care physician with multiple health issues, including dementia, a heart condition, diabetes, and bleeding problems.

According to her daughter and primary caregiver, Karen Brooks, she was also in pain.

“She was not able to articulate where the pain was, but it was clear she was very uncomfortable,” Brooks says. “In addition, she was constantly nauseated.” After a series of tests, she was diagnosed with gallbladder disease. Surgical removal was recommended as the best course of action.

That set in motion a comprehensive process to ensure Anderson was as prepared as she could be for surgery. This initially involved a team from the Center for Successful Aging that included Dr. Parshall as well as Dr. Nasrallah and numerous other specialists. A key member of the team was

Scottie Berk, PAC, a certified physician assistant, who serves as a navigator for patients and their families. She sees that they understand what is going on and receive the support they need before, during, and after surgery.

Anderson was evaluated physically and mentally, underwent a cardiac work-up and blood tests, and had her medications adjusted. Three weeks later, it was agreed that she was as medically stable as possible for the minimally invasive surgical procedure.

Though she did experience some complications after the surgery, her team had anticipated them and worked together to get her stable enough to go home.

“She had a great team of physicians, nurses, and other specialists coordinating her treatment around the clock,” Brooks says. “I was very pleased with the care she received. Her pain is now managed, and her appetite is good.” She notes that even after her mom returned home, members of the care team checked on her status regularly offering much-needed support.

“The population has aged dramatically during the past two decades and with that has come an increase in the number of older patients needing surgery. Unfortunately, many of these individuals have multiple health challenges,” Dr. Nasrallah says. “Being able to accurately assess those who may be at higher risk for poor outcomes after surgery and doing whatever is possible to minimize that risk is essential.”

For more information about the Center for Successful Aging call 410-248-8322.

This article appeared in the fall 2018 issue of Destination: Good Health. Read more articles from this issue.