Prineiples and Praetiee of Geriatrie Surgery

Springer Science+Business Media, LLC

Ronnie A. RosenthaI, MD Associate Professor, Department of Surgery, Yale University School of Medicine, New

Haven, and Chief, Surgical Service, VA Connecticut Healthcare System, West Haven,

Connecticut

Michael E. Zenilman, MD Associate Professor and Vice-Chairman, Department of Surgery, Montefiore Medical

Center, Albert Einstein College of Medicine, Bronx, New York, and Chief of Surgery,

Jack D. Weiler Hospital of the Albert Einstein College of Medicine, Bronx, New York

Mark R. Katlic, M.D. Wyoming Valley Surgical Associates, Kingston, Pennsylvania, and Chief of Thoracic

Surgery, Wyoming Valley Healthcare System, Wilkes-Barre, Pennsylvania

Editors

Prineiples and Praetiee of Geriatrie Surgery

With 393 Figures

Springer

Ronnie A. Rosenthai, MD l\ssociate Professor Department of Surgery Yale University School

of Medicine New Haven, CT 06520 and Chief, Surgical Service Department of Veterans l\ffairs Vl\ Connecticut Healthcare

System West Haven, CT 06516, USl\

Michael E. Zenilman, MD l\ssociate Professor and

Vice-Chairman Department of Surgery Montefiore Medical Center l\lbert Einstein College of

Medicine Bronx, NY 10461, USl\ and Chief of Surgery Jack D. Weiler Hospital of the

l\lbert Einstein College of Medicine

Bronx, NY 10461, USl\

Mark R. Katlic, MD Wyoming Valley Surgical

l\ssociates Kingston, Pl\ 18704, USl\ and Chief of Thoracic Surgery Wyoming Valley Healthcare

System Wilkes-Barre, Pl\ 18702, USl\

Chapter opening art: From Gruman GJ (ed) Roots of Modem Gerontology and Geriatrics. New York: l\yer Company Publishers, 1979, with permission.

Library of Congress Cataloging-in-Publication Data Principles and practice of geriatrie surgery / editors, Ronnie A. Rosenthal, Michael E. Zenilman, Mark R. Katlic

p. cm. Includes bibliographical references and index.

1. Aged-Surgery. 2. Surgery, Operative. I. Rosenthal, Ronnie A. H. Zenilman, Michael E. III. Katlic, Mark R., 1951-

[DNLM: 1. Surgical Procedures, Operative-Aged. WO 950 P957 20001 RD145 .P75 2000 617.9'7-dc21

Printed on acid-free paper.

ISBN 978-1-4757-3434-8 ISBN 978-1-4757-3432-4 (eBook) DOI 10.1007/978-1-4757-3432-4

© 2001 Springer Science+Business Media New York Originally published by Springer-Verlag New York, Inc in 2001. Softcover reprint of the hardcover 1 st edition 2001

99-055303

All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher Springer Science+Business Media, LLC except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar meth­odology now known of hereafter developed is forbidden. The use of general descriptive names, trade names, trademarks, etc., in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied with respect to the material contained herein.

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9 8 7 6 5 4 3 2 1

To Doris (Nana) and David (Poppa) Rosenthai Karen (Rosenthal) Worchel

Lauren Andersen, Cori (Worchel) Novellion, Dana Worchel and Ashley Andersen.

Three generations that epitomize the most important consideration in the care of our elders-quality of

life. RAR

To Blanche [doll, my late mother-in-Iaw, who personified the need tor focused,

specialized surgical care of the geriatrie patient. MEZ

To my parents, Nancy and John Katlic, whose support of my grandparents-Frederick and Eva

Nicely and Dorothy Deringer-is a model of compassionate care.

MRK

Preface

More than two decades ago, in response to the special healthcare needs of the aging Ameriean population, interest in the field of geriatrie medieine began to grow and blossom in the United States. In 1984 and 1985, under the editorialleadership of Christine K. Cassel and William R. Hazzard, respectively, two major textbooks devoted to the medieal care of aged patients were published. These scholarly, comprehensive texts provided insight into the principles of aging and guidance in the care of the geriatrie patient. Three editions later, the need to understand the special issues involved in the medieal care of the elderly is widely accepted by intemists, primary care providers, and medieal specialists.

For the editors of this book, the special issues involved in the surgieal care of the elderly have been apparent for nearly as long. Although there have been a few scholarly texts on the subject, including one in 1990 by Mark R. Katlic, general acceptance of the concept of geriatrie surgery by our surgieal and medieal colleagues has, however, lagged. This is not the result of a proportionately smaller number of older patients with surgieal disease, because cancer, cardiovascular disease, and orthopedie problems are diseases, of the aged. It is rather the result of uncertainty about the value of surgery in the elderly and concems about the risks of operations. In the past, such concems prevented primary care givers from referring patients for surgieal care and prevented surgeons from agreeing to operate. With the improvements in technology, monitoring, and anesthesia, we are now able to safely operate on most older patients, based on indieations that are determined by the disease and the patient's overall health rather than by age. Since 1980, the percentage of operations performed in whieh the patient was over age 65 has nearly doubled to almost 40%. It is now estimated that approximately half of the patients in most general surgery practiees, and even higher percentages in most cardiac and vascular surgery practices, are 65 years of age or older.

This recent rapid increase in the elderly surgieal population has increased the aware­ness that older surgieal patients are different from younger surgieal patients and therefore require special consideration. In 1995, shortly before this text was conceived, the Ameriean College of Surgeons, with input from three well-respected senior surgeons, George E. Block, Ben Eiseman, and Gerald O. Strauch, added a panel on Surgery in the Elderly to that year's program at the Annual Clinieal Congress. Similar programs have since been presented at each of the last three Clinieal Congresses. Also in 1995, the Ameriean Geriatries Society in association with the Hartford Foundation began a program to increase geriatrie expertise in nonprimary care specialties, including general surgery, orthopedies, urology, and gynecology. As part of this program, Drs. Walter Pories and Sherralyn Cox developed a geriatrie syllabus that has now been added to the Surgieal Resident Currieulum of the Association of Program Directors in Surgery. The field of "Geriatrie Surgery" has begun to emerge.

Our goal in developing the present book was not to form the basis for a new surgieal specialty because most surgeons, with the exception of our pediatrie colleagues, will need

vii

viii Preface

to be "geriatrie surgeons" soon. It was rather to provide a comprehensive collection of information that would allow all providers of healthcare to the elderly to understand the issues involved in choosing surgery as a treatment option for their patients. We have, by now, shown that we can operate on the elderly, the question is often whether we should. To help answer this question, we have divided the book into two parts. Part I, General Principles, describes general aspects of the physiology of aging and gives an overview of surgieal management and important ethical considerations. Part II, Specifie Issues, is organized by organ system. The first chapter in each section details the physiologie changes of that organ system with age. The subsequent chapters describe the patho­physiology, surgical treatment, and outcome of treatment for the disease of that organ system that are commonly encountered in elderly patients. With this information in hand, geriatrieians, internists, and other primary care providers can better decide whieh of their patients will benefit from surgieal referral; surgeons, surgieal residents, and students can better understand how aging changes the assessment of risks, the choiee of operation, the perioperative management, and treatment outcome.

Each section is also preceded by an invited commentary from well-known and widely respected senior members of each discipline. We have asked them to reflect on the changes they have seen in their area of expertise over the course of their careers and to comment on how they feel these changes have influenced the care of the elderly. We are extremely grateful to them for graciously agreeing to share their thoughts.

The road from concept to reality of this book has been long and somewhat bumpy, but throughout, there has been a genuine commitment to the importance of such a book by all involved. We are most grateful to our editor at Springer-Verlag, Laura Gillan, and her assistants for maintaining the high level of enthusiasm for the topie and commitment to the quality of the work. It has been a great pleasure to work with, and learn from, someone who understands so well why we embarked on this kind of journey and who so clearly shares our goal. Without her help, it would not have happened. We also thank Barbara Chernow and her associates for the very skillful copyediting done under considerable pressure. Finally' we are extremely grateful to all of our authors, who have given so generously of their valuable time and effort to produce outstanding chapters in an era when rewards for such efforts are primarily internal. It is our belief that the information they have so carefully provided will bring significant improvements to the overall health­care of our elderly patients.

Contents

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv

Part I General Principles Section 1 Physiology of Aging

Invited Commentary Leonard Hayflick

3

1. Cell and Molecular Aging ................................ 8 Bruce Robert Troen and Vincent Joseph Cristofalo

2. Demography of Aging; Comparative, Differential, and Successful Aging; Geriatrie Assessment .................... 24 John R. Wilmoth and Paoia S. Timiras

3. Cancer, Carcinogenesis, and Aging ........................ 38 Lodovico Balducci and Martine Extermann

4. Effects of Aging on Immune Function . . . . . . . . . . . . . . . . . . . . . . 46 Edith A. Burns and James S. Goodwin

5. Nutrition, Metabolism, and Wound Healing in the Elderly 65 Danny G. Jacobs and Tirso Mark Lara

Section 2 Surgical Management of the Elderly Patient

Invited Commentary Ben Eiseman

89

6. Principles of Geriatrie Surgery ............................ 92 Mark R. Katlic

7. Aging of Ameriea: Implications for the Surgieal Workforce 105 GIga Jonasson and Francis Kwakwa

8. Should Surgery Be Rationed for the Elderly on Cost-Effectiveness Grounds? .............................. 111 Mark Roberts

ix

x Contents

9. Interaeting with the Elderly Patient, Family, and Referring Physicians ..................................... 118 Dennis W. Iahnigen

10. Preoperative Evaluation of the Elderly Surgieal Patient. . . . . . . 126 Darlene Gabeau and Ronnie A. Rosenthai

11. Anesthetie Considerations for Geriatrie Surgery Stephen N. Harris

144

12. Pain Management ....................................... 160 R. Sean Morrison, Maria Torroella Carney, and Paolo L. Manfredi

13. Drug Usage in Elderly Persons ............................ 174 Richard A. Marottoli, Marla J. Campbell, and Roshini C. Pinto Powell

14. Postoperative Outeome and Rehabilitation. . . . . . . . . . . . . . . . . . 185 Leo M. Cooney, Ir.

Seetion 3 Ethical Considerations

Invited Commentary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 Michael E. Zenilman

15. Ethies in Clinieal Praetiee Margaret Drickamer

195

16. Surgery in the Frail Elderly: Nursing Horne Patients . . . . . . . . . 202 Michael E. Zenilman

17. Surgery in Centenarians Mark R. Katlic

Part 11 Seetion 1

Specifie Issues in Geriatrie Surgery Critical Care and Trauma

211

Invited Commentary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221 G. Tom Shires

18. Critieal Care ............................................ 225 Iames M. Watters and Palmer Q. Bessey

19. Care of the Injured Elderly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240 Thomas A. Santora, Stanley Z. Trooskin, and Lewis J. Kaplan

Section 2 Endocrine System

Invited Commentary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263 Samuel A. WeHs, Jr.

20. Endoerinology and Aging ................................ 265 Hosam K. Kamel and lohn E. Morley

Contents xi

21. Surgieal Diseases of the Thyroid and Parathyroid Glands 281 Barbara Kinder

22. Neoplasms of the Adrenal and Endocrine Pancreas in the Elderly ........................................... 301 Christopher P Coppola and Ronald C. Merrell

Invited Commentary David W. Kinne

23. Physiologie Changes and Benign Perimenopausal

323

Breast Disease ........................................... 325 Sancar Bayar and Barbara A. Ward

24. Breast Cancer in Elderly Women Nora Hansen and Monica Morrow

Section 3 Eyes, Ears, Nose, and Throat

Invited Commentary Charles W. Cummings

25. Pathogenesis and Surgical Management of Common Geriatrie

331

345

Ophthalmie Disorders .................................... 348 Ray F. Gariano, layne N. Ge, and Kathleen M. Stoessel

26. Physiologie Changes in the Ears, Nose, and Throat lohn F. Kveton and Ravi Goravalingappa

368

27. Head and Neck Cancer in the Elderly . . . . . . . . . . . . . . . . . . . . . . 376 Michael Coomaraswamy and Loren Kroetsch

Section 4 Respiratory System

Invited Commentary Earle W. Wilkins, Ir.

28. Physiologie Changes in Respiratory Function Edward J. Campbell

393

396

29. Pulmonary Malignancies: Pathophysiology and Treatment.. .. 406 David S. Schrump

Section 5 Cardiovascular System

Invited Commentary Timothy J. Gardner

435

30. Physiologie Changes in Cardiac Function with Aging ........ 437 Wilbert S. Aronow and William H. Frishman

xii

31. Risk Factors for Atherosclerosis in the Elderly Wilbert S. Aronow and William H. Frishman

Contents

448

32. Cardiac Surgery in the Elderly ............................ 460 Margarita T. Camacho, Konstadinos A. Plestis, and Jeffrey P. Gold

Invited Commentary: Vascular System John A. Mannick

33. Surgieal Treatment of Occlusive Vascular Disease

471

in the Elderly ........................................... 475 William D. Suggs, Frank J. Veith, and Luis A. Sanchez

34. Natural History and Treatment of Aneurysms Jeffrey M. Reilly and Gregorio A. Sicard

35. Natural History and Treatment of Extracranial

485

Cerebrovascular Disease in the Elderly ..................... 497 George H. Meier

Section 6 Gastrointestinal System

Invited Commentary: Gastrointestinal System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 509 William Silen

36. Age-Related Physiologie Changes in the Gastrointestinal Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 511 Joshua L. Levine and Michael E. Zenilman

37. Benign Esophageal Disease in the Elderly Seth A. Spector and Neal E. Seymour

528

38. Esophageal Cancer in the Elderly . . . . . . . . . . . . . . . . . . . . . . . . . . 542 Richard F. Heitmiller and Arlene A. Forastiere

39. Pathophysiology and Treatment of Benign Diseases of the Stomach and Duodenum ................................. 555 Robert R. Cima and David I. Soybel

40. Small Bowel Obstruction in the Elderly J. Chris Eagon

41. Lower Gastrointestinal Bleeding in the Elderly David McAneny and Craig L. Weinstein

42. Ischemic Disorders of the Large and Small Bowel Jeffrey M. Reilly and Gregorio A. Sicard

43. Inflammatory Bowel Disease in the Elderly Tonia M. Young-Fadok and Bruce G. Wolff

44. Divertieulitis and Appendicitis in the Elderly Scott C. Thornton

45. Benign Colorectal Disease Elisa H. Birnbaum

569

580

595

609

620

635

Contents xiii

46. Neoplastie Diseases of the Colon and Reetum . . . . . . . . . . . . . . . 644 lasleen lasleen, Edward E. Whang, K. Robert Shen, Elizabeth Breen, and Stanley W. Ashley

47. Abdominal Wall Hemia in the Elderly Seth A. Spector and Ronnie A. Rosenthai

Section 7 Hepatobiliary System

Invited Commentary Seymour Schwartz

662

677

48. Hepatobiliary and Panereatie Function: Physiologie Changes 679 D. LaRon Mason and F. Charles Brunicardi

49. Gallstone Disease in the Elderly ........................... 690 Kim U. Kahng and lennifer A. Wargo

50. Malignant Diseases of the Gallbladder and Bile Duets Steven A. Ahrendt and Thomas H. Magnuson

51. Benign and Malignant Tumors of the Liver Emery A. Minnard and Yuman Fong

711

729

52. Pancreatitis in the Elderly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 740 Peter D. Zdankiewicz and Dana K. Andersen

53. Panereatie Tumors: Pathophysiology and Treatment. . . . . . . . . . 748 Keith D. Lillemoe

Section 8 Urogenital System

Invited Commentary Bernard Lytton

763

54. Renal Function and Fluid and Eleetrolyte Balance ........... 767 ,ohn J. Ryan and Edward T. Zawada, Ir.

55. Urinary Ineontinenee in the Elderly . . . . . . . . . . . . . . . . . . . . . . . . 780 Pat O'Donnell

56. Renal and Bladder Neoplasms in the Elderly ............... 790 Daniel B. Rukstalis, David M. Hoenig, and Bruce J. Giantonio

57. Benign and Malignant Diseases of the Prostate . . . . . . . . . . . . . . 806 Peter C. Albertsen

58. Benign Gyneeologic Disorders in the Elderly . . . . . . . . . . . . . . . . 817 Richard J. Scotti, luana Hutchinson-Colas, Lauri Ellen Budnick, George Lazarou, and Wilma Markus Greston

59. Gyneeologic Malignancies in the Elderly ................... 834 Peter E. Schwartz and Thomas L. Rutheiford

xiv Contents

Section 9 Soft Tissue and Musculoskeletal System

Invited Commentary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 847 Roby C. Thompson, Jr.

60. Physiologie Changes in Soft Tissue and Bone as a Function of Age ......................................... 850 Neal S. Fedarko and Jay R. Shapiro

61. Common Benign and Malignant Skin Lesions ............... 867 Maryam M. Asgari and David r Leffell

62. Orthopedie Injuries ...................................... 885 Jeffrey H. Richmond, Kenneth r Kaval, and Joseph D. Zuckerman

63. Joint Replacement in the Elderly Patient . . . . . . . . . . . . . . . . . . . . 900 Roger N. Levy, Joseph DiGiovanni, and Brian Cohen

Section 10 Nervous System

Invited Commentary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 923 William F. Collins

64. Effects of Aging on the Human Nervous System rc. de la Torre and L.A. Fay

926

65. Benign and Malignant Tumors of the Brain ................. 949 Elizabeth B. Claus and Joseph Piepmeier

66. Spinal Disorders and Nerve Compression Syndromes . . . . . . . . 957 Jonathan D. Lewin and John Olsewski

Section 11 Transplantation

Invited Commentary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 985 John S. Najarian

67. Selection of Elderly Patients for Transplantation . . . . . . . . . . . . . 989 John B. Dossetor

68. Transplantation in Elderly Patients . . . . . . . . . . . . . . . . . . . . . . . . . 995 Sandy Feng, Stephen L. Tomlanovich, Fraser Keith, and Nancy L. Ascher

Section 12 Applications of Minimal Access Techniques to the Surgical Case of the Elderly

69. Physiology of Laparoseopie Surgery ....................... 1021 Jeffrey H. Peters and Namir Katkhouda

70. Outcomes of Minimal Access versus Open Surgical Procedures in the Elderly ................................. 1036 L. Michael Brunt and Nathaniel r Soper

Index 1055

Contributors

Steven A. Ahrendt, MD Division of Pancreatobiliary /Endocrine Surgery, Medieal College of Wisconsin, Mil­waukee, Wisconsin, 53226, USA

Peter C. Albertsen, MD Division of Urology, The School of Medicine of the University of Connecticut Health Center, Farmington, CT 06030-3955, USA

Dana K. Andersen, MD Section of Gastrointestinal Surgery, Department of Surgery Yale University School of Medicine, New Haven, CT 06520, USA

Wilbert S. Aronow, MD Department of Geriatries and Adult Development, Mount Sinai School of Medieine, New York, NY 10029, and Hebrew Hospital Horne, Bronx and Valhalla, NY 10475, USA

Nancy L. Ascher, MD Department of Surgery, University of California, San Francisco, San Francisco, CA 94143, USA

Maryam M. Asgari, MD Dermatologie and Laser Surgery Unit, Department of Dermatology, Yale University School of Medicine, New Haven, CT 06520, USA

Stanley W. Ashley, MD Department of Surgery, Harvard Medieal School, Brigham and Women's Hospital, Boston, MA 02115, USA

Lodovico Balducci, MD H. Lee Moffit Cancer Center, University of South Florida College of Medieine, Tampa, FL 33612-9497, USA

Sancar Bayar, MD Department of Surgieal Oncology, Yale University School of Medicine, New Haven, CT 06520, USA

xv

xvi Contributors

Palmer Q. Bessey, MD Deparbnent of Surgery, University of Rochester, Rochester, NY 14642-8410, USA

Elisa H. Birnbaum, MD Division of Colon and Rectal Surgery, Deparbnent of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA

Elizabeth Breen, MD Deparbnent of Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, USA

F. Charles Brunicardi, MD Deparbnent of Surgery, Baylor College of Medicine, Houston, TX 77030, USA

L. Michael Brunt, MD Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA

Lauri Ellen Budnick, MD Deparbnent of Obstetrics and Gynecology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA

Edith A. Bums, MD Deparbnent of Medicine, University of Wisconsin Medical School, Milwaukee, WI 53233, USA

Margarita T. Camacho, MD Deparbnent of Cardiothoracic Surgery, Montefiore Medical Center, Albert Einstein Col­lege of Medicine, Bronx, NY 10461, USA

Edward J. Campbell, MD Deparbnent of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA

Marla J. Campbell, BS, Pharm. D. Faculty of Pharmacy, University of Connecticut, Bristol, CT 06010, USA

Maria Torroella Carney, MD Division of Geriatrics, Deparbnent of Medicine, Winthrop-University Hospital, Mineola, NY 11501, USA

Robert R. Cima, MD Deparbnent of Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, USA

Elizabeth B. Claus, MD Deparbnents of Epidemiology and Public Health and Neurosurgery, Yale University School of Medicine, New Haven, CT 06520, USA

Brian Cohen, MD Deparbnent of Orthopaedic Surgery, The Mount Sinai Medical Center, New York, NY 10029, USA

Contributors xvii

WilIiam F. Collins, MD Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06520, USA

Michael Coomaraswamy, MD Division of Head and Neck Surgery, Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA

Leo M. Cooney, Jr., MD Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT 06520, USA

Christopher P. Coppola, MD Department of Surgery, Yale University School of Medicine, New Haven, CT 06520, USA

Vincent Joseph Cristojalo, MD Lankenau Institute for Medical Research, Philadelphia, PA 19096, USA

Charles W Cummings, MD Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medi­eine, Baltimore, MD 21287, USA

rc. de la Torre, MD, PhD Department of Neuroscience, University of California, San Diego, La Jolla, CA 92093, USA

Joseph DiGiovanni, MD Department of Orthopaedic Surgery, The Mount Sinai Medical Center, New York, NY 10029, USA

John B. Dossetor, MD, PhD Professor Emeritus, The Glebe, Ottawa, Ontario, K1S 2G7, Canada

Margaret Drickamer, MD Department of General Internal Medicine, Yale University School of Medicine, New Haven, CT 06520, and Geriatrie Care and Extended Care Section, VA Connecticut HeaIthcare System, West Haven, CT 06516, USA

r Chris Eagon, MD Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA

Ben Eiseman, MD Department of Surgery, University of Colorado HeaIth Science Center, Denver, CO 80262, USA

Martine Extermann, MD H. Lee Moffit Cancer Center, University of South Florida College of Medicine, Tampa, FL 33612, USA

L.A. Fay, MD Division of Neurosurgery, University of New Mexico, Albuquerque, NM 87151, USA

xviii Contributors

Neal S. Fedarko, MD Division of Geriatrics, Department of Medicine, Johns Hopkins University, Baltimore, MD 21224, USA

Sandy Feng, MD, PhD Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA

Yuman Fong, MD Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA

Arlene A. Forastiere, MD Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA

William H. Frishman, MD Department of Medicine, New York Medical College, Valhalla, NY 10595, USA

Darlene Gabeau Yale University School of Medicine, New Haven, CT 06520, USA

Timothy J. Gardner, MD Division of Cardiothoracic Surgery, University of Pennsylvania School of Medicine, Hos­pital of the University of Pennsylvania, Philadelphia, PA 19104, USA

Ray F. Gariano, MD, PhD Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT 06520, USA

Jayne N. Ge, MD Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT 06520, USA

Bruce J. Giantonio, MD Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA

Jeffrey P. Gold, MD Department of Cardiothoracic Surgery, Montefiore Medical Center, Albert Einstein Col­lege of Medicine, Bronx, NY 10461, USA

James S. Goodwin, MD University of Texas Medical Branch, Sealy Center on Aging, Galveston, TX 77555, USA

Ravi Goravalingappa, MD Department of Otolaryngology, Yale University School of Medicine, New Haven, CT 06520, USA

Wilma Markus Greston, BS, MT Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA

Contributors xix

Nora Hansen, MD John Wayne Cancer Institute, Santa Moniea, CA 90404, USA

Stephen N. Harris, MD Department of Anesthesiology, Yale University School of Medieine, and Department of Anesthesiology, VA Connectieut Healthcare System, West Haven, CT 06516, USA

Leonard Hayflick, PhD Department of Anatomy, University of California, San Francisco, School of Medicine, The Sea Ranch, CA 95497, USA

Richard F. Heitmiller, MD Department of Surgery, Johns Hopkins School of Medieine, Baltimore, MD 21205, USA

David M. Hoenig, MD Department of Urology, Montefiore Medieal Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA

Juana Hutchinson-Colas, MD Department of Obstetries and Gynecology, Mount Sinai School of Medieine/Jersey City Medieal Center, Jersey City, NJ 07304, USA

Danny O. Jacobs, MD, MPH Department of Surgery, Division of General and Gastrointestinal Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA

Dennis W Jahnigen, MD [deceasedJ Department of Medieine, University of Colorado Center on Aging, Denver, CO 50262, USA

Jasleen Jasleen, MD Department of Surgery, Harvard Medieal School, Brigham and Women's Hospital, Boston, MA 02115, USA

Olga Jonasson, MD Education and Surgieal Services Department, American College of Surgeons, Chieago, IL 60611, USA

Kim U. Kahng, MD Department of Surgery, Medieal College of Wisconsin, Milwaukee, WI 53226, and Depart­ment of Surgery, Clement Zavlocki VA Medieal Center, Milwaukee, WI 53295, USA

Hosam K. Kamel, MD Division of Geriatrie Medicine, St. Louis University Health Sciences Center, St. Louis, MO 63104, USA

Lewis J. Kaplan, MD Surgieal Intensive Care Unit, MCP Hahnemann University School of Medieine, Phila­delphia, PA 19129, USA

Namir Katkhouda, MD Division of Emergency Non-Trauma Surgery, University of Southem Califomia School of Medieine, Los Angeles, CA 90033, USA

xx Contributors

Mark R. Katlic, MD Wyoming Valley Surgieal Associates, Kingston, PA 18704, and Department of Thoracic Surgery, Wyoming Valley Healthcare System, Wilkes-Barre, PA 18702, USA

Fraser Keith, MD Cardiac Transplant Pro gram, University of Califomia, San Francisco, San Francisco, CA 94143, USA

Barbara Kinder, MD Department of Surgery, Yale University School of Medieine, New Haven, CT 06520, USA

David W. Kinne, MD Department of Surgery, Columbia Presbyterian Medieal Center, New York, NY 10022, USA

Kenneth J. Koval, MD Department of Orthopaedie Surgery, Hospital for Joint Diseases, New York, NY 10003, USA

Loren Kroetsch, MD Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medieine, Bronx, NY 10461, USA

John F. Kveton, MD Department of Otolaryngology, Yale University School of Medieine, New Haven, CT 06520, USA

Francis Kwakwa, MD Education and Surgieal Serviees Department, Ameriean College of Surgeons, Chicago, IL 60611, USA

Tirso Mark Lara, MD Department of Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, USA

George Lazarou, MD Department of Obstetrics, Gynecology and Women's Health, Montefiore Medieal Center, Albert Einstein College of Medieine, Bronx, NY 10461, USA

David J. Leffell, MD Dermatologie and Laser Surgery Unit, Department of Dermatology, Yale University School of Medicine, New Haven, CT 06520, USA

Joshua 1. Levine, MD Department of Surgery, Montefiore Medieal Center, Albert Einstein College of Medieine, Bronx, NY 10461, USA

Roger N. Levy, MD Department of Orthopaedie Surgery, The Mount Sinai Medieal Center, New York, NY 10029, USA

Jonathan D. Lewin, MD Department of Orthopaedie Surgery, Montefiore Medieal Center, Albert Einstein College of Medieine, Bronx, NY 10461, USA

Contributors xxi

Keith D. Lillemoe, MD Department of Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA

Bernard Lytton, MD Department of Surgery, Yale University School of Medicine, New Haven, CT 06520, USA

Thomas H. Magnuson, MD Johns Hopkins Bayview Medical Center, Baltimore, MD 21224-2780, USA

Paolo L. Manfredi, MD Departments of Geriatrics, Anesthesia, and Neurology, Mount Sinai School of Medicine, New York, NY 10029, USA

John A. Mannick, MD Department of Surgery, Harvard Medical School, Brigham and Women' s Hospital, Boston, MA 02115, USA

Richard A. Marottoli, MD Department of General Internal Medicine, Yale University School of Medicine, New Haven, CT 06520, and Medical Service/Geriatric Section, VA Connecticut Healthcare System, West Haven, CT 06516, USA

D. LaRon Mason, MD Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA

David McAneny, MD Department of General Surgery, Boston University Medical Center, Boston, MA 02118, USA

George H. Meier, MD Northfolk Surgical Group, Brambleton Medical Center, Northfolk, VA 23510, USA

Ronald C. Merrell, MD Department of Surgery, Medical College of Virginia, Richmond, VA 23298, USA

Emery A. Minnard, MD Department of Surgery, Louisiana State University School of Medicine, New Orleans, LA 70112, USA

John E. Morley, MD Division of Geriatric Medicine, Saint Louis University Health Sciences Center, St. Louis, MO 63104, USA

R. Sean Morrison, MD Department of Geriatrics, Mount Sinai School of Medicine, New York, NY 10029, USA

Monica Morrow, MD Department of Surgery, Lynn Sage Breast Center, Northwestern University Medical School, Chicago, IL 60611, USA

John S. Najarian, MD Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA

xxii Contributors

Pat O'Donnell, MD Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA

John Olsewski, MD Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA

Jeffrey H. Peters, MD Seetion of General Surgery, USC University Hospital, University of Southem Califomia School of Medicine, Los Angeles, CA 90033-4612, USA

Joseph Piepmeier, MD Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06520, USA

Roshini C. Pinto Powell, MD Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH 03755, USA

Konstadinos A. Plestis, MD Department of Cardiothoracic Surgery, Montefiore Medical Center, Albert Einstein Col­lege of Medicine, Bronx, NY 10461, USA

Jeffrey M. Reilly, MD Vascular Surgical Associates, Marietta, GA 30060, USA

Jeffrey H. Richmond, MD Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York, NY 10003, USA

Mark Roberts, MD Department of Political Economic and Health Policy, Harvard School of Public Health, Boston, MA 02115, USA

Ronnie A. Rosenthai, MD Department of Surgery, Yale University School of Medicine, New Haven, CT 06520, and Surgical Service, Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, CT 06516, USA

Daniel B. Rukstalis, MD Department of Surgery, Allegheny University of the Health Sciences, Philadelphia, PA 19129, USA

Thomas J. Rutherford, MD Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT 06520, USA

John J. Ryan, MD Department of Surgery, University of South Dakota School of Medicine, Sioux Falls, SD 57105, USA

Luis A. Sanchez, MD Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA

Contributors xxiii

Thomas A. Santora, MD Department of Surgery, MCP Hahnemann University School of Medicine, Philadelphia, PA 19129, USA

David S. Schrump, MD Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA

Peter E. Schwartz, MD Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, Yale Univer­sity School of Medicine, New Haven, CT 06520, USA

Seymour Schwartz, MD Department of Surgery, University of Rochester, School of Medicine and Dentistry, Rochester, NY 14642, USA

Richard J. Scotti, MD Department of Obstetrics, Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA

Neal E. Seymour, MD Department of Surgery, Yale University School of Medicine, New Haven, CT 06520, USA

Jay R. Shapiro, MD Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA

K. Robert Shen, MD Department of Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, USA

G. Tom Shires, MD Department of Trauma, University of Nevada, Las Vegas, NV 89102, USA

Gregorio A. Sicard, MD Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110-1093, USA

William Silen, MD Department of Surgery, Beth Hospital, Boston, MA 02115, USA

Nathaniel J. Soper, MD Section of Hepatobiliary, Pancreatic and Gastrointestinal Surgery, Department of General Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA

David 1. Soybel, MD Department of Surgery, West Roxbury VA Medical Center, Harvard Medical School, West Roxbury, MA 02312, USA

Seth A. Spector, MD Department of Surgery, Yale University School of Medicine, New Haven, CT 06520, USA

xxiv Contributors

Kathleen M. Stoessel, MD Department of Ophthalmology, Yale University School of Medicine, New Haven, CT 06520, USA

Williarn D. Suggs, MD Division of Vascular Surgery, Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA

Roby C. Thornpson, Jr., MD Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN 55455, USA

Scott C. Thornton, MD Colon and Rectal Surgeons of Fairfield County, Bridgeport, CT 06606, USA

Paola S. Tirniras, MD Department of Molecular and Cell Biology, University of California, Berkley, Berkley, CA 04720-3202, USA

Stephen J. Tornlanovich, MD Department of Surgery, University of Califomia, San Francisco, San Francisco, CA 94143, USA

Bruce Robert Troen, MD Lankenau Institute for Medical Research, Philadelphia, PA 19096, USA

Stanley Z. Trooskin, MD Department of Surgery, MCP Hahnemann University School of Medicine, Philadelphia, PA 19129, USA

Frank J. Veith, MD Division of Vascular Surgery, Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA

Barbara A. Ward, MD Department of Surgery, Yale University School of Medicine, New Haven, CT 06520, USA

Jennifer A. Wargo, MD Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA

Jarnes M. Watters, MD Department of Surgery, Loeb Health Research Institute at the Ottawa Hospital, Ottawa, Ontario K1Y 4K9, CANADA

Craig L. Weinstein, MD Department of General Surgery, Boston University Medical Center, Boston, MA 02118, USA

Sarnuel A. Wells, Jr., MD Center for Clinical Trials and Evidence-Based Medicine, American College of Surgeons, Chicago, IL 60611, USA

Contributors xxv

Edward E. Whang, MD Division of General! Gastrointestinal Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, USA

Earle W. Wilkins, Jr., MD Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA

John R. Wilmoth, PhD Department of Demography, University of California, Berkeley, Berkeley, CA 94720, USA

Bruce G. Wolff, MD Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA

Tonia M. Young-Fadok, MD Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN 55905, USA

Edward T Zawada, Jr., MD Department of Internal Medicine, The University of South Dakota School of Medicine, Sioux Falls, SD 57105, USA

Peter D. Zdankiewicz, MD Department of Surgery, Yale University School of Medicine, New Haven, CT 06520, USA

Michael E. Zenilman, MD Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, and Department of Surgery, Jack D. Weiler Hospital of the Albert Einstein College of Medicine, Bronx, NY 10461, USA

Joseph D. Zuckerman, MD Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York, NY 10003, USA