Multidisciplinary Initiative Improves Care of Elderly Surgical Patients

By Megan Brooks

October 09, 2020

NEW YORK (Reuters Health) - A new multidisciplinary program improves the care of elderly surgical patients, and even appears to boost outcomes, researchers have found.

"The majority of all operations in the U.S. are performed on patients 65 years of age or older and postoperative morbidity and mortality is increased in our geriatric surgery patients," Dr. Alexandra Kovar, a general-surgery resident at the University of Colorado School of Medicine, in Aurora, noted in a presentation October 3 during the American College of Surgeons (ACS) virtual annual meeting.

The Aging Veterans Surgical Wellness (AVSW) program at the Rocky Mountain Regional Veterans Affairs Medical Center in Aurora has led to shorter hospital stays and lower rates of postop delirium, among other benefits, reported Dr. Kovar, chief resident for quality and safety at the Rocky Mountain VA Medical Center.

The AVSW program at Rocky Mountain is a beta test site for the ACS Geriatric Surgery Verification (ACS GSV) program introduced in 2019 to optimize surgical care for older adults.

The program at Rocky Mountain has two main components, Dr. Kovar explained. One is a preoperative conference where physicians, nurses, physical therapists, occupational therapists, social workers, nutritionist, and pharmacist meet to review the geriatric patients that are scheduled for surgery and assess what their potential inpatient and outpatient needs might be. The second is daily inpatient rounding by the care team to assess patients on a daily basis.

From January 2018 to October 2019, 186 surgery patients (median age, 79 years) participated in the program. Only 14 of those patients, or 7.5%, required readmission, compared to 10.8% nationally, Dr. Kovar reported.

They also had a statistically significantly shorter length of stay compared with those of a matched cohort of elderly patients from the VA Surgical Quality Improvement Program (four vs. five days).

"Unfortunately," said Dr. Kovar, "in the VASQIP database, postoperative variables like delirium and functional health are not routinely recorded. But we analyzed our results and compared them to the literature and our patients' rate of postoperative delirium was 9.3% compared to a national rate of 12.1%. And our rate of functional decline postoperatively was only 16.7% compared to 42.9% nationally."

"The next steps for this project are to create a geriatric postoperative telehealth clinic to improve our continuity of care, and we hope to continue to reduce readmissions, ED visits and time to return to baseline mobility," she said.

In a conference statement, Dr. Thomas Nichols Robinson, chief of surgery at Rocky Mountain Regional VA Medical Center and a member of the ACS GSV program panel, said, "Surgeons intuitively recognize that the group at highest risk of poor outcomes are older adults; the frail older adult is at highest risk for longer hospital stays, complications, and needing to go to institutions after discharge. This program directly addresses those needs unique to frail older adults to try to prevent poor outcomes after surgery."

"The results of this beta pilot show how well the Geriatric Surgery Verification program works in a hospital that puts forth the institutional commitment to improve the care of older adults facing surgery," added Dr. Clifford Y. Ko, principal investigator for the ACS GSV program.

"Identifying and addressing potential vulnerabilities specific to the geriatric surgical patient such as delirium, result in better patient outcomes. And a reduced hospital stay is not only a good outcome for patients, it also indicates a more efficient use of resources," said Dr. Ko.

SOURCE: American College of Surgeons Clinical Congress 2020, presented October 3, 2020.