Effects of Comprehensive Geriatric Care Models on Postoperative Outcomes in Geriatric Surgical Patients

A Systematic Review and Meta-analysis

Aparna Saripella; Sara Wasef; Mahesh Nagappa; Sheila Riazi; Marina Englesakis; Jean Wong; Frances Chung

Disclosures

BMC Anesthesiol. 2021;21(127) 

In This Article

Background

The current elderly population (65 years or older) is approximately 7 million in Canada, and 62 million in North America. The proportion of the elderly is increasing rapidly; 25% of the population will be 65 years or older by the year 2036.[1] Surgery on the elderly results in greater complications, prolonged length of hospital stay (LOS), increase in emergency department visits, readmission rates, post-discharge care requirements, and health care costs.[2–4] Both delirium and frailty impede recovery post-surgery with cognitive impairment, leading to a 3-fold increase in stay in hospital and rehabilitation facilities.[5–7] Frailty with decreased physical functionality and life expectancy is associated with a 2-fold increase in postoperative complications and new physical disability.[8,9]

Comprehensive geriatric care model is a co-management program to deliver the geriatric care with personnel and expert supervision. The comprehensive geriatric care model included reduction of delirium; co-morbidity management; nutritional assessment; individualized care plan; and postoperative follow-up.[10–19] The chief constituent of the comprehensive geriatric care model is comprehensive geriatric assessment (CGA). The CGA is an established multi-domain assessment addressing patients' physiological, social, psychological, and functional state of the elderly people.[17] Comprehensive geriatric care models consist of a multidisciplinary team comprising geriatricians, geriatric nurses, anaesthesiologists, surgeons, physiotherapists, occupational therapists, and dieticians. Enhanced recovery after surgery (ERAS) has been proven effective in decreasing LOS and morbidities of surgical patients, but they rarely have a CGA component or involvement of the geriatric team.[20,21]

Several studies had included CGA as a major component of the geriatric care model and evaluated its impact on postoperative outcomes.[10,11,13,15–19,22–24] The most common models are Proactive care of Older People undergoing Surgery (POPS),[17] Hospital Elder Life Program (HELP) pathway,[14] Perioperative Optimization of Senior Health (POSH) pathway,[15] person-centred care (PCC) pathway,[12] Liaison Intervention in Frail Elderly (LIFE) pathway,[13] and multidisciplinary care pathways.[10,11,16,18,19]

There are contradictory findings in the literature regarding the effectiveness of the comprehensive geriatric care models. Some CGA pathways improved clinical outcomes such as decreased prevalence of delirium,[17,19] and LOS,[10,15–17] while other studies did not show any positive results.[10,13,16] The objective of this systematic review and meta-analysis is to determine the effects of geriatric care models in decreasing adverse outcomes versus standard care in the geriatric surgical patients. This systematic review and meta-analysis concentrates on the application of comprehensive geriatric care models in totality. It shows the importance of comprehensive geriatric care models in the current geriatric care. We hypothesize that there is an association between the geriatric care models and a decrease in the adverse outcomes such as prevalence of delirium, LOS, rates of 30-day admission, and mortality.

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