Preoperative assessment of older geriatric patients is feasible in the general preoperative clinic and can help identify patients at higher risk of postoperative complications.

Background Impaired functional and cognitive status is an important outcome for older adults undergoing major cardiac surgery. We conducted this pilot study to gauge feasibility of assessing these outcomes longitudinally, from pre-operatively up to two time-points post-operatively to assess for recovery. Methods We interviewed patients ≥ age 65 years pre-operatively and repeated functional and cognitive assessments at 4–6 weeks and 4–6 months post-operatively. Simple unadjusted linear regression was used to test whether baseline measures changed at each follow-up time point. Then we used a longitudinal model to predict post-operative recovery overall, adjusting for co-morbidity. Results 62 patients (age 74.7 ± 5.9) underwent scheduled cardiac surgery. Pre-operative ADL impairment was associated with poorer functional recovery at 4–6 weeks post-operatively with each baseline ADL impairment conferring recovery of 0.5 fewer ADLs (p<.05). By 4–6 months, we could no longer detect a difference in recovery. Pre-operative cognition and physical activity was not associated with post-operative changes in these domains. Conclusion A pre- and post-operative evaluation of function and cognition was integrated into the surgical care of older patients. Pre-operative impairments in ADLs may be a means to identify patients who might benefit from careful post-operative planning, especially in terms of assistance with self-care during the first 4–6 weeks after cardiac surgery.

Background Older trauma injury patients had improved recovery after we implemented routine geriatric consultation for patients ≥ age 65 at a level-1 academic trauma center. The intervention aimed to improve quality of geriatric care. However, the specific care processes that improved are unknown. Study Design Prospective observation comparing medical care after (December 2007-November 2009) versus before (December 2006-November 2007) implementation of the geriatric consult-based intervention. To measure quality-of-care (QOC) we used 33 previously-validated care-process quality indicators (QIs) from the Assessing the Care of Vulnerable Elders (ACOVE) study, measured by review of medical records for 76 Geriatric Consult [GC] versus 71 control group patients. As pre-specified subgroup analyses, we aggregated QIs by type: geriatric (e.g., delirium screening) versus non-geriatric condition-based care (e.g., thrombosis prophylaxis) and compared QI scores by type of care. Last, we aggregated QI scores into overall, geriatric, and non-geriatric QOC scores for each patient (# QIs passed/# QIs eligible), and compared patient-level QOC for the GC versus control group, adjusting for age, gender, ethnicity, comorbidity, and injury severity. Results 63% of the GC versus 11% of the control group patients received a geriatric consultation. We evaluated 2505 QIs overall (1664 geriatric-type and 841 non-geriatric QIs). In general, fewer geriatric-type QIs were passed than non-geriatric QIs (71% vs 81%, p<.001). We provided better overall-QOC to the GC (77%) than control group patients (73%, p<.05). However, the difference was not statistically significant after multivariable adjustment (p=.08). We improved geriatric-QOC for the GC (74%) compared to the control group (68%, p<.01), a difference that was significant after multivariable adjustment (p=.01). Conclusion Geriatricians and surgeons can collaboratively improve geriatric QOC for older trauma patients.

Background Older patients account for nearly half of U.S. surgical volume and age alone is insufficient to predict surgical fitness. Various metrics exist for risk stratification, but little work has been done to describe the association between measures. We aimed to determine whether analytic morphomics, a novel objective risk assessment tool, correlates with functional measures currently recommended in the preoperative evaluation of older patients. Materials and Methods We retrospectively identified 184 elective general surgery patients over age 70 with both a preoperative CT scan and Vulnerable Elderly Surgical Pathways and outcomes Assessment (VESPA) within 90 days of surgery. We used analytic morphomics to calculate trunk muscle size (total psoas area, or TPA) and univariate logistic regression to assess the relationship between TPA and domains of geriatric function – mobility, basic and instrumental activities of daily living (ADL), and cognitive ability. Results Greater TPA was inversely correlated with impaired mobility (OR=0.46, 95% C.I. 0.25–0.85, P=0.013). Greater TPA was associated with decreased odds of deficit in any basic ADLs (OR=0.36 per SD unit increase in TPA, 95% C.I. 0.15–0.87, P<0.03) and any instrumental ADLs (OR=0.53, 95% C.I. 0.34–0.81; P<0.005). Finally, patients with larger TPA were less likely to have cognitive difficulty assessed by Mini-Cog scale (OR=0.55, 95% C.I. 0.35–0.86, P<0.01). Controlling for age did not change results. Conclusions Older surgical candidates with greater trunk muscle size, or greater TPA, are less likely to have physical impairment, cognitive difficulty, or decreased ability to perform daily self-care. Further research linking these assessments to clinical outcomes is needed.

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