Background Older surgical patients have an increased risk for postoperative complications, driving up healthcare costs. We determined if postoperative co‐management of older surgery patients is associated with postoperative outcomes and hospital costs. Methods Retrospective data were collected for patients ≥70 years old undergoing colorectal surgery at a community teaching hospital. Patient outcomes were compared between those receiving postoperative surgery co‐management care through the Optimization of Senior Care and Recovery (OSCAR) program and controls who received standard of care. Main outcome measures were postoperative complications and hospital charges, 30‐day readmission rate, length of stay (LOS), and transfer to intensive care during hospitalization. Multivariable linear regression was used to model total charge and multivariable logistic regression to model complications, adjusted for multiple variables (e.g., age, sex, race, body mass index, Charlson Comorbidity Index [CCI], American Society of Anesthesiologists score, surgery duration). Results All 187 patients in the OSCAR and control groups had a similar mean CCI score of 2.7 (p = 0.95). Compared to the control group, OSCAR recipients experienced less postoperative delirium (17% vs. 8%; p = 0.05), cardiac arrhythmia (12% vs. 3%; p = 0.03), and clinical worsening requiring transfer to intensive care (20% vs. 6%; p < 0.005). OSCAR group patients had a shorter mean LOS among high‐risk patients (CCI ≥3) (−1.8 days; p = 0.09) and those ≥80 years old (−2.3 days; p = 0.07) compared to the control group. Mean total hospital charge was $10,297 less per patient in the OSCAR group (p = 0.01), with $17,832 less per patient with CCI ≥3 (p = 0.01), than the control group. Conclusions A co‐management care approach after colorectal surgery in older patients improves outcomes and decreases costs, with the most benefit going to the oldest patients and those with higher comorbidity scores.
Background Trauma patients older than 80 years of age have higher mortality rates compared to younger peers. No studies have investigated the effectiveness of geriatrics co-management on mortality in general trauma. Methods Retrospective cohort study from 2015-2016 comparing overall and inpatient mortality in a geriatrics trauma co-management (GTC) program versus usual care (UC). Demographic and outcome measures were obtained from the trauma registry at an 11-bed trauma critical care unit within a 719-bed Level 1 Trauma Center. 1,572 patients, 80 years and older, with an admitting trauma diagnosis were evaluated. Primary outcome was in-hospital mortality and overall mortality (defined as inpatient death or discharge to hospice). Secondary outcomes included hospital length of stay (LOS), Intensive Care Unit (ICU) LOS, discharge location, and medical complications. Results 346 patients (22%) were placed in the GTC program. Overall mortality was lower in the GTC (4.9%) when compared with UC (11.9%), representing a 57% reduction (95% OR CI 0.24-0.75, p-value = 0.0028). There was a 7.42% hospital mortality rate in the UC group compared to 2.6% in the GTC group (95% CI 0.21-0.92, p-value = 0.0285) representing a 56% decrease in in-hospital mortality. GTC patients had a longer mean LOS (6.4 days versus 5.3 days, p-value <0.0001). More GTC patients were sent to inpatient rehabilitation facilities or skilled nursing facilities (80% versus 60%, p-value <0.0001). Conclusions Geriatrics trauma co-management of trauma patients above the age of 80 may reduce mortality and deserves formal study.
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