Launching a Geriatric Surgery Center: Recommendations from the Society for Perioperative Assessment and Quality Improvement

Cooper, Lisa; Abbett, Sarah K.; Feng, Aiden; Bernacki, Rachelle; Cooper, Zara; Urman, Richard D.; Frain, Laura; Edwards, Angela F.; Blitz, Jeanna; Javedan, Houman; Bader, Angela M.

doi:10.1111/jgs.16681

Cited by 54 publications

(44 citation statements)

References 23 publications

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“…With a noticeable increase in the aged population worldwide, there is a need to improve surgical care to maximize the positive outcomes and to minimize the burden of surgical comorbidities for the aged patient. The American College of Surgeons has recently introduced a geriatric surgery verification program suggesting standards for hospitals to provide better perioperative care for the aged and frail patients undergoing surgery [30]. One of the standards in the program is to advance the knowledge in geriatric surgery encouraging scholarly research in the improvement of the quality of geriatric surgery [31].…”

Section: Discussionmentioning

confidence: 99%

Mortality after benign thyroid surgery in patients aged 80 years or older

Farhad

Anders

Nordenström

et al. 2022

Langenbecks Arch Surg

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Introduction A recent report from the United Nations showed that aged people are increasing worldwide. Few data exist on overall survival for patients 80 years or older undergoing benign thyroid surgery. Short- and long-term survival and risk factors for death in patients undergoing thyroid surgery for benign disease were evaluated, using a nationwide, population-based quality register. Methods Patients operated for benign thyroid disease, 2004 to 2017, were collected from the national quality register for thyroid surgery. Mortality data were retrieved from the Swedish National Board of Health and Welfare. Mortality at 30 days, 90 days, and 1 year after surgery, for patients 80 years or older, was calculated. Overall survival was calculated using the Kaplan–Meier estimate. Risk factors for mortality were assessed with Cox’s multiple regression analysis. The standardized mortality ratio was calculated. Results There were 17,969 patients. Among them, 483 patients were 80 years or older, and of these, 397 (82.2%) were women. The mortality rate at 0–30 days, 31–90 days, and at 91–365 days after surgery was 0.4%, 0.2%, and 2.5%, respectively. The median (IQR) follow-up time was 4.5 (2.9–7.2) and the median (IQR) survival time was 8.0 (4.1–12.5) years. Apart from age, there was no other risk factor for death. The standardized mortality ratio (SMR) was 0.67 (0.49–0.91) for men and 0.76 (0.65–0.89) for women. Conclusion Mortality after surgery for benign thyroid disease in patients 80 years or older was lower than the general population with no specific risk factors for death except for age.

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Section: Discussionmentioning

confidence: 99%

Mortality after benign thyroid surgery in patients aged 80 years or older

Farhad

Anders

Nordenström

et al. 2022

Langenbecks Arch Surg

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“…Recent SPAQI recommendations for the preoperative management of frailty 35 as well those on launching a dedicated geriatric surgery center 36 have outlined specific steps and considerations in vulnerable populations undergoing elective surgery. This includes active screening for frailty as well as developing clinical pathways, and incorporating geriatric co-management, shared decision-making, and multimodal prehabilitation to improve postoperative outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…One study has shown that just a one-time session with a physical therapist to learn and practice postoperative precautions, exercises, bed mobility preoperatively achieved readiness to discharge from PT faster than the control group. 34 Recent SPAQI recommendations for the preoperative management of frailty 35 as well those on launching a dedicated geriatric surgery center 36 have outlined specific steps and considerations in vulnerable populations undergoing elective surgery. This includes active screening for frailty as well as developing clinical pathways, and incorporating geriatric co-management, shared decision-making, and multimodal prehabilitation to improve postoperative outcomes.…”

Section: Post-operative Decline In Independencementioning

confidence: 99%

Preoperative Cognitive Impairment as a Perioperative Risk Factor in Patients Undergoing Total Knee Arthroplasty

Krishnan

Brovman

Urman

2021

Geriatr Orthop Surg Rehabil

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Background: The study assessed whether pre-existing cognitive impairment (CI) prior to elective total knee arthroplasty (TKA) is associated with worse postoperative outcomes such as delirium, in-hospital medical complications, 30-day mortality, hospital length of stay and non-home discharge. Methods: A retrospective database analysis from the NSQIP Geriatric Surgery Pilot Project was used. There was an initial cohort of 6350 patients undergoing elective TKA, 104 patients with CI were propensity score matched to 104 patients without CI. Results: Analysis demonstrated a significantly increased incidence of post-operative delirium (POD) in the cohort with pre-op CI (p = < .001), a worsened functional status (p = < .001) and increased nonhome discharge postoperatively compared to the group without CI (p = 0.029). Other post-operative outcomes included 30-day mortality of 0% in both groups, and low rate of complications such as infection (2.88% vs 0.96%), pneumonia (1.92% vs 0%), failure to wean (0.96% vs 0%), and reintubation (0.96% vs 0%). Some other differences between the CI group and non-CI group, although not statistically significant, included increased rate of transfusion (10.58% vs 6.73%), and sepsis (1.92% vs 0%). The length of stay was increased in the non-CI group (4.28% vs 2.32%, p = 0.122). Conclusion: CI in patients undergoing TKA is associated with an increased risk of POD, worsened postoperative functional status, and discharge to non-home facility.

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“…It is important to understand the likelihood of an NHD for a patient who had been home-dwelling prior to elective surgical intervention because older patients continue to represent a larger share of patients presenting for elective surgery. Using risk factors identified from a broad population of older adults may help inform health care providers such as surgeons and anesthesiologists, primary care providers, and specialists of an individual's expected postoperative course should they decide to proceed with elective surgery and design preoperative evaluation pathways (Ogink et al, 2019;Cooper et al, 2020). Our study also offers information to facilitate preoperative shared decision-making, taking into account risks of the procedure and the patient's goals of care (Brovman et al, 2018;Quinn et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Preoperative Risk Factors for Nonhome Discharge of Home-Dwelling Geriatric Patients Following Elective Surgery

et al. 2020

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To identify patient risk factors for nonhome discharge (NHD) for home-dwelling older patients undergoing surgery, we performed a retrospective cohort study of patients aged ≥65 years undergoing elective surgery between 2014 and 2016 using the geriatric research file from the National Surgical Quality Improvement Program (NSQIP). Multivariable logistic regression examined the association between preoperative demographics, comorbidities, and functional status and NHD to determine which factors are most strongly predictive of NHD. Risk of NHD was higher among those of age >85 years, age 75 to 85 years, Black race, with body mass index (BMI) >30, dyspnea with exertion or at rest, partially or totally dependent in activities of daily living (ADLs), preoperative steroid use, preoperative wound infection, use of a mobility aid, fall within 3 months, or living alone at home without support. NHDs were statistically more likely among orthopedic, neurosurgery, or cardiac surgery interventions. Understanding individual patient’s risks and setting expectations for likely postoperative course is integral to appropriate preoperative counseling and preoperative optimization.

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Launching a Geriatric Surgery Center: Recommendations from the Society for Perioperative Assessment and Quality Improvement

Cited by 54 publications

References 23 publications

Mortality after benign thyroid surgery in patients aged 80 years or older

Mortality after benign thyroid surgery in patients aged 80 years or older

Preoperative Cognitive Impairment as a Perioperative Risk Factor in Patients Undergoing Total Knee Arthroplasty

Preoperative Risk Factors for Nonhome Discharge of Home-Dwelling Geriatric Patients Following Elective Surgery

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