Pre-operative Geriatric Assessment to improve outcomes in frail older
PATIENTS undergoing elective Plastic and General Surgical
procedures at Hutt Valley District Health Board
Authors List Gibbons, M; Thompson, T; Jayathissa, S; Hutt Valley DHB, Lower Hutt, New Zealand Introduction: It is known that older adults are a vulnerable group in the peri-operative setting. The Proactive care of Older People undergoing Surgery (POPS) approach has shown the benefit of frailty targeted comprehensive geriatric assessment (CGA) pre-operatively for elective surgical patients (1).
Aims: Examine if frail older patients would benefit from geriatric assessment prior to undergoing elective general and plastic surgical procedures at Hutt Valley District Health Board. Our hypothesis was that study participants would have reduced length of stay and reduced morbidity post-operatively.
Methods: A retrospective audit of all elective general and plastic surgical patients >65 years old who had an inter-rai assessment (surrogate frailty marker) between January-August 2017. Outcomes were then compared to a prospective cohort recruited between January-August 2019 (clinical frailty score 4 or above).
Results: 20 out of 99 in the retrospective audit met the surrogate marker for frailty, a similar number to the 18 that were referred for inclusion in the prospective cohort. Baseline characteristics were similar except comorbidities (mean 14.5 in prospective cohort, versus 7.5 p<0.0001). There was no significant difference in length of stay, however there was a trend to increased in the prospective cohort (Mean 12.3 days versus 7.4 p 0.1074), and a trend to more patients requiring rehabilitation (30% versus 5% p 0.0952). There was increased delirium in the prospective cohort (40% versus 0% p 0.0077).
Conclusions: This study showed a trend to increased length of stay in the prospective cohort, this could be explained by higher comorbidities. The finding of increased delirium could be due to increased screening in the prospective cohort.
References (1) D Harari, A.H. et al. Proactive care of older people undergoing surgery (‘POPS’): Designing, embedding, evaluating and funding a comprehensive geriatric assessment service for older elective surgical patients. Age and Ageing, 2007. 36: p. 190-196
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