Early Outcomes Following Implementation of a Multispecialty Geriatric Surgery Pathway
Objective:
To examine geriatric-specific outcomes following implementation of a multispecialty geriatric surgical pathway (GSP).
Background:
In 2018, we implemented a GSP in accordance with the proposed 32 standards of American College of Surgeons’ Geriatric Surgery Verification Program.
Methods:
This observational study combined data from the electronic health record system (EHR) and ACS-National Surgery Quality Improvement Program (NSQIP) to identify patients ≥65 years undergoing inpatient procedures from 2016 to 2020. GSP patients (2018–2020) were identified by preoperative high-risk screening. Frailty was measured with the modified frailty index. Surgical procedures were ranked according to the operative stress score (1–5). Loss of independence (LOI), length of stay, major complications (CD II–IV), and 30-day all-cause unplanned readmissions were measured in the pre/postpatient populations and by propensity score matching of patients by operative procedure and frailty.
Results:
A total of 533 (300 pre-GSP, 233 GSP) patients similar by demographics (age and race) and clinical profile (frailty) were included. On multivariable analysis, GSP patients showed decreased risk for LOI [odds ratio (OR) 0.26 (0.23, 0.29) P<0.001] and major complications [OR: 0.63 (0.50, 0.78) P<0.001]. Propensity matching demonstrated similar findings. Examining frail patients alone, GSP showed decreased risk for LOI [OR: 0.30 (0.25, 0.37) P<0.001], major complications [OR: 0.31 (0.24, 0.40) P<0.001], and was independently associated with a reduction in length of stay [incidence rate ratios: 0.97 (0.96, 0.98), P<0.001].
Conclusions:
In our diverse patient population, implementation of a GSP led to improved geriatric-specific surgical outcomes. Future studies to examine pathway compliance would promote the identification of further interventions.
To examine geriatric-specific outcomes following implementation of a multispecialty geriatric surgical pathway (GSP).
Background:
In 2018, we implemented a GSP in accordance with the proposed 32 standards of American College of Surgeons’ Geriatric Surgery Verification Program.
Methods:
This observational study combined data from the electronic health record system (EHR) and ACS-National Surgery Quality Improvement Program (NSQIP) to identify patients ≥65 years undergoing inpatient procedures from 2016 to 2020. GSP patients (2018–2020) were identified by preoperative high-risk screening. Frailty was measured with the modified frailty index. Surgical procedures were ranked according to the operative stress score (1–5). Loss of independence (LOI), length of stay, major complications (CD II–IV), and 30-day all-cause unplanned readmissions were measured in the pre/postpatient populations and by propensity score matching of patients by operative procedure and frailty.
Results:
A total of 533 (300 pre-GSP, 233 GSP) patients similar by demographics (age and race) and clinical profile (frailty) were included. On multivariable analysis, GSP patients showed decreased risk for LOI [odds ratio (OR) 0.26 (0.23, 0.29) P<0.001] and major complications [OR: 0.63 (0.50, 0.78) P<0.001]. Propensity matching demonstrated similar findings. Examining frail patients alone, GSP showed decreased risk for LOI [OR: 0.30 (0.25, 0.37) P<0.001], major complications [OR: 0.31 (0.24, 0.40) P<0.001], and was independently associated with a reduction in length of stay [incidence rate ratios: 0.97 (0.96, 0.98), P<0.001].
Conclusions:
In our diverse patient population, implementation of a GSP led to improved geriatric-specific surgical outcomes. Future studies to examine pathway compliance would promote the identification of further interventions.
Keywords: NSQIP; frailty; geriatric surgical pathway
Document Type: Research Article
Affiliations: 1: Division of Geriatrics, Johns Hopkins University School of Medicine, Baltimore, MD, Johns Hopkins Bayview Medical Center, Baltimore, MD 2: Johns Hopkins Bayview Medical Center, Baltimore, MD, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 3: Division of Geriatrics, Johns Hopkins University School of Medicine, Baltimore, MD 4: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 5: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 6: Johns Hopkins Bayview Medical Center, Baltimore, MD
Publication date: June 15, 2023
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