ARTICLE: Early Outcomes following Implementation of a Multispecialty Geriatric Surgery Pathway
AUTHORS: April L Ehrlich, Oluwafemi P Owodunni, Joshua C Mostales, Caroline Xu Qin, Priyanka J Hadvani, Luxey Sirisegaram, Dianne Bettick, Susan L Gearhart
JOURNAL: Ann Surg. 2022 Jul 15. doi: 10.1097/SLA.0000000000005567. Online ahead of print.
Objective: To examine geriatric-specific outcomes following implementation of a multispecialty geriatric surgical pathway (GSP).
Summary background data: 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 EHR and ACS-NSQIP to identify patients ≥65 years undergoing inpatient procedures from 2016-2020. GSP patients (2018-2020) were identified by preoperative high-risk screening. Frailty was measured with the Modified Frailty Index (mFI). Surgical procedures were ranked according to the Operative Stress Score (OSS, 1-5). Loss of independence (LOI), length of stay (LOS), major complications (CD II-IV), and 30-day all-cause unplanned readmissions were measured in the pre/post patient populations and by propensity score matching of patients by operative procedure and frailty.
Results: 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 (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 LOS (IRR 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.
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