Abstract
Objectives
Managing older patients with surgical conditions is a major challenge for hospitals.
There is therefore a growing interest in providing geriatric perioperative services.
The aim of this systematic review and meta-analysis was to characterize and assess
the impact of targeted perioperative geriatric interventions on clinical outcomes
of older adults admitted to nonorthopedic surgical teams.
Design, Setting and Participants
A systematic review and meta-analysis of studies of perioperative geriatric interventions
in older adults hospitalized under nonorthopedic surgical teams.
Methods
Ovid MEDLINE, EMBASE, PsycINFO, Scopus, Cochrane Central Register of Controlled Trials,
CINAHL, and trial registry databases were searched. Primary outcomes were change in
functional status and length of stay (LOS).
Results
Fifteen randomized controlled trials (RCTs) and 9 prospective before-and-after studies
met the inclusion criteria (n = 3026 participants). Perioperative geriatric interventions
included preoperative comprehensive geriatric assessment and management (CGA) (5 studies),
multicomponent inpatient geriatric programs (8 studies), cognitive training (1 study),
exercise (5 studies), and prehabilitation (5 studies). Exercise therapy [mean difference
(MD) −1.90, 95% confidence interval (CI) −3.01, −0.80], multicomponent inpatient geriatric
programs (MD –1.98, 95% CI –3.09, −0.88), and prehabilitation (MD –1.32, 95% CI –2.75,
0.11) reduced LOS. Functional decline was highly heterogeneous, with 4 of 8 studies
reporting significantly less functional decline. Geriatric perioperative interventions
reduced complications [exercise therapy risk ratio (RR) 0.74, 95% CI 0.48, 1.15; prehabilitation
RR 0.61, 95% CI 0.47, 0.80] and delirium (multicomponent inpatient geriatric programs
RR 0.49, 95% CI 0.27, 0.90; preoperative CGA RR 0.54, 95% CI 0.33, 0.89). There was
no significant impact on mortality or readmissions.
Conclusions and Implications
Perioperative geriatric interventions targeted at older nonorthopedic surgical patients
improve some clinically relevant outcomes. There is a need for these interventions
to be further evaluated in high-quality studies, and future research should explore
how to effectively implement these interventions within complex health care systems.
Keywords
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Article info
Publication history
Published online: May 14, 2020
Footnotes
J.T. is supported by the National Health and Medical Research Council (NHMRC) Medical Research Postgraduate Scholarship and MIGA's Doctors in Training Grants Program, and S.J.A. is supported by the Royal Australasian College of Surgeons Senior Lecturer Grant, Australian and New Zealand Society of Vascular Surgeons Vascular Foundation Grant and University of Sydney Medical Foundation Chapman Bequest and John Brooke Moore Scholarships.
The authors declare no conflicts of interest.
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© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
