Abstract
Objective
This study evaluates the impact of a novel model of care called Geriatric Comanagement
of Older Vascular surgery inpatients on clinical outcomes.
Design, Setting, and Participants
A pre-post study of geriatric comanagement, comparing prospectively recruited preintervention
(February–October 2019) and prospectively recruited postintervention (January–December
2020) cohorts. Consecutively admitted vascular surgery patients age ≥65 years at a
tertiary academic hospital in Concord and with an expected length of stay (LOS) greater than 2 days were recruited.
Intervention
A comanagement model where a geriatrician was embedded within the vascular surgery
team and delivered proactive comprehensive geriatric assessment based interventions.
Methods
Primary outcomes of incidence of hospital-acquired geriatric syndromes, delirium,
and LOS were compared between groups using univariable and multivariable logistic
regression analyses. Prespecified subgroup analysis was performed by frailty status.
Results
There were 150 patients in the preintervention group and 152 patients in the postintervention
group. The postintervention group were more frail [66 (43.4%) vs 45 (30.0%)], urgently
admitted [72 (47.4%) vs 56 (37.3%)], and nonoperatively managed [52 (34.2%) vs 33
(22.0%)]. These differences were attributed to the coronavirus disease 2019 pandemic
during the postintervention phase. The postintervention group had fewer hospital-acquired
geriatric syndromes [74 (48.7%) vs 97 (64.7%); P = .005] and reduced incident delirium [5 (3.3%) vs 15 (10.0%); P = .02], in unadjusted and adjusted analyses. Cardiac [8 (5.3%) vs 30 (20.0%); P < .001] and infective complications [4 (2.6%) vs 12 (8.0%); P = .04] were also fewer. LOS was unchanged. Frail patients in the postintervention
group experienced significantly fewer geriatric syndromes including delirium.
Conclusions and Implications
This is the first prospective study of inpatient geriatric comanagement for older
vascular surgery patients. Reductions in hospital-acquired geriatric syndromes including
delirium, and cardiac and infective complications were observed after implementing
geriatric comanagement. These benefits were also demonstrated in the frail subgroup.
Keywords
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Article info
Publication history
Published online: October 28, 2021
Footnotes
This work was supported by Sydney Local Health District The Pitch Project and The Ageing And Alzheimers Institute.
Dr Thillainadesan is supported by the National Health and Medical Research Council (NHMRC) Medical Research Postgraduate Scholarship and MIGA's Doctors in Training Grants Program. Dr Aitken 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.
Identification
Copyright
© 2021 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
