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A Description of Interventions Prompted by Preoperative Comprehensive Geriatric Assessment and Optimization in Older Elective Noncardiac Surgical Patients

  • Author Footnotes
    † Joint first authors.
    Rihan Shahab
    Footnotes
    † Joint first authors.
    Affiliations
    Perioperative Medicine for Older People undergoing Surgery (POPS), Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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  • Author Footnotes
    † Joint first authors.
    Nicola Lochrie
    Footnotes
    † Joint first authors.
    Affiliations
    Perioperative Medicine for Older People undergoing Surgery (POPS), Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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  • Ian K. Moppett
    Affiliations
    Department of Anesthesia, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom

    Anesthesia and Critical Care Section, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
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  • Prokar Dasgupta
    Affiliations
    Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom

    Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
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  • Author Footnotes
    ‡ Joint last authors.
    Judith S.L. Partridge
    Footnotes
    ‡ Joint last authors.
    Affiliations
    Perioperative Medicine for Older People undergoing Surgery (POPS), Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom

    School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
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  • Author Footnotes
    ‡ Joint last authors.
    Jugdeep K. Dhesi
    Correspondence
    Address correspondence to Jugdeep K. Dhesi, PhD, Older Persons Assessment Unit, Guy's Hospital, Bermondsey Wing, St Thomas St, London SE1 9RT, United Kingdom.
    Footnotes
    ‡ Joint last authors.
    Affiliations
    Perioperative Medicine for Older People undergoing Surgery (POPS), Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom

    School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom

    Division of Surgery and Interventional Science, Research Department of Targeted Intervention, University College London, London, United Kingdom
    Search for articles by this author
  • Author Footnotes
    † Joint first authors.
    ‡ Joint last authors.
Published:September 19, 2022DOI:https://doi.org/10.1016/j.jamda.2022.08.009

      Abstract

      Objectives

      Comprehensive Geriatric Assessment (CGA), a multicomponent, complex intervention, can be used to improve perioperative outcomes. This study aimed to describe the actions and interventions prompted by preoperative CGA and optimization in elective noncardiac, older, surgical patients.

      Design

      Retrospective observational study.

      Setting and Participants

      Five hundred consecutive patients aged over 65 years attending a preoperative CGA and optimization clinic in a single academic center.

      Methods

      A retrospective review of electronic clinical records was undertaken. CGA prompted actions and interventions were categorized a priori and examined according to the perioperative pathway and frailty status.

      Results

      Patients received a median of nine interventions (IQR 6‒12, range 0‒28). Long-term condition medication changes were made in 375 (75.0%) patients, lifestyle advice provided in 269 (53.8%), therapy interventions delivered in 117 (23.4%), shared decision making documented in 495 (99.0%) with individualized admission plans documented in 410/426 (96.2%). Following CGA, 74/500 (14.8%) patients did not undergo surgery and were more likely to have benign pathology (69% vs 53%, P = .01), higher frailty scores (Edmonton Frail Scale 8 (IQR 5‒10) vs 4 (IQR 2-6), P < .001), lower functional status (Nottingham Extended Activities of Daily Living 33 (IQR 16‒47) vs 57 (IQR 45‒64), P < .001) or cognitive scores (Montreal Cognitive Assessment 19 (IQR 14‒24) vs 24 (IQR 20‒26), P < .001).

      Conclusions and Implications

      This study provides a description of actions and interventions prompted by preoperative CGA at one center. Such a detailed exploration of the CGA process and the clinical skills necessary to deliver it, should be used to inform future multicenter studies and the development and implementation of perioperative services for older patients.

      Keywords

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