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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Age of patients undergoing surgery.Br J Surg. 2019; 106: 1012-1018
- Surgical risk factors, morbidity, and mortality in elderly patients.J Am Coll Surg. 2006; 203: 865-877
- Lower extremity arterial reconstruction in octogenarians and older.Ann Vasc Surg. 2016; 34: 171-177
- Elective and Emergency Surgery in the Elderly: An Age Old Problem. National Confidential Enquiry into Patient Outcome and Death, 2010
- Optimal preoperative assessment of the geriatric surgical patient: A best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society.J Am Coll Surg. 2012; 215: 453-466
- The High-Risk Surgical Patient: Raising the Standard. Royal College of Surgeons, 2018
- Randomized clinical trial of comprehensive geriatric assessment and optimization in vascular surgery.Br J Surg. 2017; 104: 679-687
- Optimising preoperative assessment for older people.Anaesthesia. 2018; 73: 1317-1320
- Perioperative optimization of elderly and frail patients: A narrative review.Anaesthesia. 2019; 74: 80-89
- Scaling up perioperative medicine for older people undergoing surgery (POPS) services; use of a logic model approach.Clin Med. 2019; 19: 478
- Care of older people in surgery for general surgery: A single center experience.ANZ J Surg. 2021; 91: 890-895
- Clinical effectiveness of the elder-friendly approaches to the surgical environment initiative in emergency general surgery.JAMA Surg. 2020; 155: e196021
- Best practice guidelines for the management of frailty: a British Geriatrics Society, Age UK and Royal College of General Practitioners report.Age Ageing. 2014; 43: 744-747
- What is comprehensive geriatric assessment (CGA)? An umbrella review.Age Ageing. 2018; 47: 149-155
- Comprehensive geriatric assessment: A meta-analysis of controlled trials.The Lancet. 1993; 342: 1032-1036
- Comprehensive geriatric assessment for older adults admitted to hospital.Cochrane Database Syst Rev. 2017; 9: CD006211
- Prehabilitation before surgery: Is it for all patients?.Best Pract Res Clin Anaesthesiol. 2021; 35: 507-516
- Prehabilitation in the Older People: Current developments.Curr Anesthesiol Reports. 2021; : 373-380https://doi.org/10.1007/s40140-021-00496-9
- Comprehensive geriatric assessment for older people admitted to a surgical service.Cochrane Database Syst Rev. 2018; 1: CD012485
- Preoperative comprehensive geriatric assessment and optimization prior to elective arterial vascular surgery: A health economic analysis.Age Ageing. 2021; 50: 1770-1777
- Guideline for Perioperative Care for People Living with Frailty Undergoing Elective and Emergency Surgery. Center for Perioperative Care, 2021
- Developing and evaluating complex interventions: The new Medical Research Council guidance.BMJ. 2008; 29: 337
- Better reporting of interventions: Template for intervention description and replication (TIDieR) checklist and guide.BMJ. 2014; 348: g1687
- Routine preoperative tests for elective surgery. 2016https://www.nice.org.uk/guidance/ng45Date accessed: November 1, 2022
- perioperative medicine for older people.Ann Acad Med Singapore. 2019; 48: 376-381
- Validation of the Charlson Comorbidity Index in acutely hospitalized elderly adults: A prospective cohort study.J Am Geriatr Soc. 2014; 62: 342-346
- The extended activities of daily living scale: A further validation.Disabil Rehabil. 1992; 14: 41-43
- The timed “Up & Go”: A test of basic functional mobility for frail elderly persons.J Am Geriatr Soc. 1991; 39: 142-148
- The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment.J Am Geriatr Soc. 2005; 53: 695-699
- The validity of the hospital anxiety and depression scale. An updated literature review.J Psychosom Res. 2002; 52: 69-77
- Validity and reliability of the Edmonton Frail Scale.Age Ageing. 2006; 35: 526-529
- Performance of Edmonton Frail Scale on frailty assessment: its association with multi-dimensional geriatric conditions assessed with specific screening tools.BMC Geriatr. 2017; 17: 2
- Effect of preoperative geriatric evaluation on outcomes after elective surgery: A population-based study.J Am Geriatr Soc. 2017; 65: 2665-2672
- Embedded geriatric surgical liaison is associated with reduced inpatient length of stay in older patients admitted for gastrointestinal surgery.Future Healthc J. 2018; 5: 108
- Establishing a perioperative medicine for older people undergoing surgery service for general surgical patients at a district general hospital.Clin Med. 2021; 21: e608-e614
- Can comprehensive geriatric assessment be delivered without the need for geriatricians? A formative evaluation in two perioperative surgical settings.Age Ageing. 2019; 48: 644-649
- Improving outcomes for older people undergoing emergency surgery: Opportunities for advanced practice.Journal of Advanced Nursing. 2020; 00: 1-2
- Surgical activity in England and Wales during the COVID-19 pandemic: A nationwide observational cohort study.Clin Investig. 2021; 127: 196-204
- Understanding decision making about major surgery: Protocol for a qualitative study of shared decision making by high-risk patients and their clinical teams.BMJ Open. 2020; 10: e033703
- Development and validation of an electronic frailty index using routine primary care electronic health record data.Age Ageing. 2016; 45: 353-360
- A global clinical measure of fitness and frailty in elderly people.CMAJ. 2005; 173: 489-495
Article Info
Publication History
Published online: September 19, 2022
Accepted:
August 14,
2022
Received in revised form:
August 12,
2022
Received:
June 27,
2022
Publication stage
In Press Corrected ProofFootnotes
This research did not receive any funding from agencies in the public, commercial, or not-for-profit sectors.
Identification
Copyright
© 2022 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
