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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Article info
Publication history
Published online: September 19, 2022
Accepted:
August 14,
2022
Received in revised form:
August 12,
2022
Received:
June 27,
2022
Footnotes
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.
