Preoperative Geriatric Medicine Evaluation in a Multidisciplinary Abdominal Wall Reconstruction Clinic and Outcomes in Geriatric Patients

Background: Chronological age is associated with adverse outcomes after abdominal wall reconstruction (AWR), yet many age-linked risks are modifiable. This study evaluated the benefit of integrating Geriatric Medicine (GM) into a multidisciplinary AWR clinic. Study Design: Using a prospectively maintained database, patients ≥65 years old underwent AWR after a preoperative GM consultation were propensity matched in a 1:1 fashion to (1) patients ≥65 years prior to GM integration (NGM) and (2) younger patients (<65 years). Primary outcomes were hospital length-of-stay (LOS) and 30-day medical and surgical complications. Results: GM versus NGM: 124 pairs were similar in matching covariates, including age (74.5±6.0vs. 5.7±8.0years; p =0.204). GM patients had higher rates of steroids (17.7%vs.3.2%; p <0.001), ASA class III (73.4%vs.44.4%; p <0.001) but fewer medical complications (4.8%vs.16.1%; p =0.006) and fewer ICU admissions (0.8%vs.5.6%; p =0.066). GM versus NGM ventral hernia subgroup: 62 pairs were similar in matching covariates and hernia complexity. GM patients were more comorbid but had reduced LOS (4.7±2.9vs.6.7±6.5days; p =0.028) and wound complications (3.2%vs.21.0%; p =0.004). GM versus younger: 100 pairs were similar in matching covariates, except for BMI (29.0±4.7vs.31.7±6.2kg/m 2 ; p =0.002). GM patients were older (73.0±5.0vs.49.5±7.7years; p <0.001), more comorbid (COPD: 12.0%vs.0.0%; p <0.001, steroids: 14.0%vs.5.0%; p =0.030), but comparable in hernia complexity. GM had shorter LOS (4.9±5.4vs.5.8±6.7days; p =0.001). Medical complications, wound complications, reoperations, and readmissions were not statistically different (all p >0.050). Conclusions: Embedding GM into a multidisciplinary AWR clinic was associated with clinically meaningful reductions in LOS and complications compared to matched older adults without GM and outcomes equal to a matched cohort nearly 25 years younger. Preoperative GM consultation should be considered for complex AWR candidates.