Receiving surgical care at a hospital with a geriatric surgical pathway reduced length of stay (aIRR 2.63) and hospital-acquired conditions by 51.5% compared to no pathway.
Does receiving surgical care at a hospital with a geriatric surgical pathway improve postoperative outcomes in older patients undergoing elective non-cardiac surgery?
Implementation of a geriatric surgical pathway is associated with shorter length of stay and fewer hospital-acquired conditions, though it may be associated with higher readmission rates.
Absolute Event Rate: 0% vs 0%
Background: The American College of Surgeon (ACS)’s Geriatric Surgical Verification (GSV) Program improves outcomes in pre-post implementation analyses. However, data are limited, and none have compared hospitals with and without geriatric surgical pathways (GSPs). We evaluated post-operative outcomes comparing a hospital with a GSP (GSP+) and without a GSP (GSP-) in an academic health system. Methods: We included all elective non-cardiac surgical procedures among patients ≥65 years who completed a pre-operative frailty screening from 2018-2023 at 2 hospitals in our health system. Covariates included demographics and the operative stress score to account for case variability. Outcomes were loss of independence (LOI), length of stay (LOS), readmissions, and hospital acquired conditions. Results: During the study, 3,098 older patients underwent surgery, 24% at GSP+ and 76% at GSP- site. The median age was 72 years, 50% were female, 73% were white, and 27% were frail. In univariate Poisson exact test, GSP- had 51.5% higher hospital acquired conditions per 1,000 discharges compared to GSP+ (p-value: 0.05). In multivariate analysis, GSP- had increased risk for longer LOS (aIRR 2.63, 95% CI: 1.59, 4.37) but lower odds of readmission (aOR 0.68, 95% CI: 0.53, 0.88) compared to GSP+. There was no relation for LOI (aOR 0.97, 95% CI: 0.78, 1.22) by hospital site. Conclusions: These findings demonstrate that older patients receiving care with geriatric surgical support have improved LOS and decreased reportable complications, which supports the need for randomized prospective studies to establish the unbiased benefits of GSPs that align with the ACS GSV program.
Jabour et al. (Wed,) reported a other. Receiving surgical care at a hospital with a geriatric surgical pathway reduced length of stay (aIRR 2.63) and hospital-acquired conditions by 51.5% compared to no pathway.