Improving health-related outcomes through a geriatric perioperative service targeting cognitively impaired older adults undergoing major surgery

Background: Cognitively impaired older persons are at increased risk of delirium and adverse healthcare outcomes, yet cognitive impairment is not targeted in older surgical patients. This study examines if a geriatric perioperative service (GPS) targeting cognitive impairment in these patients improves 30-day non-elective readmissions and 90-day postoperative mortality. Material and methods: This is a single-center, before–after study with the intervention involving patients (1) aged 65 years and above, (2) undergoing a major surgery, and (3) with diagnoses of delirium, mild cognitive impairment, or dementia. Such patients underwent geriatric consultation and proactive geriatric- and delirium-centered nursing management within the surgical wards and are compared to historical controls. Results: GPS improved 30-day non-elective readmission by −19.7% [95% confidence interval (CI): −34.8% to −4.0%] and 90-day postoperative mortality by −14.7% (95% CI: −26.8% to −2.6%). This is in tandem with reductions in incidence of acute coronary syndrome −16.7% (95% CI: −28.2% to −5.1%), arrhythmia −14.7% (95% CI: −28.1% to −1.2%), congestive heart failure −12.0% (95% CI: −21.9% to −2.1%), and urinary tract infections −13.3% (95% CI: −23.5% to −3.2%). There are less indwelling urinary catheters >72 h −24.7% (95% CI: −42.0% to −7.3%), less fasting >72 h −26.7% (95% CI: −41.8% to −11.6%), less dehydration episodes −26.0% (95% CI: −40.7% to −11.3%), fewer inpatient consultations with −0.7 referrals per patient (95% CI: −1.14 to −0.26), and greater proportion of patients with ≥1 point reductions in anticholinergic burden 25.9% (95% CI: 8.6–43.2%). Conclusion: In conclusion, this GPS showed that it was associated with improved healthcare outcomes.