Comprehensive geriatric assessment for older adults undergoing surgery: A protocol for a systematic review and meta-analysis

Background Older adults undergoing surgery experience higher rates of postoperative morbidity, mortality, functional decline and institutionalisation compared with younger populations. Emerging evidence suggests that frailty screening and perioperative geriatric optimisation may improve postoperative outcomes. Comprehensive Geriatric Assessment (CGA) is the gold-standard approach for the identification and management of older adults living with frailty. Previous Cochrane reviews demonstrated that CGA improves outcomes for medically admitted older adults and hip fracture patients, although evidence remains limited for other surgical populations. This systematic review aims to update the 2018 review and synthesise current evidence regarding the effectiveness of CGA in older surgical patients. Methods and analysis This protocol follows PRISMA-P guidelines and is registered with PROSPERO (CRD420261322154). MEDLINE, Embase, CINAHL, PsycINFO and CENTRAL will be searched for randomised and quasi-randomised trials published from 2017 onwards involving adults aged ≥65 years undergoing surgical care. Eligible interventions must include multidimensional CGA delivered by a geriatric-trained healthcare professional. The primary outcome will be functional status. Secondary outcomes will include length of stay, mortality, days at home alive, readmission, cognitive outcomes, adverse events and postoperative complications. Two reviewers will independently screen studies, extract data and assess risk of bias using the Cochrane RoB 2 tool. Meta-analysis will be conducted where appropriate. Discussion This review will provide an updated synthesis of evidence regarding the effectiveness of CGA in older surgical patients and will inform clinicians, researchers and policymakers regarding the delivery of age-friendly perioperative care.