Key result
Preoperative geriatrics co-management in older surgical patients resulted in a 63% rate of discharge back to the community compared to 50% for those seen after surgery (P=0.10).
Why the study?
Does preoperative geriatrics co-management improve rates of discharge back to the community in older adults undergoing surgery compared to postoperative evaluation?
Observational (n=211)
No
Does preoperative geriatrics co-management improve rates of discharge back to the community in older adults undergoing surgery compared to postoperative evaluation?
Absolute Event Rate: 63% vs 50%
p-value: p=.10
A geriatrics co-management model for older surgical patients is feasible and may improve rates of discharge to the community when initiated preoperatively.
Preoperative geriatrics co-management was not significantly associated with higher community discharge; hypothesis-generating and should not yet change practice.
Surgery is common in older adults, so geriatric and surgical providers need to develop expertise in the care of older adults undergoing surgery. The Co-management of Older Operative Patients En Route Across Treatment Environments (CO-OPERATE) program is a clinical and educational collaboration between geriatrics and several surgical specialties at Veterans Affairs Health Care Connecticut. Individuals in CO-OPERATE are co-managed during the pre-, peri-, and postoperative periods. General surgery, urology, vascular surgery, orthopedics, cardiothoracic surgery and neurosurgery all participate in the program, with geriatrics expertise provided by a geriatrician, geriatric nurse practitioner and a geriatric clinical pharmacist. In the initial 3 years, there were 211 CO-OPERATE participants; 31% were evaluated preoperatively, and 62% of the individuals seen preoperatively were seen in clinic. There was a median of three recommendations per consultation. At discharge, 56% returned to the community. Individuals seen preoperatively were more likely to return to the community (63%) than those seen after surgery (50%, P = .10). Geriatrics co-management with a variety of surgical specialties is feasible and may be associated with higher rates of discharge back to the community.
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Walke et al. (2014) conducted an observational in Older adults undergoing surgery (n=211). Preoperative geriatrics co-management vs. Postoperative geriatrics co-management was evaluated on Return to the community at discharge (p=.10). Preoperative geriatrics co-management in older surgical patients resulted in a 63% rate of discharge back to the community compared to 50% for those seen after surgery (P=0.10).
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