Pre-Operative Comprehensive Geriatric Assessment for Frail Older Surgical Patients: A Service Model

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Introduction Pre-operative Comprehensive Geriatric Assessment (CGA) prior to surgery is recommended for all patients living with frailty, although no standardised model exists. We describe a model of care at a tertiary surgical centre embedded within an existing pre-operative pathway. Methods This is a descriptive study of 100 consecutive patients seen in a pre-operative geriatrician-led CGA clinic from March 2023 until November 2024. Referrals to the clinic were made following anaesthetic pre-operative assessment or after discussion at a ‘High-risk Anaesthetic’ multi-disciplinary team meeting. Data was collected from electronic medical records. The study was registered within the organisation as a service evaluation. Results Mean age was 79 years; 50% were male. Mean Clinical Frailty Scale score was 5. Mean Charlson Comorbidity Index was 6. Polypharmacy was present in 92%, with de-prescribing in 42%. 27% of patients had cognitive impairment. Surgical specialties included Orthopaedics (33%), Uro-Gynaecology (23%) and Vascular (17%). 50% did not undergo surgery; active shared decision-making was the leading reason (52%), and 1-year mortality was 12%. In the operative group, 40% had a post-operative geriatrician review. 16% developed post-operative delirium. Median length of stay was 7 days. 72% were discharged to their pre-operative level of care. 30-day and 1-year mortality was 2% and 10%, respectively. For both groups, 1-year survivors had lower mean Charlson co-morbidities scores than those who died (5 [range 3-12] versus 7 [range 5-10]; p=0.04). Conclusions We describe a service identifying frail patients within an existing pathway who might benefit from surgery. For those who had surgery, the majority went home to preexisting levels of care. Mortality at 1 year was high for all patients.