Surrogate consent (OR 1.5; 95% CI 1.3-1.8) and use of a mobility aid (OR 1.3; 95% CI 1.1-1.4) increased the risk for serious morbidity or mortality in older adults undergoing general-vascular surgery.
Observational (n=36,399)
Yes
Incorporating geriatric-specific risk factors like cognition and mobility into surgical datasets improves risk adjustment for predicting postoperative outcomes in older adults.
Odds Ratio: 1.5 (95% CI 1.3–1.8)
BACKGROUND: Surgical quality datasets can be better tailored toward older adults. The American College of Surgeons (ACS) NSQIP Geriatric Surgery Pilot collected risk factors and outcomes in 4 geriatric-specific domains: cognition, decision-making, function, and mobility. This study evaluated the contributions of geriatric-specific factors to risk adjustment in modeling 30-day outcomes and geriatric-specific outcomes (postoperative delirium, new mobility aid use, functional decline, and pressure ulcers). STUDY DESIGN: Using ACS NSQIP Geriatric Surgery Pilot data (January 2014 to December 2016), 7 geriatric-specific risk factors were evaluated for selection in 14 logistic models (morbidities/mortality) in general-vascular and orthopaedic surgery subgroups. Hierarchical models evaluated 4 geriatric-specific outcomes, adjusting for hospitals-level effects and including Bayesian-type shrinkage, to estimate hospital performance. RESULTS: There were 36,399 older adults who underwent operations at 31 hospitals in the ACS NSQIP Geriatric Surgery Pilot. Geriatric-specific risk factors were selected in 10 of 14 models in both general-vascular and orthopaedic surgery subgroups. After risk adjustment, surrogate consent (odds ratio OR 1.5; 95% CI 1.3 to 1.8) and use of a mobility aid (OR 1.3; 95% CI 1.1 to 1.4) increased the risk for serious morbidity or mortality in the general-vascular cohort. Geriatric-specific factors were selected in all 4 geriatric-specific outcomes models. Rates of geriatric-specific outcomes were: postoperative delirium in 12.1% (n = 3,650), functional decline in 42.9% (n = 13,000), new mobility aid in 29.7% (n = 9,257), and new or worsened pressure ulcers in 1.7% (n = 527). CONCLUSIONS: Geriatric-specific risk factors are important for patient-centered care and contribute to risk adjustment in modeling traditional and geriatric-specific outcomes. To provide optimal patient care for older adults, surgical datasets should collect measures that address cognition, decision-making, mobility, and function.
Berian et al. (Tue,) conducted a observational in Surgical patients (general-vascular and orthopaedic) (n=36,399). Geriatric-specific risk factors (e.g., surrogate consent, mobility aid use) vs. Absence of risk factors was evaluated on Serious morbidity or mortality in the general-vascular cohort (associated with surrogate consent) (OR 1.5, 95% CI 1.3-1.8). Surrogate consent (OR 1.5; 95% CI 1.3-1.8) and use of a mobility aid (OR 1.3; 95% CI 1.1-1.4) increased the risk for serious morbidity or mortality in older adults undergoing general-vascular surgery.