Care Coordination and Optimization in Geriatric Surgery ( COGS ): A Pilot Program to Improve Surgical Outcomes in Older Adults

Older adults undergoing surgery are at increased risk for complications, functional decline, and prolonged recovery due to frailty and other age-related vulnerabilities. To address these challenges, we developed the Care Coordination and Optimization in Geriatric Surgery (COGS) program, a pilot initiative integrating comprehensive geriatric assessment and targeted optimization into routine surgical care for Veterans. Using the Risk Analysis Index-Clinical (RAI-C) to identify higher-risk patients, the COGS team-comprising geriatric providers, nursing, and surgical staff-provides individualized evaluation and interventions focused on nutrition, mobility, medication safety, cognition, and social support. By embedding geriatric expertise directly into the surgical clinic, the program fosters collaboration among surgeons and geriatricians, improving communication and supporting shared decision-making about surgical readiness. Early experience demonstrates that COGS is both feasible and well-received, enhancing the coordination of care for older Veterans and aligning surgical decisions with patients' goals and overall health status. Expansion of the program to additional surgical specialties and evaluation of short and long-term outcomes are underway. The COGS model demonstrates how integrating geriatrics principles within surgical care can promote safer, more goal-aligned surgery for older adults.