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Journal of the American College of Surgeons ; 233(5):e75, 2021.
Article in English | EMBASE | ID: covidwho-1466564


Introduction: Older adults comprise an increasing proportion of emergency general surgery (EGS) admissions and face high morbidity and mortality. We created a geriatric surgical service with geriatric and palliative expertise to mitigate risks of hospitalization most hazardous to older patients. In this study, we identified geriatric surgical service interventions most relevant to EGS patients. Methods: We conducted a retrospective chart review of patients >75 years admitted to the EGS service at our urban tertiary care hospital with a score >3 by the FRAIL scale, a five-point frailty screening instrument, or history of dementia. The geriatric surgical service, led by a dually-board certified geriatric and palliative care specialist, consulted on these patients from January 2020-January 2021;a hiatus was taken for the COVID-19 pandemic. Consults included a comprehensive geriatric assessment and calculated a modified Rockwood Frailty Index. Hospital admission characteristics and consultation components were collected via chart review. Results: Forty patients were evaluated (median age 82 years (IQR 78-89), 55.0% female). The most common admission diagnosis was small bowel obstruction (32.5%). 62.5% of patients underwent >1 surgical procedure. Median time to geriatric consult from admission was 3 days (IQR 1.0-4.3). By Frailty Index, 58% were moderately or severely frail. Interventions included medication changes (97.5%), symptom management (82.5%), delirium prevention and management (65.0%), mobility and function recommendations (65.0%), serious illness conversations (55.0%), and code status change (17.5%). Conclusion: Geriatric service involvement identifies and addresses a high burden of both geriatric and palliative care needs in older adult EGS patients.

Journal of the American Geriatrics Society ; 69(SUPPL 1):S60, 2021.
Article in English | EMBASE | ID: covidwho-1214833


Background: Preoperative cognitive assessment has been advocated for adults ≥ 65 years-old due to increased risk for post-operative complications such as postoperative delirium, postoperative cognitive decline, and increased mortality. Most screening tools for cognitive impairment require in-person evaluation. During the COVID-19 pandemic, most medical centers have changed their workflows to telemedicine platforms. In this study we aim to assess the feasibility of a telephone-based cognitive assessment tool, the Mini-Montreal Cognitive Assessment (Mini-MOCA) prior to surgery and 30-day post surgery to evaluate any changes in cognitive function. Methods: Patients age ≥70 year who were candidates for surgery and had a telemedicine visit in the preoperative clinic during December 2020 were included. Exclusion criteria included hearing impairment, day-surgery, inability to speak English and a prior diagnosis of Dementia. Eligible patients were asked to complete an attention test, the Mini-MOCA and function assessment using the Katz score for activities of daily living (ADL) and Lawton-Brody for instrumental activities of daily living (IADL). Anxiety was assessed using the Generalized Anxiety Disorder 2-item (GAD-2). Baseline demographics including medications and education level were collected. Anti-cholinergic effect was assessed using an anti-cholinergic score calculator (ACS). Results: Overall 24 patients completed the preoperative assessment. The cohort was 50% female, white (96%), with a median age of 74 years (range: 71-82). The median number of medications was 8 (range:2-20), 16/24 (67%) taking medications with anti-cholinergic effects and a median ACS of 1 (range 1-13), and 4/24 (17%) on Benzodiazepines. The median Katz score was 6 (range: 4-6) and Lawton-Brody score 8 (range: 5-8). The mean time for completion of the phone assessment was 10 minutes and 4 minutes for the Mini- MOCA. The median Mini-MOCA score was 13.5 (range: 9-15). Conclusions: In our preliminary results we show that a telephone- based cognitive assessment prior to surgery is well accepted and feasible among older adults who are candidates for surgery. Our study is ongoing, and will continue to conduct pre- and post-operative cognitive evaluations (updated results will be presented).