A Description of Interventions Prompted by Preoperative Comprehensive Geriatric Assessment and Optimization in Older Elective Noncardiac Surgical Patients.
J Am Med Dir Assoc
; 2022 Sep 20.
Article
in English
| MEDLINE | ID: covidwho-2036188
ABSTRACT
OBJECTIVES:
Comprehensive Geriatric Assessment (CGA), a multicomponent, complex intervention, can be used to improve perioperative outcomes. This study aimed to describe the actions and interventions prompted by preoperative CGA and optimization in elective noncardiac, older, surgical patients.DESIGN:
Retrospective observational study. SETTING ANDPARTICIPANTS:
Five hundred consecutive patients aged over 65 years attending a preoperative CGA and optimization clinic in a single academic center.METHODS:
A retrospective review of electronic clinical records was undertaken. CGA prompted actions and interventions were categorized a priori and examined according to the perioperative pathway and frailty status.RESULTS:
Patients received a median of nine interventions (IQR 6â12, range 0â28). Long-term condition medication changes were made in 375 (75.0%) patients, lifestyle advice provided in 269 (53.8%), therapy interventions delivered in 117 (23.4%), shared decision making documented in 495 (99.0%) with individualized admission plans documented in 410/426 (96.2%). Following CGA, 74/500 (14.8%) patients did not undergo surgery and were more likely to have benign pathology (69% vs 53%, P = .01), higher frailty scores (Edmonton Frail Scale 8 (IQR 5â10) vs 4 (IQR 2-6), P < .001), lower functional status (Nottingham Extended Activities of Daily Living 33 (IQR 16â47) vs 57 (IQR 45â64), P < .001) or cognitive scores (Montreal Cognitive Assessment 19 (IQR 14â24) vs 24 (IQR 20â26), P < .001). CONCLUSIONS AND IMPLICATIONS This study provides a description of actions and interventions prompted by preoperative CGA at one center. Such a detailed exploration of the CGA process and the clinical skills necessary to deliver it, should be used to inform future multicenter studies and the development and implementation of perioperative services for older patients.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Type of study:
Experimental Studies
/
Observational study
/
Prognostic study
Language:
English
Journal subject:
History of Medicine
/
Medicine
Year:
2022
Document Type:
Article
Affiliation country:
J.jamda.2022.08.009
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