A new study published in the Journal of the American College of Surgeons reported that addition of geriatric-specific data to a national surgical dataset might help hospitals improve post-surgery outcomes of older patients.
Lead author Dr Julia R. Berian said: “The findings confirm what many clinicians know to be true by gestalt when looking at an older patient. We collect information such as the history of falling within the prior year and found it to be significant in predicting multiple poor outcomes.”
In addition to the standard data already collected by the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), the ACS NSQIP Geriatric Surgery Pilot collected risk factors specific to geriatric patients: preoperative mobility aid use, history of falls, cognitive impairment, functional status, preoperative palliative care, living status at home, and surrogate consent.
In the study, the researchers analyzed data from 36,399 patients age 65 or older who mainly underwent general-vascular and orthopaedic surgery at 31 hospitals in the U.S. and Canada. The researchers focused primarily on four geriatric-specific outcomes: postoperative delirium, functional decline, need for a new mobility aid and new or worsened pressure ulcers.
The authors note that surrogate consent was associated with a 50% increased risk for serious morbidity or mortality after general-vascular surgery and a 30% increased risk of orthopaedic surgery. The researchers emphasize that the geriatric-specific outcomes examined in their study “may be important targets for quality improvement in older adults.
Collecting baseline cognition and function is new to clinical data registries. Improving care requires an increased awareness of these issues on the clinical side and better data registries to enable us to track our progress. Registries such as ACS NSQIP have become a critically important tool in evaluating the quality of care by providing a common platform for surgical data collection and analysis.
NSQIP is the gold standard for outcomes research and quality improvement. Including specific factors that may be important in the elderly is critical to helping surgeons, patients, and families make informed decisions using high-quality data. All the findings have a significant potential impact on patient care. How surgeries affect geriatric domains and how they affect functional outcomes have been largely unknown, Dr Saket Saxena of the Cleveland Clinic in Ohio said.
The pilot study suggests where we should be in current surgical practice, raising awareness and laying the groundwork for future studies. The most interesting finding is the consenting process. The study shows that if the family consents for surgery, outcomes are poor. This parameter alone can impact, and should start discussions about outcomes, he added.