Geriatric Comanagement of Older Vascular Surgery Inpatients Reduces Hospital-Acquired Geriatric Syndromes |
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| Institution: | 1. Department of Geriatric Medicine, Concord Hospital, Concord, Sydney, Australia;2. Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, Sydney, Australia;3. Center for Education and Research on Aging, and Aging and Alzheimers Institute, Concord, Sydney, Australia;4. Concord Institute of Academic Surgery, Vascular Surgery Department, Concord Hospital, Concord, Sydney, Australia;5. Department of Vascular Surgery, Concord Hospital, Concord, Sydney, Australia;6. Susan Wakil School of Nursing, The University of Sydney, Sydney, Australia;7. Kolling Institute of Medical Research, Sydney Medical School, University of Sydney and Royal North Shore Hospital, St Leonards, Sydney, Australia;1. Aarhus University, Aarhus, Denmark;2. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark;3. Danish Clinical Quality Program (RKKP) National Clinical Registries, Aarhus University Hospital, Aarhus, Denmark;1. College of Pharmacy, University of Houston, TX, USA;2. Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA;3. Healogics Inc, Jacksonville, FL, USA;4. Wound Healing and Tissue Repair Program, University of Illinois at Chicago, Chicago, IL, USA |
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| Abstract: | ObjectiveThis study evaluates the impact of a novel model of care called Geriatric Comanagement of Older Vascular surgery inpatients on clinical outcomes.Design, Setting, and ParticipantsA pre-post study of geriatric comanagement, comparing prospectively recruited preintervention (February–October 2019) and prospectively recruited postintervention (January–December 2020) cohorts. Consecutively admitted vascular surgery patients age ≥65 years at a tertiary academic hospital in Concord and with an expected length of stay (LOS) greater than 2 days were recruited.InterventionA comanagement model where a geriatrician was embedded within the vascular surgery team and delivered proactive comprehensive geriatric assessment based interventions.MethodsPrimary outcomes of incidence of hospital-acquired geriatric syndromes, delirium, and LOS were compared between groups using univariable and multivariable logistic regression analyses. Prespecified subgroup analysis was performed by frailty status.ResultsThere were 150 patients in the preintervention group and 152 patients in the postintervention group. The postintervention group were more frail 66 (43.4%) vs 45 (30.0%)], urgently admitted 72 (47.4%) vs 56 (37.3%)], and nonoperatively managed 52 (34.2%) vs 33 (22.0%)]. These differences were attributed to the coronavirus disease 2019 pandemic during the postintervention phase. The postintervention group had fewer hospital-acquired geriatric syndromes 74 (48.7%) vs 97 (64.7%); P = .005] and reduced incident delirium 5 (3.3%) vs 15 (10.0%); P = .02], in unadjusted and adjusted analyses. Cardiac 8 (5.3%) vs 30 (20.0%); P < .001] and infective complications 4 (2.6%) vs 12 (8.0%); P = .04] were also fewer. LOS was unchanged. Frail patients in the postintervention group experienced significantly fewer geriatric syndromes including delirium.Conclusions and ImplicationsThis is the first prospective study of inpatient geriatric comanagement for older vascular surgery patients. Reductions in hospital-acquired geriatric syndromes including delirium, and cardiac and infective complications were observed after implementing geriatric comanagement. These benefits were also demonstrated in the frail subgroup. |
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| Keywords: | Comanagement surgery delirium geriatrician |
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