The use of a coordinated interdisciplinary perioperative approach for older adults undergoing elective abdominal surgery resulted in shorter duration of hospital stay, fewer postinterventional complications, and lower rates of readmission compared with those who did not receive interdisciplinary care, according to study findings published in JAMA Surgery.
Data from 183 patients undergoing elective abdominal surgery were taken from the Perioperative Optimization of Senior Health (POSH) quality improvement initiative, a program that includes expertise from geriatric, anesthesia, and general surgery teams. These data were compared with data from 143 control patients to determine whether an interdisciplinary periprocedural approach was associated with length of stay, readmission at 7 and 30 days, and quality of care at discharge. Patients were included if they were older than 85 years of age or older than 65 years of age with cognitive impairment and recent weight loss.
Patients from the POSH arm were significantly older than controls (75.6 vs 71.9 years; 95% CI, 2.27-5.19; P <.001) and presented with a greater number of chronic conditions at baseline (10.6 vs 8.5; 95% CI, 0.86-3.35; P =.001). Participants in POSH experienced a significantly shorter length of hospital stay (4 days vs 6 days; 95% CI, -1.06 to -4.21; P <.001) as well as lower 7-day (2.8% vs 9.9%; 95% CI, 0.09-0.74; P =.007) and 30-day readmission rates (7.8% vs 18.3%; 95% CI, 0.19-0.75; P =.004).
Fewer complications were experienced among POSH participants compared with those in the control group (0.9 vs 1.4; 95% CI, -0.13 to -0.89; P <.001). However, those undergoing interdisciplinary care experienced higher rates of delirium (28.4% vs 5.6%; 95% CI, 3.06-14.65; P <.001). In addition, those in the interdisciplinary care group had a greater chance of being discharged home with self-care (62.3% vs 51.1%; 95% CI, 1.02-2.47; P =.04).
One limitation associated with this study relates to the longer patient accrual duration of the POSH group compared with the control arm, resulting in a slightly higher number of patients receiving interventional support. The investigators also note that there may be potential confounders because of the quasi-experimental design of the study.
More high-quality clinical data from the POSH initiative need to be captured to help clinicians “make better decisions about delivery of interventions at appropriate time intervals with respect to elective surgeries” and provide those interventions to older adults who will see the greatest benefit.
McDonald SR, Heflin MT, Whitson HE, et al. Association of integrated care coordination with postsurgical outcomes in high-risk older adults: the Perioperative Optimization of Senior Health (POSH) initiative [published online January 3, 2018]. JAMA Surg. doi: 10.1001/jamasurg.2017.5513