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Effect of Preoperative Geriatric Evaluation on Outcomes After Elective Surgery: A Population-Based Study.
Journal of the American Geriatrics Society 2017 December
BACKGROUND/OBJECTIVES: Randomized and nonrandomized single-center studies suggest that preoperative geriatric evaluation improves postoperative outcomes in older adults. The generalizability and population-level effect of preoperative geriatric evaluation has not been determined. Our objective was to measure the adjusted association between preoperative geriatric evaluation and postoperative outcomes.
DESIGN: Multilevel multivariable regression model analysis of a population-based historical cohort.
SETTING: Publicly funded universal healthcare system in Ontario, Canada.
PARTICIPANTS: All adults aged 65 and older having major, elective, noncardiac surgery from 2002 to 2014 (N = 266,499).
INTERVENTION: We studied geriatric consultations and comprehensive assessments performed in the 4 months prior to surgery. These were identified using validated methods.
MEASUREMENTS: Ninety-day survival (primary outcome), in-hospital complications, length of stay, 30-day readmissions, need for supported discharge, and 90-day costs of care.
RESULTS: The 7,352 participants (2.8%) who had a preoperative geriatric evaluation had longer 90-day survival than those who who did not (adjusted hazard ratio = 0.81, 95% confidence interval = 0.68-0.95). Length of stay and complication rates did not differ between groups, but participants evaluated by a geriatrician preoperatively had higher rates of supported discharge, readmission rates, and costs of care. Sensitivity analyses supported the association between preoperative geriatric assessment and 90-day survival.
CONCLUSION: In individuals aged 65 and older undergoing major, elective, noncardiac surgery, preoperative geriatric evaluation was associated with longer 90-day survival, but it is used infrequently. Given these results, and those of previous small studies, the influence of a geriatric evaluation on postoperative outcomes should be determined in a multicenter randomized trial.
DESIGN: Multilevel multivariable regression model analysis of a population-based historical cohort.
SETTING: Publicly funded universal healthcare system in Ontario, Canada.
PARTICIPANTS: All adults aged 65 and older having major, elective, noncardiac surgery from 2002 to 2014 (N = 266,499).
INTERVENTION: We studied geriatric consultations and comprehensive assessments performed in the 4 months prior to surgery. These were identified using validated methods.
MEASUREMENTS: Ninety-day survival (primary outcome), in-hospital complications, length of stay, 30-day readmissions, need for supported discharge, and 90-day costs of care.
RESULTS: The 7,352 participants (2.8%) who had a preoperative geriatric evaluation had longer 90-day survival than those who who did not (adjusted hazard ratio = 0.81, 95% confidence interval = 0.68-0.95). Length of stay and complication rates did not differ between groups, but participants evaluated by a geriatrician preoperatively had higher rates of supported discharge, readmission rates, and costs of care. Sensitivity analyses supported the association between preoperative geriatric assessment and 90-day survival.
CONCLUSION: In individuals aged 65 and older undergoing major, elective, noncardiac surgery, preoperative geriatric evaluation was associated with longer 90-day survival, but it is used infrequently. Given these results, and those of previous small studies, the influence of a geriatric evaluation on postoperative outcomes should be determined in a multicenter randomized trial.
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