Economic evaluations of comprehensive geriatric assessment in surgical patients: a systematic review

Eamer, Gilgamesh; Saravana-Bawan, Bianka; Westhuizen, Brenden van der; Chambers, Thane; Öhinmaa, Arto; Khadaroo, Rachel G.

doi:10.1016/j.jss.2017.03.041

Cited by 42 publications

(49 citation statements)

References 16 publications

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“…Large studies should describe patient characteristics, adherence and outcomes for their older patient groups in detail, to enable secondary analysis of the older patient population. Future studies and (inter)national audit initiatives will have to be specifically designed to study older patients in relation to their frailty profile, preferably incorporating a comprehensive geriatric assessment for the evaluation of the older individual’s functional, cognitive and psychosocial status, comorbidities and polypharmacy [10, 48, 49]. Based on these findings, it will be possible to thoroughly describe the older population studied.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of the intervention components, adherence and outcomes of enhanced recovery programmes in older patients undergoing elective colorectal surgery

et al. 2019

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Background Enhanced recovery programmes (ERPs) aim to attenuate the surgical stress response and accelerate recovery after surgery, but are not specifically designed for older patients. The objective of this study was to review the components, adherence and outcomes of ERPs in older patients (≥65 years) undergoing elective colorectal surgery. Methods Pubmed, Embase and Cinahl were searched between 2000 and 2017 for randomised and non-randomised controlled trials, before-after studies, and observational studies. The methodological quality of the studies was evaluated using the MINORS quality assessment. The review was performed and reported according to the PRISMA guidelines. Results Twenty-one studies, including 3495 ERP patients aged ≥65 years, were identified. The ERPs consisted of a median of 13 intervention components. Adherence rates were reported in 9 studies and were the highest (≥80%) for pre-admission counselling, no bowel preparation, limited pre-operative fasting, antithrombotic and antimicrobial prophylaxis, no nasogastric tube, active warming, and limited intra-operative fluids. The median post-operative length of stay was 6 days. The median post-operative morbidity rate (Clavien-Dindo I-IV) was 23.5% in-hospital and 29.8% at 30 days. The in-hospital post-operative mortality rate was 0% in most studies and amounted to a median of 1.4% at 30 days. The median 30-day readmission rate was 4.9% and the median reoperation rate was 5.0%. Conclusions ERPs in older patients were in accordance with the ERP consensus guidelines. Although the number of intervention components applied increased over time, outcomes in earlier and later studies remained comparable. Adherence rates were under-reported. Future studies should explore adherence and age-related factors, such as frailty profile, that could influence adherence. Trial registration PROSPERO 2018 CRD42018084756 . Electronic supplementary material The online version of this article (10.1186/s12877-019-1158-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

A systematic review of the intervention components, adherence and outcomes of enhanced recovery programmes in older patients undergoing elective colorectal surgery

et al. 2019

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“…The use of comprehensive geriatric assessment (CGA) to evaluate seniors has been shown to improve outcomes in a Cochrane review of acute medical admissions. 35 A systematic review of economic evaluations of CGA in a surgical setting has shown improved outcomes while also reducing cost in patients with hip fracture, 36 and a Cochrane review of CGA in surgical patients is currently underway. 37 We are currently investigating the effect of CGA and an elder-friendly care program in an acute general surgery patient population 19 to see if we can improve outcomes in frail seniors.…”

Section: Discussionmentioning

confidence: 99%

Analysis of postdischarge costs following emergent general surgery in elderly patients

Eamer

Clement

Pederson

et al. 2018

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Background: As populations age, more elderly patients will undergo surgery. Frailty and complications are considered to increase in-hospital cost in older adults, but little is known on costs following discharge, particularly those borne by the patient. We examined risk factors for increased cost and the type of costs accrued following discharge in elderly surgical patients. Methods:Acute abdominal surgery patients aged 65 years and older were prospectively enrolled. We assessed baseline clinical characteristics, including Clinical Frailty Scale (CFS) scores. We calculated 6-month cost (in Canadian dollars) from patient-reported use following discharge according to the validated Health Resource Utilization Inventory. Primary outcomes were 6-month overall cost and cost for health care services, medical products and lost productive hours. Outcomes were log-transformed and assessed in multivariable generalized linear and zero-inflated negative binomial regressions and can be interpreted as adjusted ratios (AR). Complications were assessed according to Clavien-Dindo classification. Results:We included 150 patients (mean age 75.5 ± 7.6 yr; 54.1% men) in our analysis; 10.8% had major and 43.2% had minor complications postoperatively. The median 6-month overall cost was $496 (interquartile range $140-$1948). Disaggregated by cost type, frailty independently predicted increasing costs of health care services (AR 1.76, 95% confidence interval [CI] 1.43-2.18, p < 0.001) and medical products (AR 1.61, 95% CI 1.15-2.25, p = 0.005), but decreasing costs in lost productive hours (AR 0.39, p = 0.002). Complications did not predict increased cost. Conclusion:Frail patients accrued higher health care services and product costs, but lower costs from lost productive hours. Interventions in elderly surgical patients should consider patient-borne cost in older adults and lost productivity in less frail patients. Trial registration: NCT02233153 (clinicaltrials.gov).Contexte : Avec le vieillissement de la population, les personnes âgées seront plus nombreuses à subir des chirurgies. Il est déjà reconnu que la fragilité et les complications font augmenter les coûts d'hospitalisation chez les adultes âgés, mais on en sait relativement peu sur les coûts posthospitaliers, particulièrement ceux assumés par le patient lui-même. Nous avons analysé les facteurs de risque d'augmentation de ces coûts et les types de dépenses assumées après le congé par les patients âgés opérés.Méthodes : Pour l'étude, nous avons recruté des patients de 65 ans et plus qui allaient subir une chirurgie abdominale d'urgence. Nous avons déterminé leurs caractéristiques cliniques initiales, y compris leur score à l'échelle de fragilité clinique (EFC). Nous avons calculé les coûts échelonnés sur 6 mois (en dollars canadiens) rapportés par les patients après leur congé, selon un inventaire validé de l'utilisation des ressources de santé. Les paramètres principaux étaient le montant total des dépenses et le coût des services de santé, des produits médicaux et des heures...

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“…In this context, it is recorded whether and which specific geriatric screenings and/or assessments were conducted during the treatment. A meta-analysis about comprehensive geriatric assessments showed that use of assessments led to improved patient-related outcomes as well as reduced costs [20]. Moreover, applying assessments helps to identify vulnerable patients and adapt therapies to their specific needs better than without assessments [21,22].…”

Section: Methodsmentioning

confidence: 99%

“…Within the project, neither individual patient data nor any screening or assessments results have been stored. Rather, it has only been recorded whether screening and assessment instruments have been used and whether the main aspects—mobility, nutrition and cognition—have been covered because screening and assessments have proven to show positive impact on output and outcome of geriatric treatment [20-22].…”

Section: Methodsmentioning

confidence: 99%

Improving Treatment of Elderly Patients by Interprofessional Education in a Quality Network of Geriatric Medicine: Protocol for Evaluating an Educational Initiative

Huenefeld¹,

Rodde²,

Bureick³

et al. 2019

JMIR Res Protoc

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Background All statistics on the development of demand for care for multimorbid elderly patients highlight the acute pressure to act to adequately respond to the expected increase in geriatric patient population in the next 15 years. Against this background, great importance must be attached to the improvement of cross-occupational group and cross-sector treatment of these patients. In addition, many professionals in the health care sector often have little knowledge about the special treatment and care needs of the elderly. Objective The Quality Network of Geriatric Medicine in north-west Germany is the body responsible for the project; with its member organizations, it provides care for over 400,000 inpatients and is thus one of the largest associations for geriatrics in Germany. The Quality Network conducts binding evaluated qualification measures for staff involved in the treatment and care of multimorbid elderly patients. The training offers are especially intended for staff who have not yet been trained in working with elderly patients. This approach is intended to improve the expertise of various occupational groups on different hierarchy levels, to include patients and their family members in the evaluation process, and to initiate changes within the organizations. Methods Various instruments are used in the evaluation of qualification measures: besides written surveys and questionnaires, structured work groups (consensus groups) and interviews are conducted. The evaluation starts before the qualification measures to determine the starting point and then continues during the measure and after its completion. This allows major findings to be integrated directly into the ongoing qualification program. At least 100 trainings on geriatric topics, 80 consensus groups, and 120 patients (and family members) are going to be included in the study. Results The evaluation of the educational initiative is funded by the State of Northrhine-Westfalia (Germany; LZG TG 71 001 / 2015 and LZG TG 71 002 / 2015). The results of the study will be published after review and approval by the state authorities – presumably by the end of 2019. The before and after comparison of the treatment-related outcomes at the beginning and near the completion of the educational initiative gives insights into how transfer-oriented education can improve the treatment of elderly patients across sector lines for inpatients as well as outpatients. The evaluation of the implementation of educational content in day-to-day work and occupational groups is to facilitate recommendations about economically sensible use of educational resources and about further adjustments to the training content. Conclusions The evaluation develops the foundation for targeted and needs-oriented qualification measures as well as transfer in cross-sector, multiprofessional networks. Instruments and results will be published and provided to ...

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Economic evaluations of comprehensive geriatric assessment in surgical patients: a systematic review

Cited by 42 publications

References 16 publications

A systematic review of the intervention components, adherence and outcomes of enhanced recovery programmes in older patients undergoing elective colorectal surgery

A systematic review of the intervention components, adherence and outcomes of enhanced recovery programmes in older patients undergoing elective colorectal surgery

Analysis of postdischarge costs following emergent general surgery in elderly patients

Improving Treatment of Elderly Patients by Interprofessional Education in a Quality Network of Geriatric Medicine: Protocol for Evaluating an Educational Initiative

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