Evaluation and establishment of a ward‐based geriatric liaison service for older urological surgical patients: Proactive care of Older People undergoing Surgery (<scp>POPS</scp>)‐Urology

Braude, Philip; Goodman, Anna; Elias, Tania; Babic-Illman, G.; Challacombe, Benjamin; Harari, Danielle; Dhesi, Jugdeep

doi:10.1111/bju.13526

Cited by 58 publications

(48 citation statements)

References 13 publications

(14 reference statements)

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“…Understanding the contribution and interaction of both frailty and comorbidity may aid in surgical decision making, optimizing patients preoperatively, and tailoring interventions to the needs of patients with comorbidities, who are frail, or both. For example, perioperative interventions for patients with comorbidities may focus on polypharmacy, balancing potentially incompatible treatments for multiple diseases and prioritizing treatments, whereas frailty‐focused interventions may incorporate prehabilitation therapy, nutrition services, and involvement of geriatric providers throughout the perioperative period . Targeted interventions require accurate preoperative identification of the frail phenotype, which should be a routine part of preoperative assessment and is feasible in a busy surgical practice .…”

Section: Discussionmentioning

confidence: 99%

“…For example, perioperative interventions for patients with comorbidities may focus on polypharmacy, balancing potentially incompatible treatments for multiple diseases and prioritizing treatments, whereas frailty-focused interventions may incorporate prehabilitation therapy, nutrition services, and involvement of geriatric providers throughout the perioperative period. 22,40,41 Targeted interventions require accurate preoperative identification of the frail phenotype, which should be a routine part of preoperative assessment and is feasible in a busy surgical practice. 19 For example, Makary et al integrated a standardized frailty assessment into routine preoperative assessment, which consisted of a combination of self-report questions of recent weight loss; feelings of exhaustion; and physical activity as well as physical assessments, including grip strength and gait speed.…”

Section: Discussionmentioning

confidence: 99%

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The effect of frailty on short‐term outcomes after head and neck cancer surgery

et al. 2017

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Objective: To determine the relationship between frailty and comorbidity, in-hospital mortality, postoperative complications, length of hospital stay (LOS), and costs in head and neck cancer (HNCA) surgery.Study Design: Cross-sectional analysis. Methods: Discharge data from the Nationwide Inpatient Sample for 159,301 patients who underwent ablative surgery for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm in 2001 to 2010 was analyzed using crosstabulations and multivariate regression modeling. Frailty was defined based on frailty-defining diagnosis clusters from the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator.Results: Frailty was identified in 7.4% of patients and was significantly associated with advanced comorbidity (odds ratio [OR] , increased LOS (mean, 4.9 days), and increased mean incremental costs ($11,839), and was associated with higher odds of surgical complications and increased costs than advanced comorbidity. There was a significant interaction between frailty and comorbidity for acute medical complications and length of hospitalization, with a synergistic effect on the odds of medical complications and LOS in patients with comorbidity who were also frail.Conclusion: Frailty is an independent predictor of postoperative morbidity, mortality, LOS, and costs in HNCA surgery patients, and has a synergistic interaction with comorbidity that is associated with an increased likelihood of medical complications and greater LOS in patients with comorbidity who are also frail.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The effect of frailty on short‐term outcomes after head and neck cancer surgery

et al. 2017

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“…The preliminary study by Braude et al [5] also demonstrated a reduction in complication rate and length of stay in urological patients >65 yrs. of age by the introduction of a geriatric liaison service.…”

Section: Discussionmentioning

confidence: 87%

“…This is now established practice. However it is only recently that this has been considered in other areas of surgical practice, specifically within urology [5]. The aim of this service evaluation was to assess the impact of age on the length of stay for patients admitted as an emergency with visible haematuria in our trust.…”

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confidence: 99%

The Aging Urology Population and its impact on Hospital Stay

Henderson¹,

Thilagarajah²

2016

UNOAJ

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Submit Manuscript | http://medcraveonline.com IntroductionSince mid-2005, the UK population aged 65 and over has increased by 21%, and the population aged 85 and over has increased by 31%. The number of males aged 85 and over has increased by 54% since mid-2005, compared to a 21% increase for females [1]. In England any man reaching the age of 65 has an average life expectancy of 18.8yrs [2], a women of the same age can expect to live for a further 21.2 yrs. This translates into an increasingly elderly cohort of patients with multiple comorbidities and polypharmacy. In 2012 the Kings Fund reported "the average length of stay increases directly with age: it is eight days for patients aged 65-74 years; 10 days for patients aged 75-84 years; and 12 days for patients aged 85 years or older" [3]. It has been demonstrated that multi-disciplinary team working such as including elderly care within orthopaedic departments is effective and improves outcomes [4]. This is now established practice. However it is only recently that this has been considered in other areas of surgical practice, specifically within urology [5]. The aim of this service evaluation was to assess the impact of age on the length of stay for patients admitted as an emergency with visible haematuria in our trust. MethodAll patients admitted with visible haematuria to Mid Essex NHS trust over a 6 month period were included in this evaluation. This was a retrospective data evaluation using the hospital coding database as a source of information. All coding's for haematuria were reviewed and the length of stay (LOS) was calculated from date of admission and discharge and correlated with the age of the patient. ResultsIn total 196 patients were admitted with visible haematuria over the 6 month period. The average age of the patients was 70.68 yrs with a range of 18-93 yrs (Table 1). The average length of stay for the overall group was 7.9 days with a large range of 0-85 days. The data was further broken down into the following age ranges: <65; 65-75; 75-8; >85. A dramatic rise in length of stay can be seen as age increases, specifically over the age of 75 (Figure 1). OpinionUrol Nephrol Open Access J 2016, 3(4): 00085 AbstractIntroduction: The aim of this service evaluation was to assess the impact of age on the length of stay for patients admitted as an emergency with visible haematuria in our trust.

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“…Evidence from other sources has previously indicated that similar models of care can reduce complications and LOS in orthopaedic, urological and vascular surgical cohorts. 15,20,21 However, limited evidence has previously been published to demonstrate that the model of care can be successfully transferred to gastrointestinal surgery. Importantly, these data may indicate the potential value of this model of care to emergency general surgical services.…”

Section: Reductions In Losmentioning

confidence: 99%

Embedded geriatric surgical liaison is associated with reduced inpatient length of stay in older patients admitted for gastrointestinal surgery

Shipway

Koizia

Winterkorn

et al. 2018

Future Healthcare Journal

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The older surgical patient is well known to be at high risk of increased mortality and medical complications in the perioperative period. These occur due to a variety of patient and service related factors. The need for physician support is recognised and liaison models of care can reduce complications and length of stay (LOS) in some surgical specialties. Limited evidence exists evaluating their role in emergency and planned gastrointestinal surgery. We aimed to establish and evaluate a geriatric surgical liaison service for emergency and elective gastrointestinal surgery. We found that embedded geriatrician liaison and process change throughout the surgical pathway was associated with a mean LOS reduction of 3.1 days for all surgical patients aged >60 years (p=0.007). Mean LOS reduction for emergency surgical admissions aged >60 was 4.4 days (p=0.005).Embedded geriatric surgical liaison models of care can be successfully adapted for emergency general and gastrointestinal surgery. In times of financial constraint, reductions in LOS may make modest investment in similar services economically viable.

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Evaluation and establishment of a ward‐based geriatric liaison service for older urological surgical patients: Proactive care of Older People undergoing Surgery (POPS)‐Urology

Cited by 58 publications

References 13 publications

The effect of frailty on short‐term outcomes after head and neck cancer surgery

The effect of frailty on short‐term outcomes after head and neck cancer surgery

The Aging Urology Population and its impact on Hospital Stay

Embedded geriatric surgical liaison is associated with reduced inpatient length of stay in older patients admitted for gastrointestinal surgery

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