Implementation of a Multispecialty Geriatric Surgery Pathway Reduces Inpatient Cost for Frail Patients

Abstract

Objective: The objective of this study was to evaluate the effect of geriatric surgical pathway (GSP) implementation on inpatient cost of care. Background: Achieving high-value care for older patients is the goal of the American College of Surgeons Geriatric Verification Program (ACS-GSV). We have previously shown that implementation of our geriatric surgery pathway, which aligns with the ACS-GSV standards, resulted in a reduction in loss of independence and complications. Methods: Patients ≥ 65 years who underwent an inpatient elective surgical procedure included in the American College of Surgeons National Quality Improvement Program (ACS NSQIP) registry from July 2016 through December 2017 were compared with those patients from February 2018 to December 2019 who were cared for on our GSP. An amalgamation of Clinformatics DataMart, the electronic health record, and the ACS NSQIP registry produced the analytical dataset. We compared mean total and direct costs of care for the entire cohort as well as through propensity matching of frail surgical patients to account for differences in clinical characteristics. Results: The total mean cost of health care services during hospitalization was significantly lower in the cohort on our GSP ($23,361 ± $1110) as compared with the precohort ($25,452 ± $1723), P < 0.001. On propensity-matched analysis, cost savings was more evident in our frail geriatric surgery patients. Conclusions: This study shows that high-value care can be achieved with the implementation of a GSP that aligns with the ACS-GSV program.

Letter: Beyond Risk Assessment: A New Vision for Transdisciplinary Frailty Care Coordination in Neurosurgery

“…2 These crucial elements enhance postoperative outcomes and, when coordinated with specialized care teams, can improve the quality of life and overall health care value by optimizing health care–related expenditure. 3,4 However, challenges within the health care infrastructure hinder effective frailty care coordination pathways (Figure). 5…”

“…3,4 A transdisciplinary team integrated a multispecialty geriatric pathway for high-risk frail patients into standard practice. 3,4 As a result, it has significantly improved patient outcomes and has led to better resource management and substantial cost savings for their institution. 3,4 This success story underscores the transformative potential of a fully implemented comprehensive frailty care coordination pathway, which can also be incorporated into neurosurgery practices across the board.…”

“…Lack of such infrastructure or inequities in access to technology can severely impede the effective deployment of this strategy, leaving many of those who could benefit the most underserved. 3,4 As health care systems advance in developing care coordination strategies for our frail patients, it is essential that we confront existing barriers head-on. There are many potential solutions available as roadmaps, foremost among these steps is education and training.…”

“…Technological advancement and integration stand as another vital solution. 3,4 Leveraging innovative digital solutions can address many technological barriers that impede the strategic implementation of such efforts, ie, integrating frailty risk assessment tools as best practice advisory notifications. Finally, fostering partnerships and collaborations is paramount.…”

“…A testament to the effectiveness of this approach is the case of a group championed by Dr Susan Gearhart at The Johns Hopkins Medicine. 3,4 A transdisciplinary team integrated a multispecialty geriatric pathway for high-risk frail patients into standard practice. 3,4 As a result, it has significantly improved patient outcomes and has led to better resource management and substantial cost savings for their institution.…”