Outcomes for Surgical Care in the Elderly

Maxwell, Cathy A.; Rader, Erin; Fallon, William F.

doi:10.1007/978-1-4614-8501-8_22

Cited by 2 publications

(1 citation statement)

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“…Older surgery patients have additional need for geriatric medical care in comparison to younger hospitalized patients, such as for monitoring early signs of delirium and immobility. 34 Prior research interventions utilizing multi-disciplinary geriatric consultative care suggest that delirium can be prevented in older hip fracture 12 and acute geriatric trauma patients. 13 In addition, geriatric consultation may contribute to survival, functional recovery and quality-of-life outcomes.…”

Section: Discussionmentioning

confidence: 99%

Quality of Care Delivered Before vs After a Quality-Improvement Intervention for Acute Geriatric Trauma

Min

Cryer

Chan

et al. 2015

Journal of the American College of Surgeons

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Background Older trauma injury patients had improved recovery after we implemented routine geriatric consultation for patients ≥ age 65 at a level-1 academic trauma center. The intervention aimed to improve quality of geriatric care. However, the specific care processes that improved are unknown. Study Design Prospective observation comparing medical care after (December 2007-November 2009) versus before (December 2006-November 2007) implementation of the geriatric consult-based intervention. To measure quality-of-care (QOC) we used 33 previously-validated care-process quality indicators (QIs) from the Assessing the Care of Vulnerable Elders (ACOVE) study, measured by review of medical records for 76 Geriatric Consult [GC] versus 71 control group patients. As pre-specified subgroup analyses, we aggregated QIs by type: geriatric (e.g., delirium screening) versus non-geriatric condition-based care (e.g., thrombosis prophylaxis) and compared QI scores by type of care. Last, we aggregated QI scores into overall, geriatric, and non-geriatric QOC scores for each patient (# QIs passed/# QIs eligible), and compared patient-level QOC for the GC versus control group, adjusting for age, gender, ethnicity, comorbidity, and injury severity. Results 63% of the GC versus 11% of the control group patients received a geriatric consultation. We evaluated 2505 QIs overall (1664 geriatric-type and 841 non-geriatric QIs). In general, fewer geriatric-type QIs were passed than non-geriatric QIs (71% vs 81%, p<.001). We provided better overall-QOC to the GC (77%) than control group patients (73%, p<.05). However, the difference was not statistically significant after multivariable adjustment (p=.08). We improved geriatric-QOC for the GC (74%) compared to the control group (68%, p<.01), a difference that was significant after multivariable adjustment (p=.01). Conclusion Geriatricians and surgeons can collaboratively improve geriatric QOC for older trauma patients.

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Section: Discussionmentioning

confidence: 99%