Establishing a proactive geriatrician led comprehensive geriatric assessment in older emergency surgery patients: Outcomes of a pilot study

Abstract

Introduction: Increasing numbers of older adults are presenting with acute surgical disease to the unselected general surgical take. General surgeons have little training to manage these patients. We developed a pilot service of proactive geriatrician input into older emergency general surgical patients in a single institution. We wanted to demonstrate if geriatricians improve the management of these patients.

Methods: Patients aged 70 years or older admitted acutely under the general surgeons were assessed proactively by a geriatrician using comprehensive geriatric assessment (CGA). Data were collected prospectively using a data collection form of any new issues detected and interventions made by the geriatricians in addition to the surgical plan. This information was entered into an excel database and analysed.

Results: We obtained data for 447 patients between November 2016 and July 2017. CGA led to additional diagnoses or interventions in 83% of patients. The most common problems identified included a new medical diagnosis (35.2%), polypharmacy (30%), recent falls (19.7%), weight loss (17.2%) and uncontrolled pain (16.7%). Abbreviated mental tests were performed in 87.5% patients, with 22% being detected with cognitive impairment. Frailty screening was performed in 97% of patients resulting in 38% being identified as frail. New interventions included stopping medications (40%), starting medications (28%) and referral to multidisciplinary teams (70.1%). Length of stay was reduced by 0.55 days.

Conclusion: Proactive geriatrician input identifies medical diagnoses and geriatric syndromes missed by the surgical teams. Managing these issues has contributed to a reduced length of stay in these patients.