Scientific Publications Database

Article Title: Effect of Preoperative Geriatric Evaluation on Outcomes After Elective Surgery: A Population-Based Study
Authors: McIsaac, Daniel I.; Huang, Allen; Wong, Coralie A.; Wijeysundera, Duminda N.; Bryson, Gregory L.; van Walraven, Carl
Journal: JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Volume 65 Issue 12
Date of Publication:2017
Abstract:
BACKGROUND/OBJECTIVES: Randomized and non-randomized single-center studies suggest that preoperative geriatric evaluation improves postoperative outcomes in older adults. The generalizability and population-level effect of preoperative geriatric evaluation has not been determined. Our objective was to measure the adjusted association between preoperative geriatric evaluation and postoperative outcomes.DESIGN: Multilevel multivariable regression model analysis of a population-based historical cohort.SETTING: Publicly funded universal healthcare system in Ontario, Canada.PARTICIPANTS: All adults aged 65 and older having major, elective, noncardiac surgery from 2002 to 2014 (N = 266,499).INTERVENTION: We studied geriatric consultations and comprehensive assessments performed in the 4 months prior to surgery. These were identified using validated methods.MEASUREMENTS: Ninety-day survival (primary outcome), in-hospital complications, length of stay, 30-day readmissions, need for supported discharge, and 90-day costs of care.RESULTS: The 7,352 participants (2.8%) who had a preoperative geriatric evaluation had longer 90-day survival than those who who did not (adjusted hazard ratio = 0.81, 95% confidence interval = 0.68-0.95). Length of stay and complication rates did not differ between groups, but participants evaluated by a geriatrician preoperatively had higher rates of supported discharge, readmission rates, and costs of care. Sensitivity analyses supported the association between preoperative geriatric assessment and 90-day survival.CONCLUSION: In individuals aged 65 and older undergoing major, elective, noncardiac surgery, preoperative geriatric evaluation was associated with longer 90-day survival, but it is used infrequently. Given these results, and those of previous small studies, the influence of a geriatric evaluation on postoperative outcomes should be determined in a multicenter randomized trial.