Effect of Preoperative Geriatric Evaluation on Outcomes After Elective Surgery: A Population-Based Study

Daniel I McIsaac; Allen Huang; Coralie A Wong; Duminda N Wijeysundera; Gregory L Bryson; Carl van Walraven

doi:10.1111/jgs.15100

Effect of Preoperative Geriatric Evaluation on Outcomes After Elective Surgery: A Population-Based Study

J Am Geriatr Soc. 2017 Dec;65(12):2665-2672. doi: 10.1111/jgs.15100. Epub 2017 Oct 3.

Authors

Daniel I McIsaac^{1

2

3

4}, Allen Huang^{2

5

6}, Coralie A Wong³, Duminda N Wijeysundera^{3

7

8

9}, Gregory L Bryson^{1

2}, Carl van Walraven^{2

3

4

5}

Affiliations

¹ Department of Anesthesiology and Pain Medicine, University of Ottawa and Ottawa Hospital, Ottawa, Ontario, Canada.
² Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
³ Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada.
⁴ School of Epidemiology, Public Health and Preventive Medicine University of Ottawa, Ottawa, Ontario, Canada.
⁵ Department of Internal Medicine, University of Ottawa and Ottawa Hospital, Ottawa, Ontario, Canada.
⁶ Department of Geriatric Medicine, Ottawa Hospital, Ottawa, Ontario, Canada.
⁷ Department of Anesthesiology, University of Toronto, Toronto, Ontario, Canada.
⁸ Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
⁹ Department of Anesthesia and Pain Medicine, Toronto General Hospital, Toronto, Ontario, Canada.

PMID: 28971482
DOI: 10.1111/jgs.15100

Abstract

Background/objectives: Randomized and nonrandomized 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.

Keywords: epidemiology; geriatrician; outcomes; surgery.

MeSH terms

Aged
Cohort Studies
Elective Surgical Procedures*
Female
Geriatric Assessment*
Humans
Male
Multivariate Analysis
Postoperative Complications / epidemiology
Preoperative Care / methods*
Regression Analysis
Survival Rate
Treatment Outcome