82. Interdisciplinary care may reduce delirium in elderly spine patients: the UT Southwestern Perioperative Optimization of Senior Health Program

Abstract

BACKGROUND CONTEXT The UT Southwestern Perioperative Optimization of Senior Health (UTSW POSH) program is an interdisciplinary effort involving surgery, geriatrics, and anesthesia to provide specialized care to high-risk older adults undergoing elective surgery. One goal of the UTSW POSH program is to prevent postoperative delirium, an often under-recognized source of adverse outcomes that affects up to 50% of older adults undergoing surgery. PURPOSE The purpose of this study is to assess changes in the incidence and provider recognition of delirium before and after implementation of UTSW POSH. STUDY DESIGN/SETTING Retrospective cohort study at a tertiary academic center. PATIENT SAMPLE High risk older adults (≥65 with >3 comorbidities, >5 prescription medications, known or suspected cognitive impairment, or BMI >25; all patients ≥85 years old) undergoing elective inpatient spine surgery between January 2014 and March 2019 (N=324). OUTCOME MEASURES The primary outcome was the incidence of delirium. Secondary outcomes included recognition of delirium and length of stay (LOS). Baseline characteristics were also compared between groups. METHODS The UTSW POSH program was implemented in January 2017. Patients referred to UTSW POSH and treated surgically (n=147) were evaluated approximately 30 days prior to surgery by a geriatric specialist and co-managed by the primary surgical team and an inpatient geriatrics team postoperatively. The geriatrics team provided patient and family delirium education, recommendations to prevent delirium, and daily postoperative delirium assessments. A risk factor- and procedure-matched historical control group was created (n=177; January 2014 through December 2016) using UTSW POSH referral criteria for comparison of outcomes. Postoperative delirium was assessed via a validated retrospective chart review and cases were confirmed by an expert (SAW). Recognition of delirium was defined as an MD, PA, or NP posing the diagnosis of delirium in the patient chart. RESULTS The mean age at the time of surgery was 73.4 years (UTSW POSH:75.5 years vs control group: 71.5 years; p CONCLUSIONS This study suggests that postoperative delirium is under-recognized in older adults undergoing spine surgery. Enrollment in the UTSW POSH program was associated with a 3-fold increase in the recognition of postoperative delirium by providers and decreased length of stay. Enrollment was associated with a 40% decrease in the incidence of delirium, despite UTSW POSH patients being significantly older and more likely to receive pelvic fixation. Since delirium recognition was not 100% in the UTSW POSH program, additional educational initiatives may be beneficial to further increase recognition and reduce the incidence of delirium. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.