A Systemic Review & Meta-Analysis of the Impact of Vascular-Geriatric Service Models on Short-Term Outcomes in Vascular Surgery Inpatients

Abstract

Abstract Background Vascular surgeons are treating progressively older, frailer and more medically complex patients. Care models including both surgeons and geriatricians have improved peri-operative outcomes in orthopaedics and surgical oncology. This meta-analysis investigates the impact of “vascular-geriatric” services on short-term inpatient outcomes. Methods Search strategy included PubMed, Scopus and Embase databases, conference abstracts and clinical trial registries. All study methodologies comparing outcomes before and after the introduction of a dedicated vascular-geriatrics service were eligible. Meta-analyses compared the relative risk (RR) of mortality, complications and 30-day readmission using a random-effects model. Risk of bias was assessed with the MINORS tool. Results Eight studies were identified, including one randomised trial and seven ‘before & after’ observational studies. 2074 patients were included, 1065 in the “Vascular-Geriatrics” cohort and 1009 in standard care. Care models included comprehensive geriatric assessment as part of the pre-operative review process before elective aortic surgery, inpatient geriatric liaison services and formal vascular-geriatric co-management arrangements. Source studies were of moderate to high risk of bias. A meta-analysis of five studies demonstrated vascular-geriatrics models were significantly associated with lower mortality rates than standard care (pooled 2.4% vs 4.9%) (RR 0.51, 95% CI 0.28-0.94, p=.03) (I2=0%). Vascular-Geriatrics models were also significantly associated with lower risk of infective complications (RR 0.49, 95% CI 0.36–0.66, p<.001) (I2=0%) and delirium (RR 0.58, 95% CI 0.35–0.97, p=.04) (I2=48%). There was no difference in mean length of stay (SMD -2.20, 95% CI -4.6-0.19, p=.07) (I2=86%). or 30-day readmission rates between Vascular-Geriatrics models and standard care (RR 1.10, 95% CI 0.81-1.51, p=.54) (I2=38%). Conclusion While the source data is heterogenous and of limited quality, this meta-analysis suggests that dedicated geriatric intervention may reduce adverse peri-operative outcomes in vascular patients compared to traditional care models. Further studies are needed to investigate the most effective design of geriatrician-surgeon partnership.