GERIATRIC COLORECTAL SURGERY CO-MANAGEMENT PROGRAM: IMPACT ON PATIENT OUTCOMES

Abstract

In elderly surgical patients, multiple comorbidities and diminished reserve lead to increased post-operative complications and higher cost. We developed a Geriatric Surgery Co-management (GSC) program, as an innovative partnership between geriatrics and colorectal surgery, to improve patient care for elderly colorectal surgery patients in the post-operative setting. This retrospective study analyzed colorectal surgery patients aged 70 or older admitted to a community hospital before GSC program implementation. Historical control (HC) was compared to patients admitted after implementation of the GSC program. GSC patients received a post-operative comprehensive geriatric assessment, identification of risk factors for and prevention of geriatric syndromes, management of comorbidities and optimization of pain management. The data was collected via National Surgical Quality Improvement Program and chart review. The HC (n=104) and GSC (n=44) groups were comparable at baseline. The most common type of surgery was colectomy in both groups (59% of all cases). The mean length of stay (LOS) was 5% shorter (-0.6 days) in GSC (p-value= 0.74); more pronounced in older and sicker patients: 15% shorter (-1.5 days) in patients ≥80 years old, 22% shorter (-1.7 days) in patients with Charlson comorbidity index ≥ 3 (p-values=0.47 and 0.25, respectively). Postoperative cardiac arrhythmia was markedly diminished from 12/104 (11%) in HC compared to 0/44 (0%) in GSC (p-value=0.02). The mean total hospital charge was $9,500 (18%) less per patient in GSC (p-value=0.1). Our results suggest that a multidisciplinary approach to postoperative care for geriatric colorectal surgery could decrease LOS, improve patient outcomes while decreasing hospital costs.