P85. Reducing delirium after complex spinal surgery (≥4 levels): 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 reduce morbidity in high-risk older adults undergoing elective surgery. One goal of the UTSW POSH program is to prevent postoperative delirium, an often underrecognized 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 of delirium before and after the implementation of the UTSW POSH program in high-risk older adults undergoing complex spinal surgery. 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 spinal deformity surgery (≥4 levels of fusion) between January 2014 and March 2019 (N=106). OUTCOME MEASURES The primary outcome was the incidence of delirium. Baseline characteristics and length of stay were also compared between groups. METHODS The UTSW POSH program was implemented January 2017. Patients referred to UTSW POSH and treated for complex spine surgery (n=61) by a neurosurgeon or orthopedic surgeon 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 delirium education, recommendations to prevent delirium, and daily postoperative delirium assessments on the ward. A risk factor and procedure-matched historical control group was created (n=45; January 2014 through December 2016) using UTSW POSH referral criteria for comparison of outcomes. Postoperative delirium was assessed via a validated retrospective chart review method and cases were confirmed with an expert geriatrician (SAW). RESULTS The mean age at the time of surgery was 73.5 years (UTSW POSH:74.5 years vs control: 72.3 years; p=0.03). At baseline, there were no significant differences between both patient cohorts in rates of polypharmacy, use of high-risk medications, baseline Hb, number of vertebral segments fused, or ASA classification. The incidence of delirium was significantly lower in UTSW POSH patients compared to control (11.4% vs 28.9%, p=0.03). Length of stay was decreased in the UTSW POSH cohort (5.37 days vs 7.34 days; p=0.003). CONCLUSIONS This study suggests that interdisciplinary care for high-risk older adults undergoing complex spine surgery can markedly reduce the incidence of postoperative delirium and decrease hospital length of stay. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.