The benefit of geriatric intervention in surgery-increased throughput does not necessarily need more beds

Abstract

Three years ago a consultant geriatrician began regular visits to the coloproctology and general surgery wards of an acute Trust every weekday, to assist staff with the medical management, rehabilitation and discharge planning of patients aged 65 years and above. The length of stay of these patients in the first 10 months of the appointment was compared with younger concurrent controls and with historical controls in the preceding 10 months. The mean length of stay for the 4146 patients aged 16 years and above in a 10-month intervention period was 1.3 days shorter (95% confidence interval (CI) 0.86-1.74 days) than for the 4002 patients in the 10-month control period. This pattern was consistent across all ages and types of surgery, including major colorectal resection. There was an important benefit to the availability of coloproctology and general surgical beds in this acute Trust. More efficient rehabilitation of elderly patients reduces 'bed blockage' post-operatively, and allows more effective use of available resources. Co-ordination of the geriatric service with the specialized stoma support service allows earlier discharge of the elderly, and their relocation to appropriate premises where long-term changes in bowel habit and problems with stoma care can be managed away from the acute surgical unit.