The role of medical speciality input in the management of older neurosurgical inpatients

Abstract

Background With an increasing elderly population, the number of neurosurgical patients aged 65 and over is rising. Ageing is closely related to multimorbidity and frailty, which are both recognised risk factors for postoperative complications and mortality. Comanagement by geriatricians and surgeons has been shown to reduce the length of admission and improve postoperative outcomes in orthopaedics, but evidence for this in neurosurgical patients is limited. Aims To evaluate the demographics of the elderly neurosurgical population, and determine if input by medical teams or completion of frailty scores impacts patient outcomes. Methods A retrospective notes review and review of coding and HES data, including length of stay, number of comorbidities, and mortality rate, was collected for geriatric neurosurgery and spinal surgery patients 65 years and older who were discharged following inpatient admission from April 2019 – March 2020. Full medical notes were retrieved for patients with a length of stay exceeding 14 days, with data on frailty scores and involvement of medical teams collected. Statistical tests were applied to evaluate the difference in outcomes between those reviewed and those not reviewed by medical teams. Results Eighty-one patients had a length of stay over 14 days. 43% of these 81 patients were reviewed by medical teams during their admission. The mean length of stay was significantly shorter in those receiving medical input (22.8 ± 10.6 days vs 32.4 ± 16.0 days, p = 0.003). There was also a significant association between the completion of a frailty score and subsequent input by medical teams. Conclusions The reduction in length of stay observed when patients were reviewed by medical teams supports the role of elderly care physician comanagement in the elderly inpatient neurosurgical population.