Older veterans undergoing inpatient surgery: What is the compliance with best practice guidelines?

• Published in: Surgery 2021-02, Vol.169 (2), p.356-361
• Main Authors: Dworsky, Jill Q., Shenoy, Rivfka, Childers, Christopher P., Russell, Marcia M.
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Aged, 80 and over; Elective Surgical Procedures - adverse effects; Female; Geriatrics - standards; Guideline Adherence - statistics & numerical data; Hospitals, Veterans - organization & administration; Hospitals, Veterans - standards; Hospitals, Veterans - statistics & numerical data; Humans; Length of Stay - statistics & numerical data; Male; Patient Readmission - statistics & numerical data; Perioperative Care - standards; Perioperative Care - statistics & numerical data; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Practice Guidelines as Topic; Quality Improvement; Retrospective Studies; Societies, Medical - standards; United States
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2020.08.033

The United States population is aging, and the number of older adults requiring operative care is increasing at a rapid rate. In order to address this issue, the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society created best practice guidelines surrounding optimal perioperative care for the older adult surgical patient. This study aimed to determine the documented compliance with these guidelines at a single institution. A retrospective chart review was performed on 86 older adults undergoing elective, inpatient coronary artery bypass graft, prostatectomy, or colectomy over a 2-year period (1/2016–12/2017) at a single Veterans Affairs institution. The primary outcome was compliance with the 38 measures from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society Best Practice Guidelines. The secondary outcome was postoperative (including geriatric-specific) complications. The mean reported compliance across all measures was 41% ± 4%. Of 38 analyzed measures, compliance for 10 measures was achieved for 0 patients, and only 1 patient for 7 measures. There was variance in compliance by phase of care (P < .05) with a high of 56% ± 8% (immediate preoperative phase of care) and a low of 35% ± 4% (intraoperative phase of care). Overall reported compliance with the Best Practice Guidelines of the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society is low (41%) at this institution. This study identifies a need to improve the care provided to the vulnerable population of older adults undergoing an operation. Future work is needed to understand barriers for implementation and how compliance relates to outcomes.