Surgical outcome improvement by shared decision-making: value of a preoperative multidisciplinary target clinic for the elderly in colorectal surgery

• Published in: Langenbeck's archives of surgery 2023-08, Vol.408 (1), p.316-316, Article 316
• Main Authors: Staiger, Roxane D., Curley, Daniel, Attwood, Natalie V., Haile, Sarah R., Arulampalam, Tan, Simpson, Joanna C.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Aged; Aged, 80 and over; Cardiac Surgery; Colorectal Surgery; Digestive System Surgical Procedures; General Surgery; Humans; Medicine; Medicine & Public Health; Postoperative Complications - epidemiology; Prospective Studies; Quality of Life; Thoracic Surgery; Traumatic Surgery; Treatment Outcome; Vascular Surgery
• ISSN: 1435-2451; 1435-2451
• DOI: 10.1007/s00423-023-03031-y

Purpose Frailty and comorbidities increase the risk of postoperative complications and raise treatment costs. Perioperative optimisation is shown to improve surgical outcomes for the elderly. The aim of this study was to assess the impact of introducing a multidisciplinary preoperative clinic for older patients (Colchester Older Persons’ Evaluation for Surgery (COPES) clinic) undergoing major colorectal surgery. Methods This 5-year single centre study included patients >65 years with ≥3 comorbidities undergoing major colorectal surgery. From October 2018, patients with these characteristics were evaluated and optimised in the COPES clinic by a geriatrician and an anaesthetist. Outcomes were compared to high-risk patients operated on prior to COPES (pre-COPES group). The primary outcomes were postoperative morbidity at discharge and 6 months measured by the Comprehensive Complication Index. Patients were matched on age and number of comorbidities. Results A total of 54 patients were enrolled in the pre-COPES and 18 in the COPES group. After matching, the results were comparable for both groups. The length of stay was shorter in the COPES group and the recurrence rate was higher; however, it did not reach statistical significance in both findings. Conclusion This clinic intends to improve treatment quality, placing emphasis on shared decision-making. More focus should be put on patient-reported outcomes and experiences. Especially for elderly patients, quality of life and maintaining independence are often their priority. To determine the true value of a preoperative multidisciplinary clinic targeting elderly comorbid patients, a prospective study with larger cohort is needed, focusing not only on objective outcomes but also on patient-reported outcomes.