Importance Older adults undergoing elective surgery experience higher rates of preventable postoperative complications than younger patients.

Objective To assess clinical outcomes for older adults undergoing elective abdominal surgery via a collaborative intervention by surgery, geriatrics, and anesthesia focused on perioperative health optimization.

Design, Setting, and Participants Perioperative Optimization of Senior Health (POSH) is a quality improvement initiative with prospective data collection. Participants in an existing geriatrics-based clinic within a single-site academic health center were included if they were at high risk for complications (ie, older than 85 years or older than 65 years with cognitive impairment, recent weight loss, multimorbidity, or polypharmacy) undergoing elective abdominal surgery. Outcomes were compared with a control group of patients older than 65 years who underwent similar surgeries by the same group of general surgeons immediately before implementation of POSH.

Main Outcomes and Measures Primary outcomes included length of stay, 7- and 30-day readmissions, and level of care at discharge. Secondary outcomes were delirium and other major postoperative complications. Outcomes data were derived from institutional databases linked with electronic health records and billing data sets.

Results One hundred eighty-three POSH patients were compared with 143 patients in the control group. On average, patients in the POSH group were older compared with those in the control group (75.6 vs 71.9 years; P < .001; 95% CI, 2.27 to 5.19) and had more chronic conditions (10.6 vs 8.5; P = .001; 95% CI, 0.86 to 3.35). Median length of stay was shorter among POSH patients (4 days vs 6 days; P < .001; 95% CI, –1.06 to –4.21). Patients in the POSH group had lower readmission rates at 7 days (5 of 180 [2.8%] vs 14 of 142 [9.9%]; P = .007; 95% CI, 0.09 to 0.74) and 30 days (14 of 180 [7.8%] vs 26 of 142 [18.3%]; P = .004; 95% CI, 0.19 to 0.75) and were more likely to be discharged home with self-care (114 of 183 [62.3%] vs 73 of 143 [51.1%]; P = .04; 95% CI, 1.02 to 2.47). Patients in the POSH group experienced fewer mean number of complications (0.9 vs 1.4; P < .001; 95% CI, –0.13 to –0.89) despite higher rates of documented delirium (52 of 183 [28.4%] vs 8 of 143 [5.6%]; P < .001; 95% CI, 3.06 to 14.65). A greater proportion of POSH patients underwent laparoscopic procedures (92 of 183 [50%] vs 55 of 143 [38.5%]; P = .001; 95% CI, 1.04 to 2.52). Tests for interactions between POSH patients and procedure type were insignificant for all outcomes.

Conclusions and Relevance Despite higher mean age and morbidity burden, older adults who participated in an interdisciplinary perioperative care intervention had fewer complications, shorter hospitalizations, more frequent discharge to home, and fewer readmissions than a comparison group.

重要性 进行择期手术的老年人比年轻患者的可预防的术后并发症发生率更高。

目的 通过以围手术期健康优化为重点的外科，老年医学和麻醉学合作干预，评估接受择期腹部手术的老年人的临床效果。

设计，设置和参加者 围手术期优化高级保健（POSH）是一项具有前瞻性数据收集的质量改进计划。如果他们存在并发症的高风险（例如，年龄超过85岁或65岁以上，患有认知障碍，近期体重减轻，多发病或多药房），则将其纳入单站点学术健康中心内现有的老年医学诊所的参与者。 ）正在接受选择性腹部手术。将结果与对照组的65岁以上患者进行比较，这些患者在立即实施POSH之前由同一组普通外科医师进行了类似的手术。

主要结果和措施 主要结果包括住院时间，7天和30天再入院以及出院时的护理水平。次要结果是were妄和其他主要的术后并发症。结果数据来自与电子健康记录和计费数据集链接的机构数据库。

结果 将183例POSH患者与对照组的143例患者进行比较。平均而言，POSH组的患者比对照组的患者年龄更大（75.6 vs 71.9岁；P  <.001； 95％CI，2.27至5.19），并且患有更多的慢性病（10.6 vs 8.5；P  = .001 ； 95％CI，0.86至3.35）。POSH患者的中位住院时间较短（4天vs 6天；P  <.001； 95％CI，从–1.06至–4.21）。POSH组的患者在7天和 30天时（分别为180天中的14 [180 [14 ] [2.8％]和142 [9.9％]中的14 [9.9％]）；P = .007； 95％CI，0.09至0.74）较低。 7.8％]对142个中的26个[18.3％]；P = .004; CI为95％，从0.19至0.75），并且更有可能通过自理在家出院（183人中的114人[62.3％]，而143人中的73人[51.1％]；P  = .04； 95％CI，1.02至2.47） 。 尽管有文献记载的higher妄发生率较高，但POSH组患者的平均并发症发生率却较低（0.9比1.4；P <.001； 95％CI，–0.13至–0.89）（52例为183例[28.4％]，而8例为143例[ 5.6％]；P  <0.001； 95％CI，3.06至14.65）。较大比例的POSH患者接受了腹腔镜手术（183例中的92例[50％] 143例中的55例[38.5％]；P  = .001； 95％CI为1.04至2.52）。POSH患者与手术类型之间的相互作用测试对于所有结局均无关紧要。

结论与相关性 尽管平均年龄和发病率较高，但参加跨学科围手术期护理干预的老年人与对照组相比，并发症少，住院时间短，出院频率高，再入院率低。