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Association of Integrated Care Coordination With Postsurgical Outcomes in High-Risk Older Adults: The Perioperative Optimization of Senior Health (POSH) Initiative.

Publication ,  Journal Article
McDonald, SR; Heflin, MT; Whitson, HE; Dalton, TO; Lidsky, ME; Liu, P; Poer, CM; Sloane, R; Thacker, JK; White, HK; Yanamadala, M ...
Published in: JAMA Surg
May 1, 2018

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.

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Published In

JAMA Surg

DOI

EISSN

2168-6262

Publication Date

May 1, 2018

Volume

153

Issue

5

Start / End Page

454 / 462

Location

United States

Related Subject Headings

  • United States
  • Retrospective Studies
  • Postoperative Complications
  • Perioperative Care
  • Patient Readmission
  • Morbidity
  • Male
  • Length of Stay
  • Humans
  • Follow-Up Studies
 

Citation

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Chicago
ICMJE
MLA
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McDonald, S. R., Heflin, M. T., Whitson, H. E., Dalton, T. O., Lidsky, M. E., Liu, P., … Lagoo-Deenadayalan, S. A. (2018). Association of Integrated Care Coordination With Postsurgical Outcomes in High-Risk Older Adults: The Perioperative Optimization of Senior Health (POSH) Initiative. JAMA Surg, 153(5), 454–462. https://doi.org/10.1001/jamasurg.2017.5513
McDonald, Shelley R., Mitchell T. Heflin, Heather E. Whitson, Thomas O. Dalton, Michael E. Lidsky, Phillip Liu, Cornelia M. Poer, et al. “Association of Integrated Care Coordination With Postsurgical Outcomes in High-Risk Older Adults: The Perioperative Optimization of Senior Health (POSH) Initiative.JAMA Surg 153, no. 5 (May 1, 2018): 454–62. https://doi.org/10.1001/jamasurg.2017.5513.
McDonald SR, Heflin MT, Whitson HE, Dalton TO, Lidsky ME, Liu P, et al. Association of Integrated Care Coordination With Postsurgical Outcomes in High-Risk Older Adults: The Perioperative Optimization of Senior Health (POSH) Initiative. JAMA Surg. 2018 May 1;153(5):454–62.
McDonald, Shelley R., et al. “Association of Integrated Care Coordination With Postsurgical Outcomes in High-Risk Older Adults: The Perioperative Optimization of Senior Health (POSH) Initiative.JAMA Surg, vol. 153, no. 5, May 2018, pp. 454–62. Pubmed, doi:10.1001/jamasurg.2017.5513.
McDonald SR, Heflin MT, Whitson HE, Dalton TO, Lidsky ME, Liu P, Poer CM, Sloane R, Thacker JK, White HK, Yanamadala M, Lagoo-Deenadayalan SA. Association of Integrated Care Coordination With Postsurgical Outcomes in High-Risk Older Adults: The Perioperative Optimization of Senior Health (POSH) Initiative. JAMA Surg. 2018 May 1;153(5):454–462.

Published In

JAMA Surg

DOI

EISSN

2168-6262

Publication Date

May 1, 2018

Volume

153

Issue

5

Start / End Page

454 / 462

Location

United States

Related Subject Headings

  • United States
  • Retrospective Studies
  • Postoperative Complications
  • Perioperative Care
  • Patient Readmission
  • Morbidity
  • Male
  • Length of Stay
  • Humans
  • Follow-Up Studies