Preoperative Geriatric Medicine Evaluation in a Multidisciplinary Abdominal Wall Reconstruction Clinic and Outcomes in Geriatric Patients.

Abstract

Chronological age is associated with adverse outcomes after abdominal wall reconstruction (AWR), yet many age-linked risks are modifiable. This study evaluated the benefit of integrating geriatric medicine (GM) into a multidisciplinary AWR clinic. Using a prospectively maintained database, patients 65 years or older underwent AWR after a preoperative GM consultation were propensity matched in a 1:1 manner to (1) patients 65 years or older before GM integration (NGM) and (2) younger patients (younger than 65 years). Primary outcomes were hospital length-of-stay (LOS) and 30-day medical and surgical complications. GM vs NGM: 124 pairs were similar in matching covariates, including age (74.5 ± 6.0 vs 5.7 ± 8.0 years; p = 0.204). GM patients had higher rates of steroids (17.7% vs 3.2%; p < 0.001), American Society of Anesthesiologists class III (73.4% vs 44.4%; p < 0.001) but fewer medical complications (4.8% vs 16.1%; p = 0.006) and fewer ICU admissions (0.8% vs 5.6%; p = 0.066). GM vs NGM ventral hernia subgroup: 62 pairs were similar in matching covariates and hernia complexity. GM patients were more comorbid but had reduced LOS (4.7 ± 2.9 vs 6.7 ± 6.5 days; p = 0.028) and wound complications (3.2% vs 21.0%; p = 0.004). GM vs younger: 100 pairs were similar in matching covariates, except for BMI (29.0 ± 4.7 vs 31.7 ± 6.2 kg/m 2 ; p = 0.002). GM patients were older (73.0 ± 5.0 vs 49.5 ± 7.7 years; p < 0.001), more comorbid (COPD: 12.0% vs 0.0%; p < 0.001, steroids: 14.0% vs 5.0%; p = 0.030), but comparable in hernia complexity. GM had shorter LOS (4.9 ± 5.4 vs 5.8 ± 6.7 days; p = 0.001). Medical complications, wound complications, reoperations, and readmissions were not statistically different (all p > 0.050). Embedding GM into a multidisciplinary AWR clinic was associated with clinically meaningful reductions in LOS and complications compared with matched older adults without GM and outcomes equal to a matched cohort nearly 25 years younger. Preoperative GM consultation should be considered for complex AWR candidates.