A Tale of Two Hospitals: Receiving Surgical Care at a Hospital with a Geriatric Surgical Pathway Improves Postoperative Outcomes.

Abstract

The American College of Surgeons Geriatric Surgery Verification Program improves outcomes in pre-post implementation analyses. However, data are limited, and none have compared hospitals with and without geriatric surgical pathways (GSPs). We evaluated postoperative outcomes comparing a hospital with a GSP (GSP+) and without a GSP (GSP-) in an academic health system. We included all elective noncardiac surgical procedures among patients 65 years of age or older who completed a preoperative frailty screening from 2018 to 2023 at 2 hospitals in our health system. Covariates included demographics and the operative stress score to account for case variability. Outcomes were loss of independence, length of stay (LOS), readmissions, and hospital-acquired conditions. During the study, 3,098 older patients underwent surgery, 24% at GSP+ and 76% at GSP- site. The median age was 72 years, 50% were women, 73% were White, and 27% were frail. In univariate Poisson exact test, GSP- had 51.5% higher hospital-acquired conditions per 1,000 discharges compared with GSP+ (p value: 0.05). In multivariate analysis, GSP- had increased risk for longer LOS (adjusted incidence rate ratio 2.63, 95% CI 1.59 to 4.37) but lower odds of readmission (adjusted odds ratio 0.68, 95% CI 0.53 to 0.88) compared with GSP+. There was no relation for loss of independence (adjusted odds ratio 0.97, 95% CI: 0.78 to 1.22) by hospital site. These findings demonstrate that older patients receiving care with geriatric surgical support have improved LOS and decreased reportable complications, which supports the need for randomized prospective studies to establish the unbiased benefits of GSPs that align with the American College of Surgeons Geriatric Surgery Verification Program.