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| Postoperative delirium and hospital-acquired complications in patients undergoing comprehensive geriatric assessment prior to orthopaedic surgery |
| Siobhan Hulston, Leena Nagappan, Afsana Habib Fiona Stanley Fremantle Hospital Group, Perth, Australia |
BACKGROUND: As the life expectancy is getting older, there is an increase in the number of elderly patients presenting for elective procedures.[1] There is an increase in hospital-acquired complications (HAC) post-operatively in elderly patients when compared to younger patients undergoing the same procedure. This can result in an increased length of stay (LOS), putting pressure on hospital resources. [2] The Comprehensive Geriatric Assessment (CGA) is an interdisciplinary multidimensional diagnostic process focused on determining a patient’s medical, psychological, and functional capability to develop a plan for treatment. [3] Frailty, cognition and nutritional status are quantified to gain a better understanding of pre-operative function. METHODS: Retrospective data was collected from 55 patients aged 65 years and above who underwent a CGA as an outpatient in a Geriatric Perioperative Service (GPS), prior to undergoing an elective hip or knee arthroplasty in a Specialist Hospital in Australia. The same data was collected from 55 patients who underwent an elective hip or knee arthroplasty but did not attend this clinic. RESULTS: Both groups had similar characteristics and operations performed. Post-operative delirium was more common in the GPS group vs non-GPS group (8 vs 1). Twice as many women were found to have post-operative delirium (6 vs 3). A poor MMSE score was not found to be a significant predictor of post-operative delirium. Post-operative AKI was the most common HAC observed in non-clinic patients, mainly associated with nephrotoxic medications. LOS was not significantly increased in GPS cohort, but was increased in those experiencing a HAC in both groups. CONCLUSIONS: The CGA is an effective method in predicting patients that will encounter post-operative complications. It is a useful tool in allowing for pre-operative optimisation, post-operative management, and disposition planning. More routine referral to GPS clinic would improve patient outcomes in this population. There is also a role for post-operative review by the geriatric service where feasible.   |