Breaking News
January 20, 2018 - UCLA researchers describe herpes virus structure associated with Kaposi’s sarcoma
January 20, 2018 - New study enrolls first patient to evaluate potential of WaveCrest LAAO System
January 20, 2018 - New review explores effects of exposing developing brains to general anesthesia
January 20, 2018 - GW Pharmaceuticals Announces Acceptance of NDA Filing for Epidiolex (cannabidiol) in the treatment of Lennox-Gastaut syndrome and Dravet syndrome
January 20, 2018 - Weight-Loss Surgery Approaches Offer Similar Results
January 20, 2018 - Free online access to millions of documents on chemical toxicity
January 20, 2018 - CE marked MAST Toxoreagent kit for detection of Toxoplasma antibodies
January 20, 2018 - DNA study sheds light on longstanding puzzle of cell division
January 20, 2018 - Montefiore provides specialized medical care to parents of adopted children
January 20, 2018 - Enzyme discovery provides new horizon of therapeutic opportunities across disease spectrum
January 20, 2018 - New smartphone app successfully enables remote monitoring of surgical wounds
January 20, 2018 - Liquid Biopsy Shows Promise for Colon Cancer
January 20, 2018 - Surgery death rates in Africa are twice global average: study
January 20, 2018 - New isothermal amplification kit using LAMP technology
January 20, 2018 - Pretreatment improves outcomes in high-risk stage 3 melanoma, study shows
January 20, 2018 - Health Highlights: Jan. 17, 2018
January 20, 2018 - House Opioid Task Force has Big Plans for 2018
January 20, 2018 - Perfectionism among young people significantly increased since 1980s, study finds
January 20, 2018 - Evidensia Sweden orders Sectra cloud-based PACS for reviewing all medical images
January 20, 2018 - Researchers test new anti-malaria medication
January 20, 2018 - Small Joint Surgeries Drop among RA Patients
January 20, 2018 - Young people with shared residency have fewer mental problems
January 20, 2018 - Childhood physical activity may have far-reaching implications
January 20, 2018 - Overweight female kidney donors of childbearing age may have greater preeclampsia risk
January 20, 2018 - MSU scientists seek to identify brain mechanisms related to psychosis
January 20, 2018 - Scientists find how potential new eczema treatment could also alleviate asthma
January 20, 2018 - Older hospitalized patients less likely to be tested for influenza
January 20, 2018 - Syndax Pharmaceuticals Announces Clinical Collaboration to Evaluate Entinostat in Combination with anti-PD-L1 Cancer Immunotherapy in Breast Cancer
January 20, 2018 - Endoscopes Over Microscopes in Retinal Surgery: Ophthalmology Times
January 20, 2018 - Technology not taking over children’s lives despite screen-time increase
January 20, 2018 - Study finds extensive contamination around lead battery recycling plants in 7 African countries
January 20, 2018 - Flu may pass to others through exhaled breath, study shows
January 20, 2018 - Neuronal loss very limited in Alzheimer’s disease, new study shows
January 20, 2018 - Novel robot can aid treatment of rare birth defect
January 19, 2018 - TherapeuticsMD Announces Submission of New Drug Application for TX-001HR
January 19, 2018 - Fighting Infant Mortality | Medpage Today
January 19, 2018 - Researchers offer new evidence on four-year-old children’s knowledge about ecology
January 19, 2018 - Analysis finds overlooked crucial factor in determining prognosis for DIPGs
January 19, 2018 - Review explores consequences of genetic testing and cancer risk-reducing surgery
January 19, 2018 - Morning Break: HHS Div. of Religious Freedom; Trump’s Heart Health; Minister of Loneliness
January 19, 2018 - Parkinson’s disease ‘jerking’ side effect detected by algorithm
January 19, 2018 - New analysis finds dramatic increases in maternal mortality rates
January 19, 2018 - Study provides more evidence for link between increased cancer risk and advanced gum disease
January 19, 2018 - Study reveals key mechanism of how cancer metastasis happens
January 19, 2018 - Weight-Loss Surgery’s Benefits Wane Over Time for Diabetics
January 19, 2018 - Cath Lab Recap: Sapien 3 Delivery System Recall; Transatlantic PCI Smackdown
January 19, 2018 - Parkinson’s treatment could be more effective, student finds
January 19, 2018 - New vaccine approach offers effective protection against tuberculosis
January 19, 2018 - Home care agencies often wrongly deny Medicare help to the chronically ill
January 19, 2018 - One hundred percent fruit juice does not alter blood sugar levels
January 19, 2018 - Prebiotics could enhance learning and memory skills in infants
January 19, 2018 - CMS May Cover MRI With Cardiac Devices Across the Board
January 19, 2018 - As income rises, women get slimmer—but not men
January 19, 2018 - Researchers develop adhesive materials to prevent bracket stains on teeth
January 19, 2018 - Flu can be spread without coughs and sneezes
January 19, 2018 - AMSBIO’s new recombinant protein shows great promise for organoid culture
January 19, 2018 - AbbVie’s Upadacitinib Granted Breakthrough Therapy Designation from the U.S. Food and Drug Administration for Atopic Dermatitis
January 19, 2018 - ASH: Pomalidomide Dose Escalation Improves Response
January 19, 2018 - Is your child’s school an obesity risk?
January 19, 2018 - Scientists describe groundbreaking training effect on the innate immune system
January 19, 2018 - MAST announces new AmpC, ESBL & Carbapenemase Detection Set
January 19, 2018 - Signaling molecules likely involved in concussions, rodent studies show
January 19, 2018 - Mast introduces Carba plus for CPE and OXA-48 confirmation
January 19, 2018 - Paleolithic diet helps overweight women maintain weight loss
January 19, 2018 - Agios Submits New Drug Application to the FDA for Ivosidenib for the Treatment of Patients with Relapsed/Refractory AML and an IDH1 Mutation
January 19, 2018 - This Flu Season, Don’t Forget About Tamiflu
January 19, 2018 - Amsterdam wins battle to host EU medicines agency after Brexit
January 19, 2018 - Study suggests movement as accurate method to diagnose neurodevelopmental disorders
January 19, 2018 - Maximize resolution in deep imaging for neuroscience research with Olympus TruResolution objectives
January 19, 2018 - Bilingualism may benefit children with ASD
January 19, 2018 - FDA Alert: Levofloxacin in 5 Percent Dextrose 250mg/50mL by AuroMedics: Recall
January 19, 2018 - USPSTF Not Backing Ankle-Brachial Index, CRP, or Coronary Calcium
January 19, 2018 - Higher omega-3 fatty acid intake tied to lower glaucoma risk
January 19, 2018 - Findings reveal conventional cancer therapy as double-edged sword
January 19, 2018 - Health Highlights: Jan. 16, 2018
January 19, 2018 - Morning Break: Anti-Emetic Warning; Uninsured Rate Jumps; Flu Worsens Saline Shortage
January 19, 2018 - Increased use of ambulatory surgery centers for cataract surgery
January 19, 2018 - Not-for-profit hospitals coming up with their own generic medicines to combat shortages
January 19, 2018 - $500 cancer detection blood tests may soon become reality
January 19, 2018 - Chronic traumatic encephalopathy may start early even without signs of concussions
New program improves outcomes for older people undergoing elective surgery

New program improves outcomes for older people undergoing elective surgery

image_pdfDownload PDFimage_print

Compared to younger adults, older people have higher rates of complications from surgery. But many problems can be avoided by intervening with assessments and risk-reduction strategies before, during and after procedures.

The effort — a program developed at Duke Health called Perioperative Optimization of Senior Health, or POSH – was established in June 2011 by co-directors Sandhya Lagoo-Deenadayalan, M.D., Ph.D., a general surgeon, and Mitchell Heflin, M.D., a geriatrician, with support from the Departments of Surgery and Medicine.

It includes a coordinated approach by surgery, geriatrics and anesthesiology to help older patients make an informed decision about proceeding with and preparing for elective surgeries in order to have the best possible outcomes.

Published Jan. 3 in JAMA Surgery, the researchers report that redesigning care resulted in shorter hospitals stays, lower readmission rates and a greater likelihood that patients would be discharged directly home without a nursing home stay or need for home health care. Patients in the POSH program also had overall fewer complications during their hospitalization.

“Our study shows that older adults do better when we proactively identify individual risks — particularly those associated with aging — and implement optimization strategies across a longer preoperative and postoperative timeframe,” said lead author and geriatrics specialist Shelley McDonald, D.O., Ph.D., assistant professor of medicine at Duke. “This is a growing need as the population ages, and these results demonstrate that by preparing patients and their caregivers for surgery we can improve outcomes for older people undergoing elective surgery.”

The Duke team focused on older patients planning to undergo elective abdominal surgeries. The patients were at least 65 years old, with one or more health factors that put them at higher risk of complications from surgery, including cognitive impairment, recent weight loss, chronic diseases, multiple medication needs, mobility difficulties and frailty.

From 2011-2015, the researchers evaluated a subset of patients enrolled in the POSH program, and compared their outcomes to those who underwent similar surgeries but did not have the intervention. The POSH patients tended to be older and had a higher number of chronic health conditions.

Following evaluation by surgeons, patients were referred to the POSH clinic where they were seen jointly by a multidisciplinary team, including geriatricians and anesthesia nurse practitioners. The team conducted a comprehensive risk assessment, then developed risk-mitigation strategies for patients and families to work on ahead of the surgery. Following surgery, the geriatrics team assisted the surgeons with post-operative management, focusing particularly on preventing complications and preparing for the transition from hospital to home.

Patients enrolled in the POSH program had shorter hospital stays by an average of two days. They also had lower readmission rates, with 2.8 percent of POSH patients readmitted within seven days of discharges, and 7.8 percent within 30 days of discharge. This compared to 9.9 percent of standard-care patients being readmitted at seven days, and 18.3 percent at 30 days.

Despite a having a lower overall complication rate, POSH patients were diagnosed more often with delirium. This might have been related to more rigorous surveillance for this condition by the geriatrics team. Regardless, a higher percentage of POSH surgery patients with delirium returned home upon discharge after surgery (62 percent) when compared to standard care patients (51 percent).

“Developing an interdisciplinary approach to treating older people undergoing surgery is an important step toward improving surgical outcomes, and what we learn from our collaboration will inform which elements of team-based care have the greatest impact so this can be more widely scaled to all health care settings,” McDonald said.

Source:

https://medschool.duke.edu/about-us/news-and-communications/med-school-blog/cross-disciplinary-program-improves-surgical-outcomes-older-patients

Tagged with:

About author

Related Articles