Implementing the American College of Surgeons (ACS) Geriatric Surgery Verification program may reduce rates of postsurgical mortality and increase the proportion of patients with documentation standards such as advanced care directives, according to two new studies presented by Horattas et al and Westling et al at the ACS Clinical Congress 2024.
Background
The Geriatric Surgery Verification program includes quality measures for surgery departments in hospitals and health-care systems to improve surgical outcomes among patients aged 75 years and older.
The Cleveland Clinic Akron General Hospital in Ohio is one of 10 hospitals nationwide that have met the Geriatric Surgery Verification criteria established by the ACS. The program incorporates 32 evidence-based standards that prioritize reducing the risk of delirium and providing patient-centered care as well as addressing other challenges unique to patients aged 75 years and older. The program also enables hospitals to reduce costs and improve efficiencies.
Methods and Findings of the New Studies
In the new studies, researchers at the Akron General Hospital examined patient outcomes following implementation of the Geriatric Surgery Verification program. The first study evaluated patient mortality rates following surgery between July 2021 and January 2024 and the second study analyzed advanced planning and documentation—known as code status documentation—among patients who underwent surgery prior to and following implementation of the Geriatric Surgery Verification program.
The researchers found that by applying the Geriatric Surgery Verification program at their hospital, they able to reduce mortality rates following surgery by 50% and nearly triple the percentage of patients who met standards for documenting care preferences.
In the year prior to the implementation of the Geriatric Surgery Verification program, the mortality rate among patients aged 75 years and older within 30 days of surgery was 10.2%. Following implementation, the mortality rate dropped to 5.7%. There were no statistically significant differences in the hospital readmission rates following surgery between the pre– and post–Geriatric Surgery Verification program periods (15.6% and 14.3%, respectively).
In the second study, the researchers found that only 26.6% of general surgery patients aged over 75 years had code status documentation prior to Geriatric Surgery Verification program implementation. Following implementation, with the addition of patient education and the introduction of an electronic medical record template, that portion increased to 39.6%. After multidisciplinary efforts to improve care for geriatric patients were introduced, the percentage rose to 74.2%.
The researchers noted that the surgery team had extensive discussions with patients prior to surgery to determine their goals for surgery and their wishes if they had a less-than-optimal outcome.
“We had discussions with them about what they would want if their heart were to stop, or if they needed prolonged intubation, or if they would want and accept dialysis,” detailed lead author of the second study Blake Westling, DO, MBA, an ACS Resident Member.
Conclusions
“What’s really exciting is that we’re one of the first hospitals to show that we're significantly improving patient outcomes by implementing ACS [Geriatric Surgery Verification] standards,” explained lead author of the first study Ileana Horattas, MD, an ACS Associate Fellow and a surgeon at the Cleveland Clinic Akron General Hospital. “We know we're having more important care conversations. We know that our hospital rooms better accommodate the diverse needs of all patients, including those with vision impairments or mobility challenges. We know that we have a strong team of professionals specializing in care for older patients, including palliative care. We know that we’re well equipped. Now we’re seeing that’s improving outcomes,” she emphasized.
“I think putting it back in the patient’s own words helps drive where the next steps are in patient care,” underscored Dr. Westling. “We always hope surgery happens with no complications, but when there is a difficulty, having the next goal or direction is really important,” he concluded.
Disclosure: For full disclosures of the study authors, visit abstractsonline.com and abstractsonline.com.
