Postoperative geriatric syndromes indicate high susceptibility and poor outcomes in older adults

Postoperative geriatric syndromes indicate high susceptibility and poor outcomes in older adults

Older adults who develop a new geriatric syndrome - such as dehydration, delirium or malnutrition - after major surgery are at dramatically higher risk for poor outcomes, including more complications, fewer days spent at home and a significantly increased chance of dying within a year, according to findings published in theJournal of the American College of Surgeons (JACS).

Researchers analyzed Medicare claims data from 2016 to 2021 for patients over age 66 who had one of five major surgeries: coronary artery bypass grafting, pneumonectomy, abdominal aortic aneurysm repair, pancreatectomy or colectomy. The study focused only on new cases and excluded patients with a history of geriatric syndromes.

The study found that 10.9% of patients developed at least one new geriatric syndrome during their hospital stay. These syndromes include delirium (sudden confusion or disorientation), dehydration, malnutrition, falls, or loss of bladder or bowel control. Patients who developed any of these conditions were significantly less likely to be discharged straight home and spent an average of 16.5 fewer days at home in the 90 days following surgery.

Geriatric syndrome can be like a “canary in the coal mine,” indicating a patient's underlying vulnerability. It is important that we do not simply dismiss these events as a normal part of “growing older.” These are important warning signs that a patient requires closer monitoring and individual support, both in hospital and after discharge.”

Timothy M. Pawlik, MD, MPH, PhD, FACS,senior author,Surgical oncologist at The Ohio State University Wexner Medical Center

Key findings

• Patienten, die ein geriatrisches Syndrom entwickelten, hatten innerhalb von 90 Tagen nach der Entlassung eine Reduzierung der Tage zu Hause um 27 %. Bei denjenigen, bei denen auch eine postoperative Komplikation auftrat, verringerten sich die durchschnittlichen Tage zu Hause auf nur 15 Tage.

• Die Entwicklung eines geriatrischen Syndroms war mit einem um 132 % höheren Sterberisiko innerhalb eines Jahres verbunden. Das Vorliegen von zwei oder mehr Syndromen führte in diesem Zeitraum zu einem um 272 % höheren Sterberisiko.

• Das erhöhte Sterblichkeitsrisiko blieb auch bei Patienten hoch, bei denen keine größeren postoperativen Komplikationen auftraten, mit einem um 54 % höheren Sterberisiko.

• Dehydration war das am häufigsten auftretende Syndrom (66,7 % der betroffenen Patienten), gefolgt von Delirium (25,2 %) und Unterernährung (13,2 %).

The study also identified factors associated with a higher risk of developing geriatric syndrome, including older age, a higher burden of other health conditions and the need for emergency surgery. According to the authors, minimally invasive surgery was associated with a 49% lower risk of developing geriatric syndrome.

The researchers suggest that the findings underscore the urgent need for a specialized, systematic approach to the surgical care of older adults through programs such as the American College of Surgeons (ACS) Geriatric Surgery Verification (GSV) program.

The ACS GSV program provides hospitals with a set of evidence-based standards designed to optimize surgical care for older adults. These standards emphasize proactive patient assessment, delirium prevention and management, and patient-centered goal setting to improve outcomes and preserve patients' independence and quality of life after surgery.

“This research provides compelling evidence as to why programs like GSV are so important,” said Dr. Pawlik. “By focusing on the unique needs of older patients, we can better anticipate, prevent and manage these syndromes, which translates directly into helping patients return home and to their lives.”

Co-authors include Andrea Baldo, MD; Odysseas P Chatzipanagiotou, MD; Selamawit Woldesenbet, MS, MPH, PhD; Miho Akabane, MD; Gaya Spolverato, MD, FACS.

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