Proactive care of older people undergoing surgery ('POPS'): Designing, embedding, evaluating and funding a comprehensive geriatric assessment service for older elective surgical patients
Proactive care of older people undergoing surgery ('POPS'): Designing, embedding, evaluating and funding a comprehensive geriatric assessment service for older elective surgical patients
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DOI：
10.1093/ageing/afl163
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发表时间：
2007-03-01
期刊：
影响因子：
6.7
通讯作者：
Martin, Finbarr
中科院分区：
文献类型：
--
作者：
Harari, Danielle;Hopper, Adrian;Martin, Finbarr
背景：接受择期手术的老年人有明显的术后问题，延长住院时间。目的：设计、嵌入和评估一种基于证据的老年综合评估（CGA）服务，用于接受择期手术的高危老年患者。单位：城市教学医院。对象：65岁以上择期手术患者。干预：多学科术前CGA服务和术后随访（手术老年人的主动护理['POPS']）。方法：观察性队列研究和多水平调查（发展和建模阶段）。前瞻性“前后”比较（探索性评价）。结果：发展阶段的研究结果显示，老年择期手术患者术前合并症发生率高，术前无多学科投入，术后多种潜在可预防的问题延迟出院。两组择期骨科患者（术前与术后，N = 54）的比较显示，术后并发症包括肺炎（20% vs 4% [p = 0.008]）和谵妄（19% vs 6% [p = 0.036]）较少，反映多学科实践的领域有显著改善，包括压疮（19% vs 4% [p = 0.028]），疼痛控制不良（30% vs 2% [p < 0.001]）。活动迟缓（28%对9% [p = 0.012]）和导管使用不当（20%对7% [p = 0.046]）。住院时间减少了4.5天。与医疗并发症相关的延迟出院（37%对13%）或等待OT评估或设备（20%对4%）较少。结论：根据MRC复杂干预框架，为高危老年择期手术患者开发了一种主动循证CGA服务。择期骨科患者的术前/术后比较显示（在方法学限制范围内）术后结果改善，表明临床效果和效率更高，并有助于该服务获得主流资金。根据目前的研究，一项随机对照试验正在进行中。
Background: older people undergoing elective surgery have significant post-operative problems prolonging hospitalisation.Objective: to design, embed, and evaluate an evidence-based comprehensive geriatric assessment (CGA) service for at-risk older patients undergoing elective surgery.Setting: urban teaching hospital.Subjects: elective surgical patients aged 65+.Intervention: multidisciplinary preoperative CGA service with post-operative follow-through (proactive care of older people undergoing surgery ['POPS']).Methods: observational cohort study and multilevel surveys (development and modelling phase). Prospective 'before and after' comparison (exploratory evaluation).Results: findings from the development phase showed high levels of preoperative co-morbidity, no multidisciplinary preoperative input, and multiple potentially preventable post-operative problems delaying discharge in older elective surgery patients. Comparison of 2 cohorts of elective orthopaedic patients (pre-POPS vs POPS, N = 54) showed the POPS group had fewer post-operative medical complications including pneumonia (20% vs 4% [p = 0.008]) and delirium (19% vs 6% [p = 0.036]), and significant improvements in areas reflecting multidisciplinary practice including pressure sores (19% vs 4% [p = 0.028]), poor pain control (30% vs 2% [p < 0.001]), delayed mobilisation (28% vs 9% [p = 0.012]) and inappropriate catheter use (20% vs 7% [p = 0.046]). Length of stay was reduced by 4.5 days. There were fewer delayed discharges relating to medical complications (37% vs 13%) or waits for OT assessment or equipment (20% vs 4%).Conclusion: a proactive evidence-based CGA service for at-risk older elective surgical patients was developed according to MRC framework for complex interventions. Pre/post comparison in elective orthopaedic patients showed improved (within methodological limitations) post-operative outcomes indicative of better clinical effectiveness and efficiency, and contributed to the service obtaining mainstream funding. Informed by the present study, a randomised controlled trial is ongoing.