Preliminary data demonstrate the Geriatric Surgery Verification program reduces postoperative length of stay
Preliminary data demonstrate the Geriatric Surgery Verification program reduces postoperative length of stay
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DOI：
10.1111/jgs.17154
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发表时间：
2021-04-07
影响因子：
6.3
通讯作者：
Robinson, Thomas N.
中科院分区：
文献类型：
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作者：
Jones, Teresa S.;Jones, Edward L.;Robinson, Thomas N.
目的/背景老年手术验证(GSV)计划促进临床标准，旨在优化为老年人提供的手术护理质量。这项研究的目的是确定GSV计划标准的初步实施是否会改善手术结果。设计前瞻性研究，采用队列匹配。设置来自单个机构的数据与全国数据集队列进行比较。参与者包括在2018年1月至2019年12月期间接受住院手术的所有年龄为75岁的患者。根据年龄和手术程序代码进行队列匹配，使用国家数据集。测量基线、术前和术中特征采用退伍军人事务部外科质量改进计划(VASQIP)变量定义进行前瞻性记录。记录术后结果，包括VASQIP定义的并发症、30d死亡率和住院时间。结果共有162名患者参与GSV计划，308名患者为匹配的对照组。两组术后一个或多个并发症的发生率(p=0.81)或30天的死亡率(p=0.61)无差异。与匹配队列相比，接受GSV计划护理的患者术后住院时间缩短(中位数4天[范围1，31]比5天[范围1，86]；p<；0.01；平均5.4+/-4.8比8.8+/-11.8天；p<；0.01)。在多变量回归模型中，GSV计划减少的住院时间与包括年龄、手术时间和合并症在内的其他相关协变量无关(p<；0.01)。结论GSV计划标准的初步实施减少了接受住院手术的老年人的住院时间。这一发现证明了GSV计划的临床和财务价值。
Objectives/Background The Geriatric Surgery Verification (GSV) Program promotes clinical standards aimed to optimize the quality of surgical care delivered to older adults. The purpose of this study was to determine if preliminary implementation of the GSV Program standards improves surgical outcomes.Design Prospective study with cohort matching.Setting Data from a single institution compared with a national data set cohort.Participants All patients aged >= 75 years undergoing inpatient operations between January 2018 and December 2019 were included. Cohort matching by age and procedure code was performed using a national data set.Measurements Baseline pre- and intraoperative characteristics prospectively recorded using Veterans Affairs Surgical Quality Improvement Program (VASQIP) variable definitions. Postoperative outcomes were recorded including complications as defined by VASQIP, 30-day mortality, and length of stay.Results A total of 162 patients participated in the GSV program, and 308 patients comprised the matched comparison group. There was no difference in postoperative occurrence of one or more complications (p = 0.81) or 30-day mortality (p = 0.61). Patients cared for by the GSV Program had a reduced postoperative length of stay (median 4 days [range 1,31] vs. 5 days [range 1,86]; p < 0.01; and mean 5.4 +/- 4.8 vs. 8.8 +/- 11.8 days; p < 0.01) compared with the matched cohort. In a multivariable regression model, the GSV Program's reduced length of stay was independent of other associated covariates including age, operative time, and comorbidities (p < 0.01).Conclusion Preliminary implementation of the GSV Program standards reduces length of stay in older adults undergoing inpatient operations. This finding demonstrates both the clinical and financial value of the GSV Program.