Effectiveness of Comanagement Model: Geriatric Medicine and Vascular Surgery
Effectiveness of Comanagement Model: Geriatric Medicine and Vascular Surgery
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DOI：
10.1016/j.jamda.2021.10.022
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发表时间：
2022-04-01
影响因子：
7.6
通讯作者：
Lo, Zhiwen Joseph
中科院分区：
文献类型：
--
作者：
Natesan, Selvaganapathi;Li, Jennifer Yuan;Lo, Zhiwen Joseph
目的：老年外科患者由于身体虚弱和多种合并症，经常发生术后并发症。老年医学会诊有助于优化危险因素，改善髋部骨折患者的预后。本研究的目的是评估老年医学之间实施comanadministration模式前后的患者结局设计：这是一项病例对照研究，涉及由血管外科、老年医学和老年护理服务共同管理的急诊血管外科患者。本研究于2015年至2018年在新加坡的一家三级医院进行，对象为年龄超过65岁的急性血管外科患者。2013年至2014年135例患者的回顾性队列（对照组）将符合comanasthenia模型标准的患者与348例由老年外科服务进行comanasthenia的前瞻性队列进行比较，2015 - 2018年，以及2015 - 2016年患者的进一步亚组分析（n = 150）（早期干预组）和2017年至2018年（n = 198）（晚期干预组）。合并治疗的患者住院时间明显缩短（11.6 vs 20.8天，P = 0.001），减少医院感染（尿路感染为3% vs 12%，P = 0.003）并降低30天再入院率（22% vs 34%，P = 0.011）。在接受老年外科服务的患者中，观察到液体超负荷发生率下降的趋势（3% vs 7%，P = 0.073）。亚组分析显示，早期干预组和晚期干预组的住院时间（15.4 vs 11.6天，P = 0.001）、30天再入院率（35% vs 22%，P = 0.01）和医院尿路感染（8% vs 3%，P = 0.003）逐渐减少。虽然没有统计学意义，但也观察到谵妄发生率降低（13%vs11%）和其他术后内科并发症。结论和意义：尽管合并症增加，老年血管外科住院患者的住院时间明显缩短，院内感染减少，并通过与血管外科和老年医学服务的联合治疗模式降低了30天的再入院率。随着护理模式的发展，随着时间的推移，观察到结果有所改善。围手术期老年医学干预可改善老年急性血管外科患者的预后。(C)2021 AMDA -急性后和长期护理医学协会。
Objectives: Older surgical patients frequently develop postoperative complications due to their frailty and multiple comorbidities. Geriatric medicine consultation helps to optimize risk factors and improve outcomes in patients with hip fracture. This study aimed to evaluate patient outcomes before and after comanagement model implementation between geriatric medicine (Geriatric Surgical Service) and vascular surgery services.Design: This was a case-control study involving emergency vascular surgical patients who were comanaged by vascular surgery, geriatric medicine, and geriatric nursing services.Settings and Participants: This study was conducted in a tertiary hospital in Singapore from 2015 to 2018 with acute vascular surgical patients aged older than 65 years.Methods: A retrospective cohort of 135 patients from 2013 to 2014 (control group) who fulfilled the criteria for the comanagement model was compared with a prospective cohort of 348 patients who were comanaged by a geriatric surgical service from 2015 to 2018, and a further subgroup analysis of patients between 2015 and 2016 (n = 150) (early intervention group) and between 2017 and 2018 (n = 198) (late intervention group) was performed.Results: Comanaged patients had a significantly shorter length of hospital stay (11.6 vs 20.8 days, P = .001), reduced nosocomial infections (3% vs 12% for urinary tract infection, P = .003) and decreased 30-day readmission rates (22% vs 34%, P = .011). A trend of a decreased incidence of fluid overload was noted in patients comanaged with the geriatric surgical service (3% vs 7%, P = .073). Subgroup analysis showed progressive reductions in the length of stay (15.4 vs 11.6 days, P = .001), 30-day readmission rate (35% vs 22%, P = .01), and nosocomial urinary tract infection (8% vs 3%, P = .003) between the early intervention group and the late intervention group. Although they were not statistically significant, reductions were also observed in the delirium rate (13% vs 11%) and other postoperative medical complications in the early intervention group and the late intervention group.Conclusion and Implications: Despite having increasing comorbidities, older vascular surgical inpatients had a significantly shorter length of stay, reduced nosocomial infections, and decreased 30-day readmission rates through a comanagement model with vascular surgery and geriatric medicine services. Improvements in outcomes were observed over time as the model of care evolved. Geriatric medicine intervention in the perioperative period improves the outcomes of older acute vascular surgical patients. (C) 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.