Adapting the Preoperative Assessment of Older Patients - the Value of Inter-Disciplinary Working Between Geriatricians and Anaesthetists

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Abstract Introduction Prior to implementation of a Perioperative care for Older People undergoing Surgery (POPS) service at our hospital, older patients ≥65 years with a clinical frailty scale score (CFS) ≥5 were referred to anaesthetics following nurse pre-assessment. Integrating a POPS pathway into preoperative assessment facilitated direct referral for Comprehensive Geriatric Assessment (CGA), with anaesthetic input at a weekly multidisciplinary team meeting. We assessed the workability and cost savings of the new pathway. Methods Complying with ethical standards, data from patients assessed by a geriatrician in a POPS clinic over a 13-month period were reviewed. Additional anaesthetics assessments (notes reviews and/or clinical consultation) were recorded. Results 182 patients underwent preoperative assessment by a geriatrician – median CFS 6 (interquartile range 5-6), median age 81 (range 75.5-84), and M:F ratio 1.1. The magnitude of the surgical procedure was major (n=16), intermediate (n=62) or minor (n=104). 82% (n=150) required no anaesthetics input. 13% (n=23) underwent geriatrician review and anaesthetics notes review. 5% (n=9) underwent a clinical consultation with both geriatrics and anaesthetics – 7/9 had an initial anaesthetics consultation and 2/9 were referred by the geriatrician for airway assessment. Avoidance of duplicate anaesthetics appointments in this cohort saved £27,450. There were 30 unnecessary anaesthetic interventions in the pathway. Conclusion Preparing frail patients for surgery is a complex process vulnerable to duplication. Most patients in the POPS pathway do not require additional anaesthetics input preoperatively, releasing those appointments for non-frail high-risk individuals. However, it is important to recognise when dual assessment is indicated to optimally prepare patients for surgery.

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