Optimizing Surgical Quality Datasets to Care for Older Adults: Lessons from the American College of Surgeons NSQIP Geriatric Surgery Pilot

Julia R Berian; Lynn Zhou; Melissa A Hornor; Marcia M Russell; Mark E Cohen; Emily Finlayson; Clifford Y Ko; Thomas N Robinson; Ronnie A Rosenthal

doi:10.1016/j.jamcollsurg.2017.08.012

Optimizing Surgical Quality Datasets to Care for Older Adults: Lessons from the American College of Surgeons NSQIP Geriatric Surgery Pilot

J Am Coll Surg. 2017 Dec;225(6):702-712.e1. doi: 10.1016/j.jamcollsurg.2017.08.012. Epub 2017 Oct 17.

Authors

Julia R Berian¹, Lynn Zhou², Melissa A Hornor², Marcia M Russell³, Mark E Cohen², Emily Finlayson⁴, Clifford Y Ko⁵, Thomas N Robinson⁶, Ronnie A Rosenthal⁷

Affiliations

¹ Department of Surgery, University of Chicago Medical Center, Chicago, IL; American College of Surgeons, Division of Research and Optimal Patient Care, Chicago, IL. Electronic address: julia.berian@uchospitals.edu.
² American College of Surgeons, Division of Research and Optimal Patient Care, Chicago, IL.
³ Department of Surgery, University of California-Los Angeles, Los Angeles, CA.
⁴ Department of Surgery, University of California-San Francisco, San Francisco, CA.
⁵ Department of Surgery, University of California-Los Angeles, Los Angeles, CA; American College of Surgeons, Division of Research and Optimal Patient Care, Chicago, IL.
⁶ Department of Surgery, University of Colorado-Denver, Aurora, CO.
⁷ Department of Surgery, Yale University, New Haven, CT.

PMID: 29054389
DOI: 10.1016/j.jamcollsurg.2017.08.012

Abstract

Background: Surgical quality datasets can be better tailored toward older adults. The American College of Surgeons (ACS) NSQIP Geriatric Surgery Pilot collected risk factors and outcomes in 4 geriatric-specific domains: cognition, decision-making, function, and mobility. This study evaluated the contributions of geriatric-specific factors to risk adjustment in modeling 30-day outcomes and geriatric-specific outcomes (postoperative delirium, new mobility aid use, functional decline, and pressure ulcers).

Study design: Using ACS NSQIP Geriatric Surgery Pilot data (January 2014 to December 2016), 7 geriatric-specific risk factors were evaluated for selection in 14 logistic models (morbidities/mortality) in general-vascular and orthopaedic surgery subgroups. Hierarchical models evaluated 4 geriatric-specific outcomes, adjusting for hospitals-level effects and including Bayesian-type shrinkage, to estimate hospital performance.

Results: There were 36,399 older adults who underwent operations at 31 hospitals in the ACS NSQIP Geriatric Surgery Pilot. Geriatric-specific risk factors were selected in 10 of 14 models in both general-vascular and orthopaedic surgery subgroups. After risk adjustment, surrogate consent (odds ratio [OR] 1.5; 95% CI 1.3 to 1.8) and use of a mobility aid (OR 1.3; 95% CI 1.1 to 1.4) increased the risk for serious morbidity or mortality in the general-vascular cohort. Geriatric-specific factors were selected in all 4 geriatric-specific outcomes models. Rates of geriatric-specific outcomes were: postoperative delirium in 12.1% (n = 3,650), functional decline in 42.9% (n = 13,000), new mobility aid in 29.7% (n = 9,257), and new or worsened pressure ulcers in 1.7% (n = 527).

Conclusions: Geriatric-specific risk factors are important for patient-centered care and contribute to risk adjustment in modeling traditional and geriatric-specific outcomes. To provide optimal patient care for older adults, surgical datasets should collect measures that address cognition, decision-making, mobility, and function.

MeSH terms

Aged
Databases, Factual*
Female
Humans
Male
Pilot Projects
Postoperative Complications / epidemiology
Quality Improvement*
Risk Factors
Surgical Procedures, Operative / standards*
Treatment Outcome
United States