Development of a minimum clinical dataset for preoperative comprehensive geriatric assessment using a modified Delphi technique

Margot Lodge; Rachel Aitken; Yih Harng Chong; Janani Thillainadesan

doi:10.1111/ajag.13334

Development of a minimum clinical dataset for preoperative comprehensive geriatric assessment using a modified Delphi technique

Australas J Ageing. 2024 May 16. doi: 10.1111/ajag.13334. Online ahead of print.

Authors

Margot Lodge^{1

2

3}, Rachel Aitken⁴, Yih Harng Chong^{5

6}, Janani Thillainadesan^{7

8}

Affiliations

¹ Alfred Health, Melbourne, Victoria, Australia.
² National Centre for Healthy Ageing, Melbourne, Victoria, Australia.
³ Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
⁴ Department of Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
⁵ Te Whatu Ora (Waitemata District), Auckland, New Zealand.
⁶ School of Medicine, University of Auckland, Auckland, New Zealand.
⁷ Department of Geriatric Medicine, Centre for Education and Research on Ageing, Sydney, New South Wales, Australia.
⁸ Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.

PMID: 38754868
DOI: 10.1111/ajag.13334

Abstract

Objective: To construct a standardised, consensus-guided minimum clinical dataset (MCDS) for preoperative comprehensive geriatric assessment and optimisation (CGA) in Australia and Aotearoa New Zealand.

Methods: We conducted a review of the international perioperative literature to identify CGA domains and tools for potential inclusion in the MCDS. We invited members of the Australian and New Zealand Society for Geriatric Medicine to participate in a Delphi study to obtain consensus on MCDS tools. Participants were asked to rate proposed tools using Likert scales (when >2 tools) or make a binary choice between two proposed tools. Consensus was considered to be achieved when there was at least 75% concordance between the two rounds amongst the participants, and at least one variable attaining over 50% of participants' votes. Domains that did not achieve consensus in Round 1 were carried over to Round 2.

Results: There were 73 participants in Round 1 of the Delphi study and 47 participants in Round 2. Consensus was achieved on tool/s recommended for every MCDS domain: Clinical Frailty Scale (frailty); sMMSE, RUDAS, MoCA (cognition); 4AT (delirium); timed-up-and-go (physical function); GDS-15 (mood); Barthel Index (functional status); and MUST (malnutrition).

Conclusions: We recommend clinicians delivering preoperative CGA consider the use of the MCDS we have constructed when assessing older people contemplating surgery, as part of a multicomponent and multidisciplinary approach to optimising perioperative outcomes.

Keywords: Delphi technique; geriatric assessment; perioperative care; preoperative care.