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Coordinated Care Makes Surgery Safer For Older Patients

A study finds that teamwork shortens hospital stays, reduces complications

Surgeons work in an operating room

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The median hospital stay for older patients was two days shorter and readmission rates were sharply lower, the study found.

For older patients, surgery carries a higher risk of potentially dangerous complications. But a new study has found that having a multi-disciplinary team of healthcare professionals to coordinate care before, during and after operations can get patients home sooner, reduce readmissions and increase the chances of a safe recovery.

The study, published in JAMA Surgery, analyzed outcomes for 183 patients undergoing elective abdominal surgery who participated in Duke University health system’s seven-year-old Perioperative Optimization of Senior Health (POSH) program, which coordinates surgery, geriatrics and anesthesiology care. Compared to a control group, the POSH patients were older — with an average age of 75.6 — and had more chronic conditions. Nevertheless, their median hospital stay was two days shorter, and their readmission rate was sharply lower, with just 7.8 percent needing to return to the hospital after 30 days, compared to 18.3 percent for the control group.

The POSH patients experienced complications at a 0.9 percent rate, compared to 1.4 percent for the control group.

“These results demonstrate that by preparing patients and their caregivers for surgery, we can improve outcomes for older people,” lead author Dr. Shelley McDonald, assistant professor of medicine at Duke, said in a press release.

Patients who opt to use the POSH program meet with team members several weeks before surgery for an assessment of their health and the issues that might make it harder for them to undergo and recover from the operation. As a result, the team may adjust their medications, suggest an exercise or physical therapy regimen or refer them for treatment to improve management of a chronic condition, such as diabetes.

In addition, the team shares information with the surgeon and anesthesia department about anything that might require attention during or after surgery.