J. Q. Dworsky1,2, Y. Sanaiha1, C. P. Childers1,2, M. Maggard-Gibbons1, M. M. Russell1,3 1David Geffen School Of Medicine, University Of California At Los Angeles,General Surgery,Los Angeles, CA, USA 2University Of California – Los Angeles,Health Policy & Management,Los Angeles, CA, USA 3VA Greater Los Angeles Healthcare System,Surgery,Los Angeles, CA, USA
Introduction: The population is aging and increasingly undergoing surgery. Older adults require specialized perioperative care and are at high risk for poor outcomes. We currently do not provide standardized geriatric-specific education to surgical specialists, and only recently have national efforts focused on improving the quality of care for older adults undergoing surgery. Understanding the contemporary landscape of geriatric surgery is important in order to improve the quality of care through education and targeted quality improvement projects. This study aimed to define the full extent of inpatient surgery performed on older adults and which subspecialty providers performed these procedures.
Methods: This study used the 2014 National Inpatient Sample (NIS) to identify hospital admissions with major procedures in older adults (≥ 65 years). Procedures were classified as elective if they occurred on hospital day 0 or 1 and during an elective admission (defined by NIS); all others were classified as non-elective. Procedures were grouped into clinical categories based upon ICD-9 procedure codes. Because the NIS includes thousands of low-volume procedures, we limited our analysis to the top 80% of all major procedures performed. Descriptive statistics, weighted to represent the national distribution, were generated for the most frequent procedures and stratified by specialty and elective status.
Results: In 2014, a nationally weighted total of 2,875,730 major inpatient procedures were performed in patients aged ≥ 65 years (51.8% elective; 48.2% non-elective). There were 85 elective and 89 non-elective procedures that represented the top 80% of all procedures performed. Elective procedures were performed most frequently by orthopedics (40.4%), followed by spine surgery (10.3%), and general surgery (7.9%); non-elective procedures by orthopedics (24.3%), followed by general surgery (16.8%) and cardiology (15.0%). The majority of elective (59.6%) and non-elective procedures (75.7%) were not performed by orthopedists but by a variety of subspecialists including general surgeons, cardiologists, spine surgeons, vascular surgeons, cardiac surgeons, neurosurgeons, thoracic surgeons, gynecologists and urologists.
Conclusions: Over 2.8 million major inpatient procedures were performed in older adults in the United States in 2014 and nearly half were non-elective procedures. While orthopedics accounts for a high volume of geriatric surgery, the majority of procedures on older adults are performed by other subspecialists. The significant burden of geriatric surgery distributed across a variety of subspecialists suggests that efforts to improve geriatric-specific perioperative care should be widespread to target multiple subspecialties.
