G. Eamer1,3, B. Saravana-Bawan1, B. Van Der Westhuizen1, T. Chambers2, A. Ohinmaa3, R. G. Khadaroo1 1University Of Alberta,General Surgery,Edmonton, ALBERTA, Canada 2University Of Alberta,Libraries,Edmonton, ALBERTA, Canada 3University Of Alberta,School Of Public Health,Edmonton, ALBERTA, Canada
Introduction:
Seniors presenting with surgical disease are at increased risk of post-operative morbidity and mortality, and have increased treatment cost. Comprehensive Geriatric Assessment (CGA) has been proposed to reduce morbidity, mortality and cost following surgery. CGA seeks to identify and pre-emptively manage risk factors specific to elderly patients.
Methods:
A systematic review of CGA in emergency surgical patients was conducted. The primary outcome was cost effectiveness and secondary outcomes were length-of-stay, return of function and mortality. Pre-defined inclusion criteria were economic evaluation of CGA verses usual care in patients 65 and over receiving emergency surgery. Exclusion criteria include non-surgical patients, patients under 65, no economic outcomes and incomplete CGA. Systematic searches were done using MEDLINE, EMBASE, Cochrane and NHS-EED. Text screening, bias assessment and data extraction was performed by two authors. Meta-analysis was performed with the random effects model.
Results:
There were 557 articles identified; 495 articles were excluded based on abstract and 52 after full-text review. Ten articles reporting results from 8 studies were identified; 1 non-orthopedic trauma and 7 orthopedic trauma studies. Bias assessment revealed moderate to high risk of bias for all studies. Economic evaluation assessment identified 1 high-quality study and 7 moderate or low quality studies. All studies identified improved overall cost effectiveness. Four studies assessed return of function; combined odds ratio demonstrates improved functional outcome (OR 1.61, 95% CI 1.23-2.11). Seven studies assessed mortality demonstrating a significant decrease (OR 0.72, 95% CI 0.55-0.94). Six studies assessed length of stay; mean difference nears a significant reduction (mean difference -1.19, 95% CI -2.58-0.20) after excluding the non-orthopedic trauma study.
Conclusion:
CGA demonstrates improved return of function and mortality with reduced cost or improved utility in all studies. Our review suggests CGA is economically dominant choice in geriatric orthopedic hip fracture patients; further research should be conducted in other surgical fields. There is evidence that CGA should become standard of care in orthogeriatric patients. To implement perioperative CGA nationwide, workforce modeling should account for the increased demand for trained geriatricians that will occur.