The Perioperative Surgical Home for the Geriatric Population

  • Gary E. LoydEmail author
  • Anahat Dhillon


The perioperative surgical home while in its infancy in many ways is a concept trialed under different names for decades with the goals being to improve patient outcomes and satisfaction while decreasing costs. This can be achieved by decreasing variability, utilizing multidisciplinary teams, coordinating care across the continuum, and engaging the patient in the process. Geriatric patients serve as the prime population to benefit from these concepts given their increased risk and cost due to their comorbidities, increased concentration on quality of life, and the magnitude of impact of a “simple procedure.” With only increasing operative and nonoperative procedures being performed in these patients, development of rigorous programs utilizing concepts of the PSH will improve care into the future.


Perioperative Surgical Home PSH Enhanced Recovery After Surgery ERAS Geriatric Outcome improvement Surgical outcomes Cost containment 


  1. 1.
    Sia C, Tonniges TF, Osterhus E, Taba S. History of the medical home concept. Pediatrics. 2004;113(5 Suppl):1473–8.PubMedGoogle Scholar
  2. 2.
    Vetter TR, Goeddel LA, Boudreaux AM, et al. The perioperative surgical home: how can it make the case so everyone wins? BMC Anesthesiol. 2013;13:6. Scholar
  3. 3.
    Kash BA, Zhang Y, Cline KM, Menser T, Miller TR. The perioperative surgical home (PSH): a comprehensive review of US and non-US studies shows predominantly positive quality and cost outcomes. Milbank Q. 2014;92(4):796–821.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    ASA Definition of the Perioperative Surgical Home. Last accessed 21 Aug 2016.
  5. 5.
    American Association of Orthopedic Surgeons definition of the Perioperative Surgical Home, Pollack P. Perioperative Surgical Home Model Moves Forward. Last accessed 22 Aug 2016.
  6. 6.
    Vetter TR, Boudreaux AM, Jones KA, et al. The perioperative surgical home: how anesthesiology can collaboratively achieve and leverage the triple aim in health care. Anesth Analg. 2014;118(5):1131–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Schweitzer M, Fahy B, Leib M, et al. The perioperative surgical home model. ASA Newsl. 2013;77:58–9.Google Scholar
  8. 8.
    Qiu C, Cannesson M, Morkos A, et al. Practice and outcomes of the perioperative surgical home in a California integrated delivery system. Anesth Analg. 2016;123(3):597–606.CrossRefPubMedGoogle Scholar
  9. 9.
    Lavernia CJ, D’Apuzzo MR, Hernandez VH, et al. Postdischarge costs in arthroplasty surgery. J Arthroplast. 2006;21(6 Suppl 2):144–50.CrossRefGoogle Scholar
  10. 10.
    Liu LL, Leung JM. Predicting adverse postoperative outcomes in patients aged 80 years or older. J Am Geriatr Soc. 2000;48(4):405–12.CrossRefPubMedGoogle Scholar
  11. 11.
    Partridge JSL, Harari D, Dheshi JK. Frailty in the older surgical patient: a review. Age Ageing. 2012;41(2):142–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Poldermans D, Bax JJ, Boersma E, DeHert S, et al. Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery: the task force for preoperative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery of the European Society of Cardiology. Eur Heart J. 2010;30(22):2769–812.Google Scholar
  13. 13.
    Arya S, Long CA, Brahmbhatt R, Shafii S et al. Preoperative frailty increases risk of nonhome discharge after elective vascular surgery in home-dwelling patients. Ann Vasc Surg. 2016;35:19–29.Google Scholar
  14. 14.
    Dl M, Beaule PE, Bryson GL, Van Walvaren C. The impact of frailty on outcomes and healthcare resource usage after total joint arthroplasty: a population- based cohort study. Bone Joint J. 2016;98-B(6):799–805.CrossRefGoogle Scholar
  15. 15.
    Magaziner J, Hawkes W, Hebel JR, et al. Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci. 2000;55:498–507.CrossRefGoogle Scholar
  16. 16.
    Ziden L, Kreuter M, Fradin K. Long-term effects of home rehabilitation after hip fracture- 1 year follow up of functioning, balance confidence, and health related quality of life in elderly people. Disabil Rehabil. 2010;32:18–32.CrossRefPubMedGoogle Scholar
  17. 17.
    Stenvall M, Elinge E, Von Heideken WP, et al. Having had a hip fracture- association with dependency amongst the oldest old. Age Ageing. 2005;34:294–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Ziden L, Scherman MH, Wenestam CG. The break remains- elderly people’s experiences of a hip fracture 1 year after discharge. Diabil REhabil. 2010;32:103–13.CrossRefGoogle Scholar
  19. 19.
    Crotty M, Whitehead C, Miller M, Gray S. Patient and caregiver outcomes 12 months after home-based therapy for hip fracture: a randomized controlled trial. Arch Phys Med Rehabil. 2003;84(22):1019–33.Google Scholar
  20. 20.
    Ziden L, Frandin K, Kreuter M. Home rehabilitation after hip fracture. A randomized controlled study on balance confidence, physical function and everyday activities. Clin Rehabil. 2008;22:1019–33.CrossRefPubMedGoogle Scholar
  21. 21.
    Karlsson A, Berggen M, Gustafson Y, et al. Effects of geriatric interdisciplinary home rehabilitation on walking ability and length of hospital stay after hip fracture: a randomized controlled trial. JAMDA. 2016;17:464.ep–464.e15.Google Scholar
  22. 22.
    Herfjord JK, Heggestad T, Ersland H, Ranhoff A. Intermediate care in nursing home after hospital admission: a randomized controlled trial with one year follow up. BMC Res Notes. 2014;7:889.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Nordstrom P, Michaelsson K, Hommel A, et al. Geriatric rehabilitation and discharge location after hip fracture in relation to the risks of death and readmission. J Am Med Dir Assoc. 2016;17(1):91.e1–7.CrossRefGoogle Scholar
  24. 24.
    Engel PA, Spencer J, Paul T, Boardman J. The geriatrics in primary care demonstration: integrating comprehensive geriatric care into the medical home: preliminary data. J Am Geriatr Soc. 2016;64(4):875–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Della Rocca GJ, Moylan KC, Crist BD, et al. Comanagement of geriatric patients with hip fractures: a retrospective, controlled cohort study. Geriatc Orthop Surg Rehabil. 2013;4:10–5.CrossRefGoogle Scholar
  26. 26.
    Marcantonio ER, Flacker JM, Wright RJ, Resnick NM. Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc. 2001;49(5):516–22.CrossRefPubMedGoogle Scholar
  27. 27.
    Lundstrom M, Olofsson B, Stenvall M, et al. Postoperative delirium in old patients with femoral neck fracture: a randomized intervention study. Aging Clin Exp Res. 2007;19(3):178–86.CrossRefPubMedGoogle Scholar
  28. 28.
    Nabozny M, Barnato A, Rathouz P, Havlena J, et al. Trajectories and prognosis of older patients who have prolonged mechanical ventilation after high-risk surgery. CCM. 2016;44(6):1091–7.CrossRefGoogle Scholar
  29. 29.
    Fried TR, Bradley EH, Towle VR, et al. Understanding the treatment preference of seriously ill patients. N Engl J Med. 2002;346:1061–6.CrossRefPubMedGoogle Scholar
  30. 30.
    Fried TR, Van Ness PH. Byers al et al: changes in preferences for life-sustaining treatment among older persons with advanced illness. J Gen Intern Med. 2007;22:495–501.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Englesbe MJ, Lee JS, He K, et al. Analytic morphomics, core muscle size, and surgical outcomes. Ann Surg. 2012;256(2):255–61.CrossRefPubMedGoogle Scholar
  32. 32.
    Englesbe MJ, Terjimanian MN, Lee JS, et al. Morphometric age and surgical risk. J Am Coll Surg. 2013;216(5):976–85.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    ERAS®Society. History of ERAS Last accessed 21 Aug 2016.

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of AnesthesiologyHenry Ford Health SystemDetroitUSA
  2. 2.Department of AnesthesiologyUniversity of California Los AngelesLos AngelesUSA

Personalised recommendations