Abstract
The aging of the US population will place significant stress on the current health-care system. The impact of the aging population on the surgical disciplines is especially apparent given the inherent risks of undergoing surgery. It is essential that we develop strategies to deliver high quality and patient-centered care for this vulnerable population. Quality of care in surgery dates back to the early 1900s when Ernest Amory Codman was among the first to systematically measure, analyze, and compare patient care and outcomes. However, only recently has quality of care in geriatric surgery received systematic attention. For example, there have been efforts from the Institute of Medicine, American College of Surgeons, and American Geriatrics Society to improve the quality of care in this population. Using the Donabedian model of quality evaluation (e.g., structure, process, and outcomes), it is clear that there have been marked improvements within five domains important in the perioperative care of geriatric patients: cognitive impairment, functional status, frailty, medication management, and patient goals and preferences. Quality improvement in the relatively young field of geriatric surgery is progressing at a rapid rate and beginning to gain the national attention needed to optimize care for this unique patient population.
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References
Ortman JM, Velkoff VA, Hogan H (2014) An aging nation: the older population in the United States, current population reports. U.S. Census Bureau, Washington, DC, pp 25–1140
United States Census Bureau – 2014 National Population Projections. https://www.census.gov/population/projections/data/national/2014.html. Accessed 11 Mar 2017
Hall MJ, DeFrances CJ, Williams SN, Golosinskiy A, Schwartzman A (2010) National hospital discharge survey: 2007 summary. National Center for Health Statistics, Hyattsville
Etzioni DA, Liu JH, Maggard MA, Ko CY (2003) The aging population and its impact on the surgery workforce. Ann Surg 238(2):170–177
Codman EA (1916) A study in hospital efficiency. Thomas Todd Co. (Boston, Mass)
Khuri SF, Daley J, Henderson WG (2002) The comparative assessment and improvement of quality of surgical care in the department of veterans affairs. Arch Surg 137(1):20–27
Institute of Medicine (2008) Retooling for an aging America: building the healthcare workforce. National Academy Press, Washington, DC
Russell MM, Berian JR, Rosenthal RA, Ko CY (2016) Improving quality in geriatric surgery: a blueprint from the American College of Surgeons. Bull Am Coll Surg 101(12):22–28
McGory ML, Kao KK, Shekelle PG et al (2009) Developing quality indicators for elderly surgical patients. Ann Surg 250(2):338–347
Chow WB, Rosenthal RA, Merkow RP et al (2012) Optimal preoperative assessment of the geriatric surgical patient: a best practice guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg 215(4):453–466
Mohanty S, Rosentham RA, Russell MM, Neuman MD, Ko CY, Esnaola NF (2016) Optimal perioperative management of the geriatric patient: a best practices guideline from the American College of Surgeons NSQIP and the American Geriatrics Society. J Am Coll Surg 222(5):930–947
Donabedian A (1980) The definition of quality and approaches to its assessment, vol 1. Health Administration Press, Washington, DC, p 163
Gajdos C, Kile D, Hawn MT, Finlayson E, Henderson WG, Robinson TN (2015) The significance of preoperative impaired sensorium on surgical outcomes in nonemergent general surgical operations. JAMA Surg 150(1):30–36
Robinson TN, Wu DS, Pointer LF, Dunn CL, Moss M (2012) Preoperative cognitive dysfunction is related to adverse postoperative outcomes in the elderly. J Am Coll Surg 215(1):12–17
Ansaloni L, Catena F, Chattat R et al (2010) Risk factors and incidence of postoperative delirium in elderly patients after elective and emergency surgery. Br J Surg 97(2):273–280
Gleason LJ, Schmitt EM, Kosar CM et al (2015) Effect of delirium and other major complications on outcomes after elective surgery in older adults. JAMA Surg 150(12):1134–1140
Capezuti E, Boltz M, Cline D et al (2012) Nurses improving care for healthsystem elders – a model for optimizing the geriatric nursing practice environment. J Clin Nurs 21(21–22):3117–3125
Inouye SK, Bogardus ST, Charpentier PA et al (1999) A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 340:669–676
Reuben DB, Inouye SK, Bogardus ST, Baker DI, Leo-Summers L, Cooney LM (2000) The hospital elder life program: a model of care to prevent cognitive and functional decline in older hospitalized patients. J Am Geriatr Soc 48(12):1697–1706
American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults (2015) American Geriatrics Society abstracted clinical practice guideline for postoperative delirium in older adults. J Am Geriatr Soc 63(1):142–150
Schmitt EM, Saczynski JS, Kosar CM et al (2015) The successful aging after elective surgery study: cohort description and data quality procedures. J Am Geriatr Soc 63(12):2463–2471
Brouquet A, Cudennec T, Benoist S et al (2010) Impaired mobility, ASA status and administration of tramadol are risk factors for postoperative delirium in patients aged 75 years or more after major abdominal surgery. Ann Surg 251(4):759–765
Scarborough JE, Bennett KM, Englum BR, Pappas TN, Lagoo-Deenadayalan SA (2015) The impact of functional dependency on outcomes after complex general and vascular surgery. Ann Surg 261(3):432–437
Berian JR, Mohanty S, Ko CY, Rosenthal RA, Robinson TN (2016) Association of loss of independence with readmissions and death after discharge in older patients after surgical procedures. JAMA Surg 151(9):e166189
Palmer RM, Landenfeld CS, Kresevic D, Kowal J (1994) A medical unit for the acute care of the elderly. J Am Geriatr Soc 42(5):545–552
Counsell SR, Holder CM, Liebenaure LL et al (2000) Effects of a multicomponent intervention on functional outcomes and process of care in hospitalized older patients: a randomized controlled trial of Acute Care for Elders (ACE) in a community hospital. J Am Geriatr Soc 48(12):1572–1581
Malone ML, Vollbrecht M, Stephenson J, Burke L, Pagel P, Goodwin JS (2010) Acute Care for Elders (ACE) tracker and e-Geriatrician: methods to disseminate ACE concepts to hospitals with no geriatricians on staff. J Am Geriatr Soc 58(1):161–167
Hoogeboom TJ, Oosting E, Briezekolk JE et al (2012) Therapeutic validity and effectiveness of preoperative exercise on functional recovery after joint replacement: a systematic review and meta-analysis. PLoS One 7(5):e38031
Bruns ER, van den Heuvel B, Buskens CJ et al (2016) The effects of physical prehabilitation in elderly patients undergoing colorectal surgery: a systematic review. Color Dis 18(8):O267–O277
Gillis C, Li C, Lee L et al (2014) Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology 121(5):937–947
Makary MA, Segev DL, Pronovost PJ et al (2010) Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg 210:901–908
Robinson TN, Wallace JI, Wu DS et al (2011) Accumulated frailty characteristics predict postoperative discharge institutionalization in the geriatric patient. J Am Coll Surg 213:37–42
Lee DH, Buth KJ, Martin BJ et al (2010) Frail patients are at increased risk for mortality and prolonged institutional care after cardiac surgery. Circulation 121:973–978
Robinson TN, Walston JD, Brummel NE et al (2015) Frailty for surgeons: review of a national institute on aging conference on frailty for specialists. J Am Coll Surg 221(6):1083–1092
Qato DM, Alexander GC, Conti RM, Johnson M, Schumm P, Lindau ST (2008) Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA 300(24):2867–2878
Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC (1991) Explicit criteria for determining inappropriate medication use in nursing home residents. Arch Intern Med 151(9):1825–1832
American Geriatrics Society 2015 Beers Criteria Update Expert Panel (2015) American Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 63(11):2227–2246
Finlayson E, Maselli J, Steinman MA, Rothberg MB, Lindenauer PK, Auerbach AD (2011) Inappropriate medication use in elderly surgical patients: a national study. J Am Geriatr Soc 59(11):2139–2144
Hudhra K, Garcia-Caballos M, Casado-Fernandez E, Jucja B, Shabani D, Bueno-Cavanillas A (2016) Polypharmacy and potentially inappropriate prescriptions identified by Beers and STOPP criteria in co-morbid older patients at hospital discharge. J Eval Clin Pract 22(2):189–193
Poudel A, Ballokova A, Hubbard RE et al (2016) Algorithm of medication review in frail older people: focus on minimizing the use of high-risk medications. Geriatr Gerontol Int 16(9):1002–1013
Sonnichsen A, Trampisch US, Rieckert A et al (2016) Polypharmacy in chronic diseases-reduction of inappropriate medication and adverse drug events in older populations by electronic decision support (PRIMA-eDS): study protocol for a randomized controlled trial. Trials 17:57
Yang AD, Bentrem DJ, Pappas SG et al (2004) Advance directive use among patients undergoing high-risk operations. Am J Surg 188(1):98–101
Redmann AJ, Brasel KJ, Alexander CG, Schwarze ML (2012) Use of advance directives for high-risk operations: a national surgey of surgeons. Ann Surg 255(3):418–423
Cooper Z, Courwright A, Karlage A, Gawande A, Block S (2014) Pitfalls in communication that lead to nonbeneficial emergency surgery in elderly patients with serious illness: description of the problem and elements of a solution. Ann Surg 260(6):949–957
Fahy BN (2015) Fellowship training in hospice and palliative care: new pathways for surgeons. ACS Surgery News 14 July 2015. http://www.mdedge.com/acssurgerynews/article/101238/hospice-palliative-medicine/fellowship-training-hospice-and-palliative. Accessed 11 Mar 2017
Pernar LI, Peyre SE, Smink DS et al (2012) Feasibility and impact of a case-based palliative care workshop for general surgery residents. J Am Coll Surg 214:231–236
Barbas AS, Haney JC, Henry BV, Heflin MT, Lagoo SA (2014) Development and implementation of a formalized geriatric surgery curriculum for general surgery residents. Gerontol Geriatr Educ 35(4):380–394
Cooper Z, Koritsanszky LA, Cauley CE et al (2016) Recommendations for best communication practices to facilitate goal-concordant care for seriously ill older patients with emergency surgical conditions. Ann Surg 263(1):1–6
Kruser JM, Nabozny MJ, Steffens NM et al (2015) “Best Case/Worst Case”: qualitative evaluation of a novel communication tool for difficult in-the-moment surgical decisions. J Am Geriatr Soc 63(9):1805–1811
Berian JR, Rosenthal RA, Baker TL et al (2017) Hospital standards to promote optimal surgical care of the older adult: a report from the coalition for quality of care in geriatric surgery project. Ann Surg. doi:10.1097/SLA.0000000000002185
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Klausner, J., Russell, M.M. (2017). Defining Quality of Care. In: Rosenthal, R., Zenilman, M., Katlic, M. (eds) Principles and Practice of Geriatric Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-20317-1_2-1
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DOI: https://doi.org/10.1007/978-3-319-20317-1_2-1
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