Effects of comprehensive geriatric care models on postoperative outcomes in geriatric surgical patients: a systematic review and meta-analysis

BMC Anesthesiology

Frances Chung¹  Sara Wasef¹  Aparna Saripella¹  Sheila Riazi¹  Jean Wong²  Mahesh Nagappa³  Marina Englesakis⁴ 

[1] Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, MCL 2-405, 399 Bathurst St, M5T2S8, Toronto, ON, Canada;Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, MCL 2-405, 399 Bathurst St, M5T2S8, Toronto, ON, Canada;Department of Anesthesia and Pain Management, Women’s College Hospital, University of Toronto, Toronto, ON, Canada;Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre and St. Joseph Health Care, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada;Library and Information Services, University Health Network, Toronto, ON, Canada;

关键词: Comprehensive geriatric care model;    Comprehensive geriatric assessment;    Surgery;    Elderly;    Delirium;    Adverse outcomes;   

DOI  :  10.1186/s12871-021-01337-2

来源: Springer

【 摘 要 】

BackgroundThe elderly population is highly susceptible to develop post-operative complications after major surgeries. It is not clear whether the comprehensive geriatric care models are effective in reducing adverse events. The objective of this systematic review and meta-analysis is to determine whether the comprehensive geriatric care models improved clinical outcomes, particularly in decreasing the prevalence of delirium and length of hospital stay (LOS) in elderly surgical patients.MethodWe searched Medline, PubMed, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Emcare Nursing, Web of Science, Scopus, CINAHL, ClinicalTrials. Gov, and ICTRP between 2009 to January 23, 2020. We included studies on geriatric care models in elderly patients (≥60 years) undergoing elective, non-cardiac high-risk surgery. The outcomes were the prevalence of delirium, LOS, rates of 30-days readmission, and 30-days mortality. We used the Cochrane Review Manager Version 5.3. to estimate the pooled Odds Ratio (OR) and Mean Difference (MD) using random effect model analysis.ResultsEleven studies were included with 2672 patients [Randomized Controlled Trials (RCTs): 4; Non-Randomized Controlled Trials (Non-RCTs): 7]. Data pooled from six studies showed that there was no significant difference in the prevalence of delirium between the intervention and control groups: 13.8% vs 15.9% (OR: 0.76; 95% CI: 0.30–1.96; p = 0.57). Similarly, there were no significant differences in the LOS (MD: -0.55; 95% CI: − 2.28, 1.18; p = 0.53), 30-day readmission (12.1% vs. 14.3%; OR: 1.09; 95% CI: 0.67–1.77; p = 0.73), and 30-day mortality (3.2% vs. 2.1%; OR: 1.34; 95% CI: 0.66–2.69; p = 0.42). The quality of evidence was very low.ConclusionsThe geriatric care models involved pre-operative comprehensive geriatric assessment, and intervention tools to address cognition, frailty, and functional status. In non-cardiac high-risk surgeries, these care models did not show any significant difference in the prevalence of delirium, LOS, 30-days readmission rates, and 30-day mortality in geriatric patients. Further RCTs are warranted to evaluate these models on the postoperative outcomes.Trial registrationPROSPERO registration number - CRD42020181779.

【 授权许可】

CC BY