Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, Massachusetts, USA.
Department of Surgery, Brigham and Woman's Hospital, Boston, Massachusetts, USA.
J Am Geriatr Soc. 2022 Aug;70(8):2404-2414. doi: 10.1111/jgs.17916. Epub 2022 Jun 7.
Older adults comprise an increasing proportion of emergency general surgery (EGS) admissions and face high morbidity and mortality. We created a geriatric surgical service with geriatric and palliative expertise to mitigate risks of hospitalization most hazardous to older patients. We sought to identify geriatric surgical service interventions most relevant to EGS patients.
We prospectively identified patients ≥75 years admitted to the EGS service at an urban tertiary care hospital from January 2020-March 2021 who screened positive for frailty (FRAIL score ≥3 [scale 0-5, higher being worse]) or with cognitive impairment. A pilot geriatric surgical service, led by a dually-board certified geriatric and palliative care specialist, conducted a comprehensive geriatric assessment and modified Rockwood Frailty Index calculation for each eligible patient. Patient, hospital admission, and geriatric consultation characteristics were collected via chart review.
Fifty consecutive patients (median age 82 years [IQR 78-90], 56% female) received geriatric consultation (median time 3 days [IQR 1-6] from admission). The most common admission diagnosis was bowel obstruction (32%). Sixty-four percent of patients underwent ≥1 surgical procedure. Using the Frailty Index, 64% were moderately or severely frail. Interventions most frequently performed by the geriatric team included delirium prevention and management (66%), consideration of swallowing function (52%), individualized pain management (50%), and facilitation of serious illness conversations (58%).
Geriatric service involvement addresses a high burden of both geriatric and palliative care needs in older EGS patients. Geriatric recommendations may direct interventions for surgical education in fundamental geriatric and palliative care knowledge to maximize geriatric resources for the most high-risk patients.
老年人在急诊普通外科（EGS）入院患者中所占比例不断增加，他们面临着较高的发病率和死亡率。我们创建了一个具有老年病学和姑息治疗专业知识的老年外科服务团队，以降低对老年患者危害最大的住院风险。我们试图确定与 EGS 患者最相关的老年外科服务干预措施。
我们前瞻性地确定了 2020 年 1 月至 2021 年 3 月期间在一家城市三级保健医院接受 EGS 服务的年龄≥75 岁的患者，这些患者的虚弱（FRAIL 评分≥3[评分 0-5，评分越高越差]）或认知障碍筛查呈阳性。一个由同时具有老年病学和姑息治疗专业认证的专家领导的试点老年外科服务团队对每个符合条件的患者进行了全面的老年评估和改良的 Rockwood 虚弱指数计算。通过病历回顾收集了患者、住院和老年咨询的特征。
50 名连续患者（中位年龄 82 岁[IQR 78-90]，56%为女性）接受了老年咨询（从入院到咨询中位时间为 3 天[IQR 1-6]）。最常见的入院诊断是肠梗阻（32%）。64%的患者接受了≥1 次手术。使用虚弱指数，64%的患者为中度或重度虚弱。老年团队最常进行的干预措施包括预防和管理谵妄（66%）、考虑吞咽功能（52%）、个体化疼痛管理（50%）和促进严重疾病对话（58%）。
老年服务的参与满足了老年 EGS 患者的老年和姑息治疗的高需求。老年服务的建议可能会指导外科教育中有关基本老年和姑息治疗知识的干预措施，以最大限度地利用老年资源为最高危患者服务。
