James Karina, Burberry David, Soppitt Duncan, Davies Elizabeth, Dhesi Jugdeep
Consultant Geriatrician, Swansea University Health Board, Morriston Hospital, Swansea, UK.
Clinical Research Fellow, Swansea University Health Board, Morriston Hospital, Swansea, UK.
Future Healthc J. 2025 May 15;12(3):100254. doi: 10.1016/j.fhj.2025.100254. eCollection 2025 Sep.
Surgical waiting lists have increased in recent years, particularly in areas of socioeconomic deprivation, with the older population disproportionately affected. This has huge implications for the healthcare economy and is also observed in litigation related to poor shared decision making (SDM). We examined how core principles of the perioperative care for the older person undergoing surgery (POPS) model could be embedded into routine care with minimal staffing. We profiled the cholecystectomy waiting list, described the population awaiting surgery and their experience on the waiting list. Our aim was to provide SDM via a comprehensive geriatric assessment for people living with frailty. A two-tier triage system was undertaken via post and telephone for people aged over 64. All people were discussed at a multidisciplinary meeting. If people were living with frailty, they were offered a clinic appointment. We collected prospective data on diagnoses and interventions along with comparing methods for screening. 750 patients were on the cholecystectomy list. 256 patients were aged 65 or older. The median wait time for those aged over 65 was 101.7 weeks (range 0-273 weeks). 98 patients responded to an initial survey, many describing deterioration in health while on the waiting list. 32.8% met the criteria for frailty (CFS>5) and 44 were offered clinic appointments. Of 256 patients, a total of 51 patients were removed from the waiting list over two levels of triage; initial phone call or clinic (either virtual or face to face) Using a triaged approach to reviewing the waiting list, one fifth of patients aged over 65 years awaiting a cholecystectomy chose not to remain on the waiting list. Over half of these were identified through simple interventions, including those by non-clinical staff. This has very significant implications if replicated across other centres with long waiting lists for surgical interventions, especially in the older population, often the cohort at highest risk of adverse outcome. These novel approaches can address sustainability in the future and improved patient care and outcomes.
近年来，手术等候名单有所增加，尤其是在社会经济贫困地区，老年人群体受到的影响尤为严重。这对医疗经济有着巨大影响，在与糟糕的共同决策（SDM）相关的诉讼中也有体现。我们研究了如何以最少的人员配置将老年患者手术围术期护理（POPS）模式的核心原则融入常规护理中。我们梳理了胆囊切除术等候名单，描述了等待手术的人群及其在等候名单上的经历。我们的目标是通过对体弱患者进行全面的老年医学评估来提供共同决策。针对64岁以上的人群，通过邮寄和电话进行了两级分诊系统。所有患者都在多学科会议上进行了讨论。如果患者体弱，就会为他们安排门诊预约。我们收集了关于诊断和干预的前瞻性数据，并比较了筛查方法。胆囊切除术等候名单上有750名患者。256名患者年龄在65岁及以上。65岁以上患者的中位等待时间为101.7周（范围为0 - 273周）。98名患者对初始调查做出了回应，许多人表示在等候名单上时健康状况恶化。32.8%的患者符合体弱标准（CFS>5），44名患者获得了门诊预约。在256名患者中，共有51名患者在两级分诊（初始电话或门诊，无论是虚拟的还是面对面的）后从等候名单上被移除。采用分诊方法审查等候名单，五分之一等待胆囊切除术的65岁以上患者选择不再留在等候名单上。其中一半以上是通过简单干预发现的，包括非临床工作人员进行的干预。如果在其他手术干预等候名单较长的中心，尤其是在老年人群体中（通常是不良结局风险最高的群体）推广，这将具有非常重大的意义。这些新方法可以解决未来的可持续性问题，并改善患者护理和结局。
