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Cited by 387Frailty in Older AdultsCardiac, Anesthesia and Surgical OutcomesEnhanced Recovery After Surgery

Proactive care of older people undergoing surgery (‘POPS’): designing, embedding, evaluating and funding a comprehensive geriatric assessment service for older elective surgical patients

Harari, D., Hopper, A., Dhesi, J., Babic-Illman, G., Lockwood, L., Martin, F.·2007·Age and Ageing
DOI 10.1093/ageing/afl163
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Abstract

BACKGROUND: older people undergoing elective surgery have significant post-operative problems prolonging hospitalisation. OBJECTIVE: to design, embed, and evaluate an evidence-based comprehensive geriatric assessment (CGA) service for at-risk older patients undergoing elective surgery. SETTING: urban teaching hospital. SUBJECTS: elective surgical patients aged 65+. INTERVENTION: multidisciplinary preoperative CGA service with post-operative follow-through (proactive care of older people undergoing surgery ['POPS']). METHODS: observational cohort study and multilevel surveys (development and modelling phase). Prospective 'before and after' comparison (exploratory evaluation). RESULTS: findings from the development phase showed high levels of preoperative co-morbidity, no multidisciplinary preoperative input, and multiple potentially preventable post-operative problems delaying discharge in older elective surgery patients. Comparison of 2 cohorts of elective orthopaedic patients (pre-POPS vs POPS, N = 54) showed the POPS group had fewer post-operative medical complications including pneumonia (20% vs 4% [p = 0.008]) and delirium (19% vs 6% [p = 0.036]), and significant improvements in areas reflecting multidisciplinary practice including pressure sores (19% vs 4% [p = 0.028]), poor pain control (30% vs 2% [p<0.001]), delayed mobilisation (28% vs 9% [p = 0.012]) and inappropriate catheter use (20% vs 7% [p = 0.046]). Length of stay was reduced by 4.5 days. There were fewer delayed discharges relating to medical complications (37% vs 13%) or waits for OT assessment or equipment (20% vs 4%). CONCLUSION: a proactive evidence-based CGA service for at-risk older elective surgical patients was developed according to MRC framework for complex interventions. Pre/post comparison in elective orthopaedic patients showed improved (within methodological limitations) post-operative outcomes indicative of better clinical effectiveness and efficiency, and contributed to the service obtaining mainstream funding. Informed by the present study, a randomised controlled trial is ongoing.

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Crossref · 10.1093/ageing/afl163

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Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • In two CSHA studies, clinically obtained CGA results were predictive of death and need for institutional care.

    “and were predictive of death and need for institutional care.”

    From Frailty in elderly people (2013) · cites this paper as [114]

  • In two CSHA studies, clinically obtained CGA results were highly correlated with the research standard CSHA frailty index.

    “the clinically obtained CGA results were highly correlated with the research standard CSHA FI”

    From Frailty in elderly people (2013) · cites this paper as [114]

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Authors
Harari, D., Hopper, A., Dhesi, J., Babic-Illman, G., Lockwood, L., & Martin, F.
Affiliations
St Thomas' Hospital (GB)
Corresponding author
Harari, D.
ORCID
Venue
Age and Ageing
Publisher
Oxford University Press (OUP)
Published
2007-01-25
Volume
36
Issue
2
Pages
190-196
ISSN
  • 0002-0729 (ISSN-L)
  • 1468-2834
DOI
10.1093/ageing/afl163
OpenAlex
W2146558400
Cited by
387
References
19
Citations by year
2026: 7 · 2025: 13 · 2024: 23 · 2023: 23 · 2022: 21 · 2021: 28 · 2020: 39 · 2019: 36 · 2018: 29 · 2017: 36 · 2016: 32 · 2015: 20 · 2014: 19 · 2013: 15 · 2012: 9
FWCI
3.45
Type
journal article
Language
en
Open access
closed
Locations
  • Age and Ageing (publishedVersion)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (submittedVersion)
Topics
  • Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
  • Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
Keywords
comprehensive geriatric assessment, older surgical patients, elective surgery, preoperative care, postoperative complications, pneumonia, delirium, length of hospital stay, multidisciplinary care, orthopedic surgery, pressure ulcers, pain management, catheter use, service development, service funding, MRC framework for complex interventions
MeSH terms
Aged, Female, Health Status, Humans, Length of Stay, Male, Postoperative Complications, Preoperative Care, Geriatric Assessment, Elective Surgical Procedures

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