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Geriatric comanagement reduces perioperative complications and shortens duration of hospital stay after lumbar spine surgery: a prospective single-institution experience.
J Neurosurg Spine 2017; 27(6):670-675JN

Abstract

OBJECTIVE

Geriatric patients undergoing lumbar spine surgery have unique needs due to the physiological changes of aging. They are at risk for adverse outcomes such as delirium, infection, and iatrogenic complications, and these complications, in turn, contribute to the risk of functional decline, nursing home admission, and death. Whether preoperative and perioperative comanagement by a geriatrician reduces the incidence of in-hospital complications and length of in-hospital stay after elective lumbar spine surgery remains unknown.

METHODS

A unique model of comanagement for elderly patients undergoing lumbar fusion surgery was implemented at a major academic medical center. The Perioperative Optimization of Senior Health (POSH) program was launched with the aim of improving outcomes in elderly patients (> 65 years old) undergoing complex lumbar spine surgery. In this model, a geriatrician evaluates elderly patients preoperatively, in addition to performing routine preoperative anesthesia surgical screening, and comanages them daily throughout the course of their hospital stay to manage medical comorbid conditions and coordinate multidisciplinary rehabilitation along with the neurosurgical team. The first 100 cases were retrospectively reviewed after initiation of the POSH protocol and compared with the immediately preceding 25 cases to assess the incidence of perioperative complications and clinical outcomes.

RESULTS

One hundred twenty-five patients undergoing lumbar decompression and fusion were enrolled in this pilot program. Baseline characteristics were similar between both cohorts. The mean length of in-hospital stay was 30% shorter in the POSH cohort (6.13 vs 8.72 days; p = 0.06). The mean duration of time between surgery and patient mobilization was significantly shorter in the POSH cohort compared with the non-POSH cohort (1.57 days vs 2.77 days; p = 0.02), and the number of steps ambulated on day of discharge was 2-fold higher in the POSH cohort (p = 0.04). Compared with the non-POSH cohort, the majority of patients in the POSH cohort were discharged to home (24% vs 54%; p = 0.01).

CONCLUSIONS

Geriatric comanagement reduces the incidence of postoperative complications, shortens the duration of in-hospital stay, and contributes to improved perioperative functional status in elderly patients undergoing elective spinal surgery for the correction of adult degenerative scoliosis.

Authors+Show Affiliations

1Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.2Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina.1Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.4Department of Neurosurgery, University of Texas Southwestern, Dallas, Texas.3Department of Neurosurgery, Yale University, New Haven, Connecticut; and.2Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina.4Department of Neurosurgery, University of Texas Southwestern, Dallas, Texas.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28960161

Citation

Adogwa, Owoicho, et al. "Geriatric Comanagement Reduces Perioperative Complications and Shortens Duration of Hospital Stay After Lumbar Spine Surgery: a Prospective Single-institution Experience." Journal of Neurosurgery. Spine, vol. 27, no. 6, 2017, pp. 670-675.
Adogwa O, Elsamadicy AA, Vuong VD, et al. Geriatric comanagement reduces perioperative complications and shortens duration of hospital stay after lumbar spine surgery: a prospective single-institution experience. J Neurosurg Spine. 2017;27(6):670-675.
Adogwa, O., Elsamadicy, A. A., Vuong, V. D., Moreno, J., Cheng, J., Karikari, I. O., & Bagley, C. A. (2017). Geriatric comanagement reduces perioperative complications and shortens duration of hospital stay after lumbar spine surgery: a prospective single-institution experience. Journal of Neurosurgery. Spine, 27(6), pp. 670-675. doi:10.3171/2017.5.SPINE17199.
Adogwa O, et al. Geriatric Comanagement Reduces Perioperative Complications and Shortens Duration of Hospital Stay After Lumbar Spine Surgery: a Prospective Single-institution Experience. J Neurosurg Spine. 2017;27(6):670-675. PubMed PMID: 28960161.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Geriatric comanagement reduces perioperative complications and shortens duration of hospital stay after lumbar spine surgery: a prospective single-institution experience. AU - Adogwa,Owoicho, AU - Elsamadicy,Aladine A, AU - Vuong,Victoria D, AU - Moreno,Jessica, AU - Cheng,Joseph, AU - Karikari,Isaac O, AU - Bagley,Carlos A, Y1 - 2017/09/29/ PY - 2017/9/30/pubmed PY - 2018/1/3/medline PY - 2017/9/30/entrez KW - AFib = atrial fibrillation KW - BMI = body mass index KW - CAD = coronary artery disease KW - CHF = congestive heart failure KW - CVD = cardiovascular disease KW - DM = diabetes mellitus KW - HTN = hypertension KW - IQR = interquartile range KW - LOS = length of stay KW - MI = myocardial infarction KW - POSH = Perioperative Optimization of Senior Health KW - SNF = skilled nursing facility KW - comanaged care KW - complications KW - geriatric KW - length of stay KW - lumbar KW - perioperative care KW - spine surgery SP - 670 EP - 675 JF - Journal of neurosurgery. Spine JO - J Neurosurg Spine VL - 27 IS - 6 N2 - OBJECTIVE Geriatric patients undergoing lumbar spine surgery have unique needs due to the physiological changes of aging. They are at risk for adverse outcomes such as delirium, infection, and iatrogenic complications, and these complications, in turn, contribute to the risk of functional decline, nursing home admission, and death. Whether preoperative and perioperative comanagement by a geriatrician reduces the incidence of in-hospital complications and length of in-hospital stay after elective lumbar spine surgery remains unknown. METHODS A unique model of comanagement for elderly patients undergoing lumbar fusion surgery was implemented at a major academic medical center. The Perioperative Optimization of Senior Health (POSH) program was launched with the aim of improving outcomes in elderly patients (> 65 years old) undergoing complex lumbar spine surgery. In this model, a geriatrician evaluates elderly patients preoperatively, in addition to performing routine preoperative anesthesia surgical screening, and comanages them daily throughout the course of their hospital stay to manage medical comorbid conditions and coordinate multidisciplinary rehabilitation along with the neurosurgical team. The first 100 cases were retrospectively reviewed after initiation of the POSH protocol and compared with the immediately preceding 25 cases to assess the incidence of perioperative complications and clinical outcomes. RESULTS One hundred twenty-five patients undergoing lumbar decompression and fusion were enrolled in this pilot program. Baseline characteristics were similar between both cohorts. The mean length of in-hospital stay was 30% shorter in the POSH cohort (6.13 vs 8.72 days; p = 0.06). The mean duration of time between surgery and patient mobilization was significantly shorter in the POSH cohort compared with the non-POSH cohort (1.57 days vs 2.77 days; p = 0.02), and the number of steps ambulated on day of discharge was 2-fold higher in the POSH cohort (p = 0.04). Compared with the non-POSH cohort, the majority of patients in the POSH cohort were discharged to home (24% vs 54%; p = 0.01). CONCLUSIONS Geriatric comanagement reduces the incidence of postoperative complications, shortens the duration of in-hospital stay, and contributes to improved perioperative functional status in elderly patients undergoing elective spinal surgery for the correction of adult degenerative scoliosis. SN - 1547-5646 UR - https://www.unboundmedicine.com/medline/citation/28960161/Geriatric_comanagement_reduces_perioperative_complications_and_shortens_duration_of_hospital_stay_after_lumbar_spine_surgery:_a_prospective_single_institution_experience_ L2 - https://thejns.org/doi/10.3171/2017.5.SPINE17199 DB - PRIME DP - Unbound Medicine ER -