Aims: The objective of this study was to evaluate the effect of geriatrician-led comprehensive geriatric assessment (CGA) and interventions administered through a POPS (Perioperative care for Older People undergoing Surgery) Service on postoperative length of stay and complications in patients who were prefrail and frail waiting for elective hip or knee arthroplasty.
Methods: This was a retrospective observational cohort study comparing a post intervention cohort with historic controls.Patients≥65 years of age who were waiting for elective hip or knee arthroplasty with a Clinical Frailty Scale (CFS) ≥4, were evaluated in our POPS@NALHN (Northern Adelaide Local Health Network) service between October 2018 to December 2019. Postoperative outcomes were compared with patients who underwent hip or knee arthroplasty between July 2017 to September 2018, who received usual care.
Results:Following multi-domain frailty assessment and interventions administered through the POPS Service, the average postoperative length of stay was shorter: 6.0 days in the control group versus 3.6 days in the intervention group (Incidence Rate Ratio, IRR=1.66, 95% CI: 1.35, 2.04; P=<0.0001). The control group was 2.5 times more likely to have postoperative complications than the intervention group (Odds Ratio=2.55,95% CI: 1.17,5.56, P=0.018). The control group had a higher incidence of medical complications than the intervention group (IRR=2.01,95% CI:1.11,3.64, P=0.021).
Conclusion: Providing a geriatrician-led CGA and interventions to prefrail and frail older adults prior to elective hip or knee arthroplasty was associated with reduced acute hospital length of stay and medical complications. Frailty screening and intervention through CGA in the perioperative setting has the potential to enhance patient care.