Geriatric comanagement reduces perioperative complications and shortens duration of hospital stay after lumbar spine surgery: A prospective single-institution experience

Owoicho Adogwa, Aladine A. Elsamadicy, Victoria D. Vuong, Jessica Moreno, Joseph Cheng, Isaac O. Karikari, Carlos A. Bagley

Research output: Contribution to journalArticle

3 Citations (Scopus)

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 inhospital 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.

Original languageEnglish (US)
Pages (from-to)670-675
Number of pages6
JournalJournal of Neurosurgery: Spine
Volume27
Issue number6
DOIs
StatePublished - Dec 1 2017

Fingerprint

Geriatrics
Length of Stay
Spine
Health
Incidence
Delirium
Scoliosis
Decompression
Nursing Homes
Rehabilitation
Anesthesia
Infection

Keywords

  • Comanaged care
  • Complications
  • Geriatric
  • Length of stay
  • Lumbar
  • Perioperative care
  • Spine surgery

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology

Cite this

Geriatric comanagement reduces perioperative complications and shortens duration of hospital stay after lumbar spine surgery : A prospective single-institution experience. / Adogwa, Owoicho; Elsamadicy, Aladine A.; Vuong, Victoria D.; Moreno, Jessica; Cheng, Joseph; Karikari, Isaac O.; Bagley, Carlos A.

In: Journal of Neurosurgery: Spine, Vol. 27, No. 6, 01.12.2017, p. 670-675.

Research output: Contribution to journalArticle

Adogwa, Owoicho ; Elsamadicy, Aladine A. ; Vuong, Victoria D. ; Moreno, Jessica ; Cheng, Joseph ; Karikari, Isaac O. ; Bagley, Carlos A. / Geriatric comanagement reduces perioperative complications and shortens duration of hospital stay after lumbar spine surgery : A prospective single-institution experience. In: Journal of Neurosurgery: Spine. 2017 ; Vol. 27, No. 6. pp. 670-675.
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AU - Vuong, Victoria D.

AU - Moreno, Jessica

AU - Cheng, Joseph

AU - Karikari, Isaac O.

AU - Bagley, Carlos A.

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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 inhospital 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.

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