Implementation and Outcomes of a Perioperative Geriatrics Strategy, PRIME, for Older Adults Undergoing Gastrointestinal Cancer Surgery.

Abstract

Introduction: The number of older adults living with frailty undergoing gastrointestinal cancer surgery is increasing. To address the unique needs of the population, a whole pathway perioperative geriatrics strategy-PRIME-was developed to integrate geriatric principles into surgical care. The objective of this study was to evaluate the implementation of PRIME using validated structural, process, and outcome quality indicators.

Materials and methods: This retrospective cohort study included 106 consecutive patients aged 70 years and older who underwent gastrointestinal surgery for cancer or pre-cancerous lesions at a single institution between 1 July 2020 and 5 October 2023. The whole pathway perioperative geriatrics strategy, PRIME, includes preoperative comprehensive geriatric assessment (CGA), collaborative care between surgery, geriatrics, and anesthesia, and post-operative co-management. Implementation was evaluated using validated structural, process, and outcome quality indicators.

Results: Most structural indicators (five of eight) were implemented. In terms of process indicators, 96.2% (n = 102) received CGA prior to or within 24 h of admission. Adherence to screening was high: 97.2% for dementia, 96.2% for functional status, and 95.3% for frailty. The median number interventions resulting from CGA was 17 (IQR 14-20). Serious complication, delirium, and functional decline occurred in 19.8%, 27.1%, and 19.8%, respectively.

Conclusions: Implementation of a perioperative geriatrics strategy for older adults undergoing gastrointestinal cancer/pre-cancer lesion surgery is feasible, with high adherence to structural and process quality indicators.