Specialised assessments cut hospital stays for older patients

Specialised pre-operative assessments for elderly patients lead to shorter hospital stays and fewer complications, according to a new clinical trial at Guy’s and St Thomas’ NHS Foundation Trust.

The study, published in the British Journal of Surgery, found that having the assessments before planned operations shortened older patients’ average hospital stay by more than two days and reduced the rate of some complications, such as delirium (sudden confusion) and heart problems, by more than 50%.

Researchers from Guy's and St Thomas' and King’s College London recruited 176 patients over 65 who were due to have major surgery to treat problems affecting their blood vessels. Half of the patients had standard pre-operative assessments while the others had the specialised pre-operative geriatric assessment. These are carried out by clinicians including a doctor, clinical nurse specialist, social worker and occupational therapist. Patients’ medical conditions, memory, psychological health and functional status, which included looking at where they live, were examined.

The specialised assessments are more detailed, targeted and holistic than standard pre-operative assessments but they do not take much longer to complete. They aim to identify potential risks and then minimise them by introducing individual care plans and providing advice on the prevention and management of anticipated complications. 

Patients receiving the specialised pre-operative assessments stayed in hospital after surgery for an average of 3.3 days, compared with 5.5 days for patients who had standard pre-operative assessments. Reducing the length of hospital stay was the main aim of the study, as patients had identified it as being the best measure of the ‘success’ of a hospital stay, and it saves the NHS money.

Other key findings included:

• The rate of delirium (sudden confusion) after surgery in those who had a specialised pre-operative assessment was 11%, compared with 24% among patients who had the standard assessment
• Heart complications following surgery affected only 8% of the specialised pre-assessment group, compared with 27% of those who had a standard assessment
• Patients who had a specialised pre-operative assessment were less likely to have increased social care needs after leaving hospital
• The number of patients readmitted to hospital within 30 days of leaving was the same in both patient groups.

Dr Judith Partridge, lead author of the study from the Department of Ageing and Health at Guy's and St Thomas' and the Division of Health and Social Care Research at King's College London, said:

“Using specialised pre-operative assessments to evaluate and optimise care for older patients meant we could reduce the risk of complications after surgery and length of time spent in hospital.

“We think that the findings from our study, taken in the context of other research and quality improvement projects, are likely to be transferable to other types of operations, including cancer surgery.”

The study authors conclude that ongoing evaluation of this intervention is needed and that further research should focus on the mechanisms which led to the improvements.

The trial was funded by a Research into Ageing–Age UK–British Geriatrics Society grant and  by Guy's and St Thomas' Charity, and it was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas' and King's College London.

Dr Eileen Burns, President of the British Geriatrics Society, said: "This high quality research study sends a powerful message that older people having planned surgery benefit from a comprehensive assessment of their needs. Having an individualised care plan in place before an operation helps to get people back to their own home earlier and reduces their risk of serious complications. We are pleased that this research, which was part funded by the British Geriatrics Society, provides strong evidence for this care model and hope that it will be offered to all older patients receiving this form of surgery."