Effects of comprehensive geriatric care models on postoperative outcomes in geriatric surgical patients: a systematic review and meta-analysis
Abstract Background The elderly population is highly susceptible to develop post-operative complications after major surgeries. It is not clear whether the comprehensive geriatric care models are effective in reducing adverse events. The objective of this systematic review and meta-analysis is to de...
Main Authors: | , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMC
2021-04-01
|
Series: | BMC Anesthesiology |
Subjects: | |
Online Access: | https://doi.org/10.1186/s12871-021-01337-2 |
id |
doaj-fe1c0f5135f94e4383e70ad8a269124c |
---|---|
record_format |
Article |
spelling |
doaj-fe1c0f5135f94e4383e70ad8a269124c2021-04-25T11:31:14ZengBMCBMC Anesthesiology1471-22532021-04-0121111110.1186/s12871-021-01337-2Effects of comprehensive geriatric care models on postoperative outcomes in geriatric surgical patients: a systematic review and meta-analysisAparna Saripella0Sara Wasef1Mahesh Nagappa2Sheila Riazi3Marina Englesakis4Jean Wong5Frances Chung6Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of TorontoDepartment of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of TorontoDepartment of Anesthesia and Perioperative Medicine, London Health Sciences Centre and St. Joseph Health Care, Schulich School of Medicine & Dentistry, Western UniversityDepartment of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of TorontoLibrary and Information Services, University Health NetworkDepartment of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of TorontoDepartment of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of TorontoAbstract Background The elderly population is highly susceptible to develop post-operative complications after major surgeries. It is not clear whether the comprehensive geriatric care models are effective in reducing adverse events. The objective of this systematic review and meta-analysis is to determine whether the comprehensive geriatric care models improved clinical outcomes, particularly in decreasing the prevalence of delirium and length of hospital stay (LOS) in elderly surgical patients. Method We searched Medline, PubMed, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Emcare Nursing, Web of Science, Scopus, CINAHL, ClinicalTrials. Gov, and ICTRP between 2009 to January 23, 2020. We included studies on geriatric care models in elderly patients (≥60 years) undergoing elective, non-cardiac high-risk surgery. The outcomes were the prevalence of delirium, LOS, rates of 30-days readmission, and 30-days mortality. We used the Cochrane Review Manager Version 5.3. to estimate the pooled Odds Ratio (OR) and Mean Difference (MD) using random effect model analysis. Results Eleven studies were included with 2672 patients [Randomized Controlled Trials (RCTs): 4; Non-Randomized Controlled Trials (Non-RCTs): 7]. Data pooled from six studies showed that there was no significant difference in the prevalence of delirium between the intervention and control groups: 13.8% vs 15.9% (OR: 0.76; 95% CI: 0.30–1.96; p = 0.57). Similarly, there were no significant differences in the LOS (MD: -0.55; 95% CI: − 2.28, 1.18; p = 0.53), 30-day readmission (12.1% vs. 14.3%; OR: 1.09; 95% CI: 0.67–1.77; p = 0.73), and 30-day mortality (3.2% vs. 2.1%; OR: 1.34; 95% CI: 0.66–2.69; p = 0.42). The quality of evidence was very low. Conclusions The geriatric care models involved pre-operative comprehensive geriatric assessment, and intervention tools to address cognition, frailty, and functional status. In non-cardiac high-risk surgeries, these care models did not show any significant difference in the prevalence of delirium, LOS, 30-days readmission rates, and 30-day mortality in geriatric patients. Further RCTs are warranted to evaluate these models on the postoperative outcomes. Trial registration PROSPERO registration number - CRD42020181779 .https://doi.org/10.1186/s12871-021-01337-2Comprehensive geriatric care modelComprehensive geriatric assessmentSurgeryElderlyDeliriumAdverse outcomes |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Aparna Saripella Sara Wasef Mahesh Nagappa Sheila Riazi Marina Englesakis Jean Wong Frances Chung |
spellingShingle |
Aparna Saripella Sara Wasef Mahesh Nagappa Sheila Riazi Marina Englesakis Jean Wong Frances Chung Effects of comprehensive geriatric care models on postoperative outcomes in geriatric surgical patients: a systematic review and meta-analysis BMC Anesthesiology Comprehensive geriatric care model Comprehensive geriatric assessment Surgery Elderly Delirium Adverse outcomes |
author_facet |
Aparna Saripella Sara Wasef Mahesh Nagappa Sheila Riazi Marina Englesakis Jean Wong Frances Chung |
author_sort |
Aparna Saripella |
title |
Effects of comprehensive geriatric care models on postoperative outcomes in geriatric surgical patients: a systematic review and meta-analysis |
title_short |
Effects of comprehensive geriatric care models on postoperative outcomes in geriatric surgical patients: a systematic review and meta-analysis |
title_full |
Effects of comprehensive geriatric care models on postoperative outcomes in geriatric surgical patients: a systematic review and meta-analysis |
title_fullStr |
Effects of comprehensive geriatric care models on postoperative outcomes in geriatric surgical patients: a systematic review and meta-analysis |
title_full_unstemmed |
Effects of comprehensive geriatric care models on postoperative outcomes in geriatric surgical patients: a systematic review and meta-analysis |
title_sort |
effects of comprehensive geriatric care models on postoperative outcomes in geriatric surgical patients: a systematic review and meta-analysis |
publisher |
BMC |
series |
BMC Anesthesiology |
issn |
1471-2253 |
publishDate |
2021-04-01 |
description |
Abstract Background The elderly population is highly susceptible to develop post-operative complications after major surgeries. It is not clear whether the comprehensive geriatric care models are effective in reducing adverse events. The objective of this systematic review and meta-analysis is to determine whether the comprehensive geriatric care models improved clinical outcomes, particularly in decreasing the prevalence of delirium and length of hospital stay (LOS) in elderly surgical patients. Method We searched Medline, PubMed, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Emcare Nursing, Web of Science, Scopus, CINAHL, ClinicalTrials. Gov, and ICTRP between 2009 to January 23, 2020. We included studies on geriatric care models in elderly patients (≥60 years) undergoing elective, non-cardiac high-risk surgery. The outcomes were the prevalence of delirium, LOS, rates of 30-days readmission, and 30-days mortality. We used the Cochrane Review Manager Version 5.3. to estimate the pooled Odds Ratio (OR) and Mean Difference (MD) using random effect model analysis. Results Eleven studies were included with 2672 patients [Randomized Controlled Trials (RCTs): 4; Non-Randomized Controlled Trials (Non-RCTs): 7]. Data pooled from six studies showed that there was no significant difference in the prevalence of delirium between the intervention and control groups: 13.8% vs 15.9% (OR: 0.76; 95% CI: 0.30–1.96; p = 0.57). Similarly, there were no significant differences in the LOS (MD: -0.55; 95% CI: − 2.28, 1.18; p = 0.53), 30-day readmission (12.1% vs. 14.3%; OR: 1.09; 95% CI: 0.67–1.77; p = 0.73), and 30-day mortality (3.2% vs. 2.1%; OR: 1.34; 95% CI: 0.66–2.69; p = 0.42). The quality of evidence was very low. Conclusions The geriatric care models involved pre-operative comprehensive geriatric assessment, and intervention tools to address cognition, frailty, and functional status. In non-cardiac high-risk surgeries, these care models did not show any significant difference in the prevalence of delirium, LOS, 30-days readmission rates, and 30-day mortality in geriatric patients. Further RCTs are warranted to evaluate these models on the postoperative outcomes. Trial registration PROSPERO registration number - CRD42020181779 . |
topic |
Comprehensive geriatric care model Comprehensive geriatric assessment Surgery Elderly Delirium Adverse outcomes |
url |
https://doi.org/10.1186/s12871-021-01337-2 |
work_keys_str_mv |
AT aparnasaripella effectsofcomprehensivegeriatriccaremodelsonpostoperativeoutcomesingeriatricsurgicalpatientsasystematicreviewandmetaanalysis AT sarawasef effectsofcomprehensivegeriatriccaremodelsonpostoperativeoutcomesingeriatricsurgicalpatientsasystematicreviewandmetaanalysis AT maheshnagappa effectsofcomprehensivegeriatriccaremodelsonpostoperativeoutcomesingeriatricsurgicalpatientsasystematicreviewandmetaanalysis AT sheilariazi effectsofcomprehensivegeriatriccaremodelsonpostoperativeoutcomesingeriatricsurgicalpatientsasystematicreviewandmetaanalysis AT marinaenglesakis effectsofcomprehensivegeriatriccaremodelsonpostoperativeoutcomesingeriatricsurgicalpatientsasystematicreviewandmetaanalysis AT jeanwong effectsofcomprehensivegeriatriccaremodelsonpostoperativeoutcomesingeriatricsurgicalpatientsasystematicreviewandmetaanalysis AT franceschung effectsofcomprehensivegeriatriccaremodelsonpostoperativeoutcomesingeriatricsurgicalpatientsasystematicreviewandmetaanalysis |
_version_ |
1721509676222251008 |