Experience with dedicated geriatric surgical consult services: Meeting the need for surgery in the frail elderly

Rosemarie E Hardin1, Thierry Le Jemtel2, Michael E Zenilman11Department of Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA; 2Department of Medicine, Tulane Medical Center, New Orleans, LA, USABackground: Surgeons are increasingly faced with consultation for intervention in residents of ger...

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Autores principales:	Rosemarie E Hardin, Thierry Le Jemtel, Michael E Zenilman
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2009
Materias:	Surgery in the elderly aged nursing home decubitus congestive heart failure Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/d0c21409cb2145bea1e24fa11ab832e4
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spelling	oai:doaj.org-article:d0c21409cb2145bea1e24fa11ab832e42021-12-02T00:05:19ZExperience with dedicated geriatric surgical consult services: Meeting the need for surgery in the frail elderly1178-1998https://doaj.org/article/d0c21409cb2145bea1e24fa11ab832e42009-01-01T00:00:00Zhttps://www.dovepress.com/experience-with-dedicated-geriatric-surgical-consult-services-meeting--peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Rosemarie E Hardin1, Thierry Le Jemtel2, Michael E Zenilman11Department of Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA; 2Department of Medicine, Tulane Medical Center, New Orleans, LA, USABackground: Surgeons are increasingly faced with consultation for intervention in residents of geriatric centers or in patients who suffer from end stage medical disease. We review our experience with consult services dedicated to the needs of these frail patients.Study design: Patients were prospectively followed after being evaluated by three different geriatric surgical consult services: Group 1 was based at a geriatric center associated with a tertiary medical center, Group 2 was based at a community geriatric center, and Group 3 was based with an hospital-based service for ambulatory patients with end stage congestive heart failure.Results: A total of 256 frail elderly patients underwent of 311 general surgical procedures ranging from major abdominal and vascular procedures to minor procedures such as debridement of decubitus ulcers, long-term intravenous access, enterostomy and enteral tube placement. Almost half of the surgical volume in Group 1 and 3 were ‘maintenance’ (decubitus debridement, long term intravenous or stomal or tube care); all of Group 2 were for treatment of decubiti. There was minimal morbidity and mortality from surgery itself, and overall one year survival for Groups 1, 2, and 3 was 46%, 60%, and 79%, respectively. Multivariate analysis showed that each group had its own unique indicators of decreased survival: Group 1 dementia and coronary artery disease, in Group 2 gender and coronary artery disease, and Group 3, gender alone. Age, number of comorbid illnesses, and type of surgery (major vs minor) were not significant indicators.Conclusions: This is the first review of the role of dedicated surgical consult services which focused on residents of geriatric centers and frail elderly. Conditions routinely encountered in this population such as dementia, end stage disease, multiple comorbidities, polypharmacy, decreased functional and nutritional status are not frequently encountered by general surgeons. But the surgery is safe, and survival data is comparable to those in geriatric centers who did not undergo surgery. A multidisciplinary team approach gives the most effective care, with a primary goal of palliation.Keywords: surgery in the elderly, geriatrics, surgical consultations, nursing home residents, congestive heart failure, frailty, palliative care, dementia, coronary artery disease, survivalRosemarie E HardinThierry Le JemtelMichael E ZenilmanDove Medical PressarticleSurgery in the elderlyagednursing homedecubituscongestive heart failureGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 4, Pp 73-80 (2009)
institution	DOAJ
collection	DOAJ
language	EN
topic	Surgery in the elderly aged nursing home decubitus congestive heart failure Geriatrics RC952-954.6
spellingShingle	Surgery in the elderly aged nursing home decubitus congestive heart failure Geriatrics RC952-954.6 Rosemarie E Hardin Thierry Le Jemtel Michael E Zenilman Experience with dedicated geriatric surgical consult services: Meeting the need for surgery in the frail elderly
description	Rosemarie E Hardin1, Thierry Le Jemtel2, Michael E Zenilman11Department of Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA; 2Department of Medicine, Tulane Medical Center, New Orleans, LA, USABackground: Surgeons are increasingly faced with consultation for intervention in residents of geriatric centers or in patients who suffer from end stage medical disease. We review our experience with consult services dedicated to the needs of these frail patients.Study design: Patients were prospectively followed after being evaluated by three different geriatric surgical consult services: Group 1 was based at a geriatric center associated with a tertiary medical center, Group 2 was based at a community geriatric center, and Group 3 was based with an hospital-based service for ambulatory patients with end stage congestive heart failure.Results: A total of 256 frail elderly patients underwent of 311 general surgical procedures ranging from major abdominal and vascular procedures to minor procedures such as debridement of decubitus ulcers, long-term intravenous access, enterostomy and enteral tube placement. Almost half of the surgical volume in Group 1 and 3 were ‘maintenance’ (decubitus debridement, long term intravenous or stomal or tube care); all of Group 2 were for treatment of decubiti. There was minimal morbidity and mortality from surgery itself, and overall one year survival for Groups 1, 2, and 3 was 46%, 60%, and 79%, respectively. Multivariate analysis showed that each group had its own unique indicators of decreased survival: Group 1 dementia and coronary artery disease, in Group 2 gender and coronary artery disease, and Group 3, gender alone. Age, number of comorbid illnesses, and type of surgery (major vs minor) were not significant indicators.Conclusions: This is the first review of the role of dedicated surgical consult services which focused on residents of geriatric centers and frail elderly. Conditions routinely encountered in this population such as dementia, end stage disease, multiple comorbidities, polypharmacy, decreased functional and nutritional status are not frequently encountered by general surgeons. But the surgery is safe, and survival data is comparable to those in geriatric centers who did not undergo surgery. A multidisciplinary team approach gives the most effective care, with a primary goal of palliation.Keywords: surgery in the elderly, geriatrics, surgical consultations, nursing home residents, congestive heart failure, frailty, palliative care, dementia, coronary artery disease, survival
format	article
author	Rosemarie E Hardin Thierry Le Jemtel Michael E Zenilman
author_facet	Rosemarie E Hardin Thierry Le Jemtel Michael E Zenilman
author_sort	Rosemarie E Hardin
title	Experience with dedicated geriatric surgical consult services: Meeting the need for surgery in the frail elderly
title_short	Experience with dedicated geriatric surgical consult services: Meeting the need for surgery in the frail elderly
title_full	Experience with dedicated geriatric surgical consult services: Meeting the need for surgery in the frail elderly
title_fullStr	Experience with dedicated geriatric surgical consult services: Meeting the need for surgery in the frail elderly
title_full_unstemmed	Experience with dedicated geriatric surgical consult services: Meeting the need for surgery in the frail elderly
title_sort	experience with dedicated geriatric surgical consult services: meeting the need for surgery in the frail elderly
publisher	Dove Medical Press
publishDate	2009
url	https://doaj.org/article/d0c21409cb2145bea1e24fa11ab832e4
work_keys_str_mv	AT rosemarieehardin experiencewithdedicatedgeriatricsurgicalconsultservicesmeetingtheneedforsurgeryinthefrailelderly AT thierrylejemtel experiencewithdedicatedgeriatricsurgicalconsultservicesmeetingtheneedforsurgeryinthefrailelderly AT michaelezenilman experiencewithdedicatedgeriatricsurgicalconsultservicesmeetingtheneedforsurgeryinthefrailelderly
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Experience with dedicated geriatric surgical consult services: Meeting the need for surgery in the frail elderly

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