Postoperative geriatric syndromes signal high vulnerability and poor outcomes in older adults

Older adults who develop a new geriatric syndrome - such as dehydration, delirium, or malnutrition - after major surgery face a dramatically higher risk of poor outcomes, including more complications, fewer days spent at home, and a significantly increased likelihood of dying within a year, according to findings published in the Journal of the American College of Surgeons (JACS). 

Researchers analyzed Medicare claims data from 2016 to 2021 of patients over 66 who underwent one of five major operations: coronary artery bypass grafting, pneumonectomy, abdominal aortic aneurysm repair, pancreatectomy, or colectomy. The study focused only on new-onset cases, excluding patients with a prior history of geriatric syndromes. 

The study found that 10.9% of patients developed at least one new geriatric syndrome during their hospitalization. These syndromes include delirium (sudden confusion or disorientation), dehydration, malnutrition, falls, or loss of control over their bladder or bowels. Patients who developed one of these conditions were far less likely to be discharged directly home and spent a median of 16.5 fewer days at home in the 90 days following surgery. 

A geriatric syndrome can be a 'canary in the coal mine,' signaling a patient's underlying vulnerability. It's crucial we don't dismiss these events as just a normal part of 'getting older.' These are important warning signs that a patient needs closer monitoring and tailored support, both in the hospital and after discharge." 

Timothy M. Pawlik, MD, MPH, PhD, FACS, senior author, surgical oncologist at The Ohio State University Wexner Medical Center

Key findings  

• Patients who developed a geriatric syndrome had a 27% reduction of days at home within 90 days of discharge. For those who also had a postoperative complication, the median days at home decreased to just 15 days. 

• The development of any geriatric syndrome was associated with a 132% higher risk of death within one year. Having two or more syndromes led to a 272% higher risk of death in that time frame. 

• The increased mortality risk held strong even among patients who did not experience major postoperative complications, with a 54% higher risk of death. 

• Dehydration was the most frequently occurring syndrome (66.7% of affected patients), followed by delirium (25.2%) and malnutrition (13.2%). 

The study also identified factors associated with a higher risk of developing a geriatric syndrome, including older age, a higher burden of other health conditions, and undergoing emergency surgery. Having a minimally invasive procedure was associated with a 49% lower risk of developing a geriatric syndrome, according to the authors. 

The researchers suggest the findings highlight the critical need for a specialized, systematic approach to the surgical care of older adults through programs such as the American College of Surgeons (ACS) Geriatric Surgery Verification (GSV) Program. 

The ACS GSV Program provides hospitals with a set of evidence-based standards designed to optimize surgical care for older adults. These standards emphasize proactive patient assessment, delirium prevention and management, and patient-centered goal setting to improve outcomes and preserve patients' independence and quality of life after surgery. 

"This research provides powerful evidence for why programs like GSV are so essential," Dr. Pawlik said. "By focusing on the unique needs of older patients, we can better anticipate, prevent, and manage these syndromes, which directly translates to helping patients get back home and back to their lives." 

Coauthors are Andrea Baldo, MD; Odysseas P Chatzipanagiotou, MD; Selamawit Woldesenbet, MS, MPH, PhD; Miho Akabane, MD; Gaya Spolverato, MD, FACS.