Comprehensive geriatric assessment in older vascular patients in a tertiary hospital

Abstract

Comprehensive Geriatric Assessment (CGA) is a validated multidomain assessment of an older person’s myriad issues that has shown positive medical outcomes in surgical settings. However, there is paucity of evidence in older Vascular inpatients. To determine if a Geriatric Liaison Service using CGA improves medical outcomes in older Vascular inpatients in Singapore. This is a quality improvement prospective cross-sectional study. Vascular patients aged ≥65 years admitted between November 2018 to October 2019 were referred to the Vascular-Geriatric Service (VGS) at the surgeon’s discretion if they had acute medical issues, cognitive concerns, or functional decline. Patients admitted under Vascular Surgery during the preceding year but not referred to VGS were used as control. A pre- and post-analysis was conducted for outcomes of medical complications, while a multivariate analysis was done to look at LOS, 30-day unplanned medical readmissions and 30-day mortality rates. Patients had significantly lower rates of pneumonia (2.2% vs 10.8%, p = .021) and delirium (1.1% vs 18.3%, p < .001) post-VGS compared to pre-VGS. VGS decreased the odds of 30-day mortality by 79% as compared to the control group (OR = 0.21, 95% CI: 0.05-0.86, p = .030). The intervention group had increased risk of a longer hospital stay by 48% as compared to control (RR: 1.48 95% CI: 1.11 to 1.97, p = .008). VGS was associated with reduction in some medical complications, and 30-day mortality in older frail Vascular inpatients with multimorbidity.