The Management & Innovation for Longevity in Elderly Surgical patients (MILES) program: Our experience in setting up...

The global increase in life expectancy and quality of life has led to a higher demand for surgical care among the older adults. Frailty, rather than chronological age, has emerged as a critical predictor of poor surgical outcomes. This paper discusses the adoption of the PDCA cycle in the successful establishment of a nurse-led perioperative service focusing on frailty for older adults undergoing elective major surgeries.

The nurse-led program was piloted in 2017 and formally established in 2018. It focuses on frailty assessment, multimodal prehabilitation, and Enhanced Recovery After Surgery (ERAS) in the perioperative phase. Data from April 2018 to March 2023 were retrospectively reviewed. Patients aged 65 and above undergoing elective major surgeries were enrolled into the programme.

From 2018 to 2023, 949 elderly patients were enrolled into the program. The most common surgeries were colorectal (55.4 %) and hepatobiliary (29.1 %) surgeries. Referral rates increased exponentially, except during the COVID-19 pandemic. There was a 28 % reduction in median post-operative length of stay (LOS) from nine to five days. Post-operative complications and readmission rates remained stable. Patient satisfaction to the programme is high, with 99.5 % of patients feeling satisfied with the nurse-led service.

This nurse-led program has effectively identified patients with frailty, allowing for tailored perioperative care. The integration of nursing-led assessments utilizing Edmonton Frail Scale and Comprehensive Geriatric Assessment with nurse led multidisciplinary referrals contributed to reduced LOS and high patient satisfaction. Despite stable complication and readmission rates, the program's structured approach facilitated better pre-surgical preparation and post-operative care.

The nurse-led program has shown promising results in optimizing elderly patients for surgery and improving perioperative outcomes while enhancing and empowering the role of nurses.