Addressing the surgical waiting list through comprehensive geriatric assessment

Surgical waiting lists have increased in recent years, particularly in areas of socioeconomic deprivation, with the older population disproportionately affected. This has huge implications for the healthcare economy and is also observed in litigation related to poor shared decision making (SDM). We examined how core principles of the perioperative care for the older person undergoing surgery (POPS) model could be embedded into routine care with minimal staffing. We profiled the cholecystectomy waiting list, described the population awaiting surgery and their experience on the waiting list. Our aim was to provide SDM via a comprehensive geriatric assessment for people living with frailty. A two-tier triage system was undertaken via post and telephone for people aged over 64. All people were discussed at a multidisciplinary meeting. If people were living with frailty, they were offered a clinic appointment. We collected prospective data on diagnoses and interventions along with comparing methods for screening. 750 patients were on the cholecystectomy list. 256 patients were aged 65 or older. The median wait time for those aged over 65 was 101.7 weeks (range 0-273 weeks). 98 patients responded to an initial survey, many describing deterioration in health while on the waiting list. 32.8% met the criteria for frailty (CFS>5) and 44 were offered clinic appointments. Of 256 patients, a total of 51 patients were removed from the waiting list over two levels of triage; initial phone call or clinic (either virtual or face to face) Using a triaged approach to reviewing the waiting list, one fifth of patients aged over 65 years awaiting a cholecystectomy chose not to remain on the waiting list. Over half of these were identified through simple interventions, including those by non-clinical staff. This has very significant implications if replicated across other centres with long waiting lists for surgical interventions, especially in the older population, often the cohort at highest risk of adverse outcome. These novel approaches can address sustainability in the future and improved patient care and outcomes.