Perioperative Medicine for Older People Undergoing Surgery Scale Up (POPS-SUp): study protocol.

Area of Science:

• Geriatric Medicine
• Surgical Outcomes
• Health Services Research

Background:

• Older surgical patients face higher risks of complications and functional decline due to age-related physiological changes, multimorbidity, and frailty.
• Comprehensive Geriatric Assessment (CGA) can optimize these conditions, mitigating perioperative risks and improving outcomes cost-effectively.
• Variations in CGA-based Perioperative Medicine for Older People undergoing Surgery (POPS) services across the UK lead to inequitable access and increased costs.

Purpose of the Study:

• To determine if CGA-based POPS services can be implemented at scale.
• To assess the cost-effectiveness of scaled-up POPS services in improving clinical outcomes for older surgical patients.
• To address the inequitable access and associated negative consequences of current POPS service variations.

Main Methods:

• A mixed-methods hybrid implementation-effectiveness interrupted time series study design.
• Utilizing a co-produced implementation strategy to embed CGA-based POPS services nationally.
• Employing co-primary outcomes of reach and length of hospital stay, alongside process evaluation, clinical effectiveness, cost-effectiveness, and patient/staff experience.

Main Results:

• The study is designed to evaluate the implementation and effectiveness of scaled-up POPS services.
• Quantitative analysis will examine clinical and cost-effectiveness using interrupted time series.
• Qualitative appraisal will assess patient and staff experiences during implementation.

Conclusions:

• The POPS Scale Up (POPS-SUp) study anticipates significant impact at individual, organizational, and policy levels.
• Successful implementation could enhance perioperative care for older adults nationwide.
• Findings may also inform the application of CGA-based services in other clinical settings.