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

Surgery provides definitive management of many age-related diseases, relieving symptoms or extending life. Age-related physiological decline, multimorbidity, and frailty predispose older people to postoperative complications and incomplete functional recovery, with resultant health and social care costs. These age-related conditions can be optimized using Comprehensive Geriatric Assessment (CGA), thus mitigating perioperative risk to improve clinical outcomes with cost-effectiveness. National organizations advocate CGA-based services for older surgical patients. However, there is variation in the provision of CGA-based perioperative medicine for older people undergoing surgery (POPS) services across the UK National Health Service, resulting in inequitable access for older surgical patients at higher risk, unnecessary deaths, complications, and financial cost. The aim of the POPS Scale Up (POPS-SUp) study is to determine whether CGA-based POPS services can be implemented at scale to cost-effectively improve clinical outcomes for older patients undergoing surgery.

A mixed-methods hybrid implementation-effectiveness interrupted time series study will examine the use of a coproduced implementation strategy to embed CGA-based POPS services at scale in the UK. Co-primary implementation-effectiveness outcomes will be used, namely reach and length of hospital stay, respectively. Evaluation will include an embedded process evaluation, quantitative evaluation of clinical effectiveness and cost-effectiveness, and qualitative appraisal of patient and staff experience. The proposed analysis is to embed a process evaluation using real-time framework analysis, enabling iterative refinement and evaluation of the implementation strategy. Accepted interrupted time series analysis will be used to examine and compare outcomes per participating site. A predefined dissemination strategy has been co-designed with patients/carers, clinical community of practice, and organizational bodies.

The anticipation is that POPS-SUp will have impact at the individual (patient and clinician), organizational, and policy levels in the perioperative setting, but with additional potential application to other clinical settings.Registration numbers: ISRCTN 45327 (https://www.isrctn.com/); NIHR 157443 (https://www.nihr.ac.uk/).