Perioperative Optimization of Frail Older Adults Undergoing Elective Colorectal Surgery

The Perioperative Optimization of Senior Health (POSH) clinic was established to address vulnerabilities and improve outcomes in frail older patients. This study describes the results of comprehensive perioperative optimization by the POSH interdisciplinary team (IDT) in patients who underwent colorectal surgery.

Frail patients planned for colorectal surgery and enrolled in the POSH clinic (10/2021-09/2023) were retrospectively identified. Descriptive statistics were used to summarize the findings of preoperative geriatric assessment and postoperative outcomes. Outcomes were compared with a contemporary propensity-matched cohort using chi-squared analysis and two-sample t-tests for categorical and continuous variables, respectively.

Thirty-six patients with a median age of 80 years and a mean Charlson Comorbidity Index of 6.11 were planned for colorectal surgeries, most commonly colectomy (62.1%) and ostomy reversal (20.7%). Twenty-nine patients underwent surgical management after interdisciplinary optimization in the POSH clinic. The most common interventions recommended included advance care planning (86.2%), physical therapy (55.2%), and medication management (34.5%). Postoperatively, 75% of patients were discharged home, and there were no mortalities within 90 days. There were no significant differences in postoperative outcomes when compared to a contemporary propensity-matched cohort. The remaining seven patients enrolled in POSH did not undergo surgical management after surgery was deemed inconsistent with their goals of care, and three of these patients expired within 1 year of evaluation in POSH.

The POSH model provides high-risk patients with individualized risk stratification, comprehensive interdisciplinary strategies for risk mitigation, and alignment of care with patient goals. When elective colorectal surgery was within their goals of care, frail older adults safely underwent operative intervention after careful perioperative optimization. Future studies should include a mixed-method exploration of the patient perspective and a randomized controlled trial to quantify the impact of the POSH clinic on short- and long-term postoperative outcomes.