Collaborative care pathways in geriatrics and neurosurgery: a scoping review of current practices

Although widespread in orthopaedic surgery, there is a paucity of data on neurosurgery-geriatrics services, despite an increasing number of geriatric patients being offered neurosurgical procedures. This review aimed to identify whether neurosurgery-geriatrics services have been described in the literature, how these services are organised and function in practice, which models of care are employed, and what outcomes have been reported.

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA ScR) guideline was utilised for this scoping review. All studies describing a neurosurgery-geriatrics service were included in this study. Our primary database search included PubMed and OVID Embase. Data on the author and country, type of study, sample size, service type, outcomes, and service model were extracted from each study.

Eight observational studies from six centres describing different types of a neurosurgery-geriatrics joint service were identified and included in the review. The identified service models were categorised into two distinct types. Model 1 describes a perioperative collaborative management approach for geriatric patients, wherein geriatricians are engaged during the preoperative and postoperative phases of neurosurgical care. Model 2 represents a comprehensive model of care, encompassing all geriatric admissions to the neurosurgery unit that meet a predefined eligibility criterion.

There are different models of neurosurgery-geriatrics services, each with positive effects on patient safety and flow. Further research is needed to inform clinical practice and service development, with the aim of improving the quality of care and outcomes for older neurosurgical patients.