2SYSTEMATIC MEDICAL ASSESSMENT BY A CONSULTANT GERIATRICIAN FOR PATIENTS UNDERGOING ELECTIVE SPINAL SURGERY

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Abstract

Background: Recent service developments nationally have sought to improve pre-and peri-operative care of older patients undergoing elective surgery. Services have been described in orthopaedic, vascular, cardiovascular and urological – but not spinal – surgery. We were asked to develop a clinic to assess and manage frail older patients undergoing elective spinal procedures.

Innovation: Spinal surgeons and anaesthetists were encouraged to refer patients they identified as “frail” or with multiple comorbidities to a consultant geriatrician in addition to routine pre-operative assessment. After 18 months a retrospective audit of all clinic correspondence was undertaken.

Evaluation: 82 (44 female) patients attended. Average age was 70.9 (SD 10.9; range 46-95). Investigations were requested in 44 (54%) patients: blood tests in 30 (37%), spirometry in 10 (12%), chest x-ray in 9 (11%) and ECG in 8 (10%) patients. New diagnoses were made in 43 (52%) patients: most commonly iron-deficiency anaemia in 8 (10%), orthostatic hypotension in 4 (5%), uterine prolapse in 3 (4%) and uncontrolled hypertension in 2 (2%).

Medications were started, stopped or altered in 28 (34%), 15 (18%) and 7 (9%) patients respectively. Most commonly prescribed were analgesics in 19 (23%), iron in 8 (10%) and antianginals in 5 (6%). Most commonly stopped were analgesics in 11 (13%), antihypertensives in 3 (4%) and proton pump inhibitors in 3 (4%) patients.

An opinion from another specialty was sought for 24 (30%) patients, most commonly from cardiology (12 patients). 17 (21%) patients had no change to their management. One patient cancelled their surgery post-consultation.

Conclusions: Attendance at the clinic changed management by making new diagnoses, changing prescriptions and making specialty referrals that would not have taken place otherwise. The broad age range and proportion of patients with no change to management suggests that pre-clinic screening for appropriateness of geriatrician input might be useful.

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