Systematic Reviews of Surgical Comprehensive Geriatric Assessment and Assessment of Drivers of Cost in Elderly Emergency Surgery Patients
Bibliographic record
Abstract
Aging populations are increasing the demand for surgical intervention in those over 65 years of age. Older patients experience higher morbidity and mortality. Comprehensive geriatric assessment (CGA) is a multi-faceted approach to in-patient care that addresses medical, functional and psychosocial factors. It is proposed to decrease cost and adverse outcomes in the elderly. I will investigate the effectiveness of CGA in published studies then examine the costs associated with emergency abdominal surgery in a cohort of elderly surgical patients. Two systematic reviews of CGA in surgical patients were conducted. Both examined CGA in surgical patients 65 and older. The primary outcomes for the Cochrane review were mortality and return of pre-morbid function. The primary outcome in the economic review was reported economic outcomes. We also retrospectively examined general surgical inpatient costs over two fiscal years at four hospitals within the Edmonton zone. Costs were compared between surgical risk profile, urgency and age. The Cochrane review found end-of-study mortality trended towards improvement and discharge disposition was significantly improved. Length of stay and readmission were unchanged and complications were decreased. The economic systematic review found lower cost while loss of function, length of stay and mortality were all reduced suggesting CGA may be the economically dominant choice when compared to usual care. All but one study in each review were in orthogeriatric patients; there are insufficient studies to draw conclusions about other surgical populations. Within the Edmonton zone, unscheduled cases were statistically and clinically significantly costlier for 65-79 and 80+ year-old age groups when compared to those under 65. Scheduled surgeries were not clinically significantly different between age groups. Economic evaluation of acute abdominal surgical patients aged 65 and older was conducted. Patients were prospectively enrolled in the Elder-friendly Approaches to the Surgical Environment (EASE) study at two Canadian hospitals in a trial of CGA versus usual surgical care. Baseline clinical, social and demographic characteristics were assessed. Follow-up was conducted at 6 weeks and 6 months following discharge. The Alberta Health Services (AHS) microcosting database along with other AHS and Alberta Health costing databases were used to calculate inpatient, readmission and total healthcare costs from enrolment to 6-months following discharge. Patient-reported resource use within 6 months of discharge was measured using a validated Health Resource Utilization Inventory (HRUI). The primary outcome for database costs analysis was total government healthcare costs; which was assessed using multivariate generalized linear regression. HRUI costs were assessed in a separate analysis with regression. Analysis of the costs accrued by patients enrolled in the EASE study found mean total government costs was $33,752. Multivariate regression found the cost of care increased with higher ASA (Adjusted ratio [AR]=1.24, p=0.002), higher frailty (AR=1.27, p<0.001) and both minor (AR=1.50, p<0.001) and major complications (AR=2.01, p<0.001). After controlling for clinical and demographic data, patients who completed the HRUI had frailty predicted increased cost of healthcare services (AR=1.50, p=0.001) and medical products (AR=1.62, p=0.005) and decreased cost in lost productive hours (AR=0.39, p=0.002). Complications did not predict any change in cost in any category. Overall, CGA is a promising tool to reduce the cost of care while improving outcomes in seniors undergoing unscheduled orthogeriatric procedures. Retrospective analysis identified increased surgical costs with age for unscheduled surgery. Screening elective surgical candidates may decrease admission costs; innovative programs are needed to reduce emergency admission costs. Frailty was also found to predict increased total government costs over 6-months and predicted increased cost of healthcare services and medical products. The EASE study is currently examining the effectiveness of CGA in an unscheduled general surgical population.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".