Effect of Preoperative Geriatric Evaluation on Outcomes After Elective Surgery: A Population-Based Study.

BACKGROUND/OBJECTIVES Randomized and nonrandomized single-center studies suggest that preoperative geriatric evaluation improves postoperative outcomes in older adults. The generalizability and population-level effect of preoperative geriatric evaluation has not been determined. Our objective was to measure the adjusted association between preoperative geriatric evaluation and postoperative outcomes. DESIGN Multilevel multivariable regression model analysis of a population-based historical cohort. SETTING Publicly funded universal healthcare system in Ontario, Canada. PARTICIPANTS All adults aged 65 and older having major, elective, noncardiac surgery from 2002 to 2014 (N = 266,499). INTERVENTION We studied geriatric consultations and comprehensive assessments performed in the 4 months prior to surgery. These were identified using validated methods. MEASUREMENTS Ninety-day survival (primary outcome), in-hospital complications, length of stay, 30-day readmissions, need for supported discharge, and 90-day costs of care. RESULTS The 7,352 participants (2.8%) who had a preoperative geriatric evaluation had longer 90-day survival than those who who did not (adjusted hazard ratio = 0.81, 95% confidence interval = 0.68-0.95). Length of stay and complication rates did not differ between groups, but participants evaluated by a geriatrician preoperatively had higher rates of supported discharge, readmission rates, and costs of care. Sensitivity analyses supported the association between preoperative geriatric assessment and 90-day survival. CONCLUSION In individuals aged 65 and older undergoing major, elective, noncardiac surgery, preoperative geriatric evaluation was associated with longer 90-day survival, but it is used infrequently. Given these results, and those of previous small studies, the influence of a geriatric evaluation on postoperative outcomes should be determined in a multicenter randomized trial.