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Geriatric Surgery Service

 

The Geriatric Surgery Service (GSS) is a trans-disciplinary and collaborative model of care designed for elderly patients requiring major colorectal surgery1.

The GSS team comprises of a trans-disciplinary team of healthcare workers with specific roles, who work together for the total well-being of the elderly patient. This team manages patients at a higher level of co-operation than the care involved with standard management. The GSS team has open communication and a seamless assessment and management of their patients, as opposed to having inter-disciplinary referrals among healthcare workers. Each team member moves from a functional to a collective approach in caring for the patient. Through coordinated trans-disciplinary care, the team has been able to ensure the patients return to good functional health after the surgery. As compared to most young patients, elderly patients have a greater number of comorbidities and thus, management of their care is complex. Their functional reserves are poorer therefore reducing the margin of error allowed in their management. Chronic pain may also lead to immobility and reduced functional status thus increasing their risk associated with surgery. As such, it is essential to provide the elderly with additional care as compared to other patients.

Since the start of this service, our patients have been able to achieve consistent successful outcomes as compared to those under standard management. Patients under GSS had lower major complication rates and death. Having achieved promising results through a transdisciplinary approach, we embarked on a transinstitutional approach of prehabilitating frail elderly patients prior to surgery and achieved further improvement in surgical outcomes2.

Since the commencement of the GSS, major complication rates have decreased from 30.8% to 5.3%. The thirty-day mortality rate fell from 9.6% to 1.7%. The mean length of hospital stay for frail elderly patients was reduced from 11.0 days to 8.4 days. Ninety eight percent of patients regained full functional recovery by 6 weeks after major colorectal surgery.

Reference:

1. Tan, K. Y., Tan, P. & Tan, L. (2011). A Collaborative Transdisciplinary “Geriatric Surgery Service” Ensures Consistent Successful Outcomes in Elderly Colorectal Surgery Patients. World J Surg. 35, 1609-1614.

2. Chia CL, Mantoo SK, Tan KY. ‘Start to Finish transinstitutional transdisciplinary care’: a novel approach improves colorectal surgical results in frail elderly patients. Colorectal Dis. 2016 Jan;18(1):O43-50.