@article{a8cd264d83af40faa835362911a31dd1,
title = "Perioperative Optimization of Senior Health in Spine Surgery: Impact on Postoperative Delirium",
abstract = "Background: Delirium is a common postoperative complication in geriatric patients, especially in those with underlying risk factors. Multicomponent nonpharmacologic interventions are effective in preventing delirium, however, implementation of these measures is variable in perioperative care. The aim of our study was to assess the impact of our Perioperative Optimization of Senior Health Program (UTSW POSH) on postoperative delirium in patients undergoing elective spine surgery. Study Design: The UTSW POSH program is an interdisciplinary perioperative initiative involving geriatrics, surgery, and anesthesiology to improve care for high-risk geriatric patients undergoing elective spine surgery. Preoperatively, enrolled patients (n = 147) were referred for a geriatric assessment and optimization for surgery. Postoperatively, patients were co-managed by the primary surgical team and the geriatrics consult service. UTSW POSH patients were retrospectively compared to a matched historical control group (n = 177) treated with usual care. Main outcomes included postoperative delirium and provider recognition of delirium. Results: UTSW POSH patients were significantly older (75.5 vs 71.5 years; P <.001), had more comorbidities (8.02 vs 6.58; P <.001), and were more likely to undergo pelvic fixation (36.1% vs 17.5%; P <.001). The incidence of postoperative delirium was lower in the UTSW POSH group compared to historical controls, although not statistically significant (11.6% vs 19.2%; P =.065). Delirium was significantly lower in patients who underwent complex spine surgery (≥4 levels of vertebral fusion; N = 106) in the UTSW POSH group (11.7% vs 28.9%, P =.03). There was a threefold increase in the recognition of postoperative delirium by providers after program implementation, (76.5% vs 23.5%; P =.001). Conclusions: This study suggests that interdisciplinary care for high-risk geriatric patients undergoing elective spine surgery may reduce the incidence of postoperative delirium and increase provider recognition of delirium. The benefit may be greater for those undergoing larger procedures.",
keywords = "deformity, delirium, geriatric, interdisciplinary | surgery, prevention, spine",
author = "Pernik, {Mark N.} and Deme, {Palvasha R.} and Nguyen, {Madelina L.} and Aoun, {Salah G.} and Owoicho Adogwa and Kristen Hall and Stewart, {Nick A.} and Dosselman, {Luke J.} and {El Tecle}, {Najib E.} and McDonald, {Shelley R.} and Bagley, {Carlos A.} and Wingfield, {Sarah A.}",
note = "Funding Information: No funding was received for the current study. Dr. Sarah Wingfield receives funding from the Health Resources and Services Administration Geriatrics Academic Career Award. Dr. Bagley receives royalties from K2M/Stryker. The other authors have no disclosures to report. Funding Information: This publication was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of the Geriatrics Academic Career Award totaling $300,000 with 0% financed with nongovernmental sources. The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government. Funding Information: The authors would like to thank all providers and staff in the UT Southwestern Department of Internal Medicine and Multidisciplinary Spine Center for their contributions in developing this program and exceptional patient care. No funding was received for the current study. Dr. Sarah Wingfield receives funding from the Health Resources and Services Administration Geriatrics Academic Career Award. Dr. Bagley receives royalties from K2M/Stryker. The other authors have no disclosures to report. CAB receives royalties from K2M/Stryker. The other authors have no conflicts of interest to report. CAB, SAW, SGA, MNP, PRD, SRM and OA contributed to study conception and design. MNP, PRD, MLN, KH, NAS, and LJD contributed to data acquisition and management. MNP, PRD, OA, LJD, NET, CAB, and SAW contributed to data analysis and interpretation. MNP, PRD, SGA, MLN, and SAW drafted the manuscript. SGA, OA, NET, SRM, CAB, and SAW critically revised the manuscript. All authors approved of the final version of the submitting manuscript. This publication was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of the Geriatrics Academic Career Award totaling $300,000 with 0% financed with nongovernmental sources. The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government. Publisher Copyright: {\textcopyright} 2020 The American Geriatrics Society",
year = "2021",
month = may,
doi = "10.1111/jgs.17006",
language = "English (US)",
volume = "69",
pages = "1240--1248",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",
number = "5",
}