Randomized clinical trial of comprehensive geriatric assessment and optimization in vascular surgery

BackgroundIncreasing numbers of older patients are undergoing vascular surgery. Inadequate preoperative assessment and optimization may contribute to increased postoperative morbidity and mortality. MethodsPatients aged at least 65 years scheduled for elective aortic aneurysm repair or lower-limb arterial surgery were enrolled in an RCT of standard preoperative assessment or preoperative comprehensive geriatric assessment and optimization. Randomization was stratified by sex and surgical site (aorta/lower limb). Primary outcome was length of hospital stay. Secondary outcome measures included new medical co-morbidities, postoperative medical or surgical complications, discharge to a higher level of dependency and 30-day readmission rate. ResultsA total of 176 patients were included in the final analysis (control 91, intervention 85). Geometric mean length of stay was 553days in the control group and 332days in the intervention group (ratio of geometric means 060, 95 per cent c.i. 046 to 079; P<0001). There was a lower incidence of delirium (11 versus 24 per cent; P=0018), cardiac complications (8 versus 27 per cent; P=0001) and bladder/bowel complications (33 versus 55 per cent; P=0003) in the intervention group compared with the control group. Patients in the intervention group were less likely to require discharge to a higher level of dependency (4 of 85 versus 12 of 91; P=0051). ConclusionIn this study of patients aged 65years or older undergoing vascular surgery, preoperative comprehensive geriatric assessment was associated with a shorter length of hospital stay. Patients undergoing assessment and optimization had a lower incidence of complications and were less likely to be discharged to a higher level of dependency. Registration number: ISRCTN23142588 (). Better outcomes