Aims
Surgical-geriatric shared care services are expanding; however, it is still a novel concept in neurosurgery. Neurosurgical patients are often frail and co morbid with pathologies that can significantly impair function and cognition. Proactive geriatrician input aims to improve quality of care in this vulnerable patient group. This study describes the utility of a proactive neurosurgery-geriatric shared care model, established at a quaternary hospital in WA. To our knowledge, no similar models have been described in published literature.
Methods
Consecutive neurosurgical patients (>65 yrs, elective and emergency) admitted over a 3-month period were included. Relevant data from medical records was collected, including patient comorbidities, frailty, medical interventions and discharge disposition.
Results
103 patients were included. Approximately half were seen by our geriatric team pre-operatively, and all had a post-operative assessment. 25% of pre-operative reviews and 50% of post-operative reviews led to an intervention. The most common peri-operative interventions were pre-operative medical optimisation, and post-operative diagnosis and management of acute medical complications. Delirium and infection were the most common complications. The geriatric team completed goals of care decisions in 80% of patients and performed weekly multidisciplinary team meetings for all patients. Almost half the patients in this study required inpatient rehabilitation.
Conclusions
This study demonstrates a high need for proactive geriatrician input into older neurosurgical patients due to the deleterious effects neurosurgical pathologies can have on their physical and cognitive wellbeing. Collaboration is key to optimising quality of patient care.