Oral Presentation Australian and New Zealand Society for Geriatric Medicine Annual Scientific Meeting 2025

The Impact of a Perioperative care of Older Adults undergoing Surgery (POPS) clinic on Goals of Care completion: Findings from an Australian retrospective cohort study   (119838)

Johanna Lee 1 2 3 , Rosie Watson 1 2 , Kai Sin Chin 1 , Wen Kwang Lim 1 2 , Aaron Bak Ong Wong 2 4 5 6 , Chuan-Whei Lee 7 8 , Rachel Aitken 1
  1. Department of Aged Care, Royal Melbourne Hospital, Parkville, Victoria, Australia
  2. Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
  3. Palliative Care Service, Alfred Health, Melbourne, Victoria, Australia
  4. Supportive and Palliative Care Service, Eastern Health, Wantina, Victoria, Australia
  5. Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
  6. Department of Palliative Care, Royal Melbourne Hospital, Parkville, Victoria, Australia
  7. Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Victoria, Australia
  8. Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia

Aims

This study aimed to assess whether a geriatrician led perioperative clinic for older patients (POPS) improved Goals of Care (GOC) completion for elective surgical admissions. We also evaluated whether the surgical admission GOC category aligned with POPS clinic GOC recommendation.

 

Methods

A retrospective cohort study at the Royal Melbourne Hospital, compared POPS patients over 10 months (March-December 2022), and a historical surgical cohort matched 1:2 for surgical specialty, malignancy, age, gender, American Society of Anaesthesiologists Classification, National Surgical Quality Improvement Program 30 day mortality, services at home, and indoor gait aid from 2020-2021. GOC data and clinical characteristics were extracted from electronic health records.

 

Results

Fifty-nine POPS patients (median age 77, 37% female) and 118 matched controls (median age 77, 39%female) were included. GOC was completed for 37/59 (62.7%) of POPS patients compared to 68/118 (57.6%) of the matched cohort(p=0.516). Thirty-one POPS patients (52.5%) had a recommended GOC documented in clinic. However almost half of these patients (14/31 [45.2%]) had a different GOC selected by the surgical team during their admission.

 

Conclusions

Preoperative POPS assessment did not significantly improve GOC completion. There was a discrepancy between POPS recommendations and surgical team decisions for GOC, highlighting a gap in ensuring patient preferences are consistently reflected in subsequent GOC decisions and documentation. These findings suggest that while POPS offers a platform for discussing GOC, further efforts are needed to address barriers to GOC completion and align recommendations with surgical decisions, ensuring patient preferences are prioritised.