Experience with dedicated geriatric surgical consult services: Meeting the need for surgery in the frail elderly

Figures & data

Table 1 Comparison of operative procedures done in patients referred to geriatric surgical consultation services

Group 1: Distribution of 168 operative procedures performed in Group 1
Procedure, specific	Percent
Decubitus, ulcer debridement	25
Amputations (all types)	13
Intravenous Access (all types)	15
Breast:	8
Biliary	7
Endoscopy or placement of gastrostomy tube	7
Laparotomy	16
Hernia	3
Other*	6
Notes: *other = parathyroid, tracheostomy, lymph node biopsy and anorectal procedure.

Table

Group 3 Distribution of 38 operative procedures performed in Group 3
Operations	Percent
Long term intravenous for inotrope	29
Colectomy/bowel resection	24
Lap-cholecystectomy/Lap Nissen	14
Rectal Surgery/Hemorrhoidectomy	16
Jejunostomy	3
Percutaneous cholecystostomy	3
Vein excision	5
Hernia repair	5
Open drainage of psoas abscess	3

Notes: Group 1 data adapted from Zenilman ME, Bender JS, Magnuson TH, Smith GS. General surgical disease in the nursing home patient: Results of a dedicated geriatric surgery consult service. J Am Coll Surg. 1996;183:361–370. All the operations in Group 2 were bedside decubitus debridements.

Table 2 Comparison of multivariate analysis of variables affecting survival

A. Group 1
Variable	Relative risk	p
CAD	3.27	0.01
MMS <24	2.39	0.04
Age >70	2.03	0.06
<1 month in GC	1.72	>0.1
# medications	0.98	>0.1
# diseases	0.86	>0.1
B. Group 2
Male	2.83	0.004
CAD	2.20	0.008
Age >70	1.47	0.33
Dementia	1.36	0.31
>1yr in GC	1.04	0.91
C. Group 3
Male	3.67	0.02
Any comorbidity	1.71	0.47
Use of tobacco/ETOH	1.71	0.46
>65 years	1.19	0.80
White vs black	1.14	0.80
ASA Class	0.891	0.84
CHF meds	0.798	0.56

Notes: Zenilman ME, Bender JS, Magnuson TH, Smith GS. General surgical disease in the nursing home patient: Results of a dedicated geriatric surgery consult service. J Am Coll Surg. 1996;183:361–370.

Abbreviations: ACE, angiotensin-converting enzyme; ASA, Anesthesia Class = 1, 2, 3, 4; Any comorbidity, any other than CHF; CAD, coronary artery disease; CHF, congestive heart failure; CHF meds, number of drugs (ACE inhibitors/diuretic/lasix) taken (stratified 1, 2, 3) GC, geriatric center; MMS, Mini Mental Status; Tobacco-ETOH, chronic use of either tobacco or ethanol.

Table 3 Tools for comprehensive geriatric assessment that can be employed by dedicated consultation services

Geriatric variable	Analysis tool
Comorbidity	Comorbidity index (Charlson scale and the Chronic Illness Rating Scale)
Function	Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL)
Mental Function	Folstein Mini Mental Status (MMS) and Assessment for Dementia Dementia Rating Scale (DRS)
Malnutrition	Mini Nutritional Assessment

Figure 1 Overall survival for the three groups observed. Data for “academic geriatric center” is adapted from Zenilman and Colleagues (1996).

Figure 2 Current demographic profile of US geriatric center residents. Adapted from Jones A. The National Nursing Home Survey: 1999 Summary. National Center for Health Statistics. Vital Health Stat. 13(152)2002:1–116.

Figure 3 The multidisciplinary approach to the geriatric patient consult service.