Quantifying the impact of establishing a new perioperative frailty service: a two-year study profiling cholecystectomy patients

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T Lee1, K James1, A Hodgson1
Dept of Elderly Care, Morriston Hospital, SBUHB
Clinical Quality
CQ - Clinical Effectiveness
Perioperative care for surgical patients

Abstract

Introduction 

A growing evidence base demonstrates that perioperative frailty screening is essential to improve post-operative outcomes, yet it is underutilised in many hospitals. People living with frailty undergoing surgery can be complex and multimorbid with a high risk of complications, and comprehensive geriatric assessment in such cases is invaluable. This study quantifies the impact of initiating a POPS service in Swansea Bay University Health Board, with outcome data over a two-year follow-up period. 

 

Method 

In 2022, a quality improvement project to establish a POPS team was undertaken and a designated junior clinical fellow appointed. The waiting list for laparoscopic cholecystectomy was profiled for frailty. All patients age >65 years were initially sent a survey by post and then contacted by telephone with a set questionnaire to generate a clinical frailty score (CFS) and a comprehensive risk assessment and needs evaluation (CRANE). A multidisciplinary team then discussed all cases and triaged into appointment type for appropriate assessment. 

 

Results  

The cholecystectomy list contained a total of 750 patients, of which 256 (34%) were age >65 years. Of these 256 patients, 22.2% described health deterioration, 6.6% had unmet care needs, 26.5% were dissatisfied with the service, and further appointments were necessary for 17.2%. Over the entire process, 19.9% were off listed from surgery for a variety of reasons. Data at 48-months post-screening revealed minimal post-operative complications for those who received surgery, or significant sequelae for those off listed. 

 

Conclusion 

Recent studies have demonstrated the paucity of POPS in many health boards. However, the project we describe here exemplifies the feasibility of establishing an effective POPS service, with objective data demonstrating improved outcomes in multiple domains spanning a two-year follow-up period. This highlights the potential to deliver better patient-centred care, whilst simultaneously improving outcomes, cutting unnecessary costs, and empowering patients through shared decision-making. 

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