Comprehensive Geriatric Assessment and Shared Decision Making in Older Surgical Patients: Outcomes from a COTE Perioperative Medicine Outpatient Clinic

Introduction: Frailty, multimorbidity and older age are associated with poorer postoperative outcomes, increased complications and greater healthcare utilisation. National guidance recommends comprehensive perioperative assessment for these patients. This study evaluates the adherence of a Perioperative Care of Older People undergoing Surgery (POPS) clinic to national standards and explores its impact on perioperative decision-making and healthcare resource utilisation.

Methods: A retrospective study was conducted of patients assessed in a POPS clinic over a 1 year period (2024-2025). Data collected included Clinical Frailty Scale (CFS) score, cognitive assessment using AMT-10, medication review and optimisation, ReSPECT discussions, patient expectations, perioperative counselling, social history and surgical recommendations and follow-ups.

Results: 35 patients underwent POPS assessment. Compliance with key domains was high, with social history documented in 100%, medication review and optimisation in 97.1% and exploration of patient expectations and perioperative risk and discharge planning discussions in 91.4%. Cognitive assessment was completed in 85.7% of patients, while CFS scoring and ReSPECT discussions were documented in 80% and 65.7%, respectively. Following POPS review, 14 patients (40%) proceeded to surgery, 15 (42.9%) did not proceed and 6 (17.1%) had surgery deferred pending optimisation and reassessment. Procedures not undertaken included orthopaedic, vascular, breast, colorectal and urological operations. Estimated operative expenditure associated with procedures not undertaken ranged from approximately GBP 84,300 to GBP 134,500 annually.

Conclusions: The POPS clinic showed high compliance to national standards and supported comprehensive geriatric assessment, optimisation and shared decision making. These findings show the role of POPS in facilitating patient-centred care and promoting appropriate utilisation of healthcare resources.