Improving Peri-Operative Assessment for Older Adults Undergoing Elective Cancer Surgery at Kings College Hospital

Introduction  

There has been a global increase in the number of older adults undergoing elective and emergency surgery in the last 50 years. Frailty, cognitive dysfunction and multi morbidity negatively impact peri-operative outcomes.  Roughly 15% of patients over 65 having surgery at Kings College Hospital are frail but previously there was no pathway in place to perform timely CGA or optimise for surgery.  

Methods   

We have set up a Geriatrician led pre-operative clinic for older adults being considered for cancer surgery. We see patients who are over 65 with a CFS of 4 and above with either multiple co-morbidities or cognitive dysfunction. We perform a CGA, have a shared decision-making conversation and create a management plan to optimise for surgery and post-operative complications.  

Results  

8 months in we have seen 156 patients with an average age of 77 and an average CFS of 4. Average number of co-morbidities per patient is 5. Average number of new diagnoses per patient is 1.5 with cognitive impairment (25%) and anaemia (30%) being the most common. Average number of interventions is 4; the most common being the SELCA exercise programme (54%), delirium counselling (52%) and intravenous iron (28%). 30% of patients that we have seen did not proceed with an operation; most commonly this was due to frailty, co-morbidity or a combination of both. We have adapted the service to be able to facilitate same day IV iron and rapid access to ECHO, lung function and CPET testing.   

Conclusions and Next Steps   

Our clinic provides a vital service for older adults undergoing surgery and we hope to incorporate this as a permanent service in the peri-operative pathway at Kings. We are now in the process of gathering data on length of stay and readmission after surgery to see if we have improved these outcomes.