Perioperative Geriatric Medicine in Head and Neck surgery

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K Millar1; I Mannan1
1. University College London Hospitals NHS Foundation Trust
Clinical Quality
CQ - Clinical Effectiveness
Perioperative care for surgical patients

Abstract

Introduction

Head and Neck surgery is complex, often requiring prolonged anaesthesia and careful postoperative care to ensure good functional recovery. The surgical pathway can be challenging for older patients living with frailty, who have longer inpatient stays and higher rates of postoperative complications and mortality. We have developed a new Geriatrician led service within the Head and Neck surgical pathway, which started in July 2024. This consists of a multidisciplinary outpatient preassessment clinic (geriatrician, anaesthetist and clinical nurse specialist) and weekly ward round during the postoperative inpatient stay. 

The preassessment clinic reviews all patients aged 65 years or above and meeting any of the following criteria: 

  1. 3 or more comorbidities
  2. Polypharmacy
  3. Living with frailty
  4. Concern from surgical team regarding cognition and capacity to consent
  5. Aged over 80 years old and undergoing major reconstructive surgery. 

Results

We have reviewed 55 patients in the preassessment clinic, 24% of these were living with frailty. The service has been shown to have made a positive impact through reducing the length of inpatient stay by 2.46 days (mean length of stay 14.03 days for intervention group vs 16.49 days for age and procedure duration matched control group). We have also contributed to the clinical decision to choose an alternative treatment option (non-surgical or smaller procedure) for 11 patients. 

Conclusion

Geriatric Medicine involvement in the perioperative period is effective at reducing inpatient length of stay and avoiding inappropriate surgical intervention in Head and Neck surgical patients. We are currently gathering data regarding the impact on patient experience and postoperative complication rates.