Vascular POPS Pilot
Abstract
Introduction
Older adults undergoing emergency vascular surgery frequently exhibit frailty, delirium risk, and complex perioperative needs. We piloted a Perioperative care of Older People undergoing Surgery (POPS) service at the Somerset and North Devon Vascular Hub, adapting a general surgery POPS model for emergency vascular patients.
Methods
Patients aged >65 were referred if meeting one criterion: Clinical Frailty Scale (CFS) ≥5, 4AT >4, or requiring complex decision-making support. Over three months, geriatric input included weekly ward rounds and Comprehensive Geriatric Assessments delivered by an Advanced Nurse Practitioner or Geriatric Registrar under consultant supervision.
Outcomes were retrospectively compared with all emergency vascular admissions three months pre-implementation. Measured outcomes included length of stay (LoS), CFS/4AT documentation, inpatient and 30-day mortality, 30-day readmissions, and discharge destination changes. The POPS cohort represented a selected high-risk subgroup, not a directly matched population.
Results
Seventeen patients were reviewed by POPS, compared with 68 pre-pilot emergency admissions. Inpatient mortality was 0/17 (0%) versus 7/68 (10.3%) (p=0.338); 30-day mortality was 1/17 (5.9%) versus 4/68 (5.9%) (p=1.0). Thirty-day readmission rates were 2/17 (11.7%) versus 8/68 (11.7%) (p=1.0).
Median LoS was significantly longer in the POPS cohort (28 [IQR 14.5–36] vs 7 [3–13] days, p<0.0001). Discharge destination changes were more common in the POPS group (35.3% vs 10.3%, p=0.034).
Frailty and delirium screening documentation improved, though often completed at POPS referral rather than upon admission.
Conclusions
The pilot was feasible, identifying a clinically complex emergency vascular subgroup requiring prolonged hospitalisation and increased discharge planning. Despite greater complexity, mortality and readmission rates mirrored the pre-pilot cohort, though the study was underpowered for clinical outcome differences.
Improved screening highlighted opportunities for early high-risk patient identification. Future work will focus on routine early CFS recording and embedding POPS within the vascular multidisciplinary pathway to facilitate pre-operative geriatric assessment and optimisation.