Virtual Perioperative Comprehensive Geriatric Assessment for Minimally Invasive Oesophagectomy: A POPS MDT Video Clinic Pilot

Introduction: Perioperative Medicine for Older People undergoing Surgery (POPS) provides preoperative Comprehensive Geriatric Assessment (CGA) and tailored optimisation to improve perioperative outcomes and inform shared decision making. With challenges of an ageing population, increasing service demand and fixed Consultant Geriatrician resource and physical capacity in the hospital setting, there is a need for innovation in service delivery. Building on established virtual Clinical Nurse Specialist (CNS) led telephone clinic follow-up within the POPS department, the POPS multidisciplinary team piloted a video-based CGA clinic for Minimally Invasive Oesophagectomy (MIO) patients. 

Methods: All patients being considered for MIO between May and September 2025 who were over 65 years, or those under 65 years presenting with clinical frailty, multimorbidity, functional, or cognitive impairment  were offered a video clinic assessment. Each patient had a CGA by a POPS CNS using secure video integrated technology. Patient data from digital health records and from UGI surgical MDT appointments was used to avoid duplication of resources. All CNS delivered video assessments were reviewed and discussed with a designated POPS Consultant. The optimisation and perioperative plan was directly integrated into the electronic health record and shared with the patient, their GP, and surgical teams.

Results: 9 out of 11 patients opted in to the pilot (78%). 98% patient satisfaction with the video clinic, with an average 3 hours travel time at a cost of £35.10 saved per patient. £3,990 saved by avoiding consultant-led clinic, with substantial physical clinic space saved for additional face-to-face reviews. No change in perioperative complications or length of stay compared to 3 months pre-pilot, with similar patient populations.

Conclusion: This pilot shows virtual perioperative CGA can be delivered with high clinical fidelity, patient satisfaction and cost savings to the patient and trust. It directly supports the NHS 10-Year Plan's digital transformation agenda while prioritising safety, quality, and patient-centred clinical care.