Abstract
In 2011, Brown University Health’s Division of Geriatrics started its inaugural geriatric co-management service to improve older adult (OA) care for patients with hip fractures. Its success in care and cost reduction prompted the health system to expand geriatric co-management. Meanwhile, oncology surgeons treat increasingly older and frailer patients due to improved therapies and survival. The literature established what we saw here: increased mortality and complications in frail OA and failure of strategies like Enhanced Recovery After Surgery and Prehabilitation. In 2021, the division launched an oncologic surgery co-management program. Explicit to its launch, hospital sponsors required a 2-year study for benchmarks and quality metrics with a primary outcome of reducing mortality and delirium. QI metrics were developed through PowerBI dashboards using hospital and EMR data, analyzing 4,359 cases, which measured length of stay (LOS), readmissions, mortality, and disposition, from July 2018 to August 2024. We compared outcomes between the pilot (Geri) and those with no geriatric involvement (UC) using 1:1 propensity score matching. Bivariate analyses used chi-square and Student’s t-tests for descriptive comparisons and multivariate linear or logistic regression analyses for outcome rates and adjusted when appropriate. The matched sample consisted of 309 cases in each group. 14% were underrepresented minorities. The Geri group had a lower odds ratio (OR) for hospice or in-hospital mortality (OR 0.27, 95% CI 0.12–0.61, p = 0.0016), as well as significantly lower odds of delirium, measured by a positive CAM (OR 0.29, 95% CI 0.11–0.73, p = 0.0086). ICU admission was lower in the geri group, although not statistically significant (18 vs 25, p = 0.0690). Overall hospital length of stay was longer in the geri group (8.2 ± 15.4 vs. 6.2 ± 5.6 days, p = 0.0350). Geri patients were less likely to be discharged home (OR 0.51, 95% CI 0.33–0.77) but were more likely to be discharged to a skilled nursing facility (OR 2.25, 95% CI 1.43–3.53) or inpatient rehabilitation facility (OR 8.52, 95% CI 1.04–69.6). Conclusion: Geriatric co-management in surgical oncology significantly reduced mortality and delirium as measured by CAM among OA, demonstrating meaningful improvements in patient outcomes. Although LOS increased and home discharges decreased, these results may indicate more appropriate discharge planning for this patient population. Geriatric co-management represents a critical, evidence-based component of surgical oncology care for OA. This study adds to the growing evidence supporting the role of Geriatric Medicine in improving the quality of care for OA.