Three years of NSQIP Pilot Data What We Learned. Julia R. Berian, MD, MS

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1 Three years of NSQIP Pilot Data What We Learned Julia R. Berian, MD, MS

2 Developing a Geriatric Surgery Program at Your Hospital Three years of NSQIP Pilot Data (4:30 4:40 PM) Building a Standards and Verification Program for Older Adults (4:40 4:50 PM) Marcia McGory Russell, MD FACS Standards Already in Practice: Q&A Sinai Center for Geriatric Surgery (4:50 5:00 PM) JoAnn Coleman, DNP, ANP, ACNP, AOCN UCSF Center for Surgery in Older Adults (5:00 5:10 PM) Victoria Tang, MD, MAS Duke and Durham VA POSH Clinic (5:10 5:20 PM) Mitch Heflin, MD MHS

3 Disclosures James C. Thompson Geriatric Surgery Fellow, position supported by the John A. Hartford Foundation & American College of Surgeons

4 What data are necessary provide optimal surgical care for older adults?

5 The absence of morbidity or mortality is not necessarily a successful outcome

6 Geriatric Surgery Pilot Project Geriatric-specific variables BOTH risk-factors and outcomes:» Cognition» Goals & Decision-Making» Function» Mobility Launch = January 2014 Surgical patients age 65+ years

7 Objectives Do geriatric-specific risk factors (cognition, decision-making, function, mobility) contribute to risk-adjustment for traditional morbidity and mortality outcomes? Can we collect and model geriatric-specific patient-centered outcomes for quality improvement purposes? postoperative delirium new mobility aid use functional decline pressure ulcers

8 NSQIP Geriatric Pilot Participating Hospitals

9 Cases Recorded by the NSQIP Geriatric Pilot Jan 2014-June 2014 July 2014-Dec 2014 Jan 2015-June 2015 July 2015-Dec 2015 Jan 2016-June 2016

10 Majority of Cases = Orthopedic and General Surgery 0.6% 2.9% 4.0% 2.6% 5.5% 9.6% 28.3% 46.4% Cardiothoracic surgery Orthopedic surgery General surgery Vascular surgery Neurosurgery Plastics & Otolaryngology Urology Gynecology

11 Function Mobility Cognition Healthcare Goals

12 Function Mobility Cognition Healthcare Goals PRE-OPERATIVE RISK FACTOR Origin from home with support lives alone at home / at home with support / not from home POST-OPERATIVE OUTCOMES Discharge functional health status Independent / partially dependent / dependent Discharge with / without services home alone with self care / with skilled care home with support & self care / with support & skilled care 30 DAY POST-OPERATIVE Discharge functional health status Independent / partially dependent / dependent

13 Function Mobility Cognition Healthcare Goals PRE-OPERATIVE RISK FACTORS Pre-op use of mobility aid Pre-op history of prior falls POST-OPERATIVE OUTCOMES Postoperative pressure ulcer Fall risk on discharge New mobility aid on discharge 30 DAY POST-OPERATIVE Physical function compared to baseline Diminished / similar / improved

14 Function Mobility Cognition PRE-OPERATIVE RISK FACTORS History of dementia or cognitive impairment yes / no Competency status on admission consent signed by patient / by surrogate POST-OPERATIVE OUTCOME Postoperative delirium yes / no Healthcare Goals

15 Function Mobility Cognition Healthcare Goals PRE-OPERATIVE RISK FACTORS Hospice care on admission DNR order in place on admission POST-OPERATIVE OUTCOMES DNR order during hospitalization Setting Where DNR order placed Postop palliative care consult Living location 30 DAY POST-OPERATIVE

16 Geriatric-specific risk factors contribute significantly to modelling traditional morbidity and mortality outcomes

17 Geriatric-Specific Outcomes Postoperative Delirium Functional Decline New Mobility Aid

18 What We Learned Geriatric-specific risk factors (cognition, decision-making, function, mobility) DO contribute to risk-adjustment for traditional morbidity and mortality outcomes We CAN collect and model geriatric-specific patientcentered outcomes for quality improvement purposes: postoperative delirium new mobility aid use functional decline pressure ulcers

19 Next Steps Further validation of pilot data Exploration of process metrics Incorporation of geriatric-specific data into a comprehensive quality program

20 Resources #1 #2 #3

21 Thank You