Establishment of a Perioperative Geriatric Medicine Service in an Acute Surgical Unit—Older Adult Surgical Inpatient Service ( OASIS )

OBJECTIVES: The objectives of this study were to outline the establishment and operationalisation of the Older Adult Surgical Inpatient Service (OASIS), a proactive, perioperative geriatric medicine in-reach service in a tertiary Acute Surgical Unit (ASU) and to describe the demographics, surgical diagnoses and management, and comprehensive geriatric assessment (CGA)-based interventions of OASIS patients. METHODS: The Older Adult Surgical Inpatient Service (OASIS) was established in May 2021. Patients receiving OASIS input over 12 months were prospectively identified, and data were collected on baseline demographics, Clinical Frailty Scale (CFS), medical comorbidities, surgical diagnoses and initial CGA-based interventions. Surgical management was retrospectively cross-checked using digital medical records. RESULTS: The Older Adult Surgical Inpatient Service (OASIS) was established by integrating a 0.5 FTE geriatrician in a tertiary hospital ASU. Older adults were identified for review at ASU handover. The Older Adult Surgical Inpatient Service (OASIS) conducted CGA-based interventions on weekday ward rounds, supported by an ASU junior doctor. The geriatrician led the daily multidisciplinary team meeting. The Older Adult Surgical Inpatient Service (OASIS) reviewed 836 patients (median age = 78.5 years). Prior to admission, 91% (n = 761) were community dwelling, 59% (n = 497) walked unaided and 60% (n = 505) were vulnerable or frail (CFS ≥ 4). Predominant surgical diagnoses were bowel obstruction 20% (n = 177), lower gastrointestinal bleeding 19% (n = 171) and acute biliary disease 18% (n = 162). Surgical management was operative in 26% (n = 215), non-operative procedural in 20% (n = 175) and conservative in 53% (n = 446). There was a correlation between operative management decreasing as age and frailty increased. CGA-based interventions on initial review included medication changes, goals of care discussions, anticoagulation management and perioperative risk assessment. CONCLUSIONS: It is feasible to initiate a geriatric medicine in-reach service in a tertiary hospital ASU by integrating a 0.5 FTE geriatrician into existing resources. A multi-domain description of demographics, frailty, surgical diagnosis and management of older adults with acute surgical pathology is provided.