The Impact of Elder-friendly Care on Infection and Delirium following Acute Care Surgery

Author(s):
Shelly Jun; Jayna Holroyd-Leduc; Diana Rucker; Rachel Khadaroo

Background:

Post-operative infections are common and universally expensive complications in surgical patients. Older adults, in particular, are especially vulnerable to postoperative complications, and may be at a higher risk for developing subsequent neurological complications due to infection. The aim of this analysis was to: (1) examine the association between postoperative infection and delirium among older patients recovering from emergency abdominal surgery; and (2) explore the impact of Elder-friendly Approaches to the Surgical Environment (EASE) interventions on postoperative infection and delirium complications.

Hypothesis:

We hypothesize that elder-friendly interventions will decrease post-operative infectious complications and delirium in older patients having emergency surgery.

Methods:

We conducted a prospective before-and-after study at a tertiary care hospital. Older patients, ≥ 65 years old, who preoperatively required assistance with less than 3 activities of daily living and were admitted for acute care surgery were eligible. We excluded patients who were transferred from other medical services, underwent elective or trauma surgery cases. In this analysis, we report on patients who received: (i) standard care; or (ii) EASE interventions.  Surgical complications were determined using the Clavian-Dindo Classification. Associations were explored with the Chi-square test (two-sided; p< 0.05).  All analyses were performed using STATA 14.0.

Results:

A total of 293 patients (mean age=75.6 years, 49% female; n=153 control) were recruited at the EASE intervention site. Postoperatively, 9.2% of these patients developed a surgical-site infection (SSI) and 19.5% delirium. There was an association, nearing statistical significance, between SSI and delirium complications (OR 1.9; 95% CI 0.90-3.9, p=0.06). Moreover, the EASE intervention, which was a multi-faceted quality improvement initiative that integrated a geriatrician to the surgical team and early mobilization practices, was significantly associated with a decrease in organ/space surgical site infection (p=0.04) and delirium (p=0.006).

Conclusions:

Older patients having acute care surgery are highly vulnerable to postoperative complications, and subsequent functional decline or death. Post-operative infections in particular pose a serious threat to older patients who may develop major neurological sequela, such as delirium. Targeted elder-friendly approaches to recovery may reduce postoperative complications among older patients and mitigate its downstream effects.