Systematic review and meta-analysis of impact of ‘Vascular Geriatrics’ interventions on short-term outcomes for vascular surgery inpatients
Megan Power Foley, Conor Young, Michelle Canavan, Stewart R WalshAbstract
Introduction
Vascular surgeons are treating more older, frail and multimorbid patients. Integrated care models including both surgeons and geriatricians have improved peri-operative outcomes in orthopaedics. This meta-analysis investigated the impact of ‘Vascular Geriatrics’ services on short-term outcomes for vascular surgery inpatients.
Methods
PubMed, Scopus, Embase and recent conference abstracts were searched for studies of all methodologies comparing outcomes before and after the introduction of ‘Vascular Geriatrics’ service. Risk of bias was assessed using Methodological Index for Non-Randomised Studies criteria for non-randomised studies and Risk of Bias Tool (Version Two) tool for randomised. Certainty of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluations analysis. Meta-analyses compared the relative risks of inpatient mortality, complications, discharge to home and 30-day readmission using a random-effects model. Length of stay (LOS) in days was compared using mean difference.
Results
Eight studies with 2441 patients were included. Models included outpatient pre-operative comprehensive geriatric assessment, inpatient geriatric liaison service and geriatrician-surgeon co-management. ‘Vascular Geriatrics’ was associated with a lower risk of inpatient mortality (RR 0.65, 95% CI 0.46–0.9, P = .010), cardiac complications (RR 0.35, 95% CI 0.19–0.62, P < .001) and infective complications (RR 0.48, 95% CI 0.38–0.63, P < .001). Delirium risk was reduced but not significantly (RR 0.58, 95% CI 0.25–1.34, P = .20). There was no association in LOS (P = .37), discharge to home (P = .55) or 30-day readmission risk (P = .64).
Conclusions
Though study quality was poor, formalised geriatric involvement was associated with a decreased risk of adverse peri-operative outcomes in vascular patients compared to traditional care models. Further studies are needed to investigate the most effective design of geriatrician–surgeon partnership.