The UT Southwestern Perioperative Optimization of Senior Health Program: Impact on Postoperative Delirium After Spine Surgery

dc.contributor.advisorBagley, Carlosen
dc.contributor.committeeMemberAoun, Salahen
dc.contributor.committeeMemberAdogwa, Owoichoen
dc.creatorPernik, Mark Nicholasen
dc.creator.orcid0000-0002-7568-7308 2022
dc.descriptionThe general metadata -- e.g., title, author, abstract, subject headings, etc. -- is publicly available, but access to the submitted files is restricted to UT Southwestern campus access and/or authorized UT Southwestern users.en
dc.descriptionPlease note that the following thesis includes data, direct excerpts, and adapted excerpts from the peer-reviewed manuscript entitled "Perioperative Optimization of Senior Health in Spine Surgery: Impact on Postoperative Delirium" published by The Journal of the American Geriatrics Society. The content of the thesis herein is not peer-reviewed and does not necessarily reflect the content or opinions presented by the authors of Pernik et al. (2021) nor the American Geriatrics Society. The full citation of the article is included below and should be referenced in lieu of the present thesis.en
dc.description.abstractBACKGROUND: Delirium is a common complication in geriatric patients who often have multiple underlying risk factors after surgery or hospitalizations. Delirium is most effectively prevented prophylactically, as treatment of delirium may not shorten the duration or severity of delirium. Several investigations of pharmacological prophylaxis have shown minimal effect, whereas many non-pharmacological interventions have been shown to reduce the incidence of delirium. Multicomponent nonpharmacologic interventions can be effective in preventing delirium; however, implementation of preventative measures and programs are variable in perioperative care. OBJECTIVE: The aim of our study was to assess whether the Perioperative Optimization of Senior Health Program (POSH) reduced the incidence of postoperative delirium in geriatric patients undergoing elective spine surgery. METHODS: The POSH program is an interdisciplinary perioperative program involving geriatrics, surgery, and anesthesia. Preoperatively, patients enrolled in POSH (n=147) were referred for a geriatric assessment and optimization for surgery. Intraoperatively, patients underwent an individualized geriatric anesthesia protocol. Patients were co-managed postoperatively by the primary surgical team and the geriatrics consult service. POSH patients were retrospectively compared to a matched historical control group (n=177) treated with standard care. Outcomes included post-operative delirium, provider recognition of delirium, ICU and hospital LOS, initiation of walking postoperatively, and readmission. RESULTS: Patients enrolled in the POSH program were significantly older (75.5 vs. 71.5 years; p<0.001), had more comorbidities (8.0 vs. 6.6; p<0.001), and were more likely to undergo pelvic fixation (36.1% vs. 17.5%; p<0.001). The incidence of postoperative delirium was lower in POSH group compared to historical controls, although not statistically significant (11.6% vs. 19.2%; p=0.065). Delirium was significantly lower in patients who underwent complex spine surgery (≥4 levels of vertebral fusion; N=106) in the POSH group (11.7% vs. 28.9%, p=0.03). There was a 3-fold increase in the recognition of postoperative delirium by providers after program implementation, (76.5% vs. 23.5%; p=0.001). CONCLUSION: Interdisciplinary care for high-risk geriatric patients undergoing elective spine surgery may reduce the incidence of postoperative delirium and increase provider recognition of delirium. The benefit may be greater for those undergoing larger procedures.en
dc.identifier.citationPernik, M. N., Deme, P. R., Nguyen, M. L., Aoun, S. G., Adogwa, O., Hall, K., Stewart, N. A., Dosselman, L. J., El Tecle, N. E., McDonald, S. R., Bagley, C. A., & Wingfield, S. A. (2021). Perioperative optimization of senior health in spine surgery: impact on postoperative delirium. J Am Geriatr Soc, 69(5), 1240-1248.
dc.subjectElective Surgical Proceduresen
dc.subjectPerioperative Careen
dc.subjectPostoperative Cognitive Complicationsen
dc.titleThe UT Southwestern Perioperative Optimization of Senior Health Program: Impact on Postoperative Delirium After Spine Surgeryen
local.embargo.terms2024-06-01 Southwestern Medical Schoolen Southwestern Medical Centeren with Distinctionen