A new program at the University of Colorado Anschutz Department of Surgery is helping older adults, particularly frail older adults, have better outcomes after major operations.
“We're trying to optimize the care of older adults undergoing major operations,” says Thomas Robinson, MD, medical director of CU’s Aging Surgical Wellness Program. “If patients have physical impairments or problems with function or mobility, our program trains vulnerable patients to improve their activity before surgery. If a patient has malnutrition, the program supplements their nutrition. The analogy we always use is that if you're going to go run the Bolder Boulder, you don’t just show up at the race; you actually train to do the race. Similarly, if you're going to show up for a major operation knowing you are at risk of having poor outcomes, you train to survive that surgery.”
A major element of the multimodal prehabilitation program is presurgical physical therapy to train people on basic activities like sitting and standing after surgery. Sessions take place in person or virtually.
“Sometimes it's hard for these patients to get back and forth to the hospital, so twice a week we have a virtual class where patients can get online and train with our physical therapy team,” Robinson says. “We also have on-demand videos that demonstrate various exercises to do. We're training patients how to transfer and stand up out of bed, skills aimed to help maintain their independence.”
The physical preconditioning is scheduled for the “sweet spot” six to eight weeks before the operation, Robinson says, though the timing changes based on the type of surgery the patient is scheduled to receive.
Another element of the geriatric surgery protocol aims to prevent deconditioning — whole-body physical and mental decline caused by prolonged inactivity, bed rest, or lack of movement — by getting patients up and moving within 12 hours after their operation.
“Delirium, or confusion, is the most common postoperative complication in older adults,” Robinson says. “We have protocols in place to prevent delirium by orienting the patient and guiding good medication choices. The delirium prevention pathway provides multimodal strategy to avoid the occurrence of delirium.”
For many older adults, preparing for a major surgery bring up fears around a long recovery or even death. The geriatric protocol helps to address these concerns.
“Often for these patients, they get scheduled for a major operation, they have a 10% chance of dying, so they're sitting at home, they can't sleep at night because they know this big event is coming up,” Robinson says. “We have an hourlong appointment, run by our social work team, that patients can go to to help manage their anxiety and help them anticipate what it's going to be like to recover from surgery. That’s one of the pillars of our multimodal prehabilitation program.”
Robinson says the philosophy of the CU Anschutz Department of Surgery is to tailor care to each patient individually, based on their needs. The geriatric surgery program is helping that happen for frailer older adults.
“We were one of the programs that realized several years ago that geriatric surgery patients, especially those who are frail, need special care before and after surgery,” he says. “This program is making a real difference when it comes to the recovery and survival of the older patients that we treat.”