Surgical Care for Geriatric Patients

After being piloted at eight hospitals throughout the country, The American College of Surgeons has finalized plans for the Geriatric Surgery Verification Program. The program (GSV) will go into effect in October 2019, at participating hospitals.

Similar to programs that already are in place for trauma, cancer, and pediatric surgery, the goal is to “continuously optimize surgical care for older adults.” The 30 standards outlined in this program attempt to address some of the concerns in patient care and safety that have surfaced in surgical care for elderly patients.

The Numbers

A Growing Population

The need for this program is well-documented in terms of population.

• There is a large and growing number of patients who are 65 and older and therefore considered “geriatric” patients. It is estimated that by 2050, people in this age category will represent 21% of the population.

• Currently, 40% of inpatient surgeries and 33% of outpatient surgeries are performed on geriatric patients.

Troubling Medical Results for this Subset of Patients

Meanwhile, research indicates that while geriatric patients make up a large percentage of the patients undergoing surgery, they don’t necessarily fare well. We know these patients tend to have more complicated health issues. Mortality and complications increase with age, hospital stays lengthen, and there is an increased tendency to need nursing home care after surgery. It is time to look at how these patients are cared for and change the way medical care is delivered, so that it is more compassionate, safer, and tailored to the specific needs of geriatric patients.

The Program

Safety Procedures to Help Geriatric Patients

The program is far-reaching, touching on everything from “geriatric friendly” patient rooms to proper staffing and improved management of medication. These nuts and bolts are essential to a patient’s health, wellbeing, and overall safety.

Screening

Dr. Ronnie Rosenthal, surgeon and geriatrician at Yale School of Medicine, and Dr. Clifford Ko, a colorectal surgeon at the University of California, Los Angeles, are the co-leaders of the American College of Surgeons’ Coalition for Quality in Geriatric Surgery.

According to Dr. Rosenthal, as stated in a New York Times article, “‘People understand that children are different from adults. It’s taken a surprisingly long time to come around to the realization that older adults are also different.’”

One main way that geriatric patients are different is that they are more “vulnerable,” meaning that they may have other factors that put them at higher risk when it comes to surgery. Advanced age, cognitive problems, malnutrition, and mobility issues can each have an impact on the outcome of surgery. Now, we at The Eisen Law Firm would point out that it is precisely because of these increased risk factors that doctors must tailor their approach when it comes to recommending or performing surgery on elderly patients. No one should just accept as fact that bad outcomes are necessarily more likely in elderly people, and then plow ahead with the typical approach to surgery that is used for younger adult patients.

In a hospital enrolled in the GSV, doctors would be aware of and consider problems unique to geriatric patients and consult with patients about how to best prepare for their procedures. Doing so might include prescribing a certain diet or exercise regime that would reduce risk and make post-operative recovery easier on the patient. And sometimes, the best approach is to not perform surgery at all.

Communication for the Safety of Patients

A very important part of the care of geriatric patients is the way doctors communicate with them. Certainly, surgery may be an option, but health care professionals need to help geriatric patients have a clearer understanding of the procedure, as well as the anticipated course of recovery. Often, potential clients of The Eisen Law Firm tell us that if they had really understood what they were signing up for, including everything they would go through during recovery, they would have opted not to proceed with a particular surgery. Too often, surgeons are focused on describing the procedure itself and not on what the patient will have to go through even after a “successful” surgery.

The GSV calls for putting the outcomes that matter most to the patients at the center of the discussion of the surgical experience. Someone who is advanced in years may have different goals in mind when it comes to having surgery as compared to someone younger. At this point, there needs to be a discussion that identifies what the particular patient values. 

For a surgeon, a successful surgery may mean that surgery solves the immediate problem but an extended stay in intensive care or additional requirements such as dialysis or a colostomy bag are a routine part of the process. However, a geriatric patient may be much more protective of the quality of their life. Perhaps palliative approach would be a better fit for a specific patient. Without a real discussion of goals, a surgeon should not be making recommendations about whether to undertake a particular procedure for a particular patient.

Takeaways for Improving Patient Safety

The Geriatric Surgical Verification Program has the potential to be a game changer in patient care by considering the needs of this specific population and by putting patient wellbeing at the center of the conversation. The approach needs to be patient-centric, not doctor-centric.

Elderly patients who are considering surgery will most certainly want to consider whether their hospital is participating in this program.

The problem is that this program is not yet mandated. In fact, hospitals get to choose whether or not they want to enroll in the program. Quite simply, there will be hospitals that don’t see the need for this type of program. They think (often mistakenly) that their doctors already voluntarily pay attention to the different needs of geriatric patients. Hopefully, insurers will scrutinize the rate at which hospitals are meeting the quality standards set out in the GSV.

In the meantime, if you or someone you love is concerned about the surgical communication and care they received, the Eisen Law Firm can help. Call our experienced Cleveland malpractice lawyers to discuss your options for legal recourse and for obtaining the compensation you deserve. To schedule your free consultation, call 216-287-0900 or contact us online today.