August 4, 2017

Preop elderly assessment tool identifies postop complication risks

By: Judy Mathias
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Editor’s Note

Screening elderly patients preoperatively using the Vulnerable Elders Surgical Pathways and Outcomes Assessment (VESPA) tool helped identify patients at higher risk of postoperative complications in this study.

A total of 736 patients 70 years of age or older were assessed in a preoperative clinic from July 9, 2008, to January 5, 2011, using the VESPA tool.

Patients were assessed on:

  • five activities of daily living (bathing, transferring, dressing, shopping, and meals)
  • history of falling or gait impairment
  • depressive symptoms (two-item Patient Health Questionnaire)
  • cognition (Mini-Cog)
  • gait and balance (Timed Up and Go test)
  • whether they thought they could manage themselves alone after discharge
  • comorbidities
  • work-related relative value units (low, moderate, and high tertiles).

On multivariate analysis, the number of difficulties with activities of daily living, anticipated difficulty with postoperative self-care, Charlson Comorbidity score of 2 or more, male gender, and work-related relative value units were independently associated with postoperative complications.

The VESPA tool was administered by physician assistants in a preoperative surgery clinic at the University of Michigan Health System.

Question Can a short, functional, geriatric assessment scale (<10 minutes) administered by surgical nonphysician staff estimate risk of postsurgical complications, including traditional postoperative occurrences and novel geriatric outcomes, such as delirium and falls?

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