Preop elderly assessment tool identifies postop complication risks

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?