Developing Quality Indicators for Elderly Surgical Patients

TLDR

The aging population is increasing the demand for surgical care, highlighting the need to improve perioperative quality for elderly patients, many of whom require processes not routinely performed in younger populations. The study aimed to develop process‑based quality indicators applicable across surgical disciplines to enhance perioperative care and outcomes for elderly patients. Using structured interviews, systematic reviews, and a RAND/UCLA panel, 96 candidate indicators were evaluated, with 91 deemed valid. The 91 valid indicators were grouped into eight domains—comorbidity assessment, elderly issues, medication use, patient‑provider discussions, intraoperative care, postoperative management, discharge planning, and ambulatory surgery—while 71 addressed processes uncommon in younger patients.

Abstract

To develop process-based quality indicators to improve perioperative care for elderly surgical patients.The population is aging and expanding, and physicians must continue to optimize elderly surgical care to meet the anticipated increase in surgical services. We sought to develop process-based quality indicators applicable to virtually all disciplines of surgery to identify necessary and meaningful ways to improve surgical care and outcomes in the elderly.We identified candidate perioperative quality indicators for elderly patients undergoing ambulatory, or major elective or nonelective inpatient surgery through structured interviews with thought leaders and systematic reviews of the literature. An expert panel of physicians in surgery, geriatrics, anesthesia, critical care, internal, and rehabilitation medicine formally rated the indicators using a modification of the RAND/UCLA Appropriateness Methodology.Ninety-one of 96 candidate indicators were rated as valid. They were categorized into 8 domains: comorbidity assessment, elderly issues, medication use, patient-provider discussions, intraoperative care, postoperative management, discharge planning, and ambulatory surgery. Of note, 71 (78%) of the indicators rated as valid address processes of care not routinely performed in younger surgical populations.Attention to the quality of care in elderly patients is of great importance due to the increasing numbers of elderly undergoing surgery. This project used a validated methodology to identify and rate process measures to achieve high quality perioperative care for elderly surgical patients.