A study reveals that older adults who develop conditions such as delirium, dehydration or experience falls after major surgery are at higher risk of poor outcomes and death.
Older adults who develop a new geriatric syndrome, such as dehydration, delirium or malnutrition, after major surgery face a dramatically higher risk of poor outcomes, including more complications, fewer days spent at home, and a significantly increased likelihood of dying within a year.
This is according to findings published in the Journal of the American College of Surgeons (JACS).
Researchers analysed Medicare claims data from 2016 to 2021 of patients over 66 who underwent one of five major operations: coronary artery bypass grafting, pneumonectomy, abdominal aortic aneurysm repair, pancreatectomy, or colectomy.
The study focused only on new-onset cases, excluding patients with a prior history of geriatric syndromes.
It found that 10.9% of patients developed at least one new geriatric syndrome during their hospital stay.
These syndromes include delirium (sudden confusion or disorientation), dehydration, malnutrition, falls or loss of control over their bladder or bowels.
Patients who developed one of these conditions were much less likely to be discharged directly home and spent a median of 16.5 fewer days at home in the 90 days following surgery.
Senior author Timothy M Pawlik, surgical oncologist at The Ohio State University Wexner Medical Centre, said: ‘A geriatric syndrome can be a “canary in the coal mine”, signalling a patient’s underlying vulnerability. It’s crucial we don’t dismiss these events as just a normal part of getting older. These are important warning signs that a patient needs closer monitoring and tailored support, both in the hospital and after discharge.’
Patients who developed a geriatric syndrome had a 27% reduction in days at home within 90 days of discharge.
For those who also had a postoperative complication, the median days at home decreased to just 15 days.
The development of any geriatric syndrome was associated with a 132% higher risk of death within one year. Having two or more syndromes led to a 272% higher risk of death in that time frame.
The increased mortality risk held strong even among patients who did not experience major postoperative complications, with a 54% higher risk of death.
Dehydration was the most frequently occurring syndrome (66.7% of affected patients), followed by delirium (25.2%) and malnutrition (13.2%).
The study also identified factors associated with a higher risk of developing a geriatric syndrome, including older age, a higher burden of other health conditions, and undergoing emergency surgery. Having a minimally invasive procedure was associated with a 49% lower risk of developing a geriatric syndrome, according to the authors.
The researchers suggest the findings highlight the critical need for a specialised, systematic approach to the surgical care of older adults through programmes, such as the American College of Surgeons (ACS) Geriatric Surgery Verification (GSV) programme.
This provides hospitals with a set of evidence-based standards designed to optimise surgical care for older adults.
These standards emphasise proactive patient assessment, delirium prevention and management, and patient-centred goal setting to improve outcomes and preserve patients’ independence and quality of life after surgery.
Dr Pawlik said: ‘This research provides powerful evidence for why programs like GSV are so essential. By focusing on the unique needs of older patients, we can better anticipate, prevent, and manage these syndromes, which directly translates to helping patients get back home and back to their lives.’
