Results of implementing an Integrated Care Area for frail patients requiring surgery. 413 patients: short and long-term postoperative morbidity and quality of life.
TL;DR
The establishment of an Integrated Care Area for frail patients requiring surgery facilitates decision-making and reduces postoperative morbidity with acceptable quality of life.
Abstract
INTRODUCTION The objective was to analyse the functioning and short and long-term outcomes of an Integrated Care Area for frail patients requiring surgery.
Methods
Observational, descriptive study with prospective data collection. From December 2016 to January 2025, 413 frail patients were included in an Integrated Care Area for the Complex Surgical Patient (AAPQC for its initials in Spanish). Age, sex, referring service, ASA, frailty index (VGI-Frail and Clinical Frailty scale), Barthel, Pfeiffer, Complex Chronic Patient (PCC), and Advanced Chronic care Model (MACA) were analysed. Operated and non-operated patients were compared. Complications (Clavien-Dindo), mean length of stay, 30-day mortality, readmissions, and quality of life at 3 months and one year were evaluated.
Results
413 patients, mean age 80 years, 251 men (60.8%). 91.8% were ASA III-IV, 259 (53%) PCC and 61 (14.7%) MACA. 298 (77.6%) came from general surgery. 7,3% lived in care facilities. 125 (30.3%) were recommended not to undergo surgery. Age, ASA, PCC, MACA, VGI-frail, Clinical Frailty Score, Barthel and Pfeiffer were significantly (P < 0.0001) better in those operated. Postoperative complications (Clavien-Dindo III-IV-V), readmissions and mortality were 9.7%, 13.2% and 3.1% respectively. 10% required convalescence resources at discharge. 82.5% of operated patients were better or the same as before surgery at three months and one year. Of those not operated (n = 125), 48.3% died during the first year.
Conclusions
The establishment of an Integrated Care Area for frail patients requiring surgery facilitates decision-making and reduces postoperative morbidity with acceptable quality of life.