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Hospital Standards to Promote Optimal Surgical Care of the Older Adult: A Report From the Coalition for Quality in Geriatric Surgery

Berian, Julia, R., MD, MS*,†; Rosenthal, Ronnie, A., MS, MD, FACS; Baker, Tracey, L., BS*; Coleman, JoAnn, DNP, ANP, ACNP, AOCN§; Finlayson, Emily, MD, MS, FACS; Katlic, Mark, R., MD, MMM, FACS§; Lagoo-Deenadayalan, Sandhya, A., MD, PhD, FACS||; Tang, Victoria, L., MD, MAS**; Robinson, Thomas, N., MD, MS, FACS††; Ko, Clifford, Y., MD, MS, MSHS, FACS, FASCRS*,‡‡; Russell, Marcia, M., MD, FACS‡‡

doi: 10.1097/SLA.0000000000002185

Objective: The aim of this study was to establish high-quality, valid standards to improve surgical care of the older adult.

Background: The aging population increases demand for high-quality surgical care. Building upon prior guidelines, quality indicators, and pilot projects, the Coalition for Quality in Geriatric Surgery (CQGS) includes 58 diverse stakeholder organizations committed to improving geriatric surgery.

Methods: Using a modified RAND-UCLA Appropriateness Methodology, 44 of 58 CQGS Stakeholders twice rated validity (primary outcome) and feasibility for 308 standards, ranging from goals and decision-making, pre-operative assessment and optimization, perioperative and postoperative care, to transitions of care beyond the acute care hospital.

Results: Three hundred six of 308 (99%) standards were rated as valid to improve quality of geriatric surgery. There were 4 sections. Section 1 included 157 (57%) standards and focused on goals and decision-making, preoperative optimization, and transitions into and out of the hospital. Section 2 included 84 (27.3%) standards focused on in-hospital care, across the immediate preoperative, intraoperative, and postoperative phases. Section 3 included 59 (19.1%) standards about program management, including personnel and committee structure, credentialing, and education. Section 4 included 8 (2.6%) standards establishing overarching concepts for data collection and patient follow-up. Two hundred ninety of 308 standards (94.2%) were rated as feasible; 18 (5.8%) were rated as uncertain in feasibility.

Conclusions: CQGS Stakeholders rated the vast majority of standards of care as highly valid (99%) and feasible (94%) for improving the quality of surgical care provided to older adults. Future work will focus on a pilot phase to better understand and address challenges to implementation of the standards.

*American College of Surgeons, Division of Research and Optimal Patient Care, Chicago, IL

University of Chicago Medical Center, Department of Surgery, Chicago, IL

Yale University, Department of Surgery, New Haven, CT

§Sinai Hospital, Department of Surgery, Sinai Center for Geriatric Surgery, Baltimore, MD

University of California, San Francisco, Department of Surgery, San Francisco, CA

||Duke University, Department of Surgery, Durham, NC

**University of California, San Francisco, Department of Medicine, Division of Geriatrics, San Francisco, CA

††University of Colorado, Denver, Department of Surgery, Aurora, CO

‡‡University of California, Los Angeles, Department of Surgery, Los Angeles, CA.

Reprints: Marcia M. Russell, MD, FACS, University of California, Los Angeles, University of California, Los Angeles, Department of Surgery, 10833 Le Conte Ave. 72-227 CHS, Los Angeles, CA 90095. E-mail:

This project is funded by a grant from the John A. Harford Foundation, under the title “American College of Surgeons Geriatric Surgery Verification and Quality Improvement Program.”

The authors report no conflicts of interest.

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