Implementation of a Multispecialty Geriatric Surgery Pathway Reduces Inpatient Cost for Frail Patients : Annals of Surgery

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Implementation of a Multispecialty Geriatric Surgery Pathway Reduces Inpatient Cost for Frail Patients

Ehrlich, April L. MD*,†; Owodunni, Oluwafemi P. MD, MPH; Mostales, Joshua C. BS*; Efron, Jonthan MD‡,§; Hundt, John MHS, BBA‡,§; Magnuson, Tom MD; Gearhart, Susan L. MD

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Annals of Surgery 278(4):p e726-e732, October 2023. | DOI: 10.1097/SLA.0000000000005902



The objective of this study was to evaluate the effect of geriatric surgical pathway (GSP) implementation on inpatient cost of care.


Achieving high-value care for older patients is the goal of the American College of Surgeons Geriatric Verification Program (ACS-GSV). We have previously shown that implementation of our geriatric surgery pathway, which aligns with the ACS-GSV standards, resulted in a reduction in loss of independence and complications.


Patients ≥65 years who underwent an inpatient elective surgical procedure included in the American College of Surgeons National Quality Improvement Program (ACS NSQIP) registry from July 2016 through December 2017 were compared with those patients from February 2018 to December 2019 who were cared for on our GSP. An amalgamation of Clinformatics DataMart, the electronic health record, and the ACS NSQIP registry produced the analytical dataset. We compared mean total and direct costs of care for the entire cohort as well as through propensity matching of frail surgical patients to account for differences in clinical characteristics.


The total mean cost of health care services during hospitalization was significantly lower in the cohort on our GSP ($23,361±$1110) as compared with the precohort ($25,452±$1723), P<0.001. On propensity-matched analysis, cost savings was more evident in our frail geriatric surgery patients.


This study shows that high-value care can be achieved with the implementation of a GSP that aligns with the ACS-GSV program.

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