Establishing a Perioperative care of Older People undergoing Surgery (POPS) clinic in elective general surgery
Cardiff and Vale University Health Board
Increasing numbers of older patients are undergoing surgery as a result of population ageing and advances in surgical and anaesthetic techniques. Older patients living with frailty are at higher risk of adverse perioperative outcomes, which is particularly true after the pandemic, as many have deconditioned whilst awaiting planned surgery. There is a growing body of evidence that this patient group benefit from a Comprehensive Geriatric Assessment (CGA) - a holistic assessment that considers physical health, psychological health, functional status and social circumstances, to inform an individualised treatment plan.
A Perioperative care of Older People undergoing Surgery (POPS) service was already in place in Cardiff and Vale University Health Board, with the capacity to provide CGA in emergency general surgery only. The team wanted to provide parity to elective surgery patients, and began looking for external funding opportunities to launch a pilot elective POPS service.
A frailty pathway was developed stating referral criteria and mode of referral. This included collaboration with NHS colleagues and third sector (Care and Repair - to enable home adaptations preoperatively). Assessment proformas, letter templates and a patient database were created to ensure standardisation of assessment, documentation and data capture. Training on frailty assessment and screening was delivered to Pre-Operative Assessment Clinic (POAC) nursing staff through small group tutorials and signposting to online resources.
Frailty screening is now part of the standardised POAC assessment for all patients age 65 or over, and CGA delivery is offered to patients living with frailty who are undergoing a general surgery procedure. As the project progressed there was capacity to expand to other surgical specialties. Shared Decision Making (SDM) compliance has improved from 12% to 94%, with 16% of patients choosing not to proceed with surgery as a result of SDM discussions with the POPS team - releasing opportunity costs, whilst also releasing spaces on the waiting list for those proceeding with surgery.
