Geriatric Surgery Verification program reduces rates of death after surgery

Implementing the American College of Surgeons (ACS) Geriatric Surgery Verification (GSV) program can reduce rates of death after surgery and increase the percentage of patients with documentation standards, such as advanced care directives, according to two studies being presented at the ACS Clinical Congress 2024 in San Francisco, California. 

Researchers found that by implementing the GSV program at their hospital, they reduced death rates after surgery by half and nearly tripled the percentage of patients who met standards for documenting care preferences. The GSV program includes quality measures for surgery departments in hospitals and health care systems to improve surgical outcomes for patients 75 years and older. 

Cleveland Clinic Akron General Hospital in Akron, Ohio, is one of 10 hospitals nationwide that have met the GSV criteria established by the ACS. The program includes 32 evidence-based standards that prioritize reducing the risk of delirium and providing patient-centered care as well as addressing other challenges unique to the 75-and-older population. The program also enables hospitals to reduce costs and improve efficiencies. 

Researchers at Akron General conducted two studies of outcomes after implementing GSV: one evaluating patient death rates after surgery from July 2021 to January 2024; the other looking at advanced planning and documentation of surgery patients -; known as code status documentation -; before and after GSV implementation. 

In the year before GSV implementation, the death rate of patients aged 75 years and older within 30 days of surgery was 10.2% at Akron General. After implementation, that rate dropped to 5.7%. Hospital readmission rates after surgery were not significantly different between the pre- and post-GSV periods: 15.6% and 14.3%, respectively. 

What's really exciting is that we're one of the first hospitals to show that we're significantly improving patient outcomes by implementing ACS GSV standards. We know we're having more important care conversations. We know that our hospital rooms better accommodate the diverse needs of all patients, including those with vision impairments or mobility challenges. We know that we have a strong team of professionals specializing in care for older patients, including palliative care. We know that we're well equipped. Now we're seeing that's improving outcomes." 

Ileana Horattas, MD, lead author, ACS Associate Fellow and surgeon at Akron General

The second study found that only 26.6% of general surgery patients over 75 years had code status documentation before GSV implementation. After implementation, with the addition of patient education and the introduction of an electronic medical record template, that portion jumped to 39.6%. After multidisciplinary efforts to improve care for geriatric patients were introduced, that increased to 74.2%. 

Blake Westling, DO, MBA, ACS Resident Member and lead author of the code status documentation study, explained that the surgery team had "exhaustive discussions" with patients before surgery to determine their goals for surgery and their wishes if they had a less-than-optimal outcome. 

"We had discussions with them about what they would want if their heart were to stop, or if they needed prolonged intubation, or if they would want and accept dialysis," Dr. Westling said. 

"I think putting it back in the patient's own words helps drive where the next steps are in patient care," he said. "We always hope surgery happens with no complications, but when there is a difficulty, having the next goal or direction is really important." 

Co-authors of the mortality study are Blake Westling, DO, MBA; Kelly Bahr, RN; Christin Boozer, APP; Adina Brett-Morris, PhD; and Mark C. Horattas, MD, FACS. 

Co-authors of the code status documentation study are Ileana Horattas, MD; Christin Boozer, APP; Kelly Bahr, RN; Adina Brett-Morris, PhD; and Mark C. Horattas, MD, FACS.