European Geriatric Medicine - Supplement 1 - Volume 6

S152

Poster presentations / European Geriatric Medicine 6S1 (2015) S32

–

S156

P-446

Goal setting for functional recovery and using fast track

principles after total knee replacement allows earlier discharge

home

G. van der Sluis

Nij Smellinghe hospital, Drachten, Netherlands

Background and Purpose:

Attitudes towards hospitalization are

often reinforcing passive coping strategies among patients. We

therefore implemented new concepts and care pathways at our

orthopedic surgery department to activate patients. The aim of our

study was to determine the effectiveness of these innovations on

inpatient recovery of activities (IROA) and length of hospital stay

(LOS) after total knee replacement (TKR).

Methods:

In this single-center, cohort study (n = 738, 73% female,

9.1 year) data were collected over a period spanning 5 years.

During this period we transitioned from a (1) joint care

pathway

(care organized in a timetable) to a (2) function tailored care

pathway (functional goal setting and promoting activity during

hospitalization), (3) pathway 2 combined with fast-track principles

(state of the art surgical and anesthiological procedures to minimize

surgical stress). Our primary outcome is IROA, measured by the

Modified Iowa Levels of Assistance Scale (MILAS). We compared the

three patient groups using one-way analysis of variance, adjusting

for preoperative predictors of recovery.

Results:

Transitioning from joint care

(n = 171), to function tailored

care (n = 360), to fast track (n = 207) resulted in a statistically

significant reduction of time to achieve IROA and LOS. Mean

(standard deviation) IROA was 4.3 (0.9), 3.5 (0.9), and 3.1 (1.0)

days respectively (p

0.01) and LOS was 5.0 (1.7), 4.1 (1.2), and 3.7

(1.3) days respectively (p

0.01).

Conclusion:

A tailored care pathway using functional goals and fast

track principles for patients undergoing TKR patients significantly

accelerated the IROA by 1.2 days and shortened LOS by 1.3 days.

P-447

Usefulness of pre-op screening checklist on fast-tracking hip

fracture surgery in a tertiary Hospital. Pilot in Singapore

S.D. Varman

, A. Huang Wan Wei

, K.S. Goh

, K.B. Poon

Changi General Hospital, Singapore, Singapore

Objectives:

Evidence based effective hip fracture programme can

optimise hip fracture management. Hence, a pilot was implemented

between July and November 2014, in our hospital, as a part of

Valuedcare hip-programme, adopted from Geisinger (USA). The

emphasis was to improve fast-track (FT) surgeries (

48 hrs) and

length of stay (LOS), on patients

65 yrs aided by a pre-op check-

list consisting common clinical parameters and lab investigations,

embedded within an Ortho-geriatric care bundle along other best

practice elements(BPE).

Method:

We performed a retrospective descriptive analysis of the

pilot data on outcomes whilst also measuring the influence of

check-list on FT surgeries.

Results:

Of 139 cases, 127 (80.5%)

65 yrs; 112 (88%) operated.

57 (50%) were FT; 40 (70%) check-list compliant. 55 (49%) operated

48 hrs; 32 (58%) check-list compliant.

There was significant improvement in fast-track surgeries compared

to baseline 19% (p

0.001). Mean LOS decreased from 13.0 to 9.0

days (p

0.001) in FT patients. The overall compliance for check-list

was 65% (p

0.0001). The odds of pre-op check list compliance in

improving the FT was (OR) 1.69 (95% CI 0.774 to 3.690), P = 0.187.

Conclusion:

We noted significant improvement in outcomes with

the pilot implementation, mandating sustainment, enhancement

and study of critical other outcomes including functions,

complications, readmissions and quality of life. Significant

compliance with check-list, may have guided the team in assessing

fitness and listing for surgery; however the usefulness of check-list

in FT surgery can be further evaluated in future study, designed

and powered for the same.

P-448

Baseline characteristics of older surgical persons admitted to a

tertiary hospital. Perioperative care of older people undergoing

surgery

–

Salford General Surgery (POPS-SG)

A. Vilches-Moraga

, J. Fox

, T. Thorpe

, K. Wardle

, M.K. Peeroo

E. Feilding

, Z.R. Alio

Salford Royal NHS Foundation Trust, Salford, Manchester, United

Kingdom;

Salford Royal NHS Foundation Trust, Salford

Objectives:

The purpose of our study was to describe the

characteristics of a cohort of elderly surgical patients admitted

to general surgical wards and reviewed by an elderly care in reach

service.

Methods:

This is a prospective study of older adults requiring

surgical admission (general, colorectal or upper gastrointestinal).

All individuals underwent comprehensive geriatric assessment,

targeted multidisciplinary interventions and discharge planning.

Results:

Between September 6th 2014 and March 31st 2015 a total

of 161 consecutive patients with a mean age 81.5 years (70–97),

22.9% elective and 51 undergoing surgery, were seen by the in reach

team on average 4 times (1–23). 53.4% were females, 91.9% lived

in the community; 146 mobilised independently, 77% independent

for basic and 59% for instrumental activities of daily living.

Mean number of co-morbidities was 5 (0–13), 118 patients had 4

or more and the most frequently recorded were hypertension (113)

and active cancer (50).

Abdominal pain (65/161), was the most common presenting

complaint whilst cholecystitis (20/161) and colonic cancer (19/161)

the most common diagnosis. Patients took on average 8 (0–26)

medications and 136 (84%) had more than 3. In total 148 received

thromboembolic prophylaxis, 105 intravenous antibiotics and 86-

probiotic therapies.

Mean length of stay was 14 days (1–70); in hospital fatality was

4.9% and 4.5% at 30 days with a 7 and 30-day readmission rates of

7.8% (12/153) and 17.6% (27/153) respectively.

Conclusions:

Older persons admitted to surgery commonly

present significant comorbidity, polypharmacy, a multifactorial

aetiology and are most often managed medically without surgical

intervention.

Psychiatric symptoms and illnesses

P-449

Medication dosage and orthostatic decline of blood pressure

among geriatric inpatients

B. Boland

, O. Dalleur

, N. Speybroeck

Cliniques Univ. St Luc, G´eriatrie; UCL/IRSS, Brussels, Belgium;

Clin

univ St-Luc, Pharmacy, Brussels, Belgium;

Institute for Health &

Society, UCL, Brussels, Belgium

Objectives:

Evidence is scarce regarding the association between

cardiovascular or psychotropic drugs and orthostatic hypotension.

Methods:

Cross-sectional study of 100 patients admitted to the

geriatric ward of an academic hospital. The maximum decline

in systolic (SBP) and diastolic (DBP) blood pressure (mmHg)

between the lying and the standing position (1 or 3 minutes)

was measured. The defined daily dose (DDD) on the day of the

orthostatic testing was used to calculate the dosage of vascular (V)

[diuretics, ACE inhibitors/angiotensin inhibitors, calcium channel

blockers,

-blockers, central

-agonists, peripheral

-blockers,

nitrates] and central nervous (N) [benzodiazepines, antipsychotics,

antidepressants, opiates] medications.