Work

The Vespa Pre-operative Tool: a Scale That Predicts Post-surgical General and Geriatric Complications

Year: 2017

Type: conference-abstract

Abstract: In response to the increasing use of elective surgery among older patients, we implemented the Vulnerable Elderly Surgical Pathways and outcomes Assessment (VESPA) into an academic health system general pre-operative clinic (2008–2011) to predict post-operative complications. We interviewed 770 patients age ≥70 years who had upcoming general surgery to assess 5 pre-operative activities of daily living (ADLs) recommended by the American College of Surgeons (bathing/dressing, transferring, shopping, meals), falls, depressive symptoms, and performed a brief cognitive examination. We also asked a novel question of whether they expected they could manage themselves alone upon discharge. We conducted chart review for geriatric and surgical complications and co-morbidity and collected Work-related Relative Value Units (wRVU, categorized into low/moderate/high tertiles). Of the 770 interviewed patients, 736 had an operative procedure; of these, 14.3% had one of 5 ADL difficulties and 38.2% foresaw themselves unable to manage self-care alone. A quarter developed either geriatric or surgical complications, 18% had geriatric complications and 15% had surgical complications. ADL difficulty count (OR 1.2[1.0–1.5]), forseen difficulty with post-operative self-care (OR 1.5[1.0–2.2]), co-morbidity (OR 1.5[1.0–2.3]), male gender (OR 1.6[1.1–2.3]), and wRVUs (moderate vs low OR 1.9[1.1–3.4]; high vs low OR 8.9 [5.4–14.8]) all independently predicted post-operative complications (overall model Area Under the Curve [AUC]=0.77), whereas age was not significant (OR 1.0[0.98–1.1]. Using these results, a whole-point VESPA score used alone to predict complications also demonstrated excellent fit (AUC=0.76). In conclusion, pre-operative geriatric assessment of the oldest patients is feasible in general pre-operative clinic and can help identify higher-risk patients.

Source: Innovation in Aging

DOI: 10.1093/geroni/igx004.3326