Journal of the American Geriatrics Society · 2025
Anesthesiologists' and Surgeons' Perceptions of the Impact of the American College of Surgeons Geriatric Verification Program on Co-Management of Older Surgical Patients: A Qualitative Mixed Methods Analysis.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Yousef Ahmed, Moustaqim-Barrette Maria, Allen Matthew B, Bader Angela M, Bernacki Rachelle E, Cooper Zara, Javedan Houman, Hepner David L
Аннотация
BACKGROUND: The American College of Surgeons (ACS) published the Geriatric Surgery Vlerification (GSV) program in 2019, establishing standards to improve geriatric care perioperatively. A multidisciplinary approach to the management of these patients aims to optimize preoperative health, mitigate perioperative complications, and provide valuable insights in terms of postoperative expectations for recovery. At Brigham and Women's Hospital (BWH), the first major academic hospital to be verified by the ACS, implementation of GSV standards has included a collaborative effort by a team including anesthesiologists, geriatricians, nurses, and surgical clinicians. Our novel study investigating clinician perceptions on the impact of this co-management program at BWH will serve to inform other hospitals that are in the process of or considering implementation of GSV.
PARTICIPANTS AND SETTING: Participants included 20 anesthesiologists who completed surveys and 22 clinicians (anesthesiologists, geriatricians, and surgeons) who participated in interviews at BWH.
METHODS: We used a convergent mixed-methods design. Quantitative surveys assessed exposure to geriatric co-management and perceived practice changes. Semi-structured interviews explored clinician experiences. Survey items covered demographics, perioperative decision making, and barriers to implementation. Interviews were transcribed and analyzed using inductive content analysis.
RESULTS: Ninety-five percent of surveyed anesthesiologists reported modifying care based on geriatric recommendations. Changes included anesthesia technique, medication choices, monitoring strategies, and attention to goals-of-care discussions. Ninety percent said geriatric input influenced their preoperative communication, and 85% indicated documentation of goals of care informed anesthesia planning. Interview themes included enhanced advance care planning, detection of vulnerability, alignment with patient goals, reinforcement of best practices, and improved interdisciplinary communication. Limited access to geriatric consultation was the primary barrier to broader implementation.
CONCLUSION: Clinicians reported favorable perceptions of GSV implementation. These findings support broader GSV dissemination and highlight opportunities to optimize interdisciplinary collaboration. Future studies should evaluate clinical outcomes, scalability, and the role of non-geriatrician providers in geriatric co-management.
PARTICIPANTS AND SETTING: Participants included 20 anesthesiologists who completed surveys and 22 clinicians (anesthesiologists, geriatricians, and surgeons) who participated in interviews at BWH.
METHODS: We used a convergent mixed-methods design. Quantitative surveys assessed exposure to geriatric co-management and perceived practice changes. Semi-structured interviews explored clinician experiences. Survey items covered demographics, perioperative decision making, and barriers to implementation. Interviews were transcribed and analyzed using inductive content analysis.
RESULTS: Ninety-five percent of surveyed anesthesiologists reported modifying care based on geriatric recommendations. Changes included anesthesia technique, medication choices, monitoring strategies, and attention to goals-of-care discussions. Ninety percent said geriatric input influenced their preoperative communication, and 85% indicated documentation of goals of care informed anesthesia planning. Interview themes included enhanced advance care planning, detection of vulnerability, alignment with patient goals, reinforcement of best practices, and improved interdisciplinary communication. Limited access to geriatric consultation was the primary barrier to broader implementation.
CONCLUSION: Clinicians reported favorable perceptions of GSV implementation. These findings support broader GSV dissemination and highlight opportunities to optimize interdisciplinary collaboration. Future studies should evaluate clinical outcomes, scalability, and the role of non-geriatrician providers in geriatric co-management.