Towards Geriatric-surgical co-management for older patients undergoing colorectal surgery in an Enhanced Recovery After Surgery programme.

With the ageing of our society, an increasingly ageing population will present to the hospital for surgical indications. Their frequently underlying multidimensional complexity and frailty presents a major challenge for the future, which is reinforced by shortages in healthcare providers with geriatric expertise. This is compelling us to develop new models of care for frail older patients, in which geriatric and non-geriatric teams collaborate more closely. The aim of this PhD, the G-ERAS project, was to fuel the development of a geriatric-surgical co-management programme that integrates the principles of Comprehensive Geriatric Assessment (CGA) into the surgical enhanced recovery programme (ERP or ERAS®) in older patients undergoing colorectal surgery. The G-ERAS project was built around three main goals, namely studying the surgical population and context, defining a target population for geriatric-surgical co-management, and preparing the co-management intervention. To achieve these goals, five studies were conducted. The first study was a systematic literature review to map the intervention components, adherence and outcomes of ERPs in older patients undergoing elective colorectal surgery. The second study was a retrospective observational cohort study to describe the ERP intervention components and to assess ERP adherence, outcomes, and risk factors for postoperative complications and prolonged length of stay in older patients undergoing elective colorectal surgery at UZ Leuven. The third study was a cross-sectional national survey in Belgian hospitals to explore current geriatric care for surgical patients in Belgian hospitals and geriatricians’ reflections on current practice. The fourth study was a prospective observational cohort study UZ Leuven, studying the predictive ability of seven frailty screening instruments for adverse postoperative outcomes. The fifth study was a multi-method national survey and interview study in Belgian hospitals with an existing geriatric-surgical co-management programme, to examine the structures and processes of the co-management initiative and experiences with the programme, as well as participants’ perspectives on geriatric-surgical co-management. In summary, the studies in this dissertation provided a better understanding of the older colorectal surgery population and of the ERP care pathway in older patients, from both a local and an international perspective. In addition, existing geriatric care for surgical patients was assessed on a national level. This will help our research team to develop a co-management programme that integrates geriatric care into the surgical care pathway in collaboration with the colorectal surgery team at UZ Leuven. Improving collaboration between geriatric and surgical teams is a major challenge for the near future.